Deficits in inhibitory force control in young adults with ADHD
Introduction
Attention deficit hyperactivity disorder (ADHD) is a common childhood-onset disorder characterized by age-inappropriate, chronic, pervasive, and impairing levels of inattention and/or hyperactivity-impulsivity (American Psychiatric Association 2013). ADHD persists into adulthood in up to 65% of cases (Faraone et al., 2006, Simon et al., 2009, Turgay et al., 2012), affects the ability to gain and maintain employment (Kessler et al., 2009, Kupper et al., 2012), and is associated with an increased risk for substance abuse (Wilens et al., 1995, Upadhyaya, 2008, Groenman et al., 2013), obesity (Cortese et al., 2008, Nazar et al., 2012, Nazar et al., 2014, Albayrak et al., 2013), workplace injuries (Swensen et al., 2004, Breslin and Pole, 2009, Hodgkins et al., 2011), and traffic accidents (Barkley et al., 1993, Jerome et al., 2006a, Jerome et al., 2006b, Barkley and Cox, 2007, Merkel et al., 2013). Though less often discussed, motor impairments are prominent among children with ADHD (Barkley, 1998) and up to 50% of pediatric ADHD patients are also comorbid for developmental coordination disorder (Kadesjo and Gillberg, 1999, Pitcher et al., 2003, Gillberg et al., 2004). Similarly, adults with ADHD have impaired visuomotor memory in gripping tasks (Neely et al., 2016), visuomotor adaptation in reaching tasks (Kurdziel et al., 2015), deficits in oculomotor control (Feifel et al., 2004, Carr et al., 2006), increased postural sway (Hove et al., 2015), and impaired timing in finger tapping tasks (Valera et al., 2010). These findings are important because motor processes have clearer neural correlates than many of the cognitive constructs associated with ADHD. Thus, the motor system provides a good avenue to examine the neurobiology of ADHD.
Inhibitory control is the process of suppressing competing responses to select the most appropriate response. The ability to suppress inappropriate behaviors in favor of appropriate alternatives is paramount to adapting behavior in changing circumstances and is thereby a critical component for controlling behavior at all levels, including movement. Although numerous studies report poor inhibitory control in ADHD (Nigg et al., 2002, Aron and Poldrack, 2005, Alderson et al., 2007, Wodka et al., 2007, Suskauer et al., 2008, Gilbert et al., 2011, Bari and Robbins, 2013), the type of task used in the majority of studies (e.g. go-no-go or stop signal reaction time, RT, task) records performance via the presence or absence of an all-or-nothing key press. Such an approach confounds cognitive, sensory, and motor processes into a single dichotomous response. As a result, we may be overlooking critical processes that provide insight into the neural mechanisms of the disorder. For example, a great deal of motor activity can be produced even when an individual does not ultimately press a key in a standard RT task. The current study overcomes this barrier by using a continuous and precise measure of motor output in a grip force variant of the classic go/no-go task. We used force output as a measure of activity in the motor system. In order to test the validity of this measure, participants completed a continuous grip force go/no-go task with both low and high force amplitude conditions as well as a standard go/no-go task that used an all-or-nothing keypress. Trials were presented rapidly, creating a prepotency to respond. In this context, the inhibition of a prepotent response requires effortful cognitive control, whereas allowing the motor response to proceed occurs in a more automatic fashion (Bargh et al., 1996, Muraven and Baumeister, 2000). We reasoned that greater activity in the motor system would be reflected by the production of larger forces during no-go trials. We included low and high force amplitude conditions as a means to examine response planning. In particular, the amount of force produced on a no-go trial may reflect a pre-planned response and scale to the target amplitude. Therefore, deficits in response planning would be indicated by force output (on no-go trials) that does not scale to the target amplitude.
Section snippets
Participants
We recruited young adults, ages 18–25, who identified as currently having ADHD or as having never been diagnosed with ADHD. Participants were community recruited through advertisements in State College, Pennsylvania. Exclusion criteria included: (1) previous concussions that resulted in a loss of consciousness for more than 10 min; (2) previous diagnosis of seizures, epilepsy, encephalitis, meningitis or an autism spectrum disorder; (3) previous diagnosis of a musculoskeletal or neurological
Participants
As reported in Table 1, independent univariate ANOVAs demonstrated that there were no differences in age or estimated IQ between the ADHD and control groups. The ADHD group reported significantly more ADHD-related symptoms in adulthood as measured by the CAADID and CAARS. As expected (Hinshaw et al., 2012, Anastopoulos et al., 2016), adults with ADHD self-reported more internalizing (e.g. anxiety or depression) and externalizing (e.g., aggression, rule-breaking behavior) difficulties on the ASR
Discussion
We report three novel findings. First, on Go trials of the force task, force output and variability was not different for adults with ADHD compared to adults without ADHD. Second, on No-Go trials in the force task, adults with ADHD produced greater and more variable force compared to adults without ADHD. Third, mean force output on No-Go trials was a stronger predictor of the CAARS S: L ADHD Index compared to performance in the standard RT task.
The lack of a group difference for force output
Conclusion
These current work represents a novel examination of inhibitory control in young adults. We demonstrated that the force variant of the Go/No-Go task is a precise and continuous measure of inhibitory control. As such, the resulting continuum of performance can be examined in relation to other behavioral, clinical, or physiological measures to provide greater information about the pathophysiology of inhibitory motor control. The results of the current study demonstrate that adults with ADHD have
Conflict of interest
The authors declare no competing financial interests.
Acknowledgements
This publication was supported, in part, by Grant UL1 TR002014 and KL2 TR002015 from the National Center for Advancing Translational Sciences (NCATS) to KAN. This publication was supported, in part, by Grant R01 MH084947 from the National institute for Mental Health (NIMH) to CHP. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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