Volumetric MRI differences in treatment-naive vs chronically treated children with ADHD

University of Nottingham, Nottigham, England, United Kingdom
Neurology (Impact Factor: 8.29). 10/2006; 67(6):1023-7. DOI: 10.1212/01.wnl.0000237385.84037.3c
Source: PubMed


To determine if there are differences in the volume of the caudate and anterior cingulate cortex (ACC) between children with attention deficit hyperactivity disorder (ADHD) and controls, and if such differences are related to the subjects' history of stimulant treatment.
We performed a case-control study in an academic medical center. Twenty-one healthy controls, 16 children with ADHD, combined type with a history of stimulant treatment, and 14 children with ADHD, combined type treatment naïve, underwent structural MRI. All children with ADHD were medication-free at the time of the MRI. Regional hemispheric volumes (in cm3) of caudate and anterior cingulate cortex were determined.
There were significant differences bilaterally on caudate volume for both ADHD groups vs controls, with no difference between the ADHD groups on either side. In contrast, the right ACC was significantly smaller for the ADHD-treatment naïve (ADHD/TN) group compared to the ADHD-treated (ADHD/Rx) and control group. The volume of left ACC approached significance contrast between ADHD/RX and ADHD/TN. There were no differences found between the ADHD/Rx and controls on the ACC volumes bilaterally.
The results from this study indicate a relationship of previous treatment history with caudate and anterior cingulate volumetric changes in children with attention deficit hyperactivity disorder-combined type.

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Available from: Margaret Semrud-Clikeman, Apr 10, 2015
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    • "The main strengths of the study are the relatively large sample size of ADHD and control groups and the fact that all patients were medication-näive at time of scanning. This is important given the long term effects of stimulant medication on brain function and structure (Nakao et al., 2011; Pliszka et al., 2006). However, also some limitations of the present study should be noted. "
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    ABSTRACT: Structural and functional brain studies on attention deficit/hyperactivity disorder (ADHD) have primarily examined anatomical abnormalities in the prefronto-striatal circuitry (especially, dorsal and lateral areas of the prefrontal cortex and dorsal striatum). There is, however, increased evidence that several temporal lobe regions could play an important role in ADHD. The present study used MRI-based measurements of cortical thickness to examine possible differences in both prefrontal and temporal lobe regions between medication-näive patients with ADHD (N=50) and age- and sex-matched typically developing controls (N=50). Subjects with ADHD exhibited significantly decreased cortical thickness in the right temporal pole and orbitofrontal cortex (OFC) relative to healthy comparison subjects. These differences remained significant after controlling for confounding effects of age, overall mean cortical thickness and comorbid externalizing conditions, such as oppositional defiant and conduct disorders. These results point to the involvement of the temporal pole and OFC in the neuropathology of ADHD. Moreover, present findings add evidence to the assumption that multiple brain regions and psychological processes are associated with ADHD.
    Psychiatry Research: Neuroimaging 10/2014; 224(1). DOI:10.1016/j.pscychresns.2014.07.004 · 2.42 Impact Factor
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    • "The strength of the study is the use of probabilistic GPC methods that confers multiple benefits for clinical studies. Another strength is the inclusion of mostly (73%) medication-naïve ADHD patients, since long-term stimulant medication has been associated with more normal GM and cortical thickness of fronto-cingulate, parietal, cerebellar and striatal regions[2], [52], [62]–[65] and 100% medication-naïve ASD patients. To increase the homogeneity of the sample, we included only males with the combined hyperactive-impulsive and inattentive subtype of ADHD. "
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    ABSTRACT: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, but diagnosed by subjective clinical and rating measures. The study's aim was to apply Gaussian process classification (GPC) to grey matter (GM) volumetric data, to assess whether individual ADHD adolescents can be accurately differentiated from healthy controls based on objective, brain structure measures and whether this is disorder-specific relative to autism spectrum disorder (ASD). Twenty-nine adolescent ADHD boys and 29 age-matched healthy and 19 boys with ASD were scanned. GPC was applied to make disorder-specific predictions of ADHD diagnostic status based on individual brain structure patterns. In addition, voxel-based morphometry (VBM) analysis tested for traditional univariate group level differences in GM. The pattern of GM correctly classified 75.9% of patients and 82.8% of controls, achieving an overall classification accuracy of 79.3%. Furthermore, classification was disorder-specific relative to ASD. The discriminating GM patterns showed higher classification weights for ADHD in earlier developing ventrolateral/premotor fronto-temporo-limbic and stronger classification weights for healthy controls in later developing dorsolateral fronto-striato-parieto-cerebellar networks. Several regions were also decreased in GM in ADHD relative to healthy controls in the univariate VBM analysis, suggesting they are GM deficit areas. The study provides evidence that pattern recognition analysis can provide significant individual diagnostic classification of ADHD patients and healthy controls based on distributed GM patterns with 79.3% accuracy and that this is disorder-specific relative to ASD. Findings are a promising first step towards finding an objective differential diagnostic tool based on brain imaging measures to aid with the subjective clinical diagnosis of ADHD.
    PLoS ONE 05/2013; 8(5):e63660. DOI:10.1371/journal.pone.0063660 · 3.23 Impact Factor
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    • "Contrary to what was expected, our results do not reveal any significant differences in the cortical thickness of the ACC between participants with ADHD and control participants . However, other studies have reported significant thinning and decreased functional connectivity in the ACC (Qiu et al., 2011; Semrud-Clikeman et al., 2006). The lack of differences in this hypothesized region could be attributed to the fact that our participant set was younger than in most other studies, and therefore closer to the illness onset. "

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