Executive Dysfunctions: The Role in Attention Deficit Hyperactivity and Post-traumatic Stress Neuropsychiatric Disorders

Executive functions (EFs) is an umbrella term for various cognitive processes controlled by a complex neural activity, which allow the production of different types of behaviors seeking to achieve specific objectives, one of them being inhibitory control. There is a wide consensus that clinical and behavioral alterations associated with EF, such as inhibitory control, are present in various neuropsychiatric disorders. This paper reviews the research literature on the relationship between executive dysfunction, frontal-subcortical neural circuit changes, and the psychopathological processes associated with attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD). A revision on the role of frontal-subcortical neural circuits and their presumable abnormal functioning and the high frequency of neuropsychiatric symptoms could explain the difficulties with putting effector mechanisms into action, giving individuals the necessary tools to act efficiently in their environment. Although, neuronal substrate data about ADHD and PTSD has been reported in the literature, it is isolated. Therefore, this review highlights the overlapping of neural substrates in the symptomatology of ADHD and PTSD disorders concerning EFs, especially in the inhibitory component. Thus, the changes related to impaired EF that accompany disorders like ADHD and PTSD could be explained by disturbances that have a direct or indirect impact on the functioning of these loops. Initially, the theoretical model of EF according to current neuropsychology will be presented, focusing on the inhibitory component. In a second stage, this component will be analyzed for each of the disorders of interest, considering the clinical aspects, the etiology and the neurobiological basis. Additionally, commonalities between the two neuropsychiatric conditions will be taken into consideration from the perspectives of cognitive and emotional inhibition. Finally, the implications and future prospects for research and interventions in the area will be outlined, with the intention of contributing scientific reference information that encompasses the knowledge and understanding of executive dysfunction and its relationship with these treated disorders.

[1]  D. Salat,et al.  White Matter and Cognitive Changes in Veterans Diagnosed with Alcoholism and PTSD. , 2013, Journal of alcoholism and drug dependence.

[2]  A. Doyle,et al.  Executive functions in attention-deficit/hyperactivity disorder. , 2006, The Journal of clinical psychiatry.

[3]  B. Schoenberg Descriptive epidemiology. , 2018, Advances in neurology.

[4]  A. Etkin,et al.  Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. , 2007, The American journal of psychiatry.

[5]  A. Aron The Neural Basis of Inhibition in Cognitive Control , 2007, The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry.

[6]  Michael C. Anderson,et al.  The Prefrontal Cortex Achieves Inhibitory Control by Facilitating Subcortical Motor Pathway Connectivity , 2015, The Journal of Neuroscience.

[7]  J. Nigg,et al.  Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality. , 2006, Journal of child psychology and psychiatry, and allied disciplines.

[8]  R. D. Hunt,et al.  The contribution of alpha 2-noradrenergic mechanisms of prefrontal cortical cognitive function. Potential significance for attention-deficit hyperactivity disorder. , 1996, Archives of general psychiatry.

[9]  B. Franke,et al.  Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence. , 2010, Journal of child psychology and psychiatry, and allied disciplines.

[10]  Yuchiao Chang,et al.  Presence and acquired origin of reduced recall for fear extinction in PTSD: results of a twin study. , 2008, Journal of psychiatric research.

[11]  S. Wiebe,et al.  Executive function deficits in preschool children with ADHD and DBD. , 2012, Journal of child psychology and psychiatry, and allied disciplines.

[12]  C. Degueldre,et al.  The Functional Anatomy of Inhibition Processes Investigated with the Hayling Task , 2001, NeuroImage.

[13]  J. Cohen,et al.  Dissociating the role of the dorsolateral prefrontal and anterior cingulate cortex in cognitive control. , 2000, Science.

[14]  N. Greenberg,et al.  Latest developments in post-traumatic stress disorder: diagnosis and treatment. , 2015, British medical bulletin.

[15]  I. Liberzon,et al.  Biological studies of post-traumatic stress disorder , 2012, Nature Reviews Neuroscience.

[16]  M. J. Emerson,et al.  The Unity and Diversity of Executive Functions and Their Contributions to Complex “Frontal Lobe” Tasks: A Latent Variable Analysis , 2000, Cognitive Psychology.

