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Specific cognitive–neurophysiological processes predict impulsivity in the childhood attention-deficit/hyperactivity disorder combined subtype

  • A. Bluschke (a1), V. Roessner (a1) and C. Beste (a1)



Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neuropsychiatric disorders in childhood. Besides inattention and hyperactivity, impulsivity is the third core symptom leading to diverse and serious problems. However, the neuronal mechanisms underlying impulsivity in ADHD are still not fully understood. This is all the more the case when patients with the ADHD combined subtype (ADHD-C) are considered who are characterized by both symptoms of inattention and hyperactivity/impulsivity.


Combining high-density electroencephalography (EEG) recordings with source localization analyses, we examined what information processing stages are dysfunctional in ADHD-C (n = 20) compared with controls (n = 18).


Patients with ADHD-C made more impulsive errors in a Go/No-go task than healthy controls. Neurophysiologically, different subprocesses from perceptual gating to attentional selection, resource allocation and response selection processes are altered in this patient group. Perceptual gating, stimulus-driven attention selection and resource allocation processes were more pronounced in ADHD-C, are related to activation differences in parieto-occipital networks and suggest attentional filtering deficits. However, only response selection processes, associated with medial prefrontal networks, predicted impulsive errors in ADHD-C.


Although the clinical picture of ADHD-C is complex and a multitude of processing steps are altered, only a subset of processes seems to directly modulate impulsive behaviour. The present findings improve the understanding of mechanisms underlying impulsivity in patients with ADHD-C and might help to refine treatment algorithms focusing on impulsivity.


Corresponding author

*Address for correspondence: C. Beste, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Cognitive Neurophysiology, Schubertstrasse 42, D-01309 Dresden, Germany. (Email:


