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Hyperactivity and sensation seeking as autoregulatory attempts to stabilize brain arousal in ADHD and mania?

  • Review Article
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ADHD Attention Deficit and Hyperactivity Disorders

Abstract

Hypoarousal as indicated by skin conductance and electroencephalography (EEG) has been discussed as a pathogenetic factor in attention-deficit/hyperactivity disorder (ADHD). The aim of this paper was to review these arousal-related pathogenetic concepts and to present the more recently proposed vigilance regulation model of affective disorders and ADHD. The latter builds on methodological advances in classifying short EEG segments into vigilance stages (Vigilance Algorithm Leipzig, VIGALL), indicating different states of global brain function (“brain arousal”). VIGALL allows the objective assessment of vigilance regulation under defined conditions, e.g. how fast vigilance declines to lower vigilance stages associated with drowsiness during 15–20-min EEG recordings under resting conditions with eyes closed. According to the vigilance regulation model, the hyperactivity and sensation seeking observed in overtired children, ADHD and mania may be interpreted as an autoregulatory attempt to create a stimulating environment in order to stabilize vigilance. The unstable regulation of vigilance observed in both mania and ADHD may thus explain the attention deficits, which become especially prominent in monotonous sustained attention tasks. Among the arguments supporting the vigilance regulation model are the facts that destabilizing vigilance (e.g. via sleep deprivation) can trigger or exacerbate symptoms of ADHD or mania, whereas stabilizing vigilance (e.g. via psychostimulants, reducing sleep deficits) alleviates these symptoms. The potential antimanic effects of methylphenidate are presently being studied in an international randomized controlled trial. We propose vigilance regulation as a converging biomarker, which could be useful for identifying treatment responders to psychostimulants and forming pathophysiologically more homogeneous ADHD subgroups for research purposes.

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Acknowledgments

This publication is supported by LIFE—Leipzig Research Center for Civilization Diseases, Universität Leipzig. LIFE is funded by means of the European Union, by the European Regional Development Fund (ERDF) and by means of the Free State of Saxony within the framework of the excellence initiative.

Conflict of interest

U. Hegerl was an advisory board member for Lilly, Lundbeck, Takeda Pharmaceuticals and Otsuka Pharma; a consultant for Nycomed; and a speaker for Bristol-Myers Squibb, Medice Arzneimittel and Roche Pharma. We declare no further conflicts of interest.

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  1. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, University of Würzburg, Füchsleinstr. 15, 97080, Würzburg, Germany

    Julia Geissler & Marcel Romanos

  2. Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany

    Ulrich Hegerl & Tilman Hensch

  3. LIFE – Leipzig Research Center for Civilization Diseases, Universität Leipzig, Philipp-Rosenthal-Straße 27, 04103, Leipzig, Germany

    Ulrich Hegerl & Tilman Hensch

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  1. Julia Geissler
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Geissler, J., Romanos, M., Hegerl, U. et al. Hyperactivity and sensation seeking as autoregulatory attempts to stabilize brain arousal in ADHD and mania?. ADHD Atten Def Hyp Disord 6, 159–173 (2014). https://doi.org/10.1007/s12402-014-0144-z

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