[17]  M. Phillips,et al.  Post-traumatic stress symptoms correlate with smaller subgenual cingulate, caudate, and insula volumes in unmedicated combat veterans , 2012, Psychiatry Research: Neuroimaging.

[18]  V. Şar Developmental trauma, complex PTSD, and the current proposal of DSM-5 , 2011, European journal of psychotraumatology.

[19]  Olga V. Demler,et al.  Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[20]  A. Baddeley,et al.  Executive functions and self-regulation , 2012, Trends in Cognitive Sciences.

[21]  J. Duann,et al.  Inhibition control and error processing in children with attention deficit/hyperactivity disorder: an event-related potentials study. , 2011, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[22]  Andrew R. A. Conway,et al.  A controlled-attention view of working-memory capacity. , 2001, Journal of experimental psychology. General.

[23]  Glyn Lewis,et al.  DSM-IV. Diagnostic and Statistical Manual of Mental Disorders , 4th edn. By the American Psychiatric Association. (Pp. 886; £34.95.) APA: Washington, DC.1994. , 1996, Psychological Medicine.

[24]  J. Mercy,et al.  Attention-deficit/hyperactivity disorder symptoms and child maltreatment: a population-based study. , 2008, The Journal of pediatrics.

[25]  A. David,et al.  Prefrontal cortex dysfunction and 'Jumping to Conclusions': bias or deficit? , 2012, Journal of neuropsychology.

[26]  R. D. Hunt,et al.  The Contribution of α2-Noradrenergic Mechanisms to Prefrontal Cortical Cognitive Function: Potential Significance for Attention-Deficit Hyperactivity Disorder , 1996 .

[27]  M. B. Jurado,et al.  The Elusive Nature of Executive Functions: A Review of our Current Understanding , 2007, Neuropsychology Review.

[28]  C. Bell DSM-IV: Diagnostic and Statistical Manual of Mental Disorders , 1994 .

[29]  J. Reitsma,et al.  The role of executive function in posttraumatic stress disorder: a systematic review. , 2012, Journal of affective disorders.

[30]  J. Vasterling,et al.  Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder comparisons. , 2002, Neuropsychology.

[31]  D. Comings Clinical and molecular genetics of ADHD and Tourette syndrome. Two related polygenic disorders. , 2001, Annals of the New York Academy of Sciences.

[32]  B. Pennington,et al.  Big five dimensions and ADHD symptoms: links between personality traits and clinical symptoms. , 2002, Journal of personality and social psychology.

[33]  M. Friedman Finalizing PTSD in DSM-5: getting here from there and where to go next. , 2013, Journal of traumatic stress.

[34]  A. Etkin,et al.  A neurobiological approach to the cognitive deficits of psychiatric disorders , 2013, Dialogues in clinical neuroscience.

[35]  M. Paulus,et al.  Executive function and PTSD: Disengaging from trauma , 2012, Neuropharmacology.

[36]  Aribert Rothenberger,et al.  Cortical inhibition in attention deficit hyperactivity disorder: new insights from the electroencephalographic response to transcranial magnetic stimulation. , 2012, Brain : a journal of neurology.

[37]  E. Coutinho,et al.  The impact of posttraumatic symptoms and comorbid mental disorders on the health-related quality of life in treatment-seeking PTSD patients. , 2015, Comprehensive psychiatry.

[38]  David E. Comings,et al.  Clinical and Molecular Genetics of ADHD and Tourette Syndrome , 2001 .

[39]  Joseph E LeDoux,et al.  Response Variation following Trauma: A Translational Neuroscience Approach to Understanding PTSD , 2007, Neuron.

[40]  S. Rauch,et al.  Amygdala, Medial Prefrontal Cortex, and Hippocampal Function in PTSD , 2006, Annals of the New York Academy of Sciences.

[41]  S. M. Carlson,et al.  Inhibitory Control and Emotion Regulation in Preschool Children. , 2007 .

[42]  P. Bisiacchi,et al.  Time-on-Task in Children with ADHD: An ex-Gaussian Analysis , 2013, Journal of the International Neuropsychological Society.

[43]  C. Nemeroff,et al.  PAGES_ 12_AG_1004_BA.qxd:DCNS#50 , 2011 .

[44]  M. Hogge,et al.  Exploration of the neural substrates of executive functioning by functional neuroimaging , 2006, Neuroscience.

