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

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          Abstract

          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.

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          Most cited references82

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          Executive Functions

          Executive functions (EFs) make possible mentally playing with ideas; taking the time to think before acting; meeting novel, unanticipated challenges; resisting temptations; and staying focused. Core EFs are inhibition [response inhibition (self-control—resisting temptations and resisting acting impulsively) and interference control (selective attention and cognitive inhibition)], working memory, and cognitive flexibility (including creatively thinking “outside the box,” seeing anything from different perspectives, and quickly and flexibly adapting to changed circumstances). The developmental progression and representative measures of each are discussed. Controversies are addressed (e.g., the relation between EFs and fluid intelligence, self-regulation, executive attention, and effortful control, and the relation between working memory and inhibition and attention). The importance of social, emotional, and physical health for cognitive health is discussed because stress, lack of sleep, loneliness, or lack of exercise each impair EFs. That EFs are trainable and can be improved with practice is addressed, including diverse methods tried thus far.
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            Amygdala, medial prefrontal cortex, and hippocampal function in PTSD.

            L Shin (2006)
            The last decade of neuroimaging research has yielded important information concerning the structure, neurochemistry, and function of the amygdala, medial prefrontal cortex, and hippocampus in posttraumatic stress disorder (PTSD). Neuroimaging research reviewed in this article reveals heightened amygdala responsivity in PTSD during symptomatic states and during the processing of trauma-unrelated affective information. Importantly, amygdala responsivity is positively associated with symptom severity in PTSD. In contrast, medial prefrontal cortex appears to be volumetrically smaller and is hyporesponsive during symptomatic states and the performance of emotional cognitive tasks in PTSD. Medial prefrontal cortex responsivity is inversely associated with PTSD symptom severity. Lastly, the reviewed research suggests diminished volumes, neuronal integrity, and functional integrity of the hippocampus in PTSD. Remaining research questions and related future directions are presented.
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              The neural basis of inhibition in cognitive control.

              The concept of "inhibition" is widely used in synaptic, circuit, and systems neuroscience, where it has a clear meaning because it is clearly observable. The concept is also ubiquitous in psychology. One common use is to connote an active/willed process underlying cognitive control. Many authors claim that subjects execute cognitive control over unwanted stimuli, task sets, responses, memories, and emotions by inhibiting them, and that frontal lobe damage induces distractibility, impulsivity, and perseveration because of damage to an inhibitory mechanism. However, with the exception of the motor domain, the notion of an active inhibitory process underlying cognitive control has been heavily challenged. Alternative explanations have been provided that explain cognitive control without recourse to inhibition as concept, mechanism, or theory. This article examines the role that neuroscience can play when examining whether the psychological concept of active inhibition can be meaningfully applied in cognitive control research.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                23 August 2016
                2016
                : 7
                : 1230
                Affiliations
                [1] 1Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, University of Brasilia Brasilia, Brazil
                [2] 2Faculty of Psychology, Social Sciences Department, Universidad Pontificia Bolivariana Seccional Bucaramanga Bucaramanga, Colombia
                [3] 3Faculty of Ceilandia, University of Brasilia Brasilia, Brazil
                [4] 4Neuroscience Research Program, University CEUMA São Luis, Brazil
                Author notes

                Edited by: Leandro Fernandes Malloy-Diniz, Universidade Federal de Minas Gerais, Brazil

                Reviewed by: Mark Dust, Claremont Graduate University, USA; Giuliano Emerenciano Ginani, Uniamérica, Brazil

                *Correspondence: Carlos Tomaz, ctomaz@ 123456unb.br ctomaz@ 123456ceuma.br

                This article was submitted to Psychopathology, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2016.01230
                4993788
                27602003
                24fa1dc6-7a8a-4f73-877d-81cd2679a7cb
                Copyright © 2016 Martínez, Prada, Satler, Tavares and Tomaz.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 26 April 2016
                : 02 August 2016
                Page count
                Figures: 4, Tables: 2, Equations: 0, References: 126, Pages: 15, Words: 0
                Categories
                Psychology
                Review

                Clinical Psychology & Psychiatry
                adhd,executive functions,inhibitory control,neuropsychiatric disorders,ptsd

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