Elsevier

Biological Psychiatry

Volume 60, Issue 10, 15 November 2006, Pages 1071-1080
Biological Psychiatry

Original article
Dorsolateral Prefrontal and Anterior Cingulate Cortex Volumetric Abnormalities in Adults with Attention-Deficit/Hyperactivity Disorder Identified by Magnetic Resonance Imaging

https://doi.org/10.1016/j.biopsych.2006.04.031Get rights and content

Objectives

Gray and white matter volume deficits have been reported in a number of studies of children with attention-deficit/hyperactivity disorder (ADHD); however, there is a paucity of structural magnetic resonance imaging (MRI) studies of adults with ADHD. This structural MRI study used an a priori region of interest approach.

Methods

Twenty-four adults with DSM-IV ADHD and 18 healthy controls comparable on age, socioeconomic status, sex, handedness, education, IQ, and achievement test performance had an MRI on a 1.5T Siemens scanner. Cortical and sub-cortical gray and white matter were segmented. Image parcellation divided the neocortex into 48 gyral-based units per hemisphere. Based on a priori hypotheses we focused on prefrontal, anterior cingulate cortex (ACC) and overall gray matter volumes. General linear analyses of the volumes of brain regions, adjusting for age, sex, and total cerebral volumes, were used to compare groups.

Results

Relative to controls, ADHD adults had significantly smaller overall cortical gray matter, prefrontal and ACC volumes.

Conclusions

Adults with ADHD have volume differences in brain regions in areas involved in attention and executive control. These data, largely consistent with studies of children, support the idea that adults with ADHD have a valid disorder with persistent biological features.

Section snippets

Subjects

Males and females between the ages of 18 and 59 were eligible for the study. ADHD (n = 24) and control (n = 18) adults were group matched to be comparable on age, socioeconomic status (SES), sex distribution, handedness, and education (Table 1). Functional imaging data using most of these subjects has been published (Valera et al 2005); this is the first report of the structural imaging data. Exclusion criteria were deafness, blindness, psychosis, neurological disorder, sensorimotor handicaps,

Demographic Characteristics, Intellectual Functioning, and Symptoms

As Table 1 shows, compared with non-ADHD adults, adults with ADHD were not significantly different on age, SES, sex distribution, handedness, or education. All subjects were Caucasian. The groups were statistically comparable on IQ, reading and arithmetic achievement, and frequency of LDs (which was low in both groups). Both groups were highly educated and were above average in general intellectual ability. There were no significant differences between groups on lifetime rates of mood, anxiety,

Discussion

In the first volumetric study of the brain in adults with ADHD, we found substantial support for the hypothesis that adults with ADHD have structural brain abnormalities in a priori predicted regions of interest (ACC, DLPFC, and overall cortical gray matter) that were based on a literature review (Seidman et al 2005) and a meta-analysis of studies in ADHD children and teenagers (Valera et al, unpublished data). These results extend to adults with ADHD previously reported findings in the

Conclusions and Future Directions

Despite these limitations, the results provide support for the hypothesis that structural brain abnormalities persist into adulthood in ADHD, thus complementing studies demonstrating neuropsychological and functional brain dysfunctions in adults with ADHD (Bush et al 2005, Seidman in press). Replication of these findings in adults is necessary to establish that the particular structures found to be abnormal are core components of the neurobiology of ADHD. Since both genetic factors (Faraone et

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