[45]  Bryce Hruska,et al.  The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. , 2013, Journal of anxiety disorders.

[46]  Gregor Hasler,et al.  Effect of acute psychological stress on prefrontal GABA concentration determined by proton magnetic resonance spectroscopy. , 2010, The American journal of psychiatry.

[47]  C. Blanco,et al.  The lifetime impact of attention deficit hyperactivity disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) , 2011, Psychological Medicine.

[48]  Rita Z. Goldstein,et al.  Motivation Deficit in ADHD is Associated with Dysfunction of the Dopamine Reward Pathway , 2010, Molecular Psychiatry.

[49]  C. Brewin The nature and significance of memory disturbance in posttraumatic stress disorder. , 2011, Annual review of clinical psychology.

[50]  Richard J. McNally,et al.  Cognitive abnormalities in post-traumatic stress disorder , 2006, Trends in Cognitive Sciences.

[51]  Ulrich Müller,et al.  Translational Approaches to Frontostriatal Dysfunction in Attention-Deficit/Hyperactivity Disorder Using a Computerized Neuropsychological Battery , 2011, Biological Psychiatry.

[52]  M. Miller,et al.  Attention-deficit/hyperactivity disorder comorbidity in a sample of veterans with posttraumatic stress disorder. , 2012, Comprehensive psychiatry.

[53]  K. Lange,et al.  The history of attention deficit hyperactivity disorder , 2010, Attention deficit and hyperactivity disorders.

[54]  M. Miller,et al.  Traumatic stress, oxidative stress and posttraumatic stress disorder: neurodegeneration and the accelerated-aging hypothesis , 2014, Molecular Psychiatry.

[55]  R. Diaz-Arrastia,et al.  Military traumatic brain injury: A review , 2014, Alzheimer's & Dementia.

[56]  H. Hart,et al.  Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects. , 2013, JAMA psychiatry.

[57]  Kerstin Plessen,et al.  Attention Network Test in adults with ADHD - the impact of affective fluctuations , 2011, Behavioral and Brain Functions.

[58]  Lisa Feldman Barrett,et al.  Considering PTSD from the perspective of brain processes: a psychological construction approach. , 2011, Journal of traumatic stress.

[59]  J. Ford,et al.  Child Maltreatment, other Trauma Exposure, and Posttraumatic Symptomatology among Children with Oppositional Defiant and Attention Deficit Hyperactivity Disorders , 2000, Child maltreatment.

[60]  T. Robbins,et al.  Inhibition and the right inferior frontal cortex , 2004, Trends in Cognitive Sciences.

[61]  A. Simmons,et al.  Dorsolateral prefrontal cortex activation during emotional anticipation and neuropsychological performance in posttraumatic stress disorder. , 2012, Archives of general psychiatry.

[62]  J. Nigg,et al.  Is ADHD a disinhibitory disorder? , 2001, Psychological bulletin.

[63]  J. Lupiáñez,et al.  Alterations of the attentional networks in patients with anxiety disorders. , 2011, Journal of anxiety disorders.

[64]  Kerry J. Ressler,et al.  PTSD and gene variants: New pathways and new thinking , 2012, Neuropharmacology.

[65]  F. Castellanos,et al.  Toward a Pathophysiology of Attention-Deficit/Hyperactivint Disorder , 1997, Clinical pediatrics.

[66]  Charles A Nelson,et al.  Neurodevelopmental effects of early deprivation in postinstitutionalized children. , 2010, Child development.

[67]  Maureen O’Brien,et al.  Loss of consciousness and post-traumatic stress disorder , 1998, British Journal of Psychiatry.

[68]  J. Epstein,et al.  Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. , 2004, Neuropsychology.

[69]  Xiaobo Li,et al.  A review of attention-deficit/hyperactivity disorder from the perspective of brain networks , 2013, Front. Hum. Neurosci..

[70]  S. Proctor,et al.  The influence of pre-deployment neurocognitive functioning on post-deployment PTSD symptom outcomes among Iraq-deployed Army soldiers , 2009, Journal of the International Neuropsychological Society.

[71]  E. Koechlin,et al.  Reasoning, Learning, and Creativity: Frontal Lobe Function and Human Decision-Making , 2012, PLoS biology.

