Neurophysiological and behavioral correlates of alertness impairment and compensatory processes in ADHD evidenced by the Attention Network Test

In Attention Deficit Hyperactivity disorder (ADHD), fMRI studies show asymmetric alterations: widespread hypoactivation in anterior cortical areas and hyperactivation in some posterior regions, and the latter is considered to be related to compensatory processes. In Posner's attentional networks, an important role is attributed to functional interhemispheric asymmetries. The psychophysiological Attention Network Test (ANT), which measures the efficiency of the alerting, orienting, and executive networks, seems particularly informative for ADHD. Potentials related to ANT stimuli (ANT-RPs) have revealed reduced cognitive potential P3 in ADHD. However, there are no studies associated with asymmetry of ANT-RPs. In the present study, conducted with 20 typically developing boys and 19 boys with ADHD, aged 11-13 years, the efficiency of the three Posner's networks regarding performance and amplitude asymmetries in ANT-RPs was evaluated according to the arithmetic difference of these parameters between different cue and target presentation conditions. The results were correlated to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) scores. Regarding accuracy and intraindividual variation in reaction time, ADHD subjects showed lower efficiency of executive and alerting network, and this effect was correlated with DSM. Regarding alerting network, ANT-RPs in ADHD did not have the right-side amplitude prevalence in the temporal regions, which was observed in controls. In all ANT conditions, significantly higher asymmetries were observed in ADHD than in controls in the occipital regions 40-200 ms after target onset. Their amplitude in ADHD subjects was inversely proportional to DSM scores of inattentiveness and directly proportional to accuracy and efficiency of the executive network. The results suggest impaired alerting and executive networks in ADHD and compensatory occipital mechanisms.