Neurocognitive Pathways in Attention-Deficit/Hyperactivity Disorder and White Matter Microstructure

Biol Psychiatry Cogn Neurosci Neuroimaging. 2019 Mar;4(3):233-242. doi: 10.1016/j.bpsc.2018.09.007. Epub 2018 Sep 29.


Background: This study sought to identify attention-deficit/hyperactivity disorder (ADHD) abnormalities in relationships between brain white matter structure and individual differences in several types of impulsive behavior.

Methods: Adolescents, n = 67 with ADHD combined subtype and n = 68 without ADHD, were given neuropsychological tests and underwent diffusion tensor imaging scans. Principal component analysis reduced test scores into factors representing different types of impulsive behavior. Tract-based spatial statistics quantified white matter integrity in relationship to components of impulsive behavior. ADHD versus non-ADHD differences in the strength and nature of linear relationships between regional white matter and three impulsivity components were examined using multiple regression.

Results: Principal component analysis found three separate impulsivity-related factors that were interpreted as motor response inhibition, impulsive choice, and delay aversion. Relationships between regional fractional anisotropy and response inhibition or impulsive choice did not differ between ADHD and non-ADHD groups. There was a significant interaction between diagnostic group and delay aversion test performance relationships with regional fractional anisotropy. For youths without ADHD, greater anisotropy in numerous tracts predicted better delay aversion test performance. In contrast, anisotropy in regions including the corpus callosum, corona radiata, internal capsule, and corticospinal tracts had either a negative or no relationship with delay aversion test performance in ADHD.

Conclusions: The results provide additional support that different proposed etiological pathways to ADHD have discretely different neurobiological features. Large disorganization of white matter microstructure appears to contribute to reward-based ADHD pathways rather than motor inhibition.

Keywords: ADHD; DTI; Delay aversion; Impulsive choice; Impulsivity; Response inhibition.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / pathology*
  • Attention Deficit Disorder with Hyperactivity / psychology*
  • Brain / pathology*
  • Child
  • Cognition / physiology*
  • Female
  • Humans
  • Impulsive Behavior
  • Inhibition, Psychological
  • Male
  • Neural Pathways / pathology
  • Neuropsychological Tests
  • White Matter / pathology*