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Researchers Find Brain Abnormalities in Children with ADHD

(Jan 27, 2009)

Children diagnosed with ADHD are "just emotionally neglected. Their mothers are exhausted and burned out from long hours at work, and these kids spend way too much time in child care," wrote a responder to an article on attention – deficit/hyperactivity disorder (ADHD) on the New York Times website. This and similar views – that kids with ADHD are really just naughty, spoiled troublemakers – are widespread. But they are also "antiquated, anachronistic, and wrong," says Bradley Peterson, a psychiatrist at NewYork-Presbyterian/Columbia University Medical Center.

Dr. Peterson's recent research shows that kids who develop ADHD have real, consistent physiological differences from other kids. Using magnetic resonance imaging (MRI) and anatomical mapping techniques, Dr. Peterson and his colleagues found that the brains of children with ADHD have anatomical abnormalities including an enlarged hippocampus, the part of the brain that deals with memory, emotions, and spatial orientation, and a smaller frontal cortex, the brain region responsible for personality, decision-making, and social behavior.

These structural differences contribute to significant abnormalities along the brain circuit "that we think is really important for controlling motor activity and unwanted impulses." Stimulant medications commonly used to treat ADHD can alter these anatomical abnormalities, Dr. Peterson says, and seem to normalize this circuit.

The hallmarks of ADHD are behavioral problems including inattention, distractibility, impulsivity, and hyperactivity. "When children with ADHD are not taking stimulant medication, they are unable to suppress the mind-wandering circuits—but when they take the stimulant medication, they are able to shut these off," said Dr. Peterson. "Medication seems to normalize the neural systems that either permit or suppress mind-wandering."

Researchers don't know how stimulant medication changes brain anatomy, he continued, "but we believe it affects activity within nerve cells, and ultimately alters gene expression and the proteins that determine brain structure." Using an array of new magnetic resonance imaging techniques (functional magnetic resonance imaging [fMRI], diffusion tensor MRI, and magnetic resonance spectroscopy), he has been able to show improved brain function in children being treated with medications for ADHD.

Dr. Peterson added that although the current neurobiological concept of ADHD is that it is a brain disorder, the child's environment is an important factor in how the disorder develops and in its severity. Rates of ADHD are substantially higher among women who smoke during pregnancy, for example. Early childhood experiences such as competent and authoritative caregiving can help lessen the severity of ADHD, as can parents who provide stimulating environments and who help kids organize their thoughts and behavior and stay on task. That does not mean that ADHD is caused by parental neglect or dysfunction, Dr. Peterson said, but that certain experiences and styles of upbringing combined with a genetic predisposition appear to increase the rates of ADHD.

Diagnosing ADHD correctly can be tricky. The disorder is a syndrome, a characteristic collection of behaviors, which can appear alongside other psychiatric problems such as anxiety, depression, and bipolar disorder, according to Margaret Hertzig, MD, a child and adolescent psychiatrist at NewYork-Presbyterian/Weill Cornell Medical Center. In addition, kids with ADHD may have symptoms that are primarily inattention/distractibility or primarily impulsivity/hyperactivity, or they may display a combination of both. For these reasons, "to determine when the criteria for a diagnosis of ADHD are met involves considerable clinical judgment," she said.

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