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Achenbach, T (1991). Manual for the Child Behavior Checklist/4–18 and 1991 Profile. University of Vermont, Department of Psychiatry: Burlington, VT.
Ahmadi, N, Mohammadi, MR, Araghi, SM, Zarafshan, H (2014). Neurocognitive profile of children with attention deficit hyperactivity disorders (ADHD): a comparison between subtypes. Iranian Journal of Psychiatry 9, 197202.
Albrecht, B, Brandeis, D, Uebel, H, Valko, L, Heinrich, H, Drechsler, R, Heise, A, Müller, UC, Steinhausen, H-C, Rothenberger, A, Banaschewski, T (2013). Familiality of neural preparation and response control in childhood attention deficit-hyperactivity disorder. Psychological Medicine 43, 19972011.
Amonn, F, Frölich, J, Döpfner, M (2013). Effectiveness of neuropsychological training in children with attention-deficit hyperactivity disorder (ADHD). Zeitschrift Für Kinder- und Jugendpsychiatrie und Psychotherapie 41, 199213; quiz 214–215.
Arns, M, Conners, CK, Kraemer, HC (2013). A decade of EEG theta/beta ratio research in ADHD: a meta-analysis. Journal of Attention Disorders 17, 374383.
Arnsten, AFT, Rubia, K (2012). Neurobiological circuits regulating attention, cognitive control, motivation, and emotion: disruptions in neurodevelopmental psychiatric disorders. Journal of the American Academy of Child and Adolescent Psychiatry 51, 356367.
Bari, A, Robbins, TW (2013). Inhibition and impulsivity: behavioral and neural basis of response control. Progress in Neurobiology 108, 4479.
Barkley, RA (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin 121, 6594.
Beste, C, Dziobek, I, Hielscher, H, Willemssen, R, Falkenstein, M (2009). Effects of stimulus–response compatibility on inhibitory processes in Parkinson's disease. European Journal of Neuroscience 29, 855860.
Beste, C, Konrad, C, Uhlmann, C, Arolt, V, Zwanzger, P, Domschke, K (2013). Neuropeptide S receptor (NPSR1) gene variation modulates response inhibition and error monitoring. NeuroImage 71, 19.
Beste, C, Ness, V, Falkenstein, M, Saft, C (2011). On the role of fronto-striatal neural synchronization processes for response inhibition – evidence from ERP phase-synchronization analyses in pre-manifest Huntington's disease gene mutation carriers. Neuropsychologia 49, 34843493.
Beste, C, Willemssen, R, Saft, C, Falkenstein, M (2010). Response inhibition subprocesses and dopaminergic pathways: basal ganglia disease effects. Neuropsychologia 48, 366373.
Bonnefond, A, Doignon-Camus, N, Touzalin-Chretien, P, Dufour, A (2010). Vigilance and intrinsic maintenance of alert state: an ERP study. Behavioural Brain Research 211, 185190.
Bukstein, OG (2010). Clinical practice guidelines for attention-deficit/hyperactivity disorder: a review. Postgraduate Medicine 122, 6977.
Campbell, J, Sharma, A (2013). Compensatory changes in cortical resource allocation in adults with hearing loss. Frontiers in Systems Neuroscience 7, 71.
Cheung, CHM, Rijsdijk, F, McLoughlin, G, Brandeis, D, Banaschewski, T, Asherson, P, Kuntsi, J (2015). Cognitive and neurophysiological markers of ADHD persistence and remission. British Journal of Psychiatry: The Journal of Mental Science. Published online 6 August 2015. doi:10.1192/bjp.bp.114.145185.
Chmielewski, WX, Mückschel, M, Stock, A-K, Beste, C (2015). The impact of mental workload on inhibitory control subprocesses. NeuroImage 112, 96104.
Clark, D, Schumann, F, Mostofsky, SH (2015). Mindful movement and skilled attention. Frontiers in Human Neuroscience 9, 297.
Coghill, DR, Hayward, D, Rhodes, SM, Grimmer, C, Matthews, K (2014 a). A longitudinal examination of neuropsychological and clinical functioning in boys with attention deficit hyperactivity disorder (ADHD): improvements in executive functioning do not explain clinical improvement. Psychological Medicine 44, 10871099.
Coghill, DR, Seth, S, Matthews, K (2014 b). A comprehensive assessment of memory, delay aversion, timing, inhibition, decision making and variability in attention deficit hyperactivity disorder: advancing beyond the three-pathway models. Psychological Medicine 44, 19892001.
Conners, CK, Sitarenios, G, Parker, JDA, Epstein, JN (1998). The revised Conners’ Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology 26, 257268.
Crunelle, CL, van den Brink, W, Dom, G, Booij, J (2014). Dopamine transporter occupancy by methylphenidate and impulsivity in adult ADHD. British Journal of Psychiatry 204, 486487.
Diamond, A (2013). Executive functions. Annual Review of Psychology 64, 135168.
Dippel, G, Beste, C (2015). A causal role of the right inferior frontal cortex in implementing strategies for multi-component behaviour. Nature Communications 6, 6587.
Döpfner, M, Görtz-Dorten, A, Lehmkuhl, G (2008). Diagnostik-System für Psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV, DISYPS-II (Diagnostic System for Mental Disorders in Childhood and Adolescence according to ICD-10 and DSM-IV, DISYPS-II). Huber: Bern.
Durston, S, van Belle, J, de Zeeuw, P (2011). Differentiating frontostriatal and fronto-cerebellar circuits in attention-deficit/hyperactivity disorder. Biological Psychiatry 69, 11781184.
Falkenstein, M, Hoormann, J, Hohnsbein, J (1999). ERP components in Go/Nogo tasks and their relation to inhibition. Acta Psychologica 101, 267291.
