Stimulant Treatment Trajectories Are Associated With Neural Reward Processing in Attention-Deficit/Hyperactivity Disorder

Schweren, L. J. S., Groenman, A., von Rhein, D., Weeda, W., Faraone, S. F., Luman, M., van Ewijk, H., Heslenfeld, D. J., Franke, B., Buitelaar, J. K., Oosterlaan, J., Hoekstra, P. J. & Hartman, C. A., Jul-2017, In : Journal of Clinical Psychiatry. 78, 7, p. e790–e796 7 p.

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Objective: The past decades have seen a surge in stimulant prescriptions for the treatment of attention-deficit/hyperactivity disorder (ADHD). Stimulants acutely alleviate symptoms and cognitive deficits associated with ADHD by modulating striatal dopamine neurotransmission and induce therapeutic changes in brain activation patterns. Long-term functional changes after treatment are unknown, as long-term studies are scarce and have focused on brain structure. In this observational study (2009-2012), we investigated associations between lifetime stimulant treatment history and neural activity during reward processing.

Methods: Participants fulfilling DSM-5 criteria for ADHD (N = 269) were classified according to stimulant treatment trajectory. Of those, 124 performed a monetary incentive delay task during magnetic resonance imaging, all in their nonmedicated state (n(EARLY& INTENSE) = 51; n(LATE& MODERATE) = 49; n(EARLY& MODERATE) = 9; n(NAIVE) = 15; mean age = 17.4 years; range, 10-26 years). Whole-brain analyses were performed with additional focus on the striatum, concentrating on the 2 largest treatment groups.

Results: Compared to the late-and-moderate treatment group, the early-and-intense treatment group showed more activation in the supplementary motor area and dorsal anterior cingulate cortex (SMA/dACC) during reward outcome (cluster size = 8,696 mm(3); P-CLUSTER

Conclusions: Our findings are compatible with previous reports of acute increases of SMA/dACC activity in individuals with ADHD after stimulant administration. Higher SMA/dACC activity may indicate that patients with a history of intensive stimulant treatment, but currently off medication, recruit brain regions for cognitive control and/or decisionmaking upon being rewarded. No striatal or structural changes were found.

Original languageEnglish
Pages (from-to)e790–e796
Number of pages7
JournalJournal of Clinical Psychiatry
Issue number7
Publication statusPublished - Jul-2017


  • Adolescent, Adult, Arousal/drug effects, Attention Deficit Disorder with Hyperactivity/drug therapy, Brain/drug effects, Brain Mapping, Central Nervous System Stimulants/therapeutic use, Child, Cognition/drug effects, Corpus Striatum/drug effects, Decision Making/drug effects, Female, Gyrus Cinguli/drug effects, Humans, Long-Term Care, Magnetic Resonance Imaging, Male, Motor Cortex/drug effects, Recruitment, Neurophysiological/drug effects, Reward, Young Adult

ID: 48410486