Anatomical Patterns Present in Childhood ADHD May Predict Phenotypic Variation

The authors identified 4 anatomical patterns in participants with attention-deficit/hyperactivity disorder associated with head size, delayed development, symptoms of attention-deficit/hyperactivity disorder, and cognitive performance.

The authors of a study published in the American Journal of Psychiatry uncovered 4 neuroimaging patterns associated with attention-deficit/hyperactivity disorder (ADHD) in children, including head size and intracranial volume.

Multimodal brain imaging synthesizes data from multiple imaging techniques, painting a fuller picture of the anatomical effect of various conditions on the brain. The authors employed multimodal imaging to better characterize ADHD, a condition that depends on diverse, complex factors and is associated with various comorbidities.

Participants were recruited from the Children’s Attention Project, a longitudinal study of children with ADHD. Parents and teachers completed Conners 3 ADHD Index screening reports, and diagnostic status was confirmed through the National Institute of Mental Health Diagnostic Interview Schedule for Children-IV. The final cohort comprised 160 children, 70 with ADHD, aged 9 to 12 years.

Participants and their parents completed a cognitive assessment, self-report survey, and parent questionnaire. A total of 44 phenotypic variables were included in the analysis, and magnetic resonance imaging scans were completed at a single site.

The authors identified 4 anatomical patterns in participants with ADHD associated with head size, delayed development, ADHD symptoms, and cognitive performance. Each of these patterns reflected higher or lower volume, area, and thickness in specific areas of the brain when compared with control patients.

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These findings accurately predicted phenotypic variation in a second, independent cohort of 231 children, 132 of whom had ADHD, with a wider age range of 7.2 to 18.0 years.

One limitation of the study was the narrow developmental period covered by the original cohort of 9- to 12-year-olds. In addition, 23 participants were not excluded on the basis of medication status, which may have affected brain structure.


Ball G, Malpas C, Genc S, et al. Multimodal structural neuroimaging markers of brain development and ADHD symptoms [published online September 17, 2018]. Am J Psychiatry. doi: 10.1176/appi.ajp.2018.18010034