 | ADULT ATTENTION DEFICIT DISORDER: BRAIN MECHANISMS AND LIFE OUTCOMES
Copyright © 2001 by the New York Academy of Sciences
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Annals of the New York Academy of Sciences 931:172-195 (2001)
© 2001 New York Academy of Sciences
Attention Deficit/Hyperactivity Disorder as a Right Hemisphere Syndrome
Selective Literature Review and Detailed Neuropsychological Case Studies
GERRY A. STEFANATOSa AND
JEANETTE WASSERSTEINb
aCognitive Neurophysiology Laboratory, MossRehab Research Institute, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA
bComprehensive Neuropsychological Services and Department of Psychiatry, Mount Sinai School of Medicine, New York, New York 10023, USA
Address for correspondence: Gerry A. Stefanatos, D. Phil., Institute Scientist, Director, Cognitive Neurophysiology Laboratory, MossRehab Research Institute, Albert Einstein Medical Center, Philadelphia, PA 19141.
Recent studies of ADHD implicate well-defined neuroanatomical networks and neurochemical pathways in its pathophysiological basis. Considerable attention has focused on the role of anterior and superior frontal regions and portions of the basal ganglia, including the caudate nucleus and globus pallidus. This paper reviews a growing literature suggesting differential involvement of right hemisphere mechanisms specialized for behavioral regulation and attention. Supportive data are drawn from neuropsychology, neuroanatomy, and neurochemistry. In addition, three cases are presented that illustrate the complex role of right hemisphere dysfunction in adult manifestations of ADHD. We suggest that the pleomorphic presentations of ADHD can be understood in terms of a spectrum of disturbances in overlapping neural regions, especially involving frontal and parietal areas of the right hemisphere and their connections to subcortical structures (including the striatum, limbic system and diencephalic nuclei).
Key Words: Attention deficit hyperactivity disorder (ADHD) • Nonverbal learning disabilities • Right hemisphere deficit • Dopaminergic • Noradrenergic • Catecholamines
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