Recent research on the disorders of attention and activity has indicated inherited variants of
genes controlling aspects of neurotransmission, abnormalities of structure and function in regions
of frontal lobes and basal ganglia, failures to suppress inappropriate responses, and a cascade of
failures in various kinds of cognitive performance and organization of behavior. This review
integrates the neurodevelopmental findings with findings from developmental psychopathology.
It outlines several developmental tracks by which constitutional factors interact with the
psychological environment. In one set of tracks, altered brain states lead to cognitive alteration.
An understimulating environment is evoked by (and may be genetically associated with) an
inattentive and cognitively impulsive style during early childhood. In another track, impulsive
and inattentive behavior shows direct continuity through childhood into late adolescence. In yet
another track, impulsiveness evokes (and may be genetically associated with) critical expressed
emotion from parents and inefficient coping strategies, which in turn contribute to the
development of antisocial conduct. This formulation emphasizes the need for several types of
research: the mapping of biological findings onto different components of disorder, the
combination of genetically informative designs with direct measurement of relevant aspects of
the environment, and the use of longitudinal studies to examine predictive and mediating factors
separately for different aspects of outcome.
The Basal Ganglia IV. New Ideas and Data on Structure and Function
