Reward processing in male adults with childhood ADHD—a comparison between drug-naïve and methylphenidate-treated subjects
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Dysfunctional reward processing has been proposed as a main deficit in attention-deficit/hyperactivity disorder (ADHD), which could be modulated by treatment with methylphenidate (MPH).
We examined differences in reward processing in adulthood (independent of actual ADHD) depending on MPH treatment during childhood.
Eleven males with childhood ADHD treated with MPH, 12 drug-naïve males with childhood ADHD, and 12 controls matched by age, handedness, and smoking behavior were studied drug-free using functional magnetic resonance imaging. BOLD-responses were compared during a monetary incentive delay task using an ANOVA design focusing on the ventral striatum during anticipation and the orbitofrontal cortex during outcome.
Controls, drug-naïve, and treated subjects did not differ significantly in their activations in the ventral striatum and orbitofrontal cortex. Explorative analyses revealed decreased insula activation during outcome of loss avoidance in drug-naïve subjects in comparison to both groups, while treated subjects did not differ from controls. Insula activation correlated significantly positive with harm avoidance in the treated group. Furthermore, comparing subjects with actual ADHD symptoms, remitters and controls we observed decreased putamen activition in ADHD persisters.
Basal ganglia reward processing seemed to be unrelated to MPH pretreatment, but was related to remission. On the other hand, the revealed differences between treated and drug-naïve subjects with childhood ADHD, i.e., in the insula, give evidence for more pronounced abnormal activation in reward-associated brain regions in untreated subjects with childhood ADHD and underpin the need of prospective studies on long-term effects of psychostimulant treatment.
KeywordsAttention-deficit hyperactivity disorder Methylphenidate Reward Punishment fMRI Ventral striatum Insula
A. Ströhle had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
We thank the participants for their patience and willingness to participate after many years and followed through with an extensive neuropsychological testing and fMRI-scanning. We thank the colleagues of the laboratory of emotional neuroscience for the assistance with the fMRI-scanning.
Conflicts of interest
Prof. A. Ströhle received research funding from the German Federal Ministry of Education and Research and speaker honoraria from Pfizer, Eli Lilly & Co, Wyeth, Lundbeck and a research grant from Lundbeck. Prof. A. Heinz received research funding from the German Research Foundation and the Bernstein Center for Computational Neuroscience Berlin (German Federal Ministry of Education and Research), Eli Lilly & Company, Janssen-Cilag, and Bristol-Myers Squibb. A. Heinz also received speaker Honoraria from Janssen-Cilag, Johnson & Johnson, Lilly, Pfizer and Servier. Prof. U. Lehmkuhl received research funding from the Deutsche Krebshilfe Research Foundation; the BfArM (Bundesinstitut für Arzneimittelforschung und Medizinprodukte); RTL Foundation “Wir helfen Kindern”; BMFSFJ Research Funding from the German Federal Ministry of Health; Steiner Arzneimittel. Mrs. Stoy, Mrs. Schlochtermeier, Dr. Schlagenhauf, Dr. Wrase, Prof. Huss, Prof. Knutson reported no conflicts of interest.
This study complies with the current laws of Germany.
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