Abstract
Understanding the neural mechanisms of emotional reactivity in Attention-Deficit/Hyperactivity Disorder (ADHD) may help develop more effective treatments that target emotion dysregulation. In adult ADHD, emotion regulation problems cover a range of dimensions, including emotional reactivity (ER). One important process that could underlie an impaired ER in ADHD might be impaired working memory (WM) processing. We recently demonstrated that taxing WM prior to the exposure of emotionally salient stimuli reduced physiological and subjective reactivity to such cues in heavy drinkers, suggesting lasting effects of WM activation on ER. Here, we investigated neural mechanisms that could underlie the interaction between WM and ER in adult ADHD participants. We included 30 male ADHD participants and 30 matched controls. Participants performed a novel functional magnetic resonance imaging paradigm in which active WM-blocks were alternated with passive blocks of negative and neutral images. We demonstrated group-independent significant main effects of negative emotional images on amygdala activation, and WM-load on paracingulate gyrus and dorsolateral prefrontal cortex activation. Contrary to earlier reports in adolescent ADHD, no impairments were found in neural correlates of WM or ER. Moreover, taxing WM did not alter the neural correlates of ER in either ADHD or control participants. While we did find effects on the amygdala, paCG, and dlPFC activation, we did not find interactions between WM and ER, possibly due to the relatively unimpaired ADHD population and a well-matched control group. Whether targeting WM might be effective in participants with ADHD with severe ER impairments remains to be investigated.
Highlights
In addition to deficits in attention, hyperactivity, and impulsivity (American Psychiatric Association, 2000), emotional dysregulation (ED) is considered a core symptom in adults with Attention-Deficit/Hyperactivity Disorder (ADHD) (Hirsch et al, 2019)
In line with the whole brain results, we found no significant interaction between working memory (WM)-load and group on PaCG activation and left dorsolateral PFC (dlPFC) (PaCG: χ2(1) = 2.01, p = 0.15, ∆Bayesian information criterion (BIC) = − 2.73; all other ∆BIC < -4.74; left dlPFC: χ2(1) = 2.62, p = 0.11, ∆BIC = − 2.13), but a main effect of WM-load was found (PaCG: χ2(1) = 41.12, p < 0.001, ∆BIC = 36.38; left dlPFC: χ2(1) = 56.35, p < 0.001, ∆BIC = 51.605)(Fig. 4A)
We assessed the effects of emotional images, the preceding WM-load and group on paracingulate gyrus (paCG) activity during emotional processing, but found no three- or two-way interactions (χ2(1) = 3.66, p = 0.45, ∆BIC = − 18.10; all other ∆BIC < − 4); neither did we find a main effect of emotional images (χ2(1) = 0.97, p = 0.32, ∆BIC = − 4.47), which suggests, in contrast to our hypothesis, paCG activity did not react to emotional salient stimuli, in either the ADHD or control group
Summary
In addition to deficits in attention, hyperactivity, and impulsivity (American Psychiatric Association, 2000), emotional dysregulation (ED) is considered a core symptom in adults with Attention-Deficit/Hyperactivity Disorder (ADHD) (Hirsch et al, 2019). ED is defined as the inability to control and minimize the disrupting effects of irrelevant emotional stimuli on goal-oriented processes (Barkley & Fischer, 2010; Wehmeier et al, 2010). In adult ADHD, problems with emotion regulation include emotional recognition, emotional responsivity, and emotional lability, adding to the complexity of the spectrum of classic symptoms (Beheshti et al, 2020). ED predicts lower quality of life in young adults (Groenewold et al, 2013) and is associated with the persistence of ADHD into adulthood (Barkley & Fischer, 2010). Better insights into underlying (neural) mechanisms of ED in adult ADHD could help develop more effective treatments
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