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• W2092121172 abstract "This commentary is on the original article by Langevin et al. on pages 257–264 of this issue. The continuous innovation and refinement of neuroimaging techniques has enabled the quantification of the brain microstructure and functional network development in vivo that were previously not detectable on conventional magnetic resonance imaging (MRI). As of now, a number of brain structures and activity fluctuation patterns have been identified as important underlying mechanisms of function and dysfunction. Advanced MRI techniques are particularly appealing for studying disorders in which specific gene anomaly or brain insult has not yet been identified. These techniques are particularly suited to exploring the neural correlates of neurodevelopmental disorders for which the etiology is, in many cases, thought to be the result of complex interactions between multiple gene expressions of small effect and environmental factors.1 Several neurodevelopmental disorders are known to present in comorbidity, resulting in heterogeneous clinical presentations, which frequently include an assortment of motor, attention, and behavioral difficulties. Despite the increasing interest in studying comorbid neurodevelopmental disorders, the relationship between motor and attention deficits remains poorly understood. There is a high incidence of overlapping symptoms between attention-deficit–hyperactivity disorder (ADHD) and developmental coordination disorder (DCD). Years of neuroimaging studies in the ADHD population have shed light on a number of structural brain and activation pattern differences when compared with typically developing peers. Although some of the central nervous system alterations described are part of the known motor pathways and therefore could intuitively explain both the attention and the motor difficulties frequently observed in individuals with ADHD, there is in fact very little concrete evidence on how these neural correlates are specific to motor performance in this population.2 Currently, very few studies have comprehensively examined structure-function relationships in these complex neurodevelopmental disorders, whether it is in their isolated or comorbid form. In their new study, Langevin et al.3 uniquely report group-specific associations between areas of cortical thinning and decreased performance on motor and attentional standardized evaluations. Although these preliminary findings need further validation in larger samples, which would enable the ability to control for more confounders, the authors made a significant attempt to increase the clinical relevance of their findings in correlating neural substrates with performance measures. These associations should nonetheless be interpreted with caution as lower performance does not unconditionally translate to impairment. Studying the developing brain is extremely challenging because of its plasticity and the seemingly infinite number of factors that are likely to influence growth trajectory. Early life experiences (i.e. pain, neonatal illness) have been shown to affect cerebral development in preterm infants,4 a group particularly at risk to later present with ADHD and/or DCD. More than the critical period surrounding birth, other events during childhood are also likely to shape the brain's developmental trajectory. For instance, ante/perinatal factors as well as environmental factors during early development have been suggested to differently contribute to the presentation of ADHD profiles.5 Moreover the use of stimulant medication, the most common treatment for ADHD, seems to normalize brain structure and activity when compared with unmedicated individuals with the disorder.6 It becomes extremely difficult to control for these variables in cross-sectional designs of samples recruited during childhood and adolescence. It is only with the very challenging implementation of large longitudinal investigations using serial neuroimaging during the neonatal period as well as in later development, that we will better understand which brain anomalies are disease-specific and which are due to certain exposures. The ultimate goals of finding a disease-specific neurobiomarker are to enable early diagnosis and to predict treatment effectiveness. Our current understanding of the neural correlates of ADHD and DCD involves multiple brain areas and has translated in only limited clinical implication to date. Studies targeting the neural correlates of performance and, more importantly, change in performance, rather than the symptoms, have the potential to elucidate the neural mechanisms involved in situations of activity limitation and to more directly guide intervention. Consequently, structure-function studies coupling both imaging and non-diagnostic skills-specific standardized evaluations has become the gold-standard of neuro-rehabilitation science." @default.
• W2092121172 created "2016-06-24" @default.
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• W2092121172 date "2014-09-30" @default.
• W2092121172 modified "2023-09-27" @default.
• W2092121172 title "The puzzling search for neural correlates of performance" @default.
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• W2092121172 doi "https://doi.org/10.1111/dmcn.12584" @default.
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