Dr Katya Rubia

In the opening session of MoM VIII, Dr Katya Rubia (King’s College London, UK) described the brain characteristics that have been associated with ADHD in structural and functional neuroimaging studies,1 particularly highlighting:

  • Deficits in fronto-striatal, fronto-parietal and fronto-cerebellar networks2-4
  • Abnormal deactivation of the default mode network1,5
  • Maturational delays in brain development during childhood/adolescence.6,7

Dr Rubia noted that the structural deficits most consistently associated with ADHD have been identified in the basal ganglia and insula,8,9 regions that can be activated through neurofeedback.10

During a subsequent panel discussion, Dr Rubia and Professor Joseph Sergeant (Vrije Universiteit, Amsterdam, the Netherlands) discussed the various factors that can complicate the interpretation of neuroimaging research, including:

  • Therapeutic effects
  • Differences between the child and adult brain
  • Inherent heterogeneity in the brains of children with ADHD (some are consistent with population norms, and others are very different).

Dr Rubia advised that larger sample sizes were required to support research into neurobiological heterogeneity and inform on appropriate grouping of patient types. Professor Sergeant also emphasised the need for more neuroimaging research, particularly calling for more longitudinal studies.

Professor Sergeant: “We will need much more longitudinal studies, much more clearly defined mechanisms, which include not only higher cortical functions… but also lower cortical functions, which are key to neurofeedback processes.”

  1. Rubia K, Alegria A, Brinson H. Imaging the ADHD brain: disorder-specificity, medication effects and clinical translation. Expert Rev Neurother 2014; 14: 519-538.
  2. Arnsten AF, Rubia K. Neurobiological circuits regulating attention, cognitive control, motivation, and emotion: disruptions in neurodevelopmental psychiatric disorders. J Am Acad Child Adolesc Psychiatry 2012; 51: 356-367.
  3. Hart H, Radua J, Mataix-Cols D, et al. Meta-analysis of fMRI studies of timing in attention-deficit hyperactivity disorder (ADHD). Neurosci Biobehav Rev 2012; 36: 2248-2256.
  4. Hart H, Radua J, Nakao T, et al. Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects. JAMA Psychiatry 2013; 70: 185-198.
  5. Christakou A, Murphy CM, Chantiluke K, et al. Disorder-specific functional abnormalities during sustained attention in youth with Attention Deficit Hyperactivity Disorder (ADHD) and with autism. Mol Psychiatry 2013; 18: 236-244.
  6. Shaw P, Eckstrand K, Sharp W, et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proc Natl Acad Sci 2007; 104: 19649-19654.
  7. Shaw P, Malek M, Watson B, et al. Development of cortical surface area and gyrification in attention-deficit/hyperactivity disorder. Biol Psychiatry 2012; 72: 191-197.
  8. Nakao T, Radua J, Rubia K, et al. Gray matter volume abnormalities in ADHD: voxel-based meta-analysis exploring the effects of age and stimulant medication. Am J Psychiatry 2011; 168: 1154-1163.
  9. Rubia K, Alegria AA, Cubillo AI, et al. Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Biol Psychiatry 2014; 76: 616-628.
  10. Emmert K, Kopel R, Sulzer J, et al. Meta-analysis of real-time fMRI neurofeedback studies using individual participant data: How is brain regulation mediated? Neuroimage 2016; 124: 806-812.