A resting-state functional magnetic resonance imaging meta-analysis of differences in brain activity between children and adolescents with attention-deficit/hyperactivity disorder using activation likelihood estimation

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that often persists from childhood into adolescence and adulthood. Resting-state functional magnetic resonance imaging (rs-fMRI) provides valuable insights into the intrinsic neural activity associated with ADHD. However, despite increasing neuroimaging research, the developmental specificity of spontaneous alterations in brain activity in children and adolescents with ADHD remains poorly understood. A comprehensive activation likelihood estimation (ALE) meta-analysis was performed on rs-fMRI data to investigate alterations in spontaneous brain activity in children and adolescents with ADHD compared with healthy controls (HCs). A contrast analysis was conducted to assess potential overlap in altered brain regions between the child and adolescent ADHD groups. The robustness of the findings was evaluated using a jackknife sensitivity analysis. A systematic review of the literature identified 28 rs-fMRI studies (1019 ADHD patients and 943 HCs). In children with ADHD, ALE revealed decreased spontaneous neural activity in the left middle frontal gyrus, superior frontal gyrus, medial frontal gyrus, precentral gyrus, and subgyral region, with no regions showing increased activity. In adolescents with ADHD, increased activity was observed in the bilateral paracentral lobule, left postcentral gyrus, and medial frontal gyrus, whereas decreased activity was found in the cerebellar tonsil, uvula, declive, anterior lobe, and superior/medial frontal gyrus. No significant clusters were identified in the contrast analyses. The jackknife sensitivity analysis demonstrated robustness in 9 of 17 iterations for children and 4 of 5 iterations for adolescent-specific cerebellar findings. Spontaneous alterations in brain activity in children and adolescents with ADHD reflect developmentally distinct neural mechanisms and may guide future age-specific neuroimaging research.