[72]  S. Funahashi,et al.  Prefrontal cortex and neural mechanisms of executive function , 2013, Journal of Physiology-Paris.

[73]  M. Banich Executive Function , 2009 .

[74]  L. Fraenkel,et al.  A four-step approach for developing diagnostic tests in psychiatry: EEG in ADHD as a test case. , 2005, The Journal of neuropsychiatry and clinical neurosciences.

[75]  Marcella H. Boynton,et al.  Understanding the Phenotypic Structure of Adult Retrospective ADHD Symptoms During Childhood in the United States , 2012, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[76]  Katherine A. Johnson,et al.  Response variability in attention deficit hyperactivity disorder: evidence for neuropsychological heterogeneity. , 2007, Neuropsychologia.

[77]  R. Yehuda POST-TRAUMATIC STRESS DISORDER , 1985, The Lancet.

[78]  Ellen Sidransky,et al.  American Journal of Medical Genetics Part B (Neuropsychiatric Genetics) 134B:67–72 (2005) Support for Association Between ADHD and Two Candidate Genes: NET1 and DRD1 , 2022 .

[79]  R. Bonsall,et al.  Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. , 2000, JAMA.

[80]  S. Faraone,et al.  Impact of executive function deficits in youth with bipolar I disorder: A controlled study , 2010, Psychiatry Research.

[81]  A. Diamond The Early Development of Executive Functions. , 2006 .

[82]  John E. Desmond,et al.  Functional Topography of the Cerebellum in Verbal Working Memory , 2010, Neuropsychology Review.

[83]  Florin Dolcos,et al.  Electrophysiological correlates of fearful and sad distraction on target processing in adolescents with attention deficit-hyperactivity symptoms and affective disorders , 2012, Front. Integr. Neurosci..

[84]  Atia Daud,et al.  Comorbidity/Overlapping Between ADHD and PTSD in Relation to IQ Among Children of Traumatized/Non-Traumatized Parents , 2009, Journal of Attention Disorders.

[85]  T. Shinba,et al.  Psychiatric symptoms of noradrenergic dysfunction: A pathophysiological view , 2014, Psychiatry and clinical neurosciences.

[86]  Diane Swick,et al.  Increased response variability as a marker of executive dysfunction in veterans with post-traumatic stress disorder , 2013, Neuropsychologia.

[87]  Rebecca Elliott,et al.  Executive functions and their disorders. , 2003, British medical bulletin.

[88]  J. Swanson,et al.  Reaction Time Distribution Analysis of Neuropsychological Performance in an ADHD Sample , 2006, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[89]  R. Barkley Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. , 1997, Psychological bulletin.

[90]  Diego A. Pizzagalli,et al.  Effects of early life stress on cognitive and affective function: an integrated review of human literature , 2011, Psychopharmacology.

[91]  Jens C. Pruessner,et al.  The brain and the stress axis: The neural correlates of cortisol regulation in response to stress , 2009, NeuroImage.

[92]  R. Ursano,et al.  A review of acute stress disorder in DSM‐5 , 2011, Depression and anxiety.

[93]  A. Arnsten,et al.  Neurobiology of Executive Functions: Catecholamine Influences on Prefrontal Cortical Functions , 2004, Biological Psychiatry.

[94]  R. Kessler,et al.  The descriptive epidemiology of commonly occurring mental disorders in the United States. , 2008, Annual review of public health.

[95]  Michael D. Robinson,et al.  Cognitive-emotional dysfunction among noisy minds: Predictions from individual differences in reaction time variability , 2011, Cognition & emotion.

[96]  J. Bremner The Relationship Between Cognitive and Brain Changes in Posttraumatic Stress Disorder , 2006, Annals of the New York Academy of Sciences.

[97]  S. Orr,et al.  Neurocognitive function in monozygotic twins discordant for combat exposure: relationship to posttraumatic stress disorder. , 2006, Journal of abnormal psychology.

[98]  Richie Poulton,et al.  Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort , 2006, Psychological Medicine.

[99]  J. Cummings,et al.  Frontal-subcortical circuitry and behavior , 2007, Dialogues in clinical neuroscience.

[100]  S. Makeig,et al.  Genetic Overlap between Evoked Frontocentral Theta-Band Phase Variability, Reaction Time Variability, and Attention-Deficit/Hyperactivity Disorder Symptoms in a Twin Study , 2014, Biological Psychiatry.

