The dual pathway model of AD/HD: an elaboration of neuro-developmental characteristics

Neurosci Biobehav Rev. 2003 Nov;27(7):593-604. doi: 10.1016/j.neubiorev.2003.08.005.

Abstract

The currently dominant neuro-cognitive model of Attention Deficit Hyperactivity Disorder (AD/HD) presents the condition as executive dysfunction (EDF) underpinned by disturbances in the fronto-dorsal striatal circuit and associated dopaminergic branches (e.g. meso-cortical). In contrast, motivationally-based accounts focus on altered reward processes and implicate fronto-ventral striatal reward circuits and those meso-limbic branches that terminate in the ventral striatum especially the nucleus accumbens. One such account, delay aversion (DEL), presents AD/HD as a motivational style-characterised by attempts to escape or avoid delay-arising from fundamental disturbances in these reward centres. While traditionally regarded as competing, EDF and DEL models have recently been presented as complimentary accounts of two psycho-patho-physiological subtypes of AD/HD with different developmental pathways, underpinned by different cortico-striatal circuits and modulated by different branches of the dopamine system. In the current paper we describe the development of this model in more detail. We elaborate on the neuro-circuitry possibly underpinning these two pathways and explore their developmental significance within a neuro-ecological framework.

Publication types

  • Review

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / physiopathology*
  • Attention Deficit Disorder with Hyperactivity / psychology
  • Cognition Disorders / physiopathology*
  • Cognition Disorders / psychology
  • Humans
  • Mental Processes / physiology*
  • Models, Neurological*
  • Models, Psychological
  • Neural Pathways / physiopathology*
  • Reinforcement, Psychology*