HOT AND COLD COGNITION IN ADHD

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HOT AND COLD COGNITION IN ADHD?

• Joseph A. Sergeant
• Chair, Clinical Neuropychology,
• Vrije Universiteit, Amsterdam

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• Traditional COGNITIVE RESEARCH
• Stimulus-Response Psychology
• Cold cognition

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• Neuroscientific approach Hot cognition
• Emotional regulation and cognition.
• Dynamic brain functions compensation for
  deficits and role of reward
• Limbic system and ventral medial frontal lobe

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Issues to Be Considered

• Developmental transitions of the brain.

• Brain is not only cognitive but an emotional
  system
• Multiple systems involved

Frontal Basal ganglia Cerebellum
Limbic system
How do these systems interact to produce intact
and produce normal and dysregulated behaviour?
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Executive Function Control Domains

• Inhibition
• stop a prepotent response
• stop an ongoing response
• interference control
• Working memory
• Planning
• Cognitive flexibility and compensation(error
  correction)
• Verbal fluency

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Inhibition (Stop)
Maturational delay?
Rubia, 2008
Rubia, 2005
Rubia, 1999
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Rubia et al., HBM, 2007
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Executive Deficits clearly present in ADHD, but
in varying degrees (Willcutt et al, 2008)
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Dissociation in ADHD betweenSubjective and
Actual Performance

• SUBJECTIVE MOTIVATION

• TASK PERFORMANCE

• No difference in liking task
• Overestimation of own performance

• Larger deviations from 1 s
• More variable responses
• Over- / undershooting

Van Meel, Oosterlaan, Heslenfeld, Sergeant
(2005), JAACAP
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ADHD Inability to learn from mistake in future
action
Sergeant van der Meere (1988) Replications
(Krusch et al, 1996 Schachar et al, 2004
Wiersema et al (2008)
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At both the behavioural and neural imaging levels
there is evidence that children with ADHD have an
atypical response to positive reinforcement. The
most consistent finding, across paradigms, is a
stronger preference for immediate reinforcement
in children with ADHD compared to controls.
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Delay Aversion and Dual Pathway Model
time
La-La
Sm-So
Willcutt, Sonuga-Barke, Nigg, Sergeant 2008
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Hot and risky decision making and immediate
gratification
Iowa Gambling task (Bechtera Damasio)
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Persistence of poor decision making over time in
ADHD depends on Magnitude and not frequency of
reward
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Environment Genes determine Inhibitory
performance Mothers Smoking During Pregnancy
Huijbregts et al (2008)
Loss of inhibitory control increased with
mothers smoking in a frustration (hot) but not
in cold inhibition task.
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ADHD sensitive to feedback but poor in utilizing
reinforcement. Hence, performance dependent on
dynamic processes.
Luman et al (2008).
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Somatic effect of Feedback, Response Cost and
RewardLuman et al (2007)
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Cortical processing of Negative Feedback
Van Meel et al, 2005.
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The Connectivity of the Brain
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Amygdala and Fear processing in ADHD and
DBDNormal fear processing in ADHD no amygdala
dysfunction in processing of fear facial stimuli
in ADHD.Important for distinguishing ADHD -
Conduct Disorder
Marsh et al (2008)
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Difference in reward processing ADHD Children and
Children with Conduct Disorder
Rubia et al., AJP, 2008, 2009
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Is empathy affected in ADHD?

• Two studies suggested empathy disordered in
  ADHD.
• Recently, this has been shown to be accounted
  for by Conduct Disorder being present with ADHD.
  (Marton et al, 2009).

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Amygdala Function and ADHD

• Amygdala sensitive to delay Is this a timing
  problem or an Emotion/Frustration problem?

• Amygdala intact in ADHD in some but not all
  Emotional face recognition tasks
• Fear processing intact and distinctive from
  children with Callous traits but ADHD children
  poorer in recognizing expression of anger and
  disgust (Pele et al, 2006).

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Emotional processing of delay? Delay is not
simply cognitive but effects the amygdala
Amygdala activity increases with delayed rewards
versus immediate rewards in children with
ADHD.Emotion/Frustration?
Plichta et al, 2008
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Knutson et al.
Nucleus Accumbens Selective increased
activation when anticipating reward and passed on
to the ventral frontal cortex.
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Both cognitive and emotional conflict monitored
in the Anterior Cingulate Cortex (ACC).
Cognitive conflict monitoring improved with
medication in ADHD adults. (Bush et al, 2008)
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Emotional Conflict monitoring in ADHD
Krauel et al (2007)
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Brain CContinuously Processing Feedback
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The hot and the cold source of conflict in ADHD?
What happens at one point in time has crucial
consequences for future behaviour. Performance
failures at one moment continue to influence
succeeding behaviour.
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The hot end Reward and ADHD

• A large immediate reward is irresistible for
  ADHD patients and its effect is maintained over
  time to the disadvantage of performance.

• Processing and decision making in time reflected
  by systematic differences in brain processing.

• Decision making is not a once and only event but
  continuous in time clear differences between
  normal and ADHD children.

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ADHD
CD/ODD
Conclusions
OFC
Rubia et al (2008,2009)