Functional deficits of the inhibitory control system in children with ADHD: A task-based fMRI meta-analysis

Abstract

Inhibitory control deficits have long been proposed as a central neurocognitive mechanism underlying childhood Attention Deficit/Hyperactivity Disorder (ADHD). However, neuroimaging findings remain heterogeneous, partly due to methodological variability across developmental samples and experimental paradigms. The present study aimed to characterize the neural architecture of motor response inhibition in typically developing (TD) children and identify reproducible functional abnormalities associated with pediatric ADHD using stringent, developmentally specific inclusion criteria. We conducted two coordinate-based meta-analyses using Activation Likelihood Estimation (ALE). Following a systematic literature search (up to August 2026), we identified 23 task-based fMRI studies reporting inhibitory-control-related activation in TD children (237 foci) and 17 studies comparing children with ADHD and TD peers (114 foci) during the Stop-Signal Task or Go/No-Go Task. \ Statistical significance was determined using cluster-level family-wise error (FWE) correction. In TD children, ALE revealed a robust inhibitory-control network encompassing the bilateral anterior insula (AI), inferior frontal gyrus (IFG), and the midline pre-supplementary motor area (preSMA) and anterior cingulate cortex (ACC). This spatial organization closely resembled the canonical inhibitory-control network consistently observed in adults, suggesting that the core neural architecture supporting motor inhibition is already detectably organized during development. In the between-group analysis, children with ADHD exhibited hypoactivation within the preSMA. Notably, this region demonstrated striking spatial overlap with the preSMA cluster reliably recruited in TD children during motor inhibition. These findings provide convergent support for inhibitory-control models of ADHD and identify altered preSMA recruitment as the key functional abnormalities associated with pediatric ADHD. While the neural infrastructure supporting inhibitory control is broadly established during childhood, children with ADHD exhibit reduced recruitment of a key cortical node within this network during motor inhibition demands.