Neural correlates of executive function and attention in children with ADHD: An ALE meta-analysis of task-based functional connectivity studies

We conducted a comprehensive meta-analysis of task-based functional MRI studies on executive function and attention in children with attention deficit hyperactivity disorder (ADHD). We searched for studies published before March 20, 2023, in PubMed, Cochrane Library, Web of Science, EBSCO, Embase, and Scopus. The ALE (activation likelihood estimation) method was used to detect differences in brain activation between children with ADHD and comparison children. Fifty-seven (57) studies were included, with 2,231 participants (1,062 children with ADHD). Based on the omnibus meta-analysis findings, significant hypoactivation in children with ADHD relative to comparisons was observed in the frontoparietal network, putamen, insula, cingulate gyrus, and middle temporal gyrus, while ADHD-related hyperactivation was present in the occipital lobe, declive, middle frontal gyrus, and parahippocampal gyrus. This study highlights the critical involvement of the parietal lobe. Results also revealed abnormalities in the frontal lobe and brainstem, suggesting unintegrated primitive reflexes. For stimulant-naive children with ADHD, significant hypoactivation in the right cerebrum was observed compared to controls. Finally, dysfunctional connectivity between the frontoparietal network and the striatum may lead to inefficient working memory, while the cerebellum plays a crucial role in inhibitory control and attention tasks. These findings provide important insights into the pathology of ADHD.