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ADHD Circuitries in the R-Do-C Perspective

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The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders

Abstract

Even though the DSM and ICD have been of value in facilitating communication between clinicians and researchers, they failed in implementing the neuroscientific data, missing to establishing “external validator” of the clinical syndrome, and therefore were unsuccessful in establishing the validity of their diagnostic categories beyond the clinical level.

Harshly criticism accompanied the publication of the fifth version of DSM (DSM-5) in 2013 by the American Psychiatric Association (APA), because it did not keep the promise of a heightened focus on neurobiological markers as well as to the use of a dimensional system. Indeed, it did not represent a radical change in the diagnosis and classification in respect to what had been imagined. In this context, the approach proposed by the National Institute of Mental Health (NIHM) called Research Domain Criteria (R-Do-C), emerged as a useful framework, as a project aiming to transform diagnosis by incorporating genetics, imaging, cognitive science, and other information levels in order to establish the starting point for a new classification system. It assumes that mental disorders are biological conditions involving brain circuits, which implicate specific domains of cognition, emotion and behavior, and therefore symptoms cannot be constrained by the current DSM categories. In the aim of a diagnostic system which should be based on the emerging research data and not on the current categories that are based on a collection of symptoms, the R-Do-C approach requires that each level of analysis should be understood across a dimension of function (the cross-cutting correction of DSM). The reason of this purpose is that it was not possible to design a system based on biomarkers or cognitive performance based on categorical definition of the clinical entities. By collecting the genetic, imaging, physiologic, and cognitive data (and not only symptoms), and analyzing how they relate each other and cluster together, we can also be informed on how these clusters relate to treatment response.

The goal of the R-Do-C project is particularly important in the treatment of ADHD, as it is an extremely heterogeneous disorder requiring specific and targeted interventions, depending by what dimension (i.e., inattention, impulsivity, hyperactivity, emotional dysregulation) is more affected at the precise moment when the patient asks for help. The R-Do-C framework can also give us an explanation on how the ADHD core dysfunctions (in terms of dimensions and executive functions) can change across the development, and how targeted treatment on one dimension can impact on the others.

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Pallanti, S., Salerno, L. (2020). ADHD Circuitries in the R-Do-C Perspective. In: The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-39051-8_4

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