Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common disorders in pediatric psychiatry affecting 3-8% of school age children. Although ADHD is primarily characterized by inattention, hyperactivity and impulsivity, emotional lability is a common and impairing symptom in this population. Little is known, however, about the neurobiological substrates that underlie emotional lability in children with ADHD. Moreover, psychostimulants, the first-line treatment of ADHD, are known to reduce ADHD symptoms including emotional lability, yet the neurobiological mechanisms by which psychostimulants have their salutary effects upon emotional lability have scarcely been studied. To address this knowledge gap, we propose to conduct a longitudinal, multimodal MRI study to examine the effects of psychostimulants on the brain's affective network in children with ADHD. We will combine a multimodal MRI study with a randomized clinical trial of the psychostimulant lisdexamfetamine such that study participants will have an MRI scan prior to treatment and then a second MRI scan after 12 weeks of treatment with either lisdexamfetamine or placebo. The study will advance our knowledge of the neurobiology underlying emotional lability in children with ADHD, as well as the mechanism by which psychostimulants alleviate this symptom. Advancing this type of knowledge is critical for several reasons, but most importantly a clearer understanding of the neurobiological mechanisms by which psychostimulants are effective will promote the development of more effective and targeted treatments, as well as advance our understand of the pathophysiology of ADHD.

Public Health Relevance

-Deficit/Hyperactivity Disorder (ADHD) is among the most common disorders in pediatric psychiatry. Emotional lability is present in many children with ADHD and often improves with treatment with a psychostimulant;however, the neurobiological mechanisms that produce this improvement are unknown. We propose to combine advanced neuroimaging with a clinical trial of a stimulant medication. Findings from this study will help increase our understanding of the neurobiology of emotional lability in children with ADHD and guide the development of new and more effective treatments.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Interventions Committee for Disorders Involving Children and Their Families (ITVC)
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Garvey, Marjorie A
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New York State Psychiatric Institute
New York
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Posner, Jonathan; Kass, Erica; Hulvershorn, Leslie (2014) Using stimulants to treat ADHD-related emotional lability. Curr Psychiatry Rep 16:478
Posner, Jonathan; Park, Christine; Wang, Zhishun (2014) Connecting the dots: a review of resting connectivity MRI studies in attention-deficit/hyperactivity disorder. Neuropsychol Rev 24:3-15
Posner, Jonathan; Siciliano, Francesco; Wang, Zhishun et al. (2014) A multimodal MRI study of the hippocampus in medication-naive children with ADHD: what connects ADHD and depression? Psychiatry Res 224:112-8
Posner, Jonathan (2014) A different approach to rising rates of ADHD diagnosis. J Am Acad Child Adolesc Psychiatry 53:697