Behavior in Children With Attention Deficit Hyperactivity Disorder and in Healthy Volunteers

The inability to exert appropriate inhibitory control over one's behavior is an important
symptom of many psychiatric illnesses. The stop signal paradigm, which involves withholding a
prepotent motor response to a signal, has proved useful in assessing this deficit in children
with a range of disorders, particularly attention deficit hyperactivity disorder (ADHD). In
order to adapt the paradigm for use in fMRI studies, it is important to address two
methodological issues: 1) the substitution of a visual stop signal for the more
commonly-employed auditory stop signal, and 2) the fact that, on the traditional stop task
(in which the subject withholds a motor response to the stop signal), correct trials do not
involve a motor response whereas incorrect trials do. The latter problem can be addressed
using the stop-change task (in which the subject executes alternative motor responses to the
stop and go signals). The first aim of this protocol is to compare behavioral data from the
stop and stop-change tasks in control adults, control children, and children with ADHD. These
data will be used to test the hypotheses that, on each of these paradigms, children with ADHD
will show an inhibitory deficit compared to control children, and control children will show
an inhibitory deficit compared to control adults. The second aim of the protocol is to
conduct a pilot fMRI study of the stop and stop-change tasks in control adults. The study has
an event-related design and will test the hypotheses that ventral prefrontal activation will
be greater during successful than unsuccessful stop (or stop-change) trials, and that stop
and stop-change trials will be associated with more anterior cingulate and right inferior
frontal activation than will go trials.

- INCLUSION CRITERIA:

CONTROL SUBJECTS:

Male and female subjects in two age cohorts will be recruited: 7-16 and 18-45 years.
Subjects must be free from any current or past psychopathology and be medication-free. The
7-16 year olds will be gender matched to the ADHD subjects.

ADHD SUBJECTS:

Male and female subjects aged 7-16 who currently meet DSM-IV criteria for ADHD. The
diagnosis will be made on the basis of a K-SADS-PL interview with the parent and a t score
greater than 65 on the hyperactivity-impulsivity subscale of the Connors Teacher Scale.
With the exception of symptoms and signs attributable to the ADHD, Oppositional Defiant
Disorder, the Learning, Communication Disorders, Elimination Disorders, and Separation or
Social Anxiety Disorders, subjects must be free from any current or past psychopathology.

fMRI STUDY:

Subjects aged 8-45 years will be recruited. Otherwise the same as for the behavioral study
above for healthy volunteers and ADHD participants.

EXCLUSION CRITERIA:

CONTROL SUBJECTS:

I.Q. less than 80; pregnancy ; ongoing medical illness; neurological disorder (including
seizures); meeting past or present criteria for any diagnosis on the K-SADS-PL (children
and adolescents) or SCID (adults).

ADHD SUBJECTS:

I.Q. less than 80; pregnancy; ongoing medical illness or neurological disorder other than
ADHD; contraindication to discontinuing medication for 72 hours; any other psychiatric
disorder that is sufficiently severe to require specific treatment, with the exception of
Oppositional Defiant Disorder, and the Learning, Communication, and Elimination Disorders,
Separation Anxiety Disorder or Social Anxiety Disorder. Explicit exclusions include
Pervasive Developmental Disorders, Tourette's syndrome, conduct disorder, and mood or
Generalized anxiety disorders.

fMRI STUDY:

I.Q. less than 80; pregnancy; ongoing medical illness; neurological disorder (including
seizures); meeting past or present criteria for any diagnosis on SCID; or KSADS except for
ADHD, Oppositional Defiant Disorder, the Learning, Communication Disorders, Elimination
Disorders, and Separation or Social Anxiety Disorders; any metallic objects in the body
that would constitute a contraindication to an fMRI scan.