Abstract
BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in adolescents characterized by inattention, hyperactivity, and impulsivity, which impact cognitive, behavioral, and emotional functioning. Resting-state functional magnetic resonance imaging (rs-fMRI) provides critical insights into the functional architecture of the brain in ADHD. Despite extensive research, specific brain regions consistently affected in ADHD patients during these formative years have not been comprehensively delineated. AIM: To identify consistent vulnerable brain regions in adolescent ADHD patients using rs-fMRI and activation likelihood estimation (ALE) meta-analysis. METHODS: We conducted a comprehensive literature search up to August 31, 2024, to identify studies investigating functional brain alterations in adolescents with ADHD. We utilized regional homogeneity (ReHo), amplitude of low-frequency fluctuations (ALFF), dynamic ALFF (dALFF) and fractional ALFF (fALFF) analyses. We compared the regions of aberrant spontaneous neural activity in adolescents with ADHD with those in healthy controls (HCs) using ALE. RESULTS: Fifteen studies (468 adolescent ADHD patients and 466 HCs) were included. Combining the ReHo and ALFF/fALFF/dALFF data, the results revealed increased activity in the right lingual gyrus [LING, Brodmann Area (BA) 18], left LING (BA 18), and right cuneus (CUN, BA 23) in adolescent ADHD patients compared with HCs (voxel size: 592-32 mm³, P < 0.05). Decreased activity was observed in the left medial frontal gyrus (MFG, BA 9) and left precuneus (PCUN, BA 31) in adolescent ADHD patients compared with HCs (voxel size: 960-456 mm³, P < 0.05). Jackknife sensitivity analyses demonstrated robust reproducibility in 11 of the 13 tests for the right LING, left LING, and right CUN and in 11 of the 14 tests for the left MFG and left PCUN. CONCLUSION: We identified specific brain regions with both increased and decreased activity in adolescent ADHD patients, enhancing our understanding of the neural alterations that occur during this pivotal stage of development.