Fallgatter, AJ, Ehlis, A-C, Seifert, J, Strik, WK, Scheuerpflug, P, Zillessen, KE, Herrmann, MJ, Warnke, A (2004). Altered response control and anterior cingulate function in attention-deficit/hyperactivity disorder boys. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology 115, 973981.
Faraone, SV, Bonvicini, C, Scassellati, C (2014). Biomarkers in the diagnosis of ADHD – promising directions. Current Psychiatry Reports 16, 497.
Fuchs, M, Kastner, J, Wagner, M, Hawes, S, Ebersole, JS (2002). A standardized boundary element method volume conductor model. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology 113, 702712.
Geng, JJ, Vossel, S (2013). Re-evaluating the role of TPJ in attentional control: contextual updating? Neuroscience and Biobehavioral Reviews 37, 26082620.
Gevensleben, H, Kleemeyer, M, Rothenberger, LG, Studer, P, Flaig-Röhr, A, Moll, GH, Rothenberger, A, Heinrich, H (2014). Neurofeedback in ADHD: further pieces of the puzzle. Brain Topography 27, 2032.
Gold, MS, Blum, K, Oscar-Berman, M, Braverman, ER (2014). Low dopamine function in attention deficit/hyperactivity disorder: should genotyping signify early diagnosis in children? Postgraduate Medicine 126, 153177.
Gomez Gonzalez, CM, Clark, VP, Fan, S, Luck, SJ, Hillyard, SA (1994). Sources of attention-sensitive visual event-related potentials. Brain Topography 7, 4151.
Greenhill, LL, Posner, K, Vaughan, BS, Kratochvil, CJ (2008). Attention deficit hyperactivity disorder in preschool children. Child and Adolescent Psychiatric Clinics of North America 17, 347366, ix.
Grunewald, M, Stadelmann, S, Brandeis, D, Jaeger, S, Matuschek, T, Weis, S, Kalex, V, Hiemisch, A, von Klitzing, K, Döhnert, M (2015). Early processing of emotional faces in a Go/NoGo task: lack of N170 right-hemispheric specialisation in children with major depression. Journal of Neural Transmission (Vienna, Austria: 1996) 122, 13391352.
Harpin, VA (2008). Medication options when treating children and adolescents with ADHD: interpreting the NICE guidance 2006. Archives of Disease in Childhood. Education and Practice Edition 93, 5865.
Herrmann, CS, Knight, RT (2001). Mechanisms of human attention: event-related potentials and oscillations. Neuroscience and Biobehavioral Reviews 25, 465476.
Hillyard, SA, Vogel, EK, Luck, SJ (1998). Sensory gain control (amplification) as a mechanism of selective attention: electrophysiological and neuroimaging evidence. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences 353, 12571270.
Houghton, S, Douglas, G, West, J, Whiting, K, Wall, M, Langsford, S, Powell, L, Carroll, A (1999). Differential patterns of executive function in children with attention-deficit hyperactivity disorder according to gender and subtype. Journal of Child Neurology 14, 801805.
Huster, RJ, Enriquez-Geppert, S, Lavallee, CF, Falkenstein, M, Herrmann, CS (2013). Electroencephalography of response inhibition tasks: functional networks and cognitive contributions. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology 87, 217233.
Kenemans, JL, Bekker, EM, Lijffijt, M, Overtoom, CCE, Jonkman, LM, Verbaten, MN (2005). Attention deficit and impulsivity: selecting, shifting, and stopping. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology 58, 5970.
Kieling, R, Rohde, LA (2012). ADHD in children and adults: diagnosis and prognosis. Current Topics in Behavioral Neurosciences 9, 116.
Kollins, SH, Adcock, RA (2014). ADHD, altered dopamine neurotransmission, and disrupted reinforcement processes: implications for smoking and nicotine dependence. Progress in Neuro-Psychopharmacology and Biological Psychiatry 52, 7078.
Lackner, CL, Santesso, DL, Dywan, J, Wade, TJ, Segalowitz, SJ (2013). Electrocortical indices of selective attention predict adolescent executive functioning. Biological Psychology 93, 325333.
Liotti, M, Pliszka, SR, Higgins, K, Perez, R, Semrud-Clikeman, M (2010). Evidence for specificity of ERP abnormalities during response inhibition in ADHD children: a comparison with reading disorder children without ADHD. Brain and Cognition 72, 228237.
Lloyd, A, Brett, D, Wesnes, K (2010). Coherence training in children with attention-deficit hyperactivity disorder: cognitive functions and behavioral changes. Alternative Therapies in Health and Medicine 16, 3442.
Marco-Pallarés, J, Grau, C, Ruffini, G (2005) Combined ICA-LORETA analysis of mismatch negativity. NeuroImage 25, 471477.
Mazziotta, J, Toga, A, Evans, A, Fox, P, Lancaster, J, Zilles, K, Woods, R, Paus, T, Simpson, G, Pike, B, Holmes, C, Collins, L, Thompson, P, MacDonald, D, Iacoboni, M, Schormann, T, Amunts, K, Palomero-Gallagher, N, Geyer, S, Parsons, L, Narr, K, Kabani, N, Le Goualher, G, Boomsma, D, Cannon, T, Kawashima, R, Mazoyer, B (2001). A probabilistic atlas and reference system for the human brain: International Consortium for Brain Mapping (ICBM). Philosophical Transactions of the Royal Society of London. Series B 356, 12931322.
Meisel, V, Servera, M, Garcia-Banda, G, Cardo, E, Moreno, I (2013). Neurofeedback and standard pharmacological intervention in ADHD: a randomized controlled trial with six-month follow-up. Biological Psychology 94, 1221.
Miyake, A (2000). The unity and diversity of executive functions and their contributions to complex ‘frontal lobe’ tasks: a latent variable analysis. Cognitive Psychology 41, 49100.
Mückschel, M, Stock, A-K, Beste, C (2014). Psychophysiological mechanisms of interindividual differences in goal activation modes during action cascading. Cerebral Cortex (New York, N.Y.: 1991) 24, 21202129.
