성인 ADHD와 우울한 성인의 인지통제 결함: 순행성 통제와 반응성 통제 요구도에 따른 AX-CPT 수행 비교 = Exploring the cognitive control deficits in adults with ADHD and adults with depression: the AX-CPT performance under different proactive and reactive control demands

다국어 초록 (Multilingual Abstract)

This study aimed to explore the characteristics of cognitive control deficits in adult ADHD from the perspective of Dual Mechanism of Control (DMC), which posits that cognitive control operates via two distinct dimensions, i.e., proactive and reactive control. AX-CPT, including nogo trials, was utilized to tap cognitive control processes in a sample of 27 adults with ADHD, 17 adults with depression, and 29 healthy adults. The performance of adults with ADHD was compared to that of adults with depression as well as healthy adults to investigate the effects of depression, which is a common comorbid condition in adult ADHD. AX-CPT is a continuous performance test consisting of four types of cue-probe pairs (AX, AY, BX, BY) and requires participants to respond to a probe based on a preceding cue. AX pairs are target pairs matched with a target response, and other pairs are non-target pairs matched with a non-target response. The proactive control demands were manipulated with the proportion of AX trials(AX-40 vs. AX-70) and the reactive control demands were manipulated with nogo trials(base vs. nogo). The order of the two AX-proportion conditions were counterbalanced, and the base condition and the nogo condition were implemented in order within each AX-proportion condition. The adult ADHD group showed lower accuracy than the depression group and the healthy control group in the performance of BX trials that require proactive inhibitory control. Both the ADHD group and the depression group performed lower than the healthy control group in nogo trials that require reactive inhibitory control. These results suggest that adults with ADHD have a deficit in overall cognitive control, including proactive and reactive control, and the reactive control deficit of adult ADHD may be associated with comorbid depression as well as ADHD itself.

국문 초록 (Abstract)

본 연구에서는 순행성 통제(proactive control)와 반응성 통제(reactive control)로 구분되는 기제를 통해 인지통제가 작동한다는 인지통제의 이중기제(Dual Mechanism of Control, DMC) 이론의 관점에서 성인 ADHD의 인지통제 결함의 특성을 탐색하였다. 이를 위해 성인 ADHD 27명, 정상 대조군 성인 29명이 본 연구에 참여하였으며, 성인 ADHD에서 흔히 동반되는 우울이 인지통제에 미치는 영향을 알아보기 위해 ADHD가 아닌 우울한 성인 17명도 참여하였다. 인지통제 과제로 사용된 AX-CPT는 4가지 유형의 단서-탐색자극 쌍(AX, AY, BX, BY)으로 구성되며, AX에는 표적 반응을 나머지 자극 쌍에는 비표적 반응을 하게 하는 연속수행과제이다. 본 연구에서는 표적 반응에 대응하는 단서-탐색자극 쌍인 AX의 비율(AX-40 vs. AX-70)로 순행성 통제의 요구도를, 탐색자극 대신에 반응을 억제해야 하는 nogo 자극이 제시되는 nogo 시행을 이용(기저 vs. nogo 조건)하여 반응성 통제의 요구도를 조작하였다. AX-비율 조건은 역균형화하였으며, AX-비율 조건 내에서 기저 조건, nogo 조건 순으로 실시되었다. 성인 ADHD 집단은 단서를 이용하여 반응을 사전에 준비하는 순행성 통제과정이 전반적으로 저하된 데 비해, 우울 집단은 강력히 편향된 반응을 순행적으로 억제해야 조건(AX-70의 BX)에서만 낮은 수행을 보였다. 또한 반응성 통제에 대한 요구도가 높은 nogo 시행에서는 ADHD 집단과 우울 집단 모두 정상 집단에 비해 낮은 수행을 보였다. 이러한 결과는 성인 ADHD가 순행성 통제와 반응성 통제를 포함한 전반적인 인지통제의 결함을 가짐을 시사하며, 반응성 통제 결함은 이차적 우울의 영향도 혼재되었을 가능성을 시사한다.

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