NIH Study Shows People With ADHD

Have Altered Brains

Attentiondeficithyperactivitydisorder(ADHD)haslongbeendiagnosedprimarilyby
subjectivemeasures.

Achildshealthcareproviders,parentsand,often,teacherstypicallycontribute
behavioralobservationsaboutthechildand,ifheorshefitstheestablishedcriteriafor
ADHDgenerallyspeaking,apersistentpatternofinattentionand/orhyperactivity
impulsivitythatinterfereswithfunctioningordevelopmentadiagnosismaybemade.1

Withoutanobjectivetestormeasure,thepotentialforoverdiagnosisormisdiagnosisis
high.Bysomeestimates,upto20percentofchildrenwithADHDaremisdiagnosed.2

ThisisonlycompoundedbythefactthatmanyADHDsymptomsareexperiencedby
nonADHDchildrenatsomepointoranotherandthefactthatmanyotherconditions,
includingsleepdisorders,anxiety,depressionandcertainlearningdisabilities,canhave
similarsymptoms.

UncoveringobjectivemeasuresbywhichtogaugeADHDinchildren(andadults)could
thereforehelpimmensely,andresearchfundedbytheNationalInstitutesofHealth(NIH)
mayhelptodojustthat.Notonlythat,butthenewfindingssuggestADHDisnotsimply
abehavioralissuebutratherstemsfromabraindisorder.3

Five Brain Regions in Children With ADHD Are Smaller Than

Normal

ResearchersfromRadboudUniversityintheNetherlandsanalyzedMRIscansfrommore
than3,200people,morethanhalfofwhomhadADHD.4Thebrainsofpeoplewith
ADHDturnedouttobesmalleroverallaswellasinfivespecificbrainregions:the
nucleus,putamen,nucleusaccumbens,amygdalaandhippocampus.5

Thedifferencesinvolumewereslightandseemedtobecomelessmagnifiedby
adulthood,whichsuggestsADHDmaybecharacterizedbydelayeddevelopmentin
certainbrainregions.Thebiggestsizedifferenceoccurredintheamygdala,whichis
associatedwithemotionsandhasntpreviouslybeenwidelylinkedtoADHD.6

Dr.JonathanPosner,anassistantprofessorinthedepartmentofpsychiatryatColumbia
University,whowasnotinvolvedinthestudybutwroteanaccompanyingeditorial,
suggestedtoCNNthatthismayexplainwhychildrenwithADHDmayhaveemotional
symptoms,suchaspoortoleranceforfrustration.

Thosetypesofsymptomsaren'tgivenasmuchfocusorattentionasthecognitive
symptomsseeninADHD,"hesaid,but,Thesefindingswouldsuggestthatit'spossible
there'sactuallyamoreprimarydisturbanceinemotionalprocessing.7Alsoofnote,the
useofADHDmedicationsdidnotseemtoaffecttheresults.

WhilepreviousstudieshavealsolinkedsizedifferencesinbrainvolumetoADHD,they
includedsmallsamplessizesleadingtoinconclusiveresults.8

Thecurrentstudy,however,wasmuchlarger.MartineHoogman,Ph.D.,ofthe
departmentofhumangeneticsatRadboudUniversityMedicalCenterinNijmegen,the
Netherlands,toldWebMD:9

"Thesedifferencesareverysmallintherangeofafewpercentsothe
unprecedentedsizeofourstudywascrucialtohelpidentifythese.Similardifferencesin
brainvolumearealsoseeninotherpsychiatricdisorders,especiallymajordepressive
disorder."

What Does Decreased Brain Volume Mean for Kids With ADHD?

Itstooearlytosaywhatthesizedifferencemaymean,orwhetheronedayMRIscans
couldbeusedtohelpdiagnoseADHD.GrahamMurray,alecturerinpsychiatryat
CambridgeUniversityinEngland,toldTime:10

"Havinglessbraininseveralregionssoundsbadbutit'snotassimpleasthatThe
brainisverygoodatadaptingJustbecauseyouhavelessbrainvolumedoesn't
condemnthechildtonotbeingabletofunctionwell."

