Impulsive aggression and response inhibition in attention-deficit/hyperactivity disorder and disruptive behavioral disorders: Findings from a systematic review

Neurosci Biobehav Rev. 2018 Jul;90:231-246. doi: 10.1016/j.neubiorev.2018.04.016. Epub 2018 Apr 22.


Background: Although impulsive aggression (IA) and dysfunctional response inhibition (RI) are hallmarks of attention-deficit/hyperactivity disorder (ADHD) and disrupted behavioral disorders (DBDs), little is known about their shared and distinct deviant neural mechanisms.

Aims and methods: Here, we selectively reviewed s/fMRI ADHD and DBD studies to identify disorder-specific and shared IA and RI aberrant neural mechanisms.

Results: In ADHD, deviant prefrontal and cingulate functional activity was associated with increased IA. Structural alterations were most pronounced in the cingulate cortex. Subjects with DBDs showed marked cortico-subcortical dysfunctions. ADHD and DBDs share similar cortico-limbic structural and functional alterations. RI deficits in ADHD highlighted hypoactivity in the dorso/ventro-lateral PFC, insula, and striatum, while the paralimbic system was primarily dysfunctional in DBDs. Across disorders, extensively altered cortico-limbic dysfunctions underlie IA, while RI was mostly associated with aberrant prefrontal activity.

Conclusion: Control network deficits were evidenced across clinical phenotypes in IA and RI. Dysfunctions at any level within these cortico-subcortical projections lead to deficient cognitive-affective control by ascribing emotional salience to otherwise irrelevant stimuli. The clinical implications of these findings are discussed.

Keywords: ADHD; Cingulate cortex; Control; DBDs; Emotional salience; Impulsive aggression; Paralimbic system; Prefrontal cortex; Response inhibition; Top-Down; fMRI; sMRI.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / physiopathology*
  • Behavior / physiology*
  • Brain / physiopathology
  • Brain Mapping
  • Emotions / physiology*
  • Humans
  • Obsessive-Compulsive Disorder / physiopathology*