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Altered cingulate and amygdala response towards threat and safe cues in attention deficit hyperactivity disorder

Published online by Cambridge University Press:  19 March 2013

S. J. Maier ,
A. Szalkowski ,
S. Kamphausen ,
B. Feige ,
E. Perlov ,
R. Kalisch ,
G. A. Jacob ,
A. Philipsen ,
O. Tüscher  and
L. Tebartz van Elst
S. J. Maier*
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Germany Faculty of Biology, Institute of Biology III, University of Freiburg, Germany
A. Szalkowski
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Germany
S. Kamphausen
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Tuebingen, Germany
B. Feige
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Germany
E. Perlov
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Germany
R. Kalisch
Affiliation:
Institute for Systems Neuroscience, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
G. A. Jacob
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Germany Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany
A. Philipsen
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Germany
O. Tüscher
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Germany Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany
L. Tebartz van Elst
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Germany
*
*Address for correspondence: Mr S. J. Maier, Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Hauptstraße 5, D 79104 Freiburg, Germany (Email: simon.maier@uniklinik-freiburg.de)
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Abstract

Background

Emotional dysregulation is becoming increasingly recognized as an important feature of attention deficit hyperactivity disorder (ADHD). In this study, two experiments were conducted investigating the neural response to either verbally instructed fear (IF) or uninstructed (classically conditioned) fear (UF) using the skin conductance response (SCR) and functional magnetic resonance imaging (fMRI).

Method

In the conditioning phase of the UF experiment (17 ADHD and 17 healthy controls), subjects experienced an unconditioned stimulus (UCS, unpleasant electrodermal stimulation) paired with a former neutral conditioned stimulus (CS+), whereas a control stimulus (CS−) was never paired with the UCS. In the subsequent test phase, only the CS+ and the CS− were presented. In the IF experiment (13 ADHD and 17 healthy controls), subjects were only told that an independently experienced UCS might occur together with the CS+ but not the CS− during testing. No UCS was presented.

Results

Groups did not detectably differ in SCR or neural responses to UF. In IF, ADHD patients showed a trend-line decreased SCR and significantly decreased activation of the dorsal anterior cingulate cortex (dACC), a region prominently involved in fear responding, to the CS+. This was accompanied by higher amygdala activation to the CS−.

Conclusions

During IF, ADHD patients showed deficits in regions centrally involved in fear learning and expression in terms of diminished CS+-related dACC and increased CS−-related amygdala signals. This suggests an impaired processing of verbally transmitted aversive information, which is central for conveying fear information in social contexts. This result extends the growing literature on emotional alterations in ADHD.

Keywords

ADHDamygdalaanterior cingulate cortexfear conditioningfear learningfunctional MRIinstructed fearuninstructed fear
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 1 , January 2014 , pp. 85 - 98
Copyright
Copyright © Cambridge University Press 2013 

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