How Does Brain Connectivity Relate to Behavioral Self-Regulation in Children With and Without ADHD?

What you need to know

• Children with ADHD showed more difficulties with behavioral self-regulation compared to typically developing children and those with developmental coordination disorder (DCD) alone.
• Specific patterns of brain connectivity were associated with behavioral self-regulation abilities across all children studied.
• Some brain connectivity patterns differed between children with and without ADHD and were related to behavioral self-regulation.

Understanding behavioral self-regulation

Behavioral self-regulation refers to a person’s ability to manage their emotions and behaviors in order to achieve goals, adapt to different situations, and follow social rules. It includes skills like:

• Inhibiting impulses and controlling behavior (inhibition)
• Flexibly shifting attention and adapting to new situations (shifting)
• Regulating emotional responses (emotion control)

Many children with neurodevelopmental disorders like attention-deficit/hyperactivity disorder (ADHD) struggle with behavioral self-regulation. This can lead to difficulties at school, in relationships, and in daily life activities. Understanding the brain basis of these challenges could help develop better ways to support children who struggle with behavioral self-regulation.

What did the researchers study?

The researchers examined brain connectivity patterns in 115 children aged 7-17 years:

• 31 typically developing children
• 35 children with ADHD
• 21 children with developmental coordination disorder (DCD)
• 28 children with both ADHD and DCD

They used a special type of brain imaging called resting-state functional MRI to look at how different brain regions communicate with each other when the brain is at rest. They also assessed children’s behavioral self-regulation skills using parent questionnaires.

The goal was to identify brain connectivity patterns associated with behavioral self-regulation abilities across all children, as well as patterns that differed between children with and without ADHD.

Key findings on behavioral self-regulation

The study found that children with ADHD (including those with ADHD+DCD) showed significantly more difficulties with behavioral self-regulation compared to typically developing children and children with DCD alone. Specifically:

• Children with ADHD had more trouble with inhibiting impulses
• They struggled more with flexibly shifting attention and adapting to new situations
• They had greater difficulty regulating their emotional responses

Interestingly, children with DCD alone did not show elevated behavioral self-regulation difficulties compared to typically developing children. This suggests that the regulation challenges seen in some previous DCD studies may have been due to undiagnosed ADHD in those samples.

Brain connectivity patterns linked to behavioral self-regulation

The researchers identified several brain connectivity patterns that were associated with behavioral self-regulation abilities across all children in the study:

Patterns linked to multiple aspects of self-regulation

Some connectivity patterns were related to more than one aspect of behavioral self-regulation. These included:

1. Connections between the ventromedial prefrontal cortex (vmPFC) and the insula. The vmPFC is involved in decision-making and emotional processing, while the insula processes internal bodily sensations and awareness. Stronger negative connectivity between these regions was associated with greater difficulties in shifting attention and inhibiting impulses.

2. Connections between the temporal pole and rostral anterior cingulate cortex (rACC). The temporal pole integrates emotional and social information, while the rACC is involved in emotional conflict monitoring. Stronger positive connectivity between these areas was linked to more problems with shifting attention and emotion control.

3. Connections between the nucleus accumbens and visual processing areas. The nucleus accumbens is part of the brain’s reward system. Stronger negative connectivity between this region and visual areas was associated with greater difficulties across all three aspects of behavioral self-regulation.

Patterns specific to one aspect of self-regulation

Other connectivity patterns were uniquely associated with just one aspect of behavioral self-regulation:

1. Connections between the insula and visual cortex were specifically related to emotion control abilities.

2. Connections between the dorsomedial prefrontal cortex (dmPFC) and visual areas were uniquely associated with inhibition skills. The dmPFC is involved in cognitive control and decision-making.

3. Connectivity within circuits involving the thalamus and striatum (brain regions important for learning and motivation) was specifically linked to shifting abilities.

Differences in children with ADHD

Some brain connectivity patterns differed significantly between children with and without ADHD:

1. Children with ADHD showed weaker positive connectivity between the orbitofrontal cortex (OFC) and areas like the nucleus accumbens and ventromedial prefrontal cortex. This pattern was associated with inhibition abilities.

2. They also had weaker positive connectivity between the subgenual anterior cingulate cortex (sgACC) and regions like the putamen and pallidum. This pattern was linked to shifting and emotion control abilities.

These findings suggest that altered connectivity in reward-related brain circuits may contribute to the behavioral self-regulation difficulties seen in ADHD.

Conclusions

• Behavioral self-regulation difficulties are a key challenge for many children with ADHD, affecting their ability to control impulses, shift attention flexibly, and manage emotions.

• Specific patterns of brain connectivity are associated with behavioral self-regulation abilities across children with and without ADHD. These involve connections between regions important for cognitive control, emotion processing, reward, and sensory integration.

• Some brain connectivity patterns differ between children with and without ADHD and relate to behavioral self-regulation skills. This suggests potential brain-based markers that could help understand and potentially address self-regulation challenges in ADHD.

• Examining individual differences in brain connectivity patterns may provide a more nuanced understanding of behavioral self-regulation abilities than simply comparing diagnostic groups.

These findings offer new insights into the brain basis of behavioral self-regulation in children with and without ADHD. They highlight the complex interplay between different brain systems in supporting these important skills. Future research may build on these results to develop new ways of assessing and supporting children who struggle with behavioral self-regulation.