[101]  S. Busch Implications of the Mental Health Parity and Addiction Equity Act. , 2012, The American journal of psychiatry.

[102]  Ralf Schulze,et al.  In Search of the Trauma Memory: A Meta-Analysis of Functional Neuroimaging Studies of Symptom Provocation in Posttraumatic Stress Disorder (PTSD) , 2013, PloS one.

[103]  J. Fuster Prefrontal Cortex , 2018 .

[104]  M. Ommeren,et al.  Lifetime events and posttraumatic stress disorder in 4 postconflict settings. , 2001, JAMA.

[105]  B. Pennington,et al.  Validity of the Executive Function Theory of Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review , 2005, Biological Psychiatry.

[106]  J. Fuster Frontal lobe and cognitive development , 2002, Journal of neurocytology.

[107]  B. Pennington,et al.  Cognitive and behavioral indicators of ADHD symptoms prior to school age. , 2013, Journal of child psychology and psychiatry, and allied disciplines.

[108]  Adam Gifford,et al.  Emotion and self-control , 2002 .

[109]  Amit Etkin,et al.  Hippocampal Network Connectivity and Activation Differentiates Post-Traumatic Stress Disorder From Generalized Anxiety Disorder , 2013, Neuropsychopharmacology.

[110]  Hans-Jochen Heinze,et al.  Structural alterations in lateral prefrontal, parietal and posterior midline regions of men with chronic posttraumatic stress disorder. , 2011, Journal of psychiatry & neuroscience : JPN.

[111]  G. Barber PHYSICAL HEALTH. , 1963, The Practitioner.

[112]  D. Rubin,et al.  The Frequency and Impact of Exposure to Potentially Traumatic Events Over the Life Course , 2013, Clinical psychological science : a journal of the Association for Psychological Science.

[113]  C. Brewin,et al.  Considering PTSD for DSM‐5 , 2011, Depression and anxiety.

[114]  L. Zoellner,et al.  Predictors of health-related quality-of-life utilities among persons with posttraumatic stress disorder. , 2011, Psychiatric services.

[115]  K. Miller Executive functions. , 2005, Pediatric annals.

[116]  T. Ahonen,et al.  Neuropsychological subgroups of adolescents with conduct disorder. , 2010, Scandinavian journal of psychology.

[117]  L. Hawk,et al.  Reaction Time Variability in ADHD: A Review , 2012, Neurotherapeutics.

[118]  D. Jansen,et al.  Post-Traumatic Stress Disorder and Other Mental Health Problems in the Military: Oversight Issues for Congress , 2013 .

[119]  R. N. Spreng,et al.  eview eurocircuitry models of posttraumatic stress disorder and beyond : meta-analysis of functional neuroimaging studies , 2012 .

[120]  V. Walsh,et al.  Modulating behavioral inhibition by tDCS combined with cognitive training , 2012, Experimental Brain Research.

[121]  Kristin W. Samuelson,et al.  Post-traumatic stress disorder and declarative memory functioning: a review , 2011, Dialogues in clinical neuroscience.

[122]  Yi Huan,et al.  Different Regional Gray Matter Loss in Recent Onset PTSD and Non PTSD after a Single Prolonged Trauma Exposure , 2012, PloS one.

[123]  Michael W Weiner,et al.  Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse. , 2006, Neuropsychology.

[124]  J. Bremner,et al.  Smaller volume of anterior cingulate cortex in abuse-related posttraumatic stress disorder. , 2006, Journal of affective disorders.

[125]  L. Adler,et al.  Attention-Deficit/Hyperactivity Disorder in adult patients with Posttraumatic stress disorder (PTSD): Is ADHD a vulnerability factor? , 2004, Journal of attention disorders.

[126]  A. Ardila,et al.  On the evolutionary origins of executive functions , 2008, Brain and Cognition.

[127]  Eric Vermetten,et al.  Structural and functional plasticity of the human brain in posttraumatic stress disorder. , 2008, Progress in brain research.

[128]  Michael P Milham,et al.  Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies. , 2012, The American journal of psychiatry.

[129]  L. Weyandt,et al.  The Physiology of Executive Functioning , 2014 .