Diffusion tensor imaging findings in children with sluggish cognitive tempo comorbid Attention Deficit Hyperactivity Disorder

Abstract

Objective: The construct of Sluggish Cognitive Tempo (SCT) is characterized by daydreaming, mental confusion, staring blankly and hypoactivity. Our main goal was to explore neuropsychological differences in Attention Deficit Hyperactivity Disorder-Inattentive presentation (ADHD-IA) groups with and without SCT symptoms compared to healthy controls. After detecting specific neuropsychological differences, we examined white matter microstructure using Diffusion Tensor Imaging (DTI) data obtained from 3.0 Tesla MRI scans of the cases with SCT symptoms comparing to Typically Developing (TD) controls.

Method: In this study, we included 24 cases in the ADHD-IA group with SCT symptoms, 57 cases in the ADHD-IA group without SCT symptoms and, 24 children in the TD group. We applied tract-based spatial statistics to the DTI measures for obtaining fractional anisotropy (FA), axial, radial and mean diffusivity (AD, RD, MD) to explore white matter differences for the whole brain.

Results: Omission error scores and longer reaction time scores were specifically associated with inattention symptoms. Commission error scores were significantly and specifically related to SCT symptoms. Cases with SCT symptoms presented increased FA in the bilateral anterior and posterior limb of the internal capsule, bilateral cerebral peduncle, and the fornix than TD group.

Conclusions: Neurobiological differences in ADHD cases are still relatively unexplored. We suggest that including an assessment for SCT in the neuropsychological and neuroimaging studies of ADHD may provide more consistent results.

Keywords:

• SCT
• Neuroimaging
• DTI
• Internal capsule
• commission errors

Acknowledgement

We would like to express our very grate appreciation to Professor Russell A. Barkley.

Disclosure statement

Eyüp Sabri Ercan is on advisory boards for Abdi İbrahim Otsuka Turkey, Ali Raif Medicine Turkey and Sanofi Turkey. The other authors declare that they have no conflict of interest.

Figure 1. Group differences in factional anisotropy (FA) between 24 patients with SCT + ADHD-IA and 24 TD subjects. Significantly increased FA in patients with SCT + ADHD-IA were shown in the bilateral anterior and posterior limb of internal capsule, bilateral cerebral peduncle and the fornix. Represented results are thresholded at a p < .05 (TFCE corrected). See Table 2 for cluster details.

Additional information

Funding

This study was supported by Ege University Scientific Research Projects Coordination Unit (Project Number: 2016-TIP-047).

Notes on contributors

Gül Ünsel-Bolat

Gül Ünsel-Bolat is MD at Child and Adolescent Psychiatry Department of Balıkesir University and PhD candidate in Neuroscience since 2018 at Ege University.

Muharrem Burak Baytunca

Muharrem Burak Baytunca provided MD degree at Child and Adolescent Psychiatry Department of Ege University and is currently resident at Psychiatry Department of Utah University since 2019.

Burcu Kardaş

Burcu Kardaş is MD at Child and Adolescent Psychiatry Department of Gazi Yaşargil Education and Research Hospital.

Melis İpçi

Melis İpçi is BS at Clinical Psychology Department of Hasan Kalyoncu University.

Sevim Berrin İnci İzmir

Sevim Berrin İnci İzmir is MSc at Clinical Psychology Department of Işık University.

Onur Özyurt

Onur Özyurt is PhD at Biomedical Engineering Department of Boğaziçi University.

Mehmet Cem Çallı

Mehmet Cem Çallı is MD and Professor at Radiology Department of Ege University.

Eyüp Sabri Ercan

Eyüp Sabri Ercan is MD and Professor at Child and Adolescent Psychiatry Department of Ege University.