Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Apr 19, 2025; 15(4): 102215
Published online Apr 19, 2025. doi: 10.5498/wjp.v15.i4.102215
Vulnerable brain regions in adolescent attention deficit hyperactivity disorder: An activation likelihood estimation meta-analysis
Yan-Ping Shu, Qin Zhang, Da Li, Jiao-Ying Liu, Xiao-Ming Wang, Qiang He, Yong-Zhe Hou
Yan-Ping Shu, Da Li, Jiao-Ying Liu, Xiao-Ming Wang, Qiang He, Yong-Zhe Hou, Department of Psychiatry of Women and Children, The Second People's Hospital of Guizhou Province, Guiyang 550004, Guizhou Province, China
Qin Zhang, Department of Radiology, The Second People's Hospital of Guizhou Province, Guiyang 550004, Guizhou Province, China
Co-corresponding authors: Qiang He and Yong-Zhe Hou.
Author contributions: Shu YP conceptualized and designed the research framework. Hou YZ and Zhang Q were responsible for conducting the literature search, carrying out the initial screening, extracting relevant data, and performing the analytical computations. Li D, Liu JY, Wang XM, and He Q contributed to critical revisions that significantly improved the intellectual content of the manuscript. Zhang Q, He Q, and Hou YZ have played important and indispensable roles in the experimental design, data interpretation, and manuscript preparation as co-corresponding authors. Zhang Q designed the overall experiment, planned the specific workflow, and, together with Hou YZ, conducted the literature search, screening, and extraction of key data. Zhang Q also provided significant assistance in data analysis and offered guidance on the software used. Hou YZ and He Q reviewed and revised early drafts of the manuscript. In addition, He Q contributed to clarifying the neuroimaging associations related to ADHD. Hou YZ, as the lead corresponding author, was primarily responsible for manuscript submission, peer review, and communication with the journal throughout the publication process. Zhang Q, He Q, and Hou YZ contributed equally to this manuscript and are therefore listed as co-corresponding authors.
Supported by National Natural Science Foundation of China, No. 82460282; Guizhou Province Science and Technology Plan Project, No. ZK-2023-195; Guizhou High-Level Innovative Talent Project, No. gzwjrs2022-013; and Health Commission of Guizhou Province Project, No. gzwkj2024-475 and No. gzwkj2021-150.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Zhe Hou, Senior Researcher, Department of Psychiatry of Women and Children, The Second People's Hospital of Guizhou Province, No. 206 South Section of Xintian Avenue, Yunyan District, Guiyang 550004, Guizhou Province, China. tedyong@163.com
Received: October 11, 2024
Revised: December 20, 2024
Accepted: February 5, 2025
Published online: April 19, 2025
Processing time: 164 Days and 14.6 Hours
Abstract
BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in adolescents characterized by inattention, hyperactivity, and impulsivity, which impact cognitive, behavioral, and emotional functioning. Resting-state functional magnetic resonance imaging (rs-fMRI) provides critical insights into the functional architecture of the brain in ADHD. Despite extensive research, specific brain regions consistently affected in ADHD patients during these formative years have not been comprehensively delineated.

AIM

To identify consistent vulnerable brain regions in adolescent ADHD patients using rs-fMRI and activation likelihood estimation (ALE) meta-analysis.

METHODS

We conducted a comprehensive literature search up to August 31, 2024, to identify studies investigating functional brain alterations in adolescents with ADHD. We utilized regional homogeneity (ReHo), amplitude of low-frequency fluctuations (ALFF), dynamic ALFF (dALFF) and fractional ALFF (fALFF) analyses. We compared the regions of aberrant spontaneous neural activity in adolescents with ADHD with those in healthy controls (HCs) using ALE.

RESULTS

Fifteen studies (468 adolescent ADHD patients and 466 HCs) were included. Combining the ReHo and ALFF/fALFF/dALFF data, the results revealed increased activity in the right lingual gyrus [LING, Brodmann Area (BA) 18], left LING (BA 18), and right cuneus (CUN, BA 23) in adolescent ADHD patients compared with HCs (voxel size: 592-32 mm³, P < 0.05). Decreased activity was observed in the left medial frontal gyrus (MFG, BA 9) and left precuneus (PCUN, BA 31) in adolescent ADHD patients compared with HCs (voxel size: 960-456 mm³, P < 0.05). Jackknife sensitivity analyses demonstrated robust reproducibility in 11 of the 13 tests for the right LING, left LING, and right CUN and in 11 of the 14 tests for the left MFG and left PCUN.

CONCLUSION

We identified specific brain regions with both increased and decreased activity in adolescent ADHD patients, enhancing our understanding of the neural alterations that occur during this pivotal stage of development.

Keywords: Attention deficit hyperactivity disorder; Adolescent; Resting-state functional magnetic resonance imaging; Activation likelihood estimation; Meta-analysis; Medial frontal gyrus; Precuneus; Cuneus; Lingual gyrus

Core Tip: This study used activation likelihood estimation meta-analysis to identify vulnerable brain regions in adolescents with attention deficit hyperactivity disorder (ADHD) based on resting-state functional magnetic resonance imaging. Increased activity was detected in the bilateral lingual gyrus and right cuneus, whereas decreased activity was detected in the left medial frontal gyrus and left precuneus. These findings provide novel insights into the neurophysiological mechanisms of ADHD and suggest potential targets for therapeutic interventions to improve cognitive and behavioral outcomes in affected adolescents.