Whatmanyexpertsdidconcurwithisthatthefindingshelpfurtherthenotionthat
ADHDoriginatesfrombrainsystemsandmayleadtoalterationsinbrainfunctionand
structure.Ultimately,thisshouldhelptoreducestigmaforthoseaffectedanddampen
mythsthatADHDistheresultoflazy,misbehavedkidsorpoorparenting.11

"Itisabitdistressingthatkidsarestillgettingfeedbackthattheyaremisbehavingorthat
[ADHD]isnotreal,TorontopediatricneurologistDr.EvdokiaAnagnostoutoldCBC
News.Ifanythingcomesoutofthisverylargestudy,it'sthatthisisabraindisorder.12

PastresearchhasalsosuggestedthatuseofanMRItechniquecalledmagneticfield
correlationimagingcouldhelpwithADHDdiagnosis.Inthatcase,theprocedurewas
abletodetectlowbrainironlevels,whichwasassociatedwithADHDinchildrenwho
hadnotbeentreatedwithpsychostimulantdrugs.13
Medicating Kids With ADHD May Not Improve Their Grades or
Symptoms

Amongveryyoungchildren(2to5years),behaviortherapyisthefirstlinetreatment
recommendedforADHD,accordingtotheAmericanAcademyofPediatrics(AAP).

However,datafromtheU.S.CentersforDiseaseControlandPrevention(CDC)revealed
thatabouthalfofpreschoolerswithADHDweretakingmedication,and1in4were
beingtreatedonlywithmedication.14

Further,onlyhalfof4to5yearoldswithADHDreceivedbehaviortherapy,despiteit
beingtherecommendedgototreatment.Byage6,thesocalledbestpractice
guidelinesforADHDincludetreatmentwithbothmedicationandbehaviortherapy.

Manypeople,parentsincluded,oftenassumethatmedicatingkidswithADHDwillmake
theirsymptomsdisappearandtheirgradesimprove,butthisisntnecessarilythecase.

Inastudythatanalyzedtheeffectsofdrugversusbehavioraltreatmentonhomework
performanceinchildrenwithADHD,thedrugtreatmentledtonosignificant
improvementsinhomeworkcompletionoraccuracycomparedtoplacebo.

Thebehavioraltherapy,however,ledtochildrenfinishingupto13percentmore
homeworkproblemsandincreasedaccuracyby8percent.15

Meanwhile,researchpublishedinTheCochraneDatabaseofSystematicReviewsfound
thatexpectationsofthedrugmethylphenidate(brandnamesRitalin,Concerta,Medikinet
andEquasym)areprobablygreaterthantheyshouldbe.16

Whiletheyfoundsomeevidenceofbenefit,itwasbasedonverylowqualityevidence.
Takingthedrugwasalsoassociatedwithanincreasedriskofsleepproblemsandappetite
loss.

Lifestyle and Environmental Factors That May Influence ADHD and

ADHD-Like Symptoms

WhileADHDmay,infact,beabraindisorder,manyfactorsarelikelyinvolved,
includingpoornutritionandenvironmentaltoxins,thelattertwoofwhichcanhavea
profoundinfluenceonyourbrainhealth.

Theredoappeartobemanyenvironmentalandlifestylefactorsthatinfluenceboththe
diagnosisofthisdisease(aswellastriggerADHDlikesymptoms)anditsprogressionor
healing.Forinstance:
Children with higher levels of the endocrine-disrupting chemical bisphenol-A (BPA), for instance, a
diagnosed with ADHD17

Children exposed to higher levels of organophosphate pesticides may have a twofold to threefold i
being diagnosed with ADHD18

Exposure to tobacco smoke in utero is also associated with ADHD 19

Eating an unhealthy diet during pregnancy may increase ADHD symptoms in youth 20