Nandam, LS, Hester, R, Bellgrove, MA (2014). Dissociable and common effects of methylphenidate, atomoxetine and citalopram on response inhibition neural networks. Neuropsychologia 56, 263270.
Nieoullon, A (2002). Dopamine and the regulation of cognition and attention. Progress in Neurobiology 67, 5383.
Nieuwenhuis, S, Yeung, N, van den Wildenberg, W, Ridderinkhof, KR (2003). Electrophysiological correlates of anterior cingulate function in a go/no-go task: effects of response conflict and trial type frequency. Cognitive, Affective and Behavioral Neuroscience 3, 1726.
Nikolas, MA, Nigg, JT (2013). Neuropsychological performance and attention-deficit hyperactivity disorder subtypes and symptom dimensions. Neuropsychology 27, 107120.
Nunez, PL, Pilgreen, KL (1991). The spline-Laplacian in clinical neurophysiology: a method to improve EEG spatial resolution. Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society 8, 397413.
Ocklenburg, S, Güntürkün, O, Beste, C (2011). Lateralized neural mechanisms underlying the modulation of response inhibition processes. NeuroImage 55, 17711778.
Pascual-Marqui, RD (2002). Standardized low-resolution brain electromagnetic tomography (sLORETA): technical details. Methods and Findings in Experimental and Clinical Pharmacology 24 (Suppl. D), 512.
Pliszka, SR, Liotti, M, Bailey, BY, Perez, R 3rd, Glahn, D, Semrud-Clikeman, M (2007). Electrophysiological effects of stimulant treatment on inhibitory control in children with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology 17, 356366.
Quetscher, C, Yildiz, A, Dharmadhikari, S, Glaubitz, B, Schmidt-Wilcke, T, Dydak, U, Beste, C (2015). Striatal GABA-MRS predicts response inhibition performance and its cortical electrophysiological correlates. Brain Structure and Function 220, 35553564.
Rabito-Alcón, MF, Correas-Lauffer, J (2014). Treatment guidelines for attention deficit and hyperactivity disorder: a critical review. Actas Españolas de Psiquiatría 42, 315324.
Ramautar, JR, Kok, A, Ridderinkhof, KR (2004). Effects of stop-signal probability in the stop-signal paradigm: the N2/P3 complex further validated. Brain and Cognition 56, 234252.
Rosch, KS, Fosco, WD, Pelham, WE, Waxmonsky, JG, Bubnik, MG, Hawk, LW (2015). Reinforcement and stimulant medication ameliorate deficient response inhibition in children with attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology. Published online 20 May 2015. doi:10.1007/s10802-015-0031-x.
Sehlmeyer, C, Konrad, C, Zwitserlood, P, Arolt, V, Falkenstein, M, Beste, C (2010). ERP indices for response inhibition are related to anxiety-related personality traits. Neuropsychologia 48, 24882495.
Sekihara, K, Sahani, M, Nagarajan, SS (2005). Localization bias and spatial resolution of adaptive and non-adaptive spatial filters for MEG source reconstruction. NeuroImage 25, 10561067.
Shang, C-Y, Pan, Y-L, Lin, H-Y, Huang, L-W, Gau, SS-F (2015). An open-label, randomized trial of methylphenidate and atomoxetine treatment in children with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology 25, 566573.
Shuler, MG, Bear, MF (2006). Reward timing in the primary visual cortex. Science (New York, N.Y.) 311, 16061609.
Slama, H, Fery, P, Verheulpen, D, Vanzeveren, N, Van Bogaert, P (2015). Cognitive improvement of attention and inhibition in the late afternoon in children with attention-deficit hyperactivity disorder (ADHD) treated with osmotic-release oral system methylphenidate. Journal of Child Neurology 30, 10001009.
Slezak, JM, Ricaurte, GA, Tallarida, RJ, Katz, JL (2014). Methylphenidate and impulsivity: a comparison of effects of methylphenidate enantiomers on delay discounting in rats. Psychopharmacology 231, 191198.
Staub, B, Doignon-Camus, N, Bacon, É, Bonnefond, A (2014). The effects of aging on sustained attention ability: an ERP study. Psychology and Aging 29, 684695.
Stroux, D, Shushakova, A, Geburek-Höfer, AJ, Ohrmann, P, Rist, F, Pedersen, A (2016). Deficient interference control during working memory updating in adults with ADHD: an event-related potential study. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology 127, 452463.
Sugimoto, F, Katayama, J (2013). Somatosensory P2 reflects resource allocation in a game task: assessment with an irrelevant probe technique using electrical probe stimuli to shoulders. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology 87, 200204.
Thomas, R, Sanders, S, Doust, J, Beller, E, Glasziou, P (2015). Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics 135, e994e1001.
Tucha, O, Tucha, L, Kaumann, G, König, S, Lange, KM, Stasik, D, Streather, Z, Engelschalk, T, Lange, KW (2011). Training of attention functions in children with attention deficit hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders 3, 271283.
Tye, C, Asherson, P, Ashwood, KL, Azadi, B, Bolton, P, McLoughlin, G (2014). Attention and inhibition in children with ASD, ADHD and co-morbid ASD + ADHD: an event-related potential study. Psychological Medicine 44, 11011116.
Waldmann, H-C (2008). Kurzformen des HAWIK-IV: Statistische Bewertung in verschiedenen Anwendungsszenarien (Short forms of HAWIK-IV: Statistical evaluation in various application scenarios). Diagnostica 54, 202210.
Wascher, E, Beste, C (2010). Tuning perceptual competition. Journal of Neurophysiology 103, 10571065.



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