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Deficits in Response Inhibition in Patients with Attention-Deficit/Hyperactivity Disorder: The Impaired Self-Protection System Hypothesis

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      Problems in inhibitory control are regarded in Psychology as a key problem associated with attention-deficit/hyperactivity disorder (ADHD). They, however, might not be primary deficits, but instead a consequence of inattention. At least two components have been identified and dissociated in studies in regards to inhibitory control: interference suppression, responsible for controlling interference by resisting irrelevant or misleading information, and response inhibition, referring to withholding a response or overriding an ongoing behavior. Poor error awareness and self-monitoring undermine an individual’s ability to inhibit inadequate responses and change course of action. In non-social contexts, an individual depends on his own cognition to regulate his mistakes. In social contexts, however, there are many social cues that should help that individual to perceive his mistakes and inhibit inadequate responses. The processes involved in perceiving and interpreting those social cues are arguably part of a self-protection system (SPS). Individuals with ADHD not only present impulsive behaviors in social contexts, but also have difficulty perceiving their inadequate responses and overriding ongoing actions toward more appropriate ones. In this paper, we discuss that those difficulties are arguably a consequence of an impaired SPS, due to visual attention deficits and subsequent failure in perceiving and recognizing accurately negative emotions in facial expressions, especially anger. We discuss evidence that children with ADHD exhibit problems in a series of components involved in the activation of that system and advocate that the inability to identify the anger expressed by others, and thus, not experiencing the fear response that should follow, is, ultimately, what prevents them from inhibiting the ongoing inappropriate behavior, since a potential threat is not registered. Getting involved in high-risk situations, such as reckless driving, could also be a consequence of not registering a threat and thus, not experiencing fear.

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      Inhibition and the right inferior frontal cortex.

      It is controversial whether different cognitive functions can be mapped to discrete regions of the prefrontal cortex (PFC). The localisationist tradition has associated one cognitive function - inhibition - by turns with dorsolateral prefrontal cortex (DLPFC), inferior frontal cortex (IFC), or orbital frontal cortex (OFC). Inhibition is postulated to be a mechanism by which PFC exerts its effects on subcortical and posterior-cortical regions to implement executive control. We review evidence concerning inhibition of responses and task-sets. Whereas neuroimaging implicates diverse PFC foci, advances in human lesion-mapping support the functional localization of such inhibition to right IFC alone. Future research should investigate the generality of this proposed inhibitory function to other task domains, and its interaction within a wider network.
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        Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD.

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          The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review.

           Erik Willcutt (2012)
          This article describes a comprehensive meta-analysis that was conducted to estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD), as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). A systematic literature review identified 86 studies of children and adolescents (N = 163,688 individuals) and 11 studies of adults (N = 14,112 individuals) that met inclusion criteria for the meta-analysis, more than half of which were published after the only previous meta-analysis of the prevalence of ADHD was completed. Although prevalence estimates reported by individual studies varied widely, pooled results suggest that the prevalence of DSM-IV ADHD is similar, whether ADHD is defined by parent ratings, teacher ratings, or a best estimate diagnostic procedure in children and adolescents (5.9-7.1 %), or by self-report measures in young adults (5.0 %). Analyses of diagnostic subtypes indicated that the predominantly inattentive type is the most common subtype in the population, but individuals with the combined type are more likely to be referred for clinical services. Additional research is needed to determine the etiology of the higher prevalence of ADHD in males than females and to clarify whether the prevalence of ADHD varies as a function of socioeconomic status or ethnicity. Finally, there were no significant prevalent differences between countries or regions of the world after controlling for differences in the diagnostic algorithms used to define ADHD. These results provide important support for the diagnostic validity of ADHD, and argue against the hypothesis that ADHD is a cultural construct that is restricted to the United States or any other specific culture.

            Author and article information

            1Laboratório de Investigações em Neurociência CLínica, Department of Mental Health, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
            2iLumina Neurociências , Belo Horizonte, Brazil
            3Quantitative Methods and Predictive Psychometrics Laboratory, Department of Psychology, Universidade Federal da Bahia , Salvador, Brazil
            4Brazilian Association of Psychiatry , Rio de Janeiro, Brazil
            5Department of Pediatrics, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
            Author notes

            Edited by: Amitai Abramovitch, Texas State University, United States

            Reviewed by: Charles W. Mathias, University of Texas Health Science Center San Antonio, United States; Avraham Schweiger, Academic College of Tel Aviv-Yafo, Israel

            *Correspondence: Thales Vianna Coutinho, thales.coutinho@

            Specialty section: This article was submitted to Psychopathology, a section of the journal Frontiers in Psychiatry

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            Front Psychiatry
            Front Psychiatry
            Front. Psychiatry
            Frontiers in Psychiatry
            Frontiers Media S.A.
            22 January 2018
            : 8
            5786525 10.3389/fpsyt.2017.00299
            Copyright © 2018 Coutinho, Reis, Silva, Miranda and Malloy-Diniz.

            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.

            Figures: 1, Tables: 0, Equations: 0, References: 163, Pages: 11, Words: 9730
            Hypothesis and Theory


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