Elsevier

Biological Psychiatry

Volume 74, Issue 8, 15 October 2013, Pages 591-598
Biological Psychiatry

Archival Report
White Matter Alterations at 33-Year Follow-Up in Adults with Childhood Attention-Deficit/Hyperactivity Disorder

https://doi.org/10.1016/j.biopsych.2013.02.025Get rights and content

Background

Attention-deficit/hyperactivity disorder (ADHD) is increasingly conceived as reflecting altered functional and structural brain connectivity. The latter can be addressed with diffusion tensor imaging (DTI). We examined fractional anisotropy (FA), a DTI index related to white matter structural properties, in adult male subjects diagnosed with ADHD in childhood (probands) and matched control subjects without childhood ADHD. Additionally, we contrasted FA among probands with and without current ADHD in adulthood and control subjects.

Methods

Participants were from an original cohort of 207 boys and 178 male control subjects. At 33-year follow-up, analyzable DTI scans were obtained in 51 probands (41.3±2.8 yrs) and 66 control subjects (41.2±3.1 yrs). Voxel-based FA was computed with tract-based spatial statistics, controlling for multiple comparisons.

Results

Probands with childhood ADHD exhibited significantly lower FA than control subjects without childhood ADHD in the right superior and posterior corona radiata, right superior longitudinal fasciculus, and in a left cluster including the posterior thalamic radiation, the retrolenticular part of the internal capsule, and the sagittal stratum (p<.05, corrected). Fractional anisotropy was significantly decreased relative to control subjects in several tracts in both probands with current and remitted ADHD, who did not differ significantly from each other. Fractional anisotropy was not significantly increased in probands in any region.

Conclusions

Decreased FA in adults with childhood ADHD regardless of current ADHD might be an enduring trait of ADHD. White matter tracts with decreased FA connect regions involved in high-level as well as sensorimotor functions, suggesting that both types of processes are involved in the pathophysiology of ADHD.

Section snippets

Participants

The study was approved by the institutional review boards of New York University Langone Medical Center and New York University. Participants provided written informed consent and were compensated for participating.

Probands originally consisted of 207 6- to 12-year-old middle class Caucasian boys referred to a research clinic from 1970 to 1978 (mean±SD: 8.3±1.6 years) 22, 23, 24. Inclusion criteria were: school referral because of behavior problems, elevated parent and teacher hyperactivity

Subjects

A total of 152 participants were scanned at FU41, of whom 144 (61 probands, and 83 control subjects) underwent diffusion-weighted scans. The DTI data for 10 probands and 17 control subjects failed quality criteria, leaving 51 probands and 66 control subjects with analyzable DTI data. Rates of magnetic resonance imaging (MRI) refusal and failure to schedule or locate subjects did not differ significantly between probands and control subjects (45% vs. 43%). However, a smaller proportion of

Discussion

This is the first DTI study in adults with ADHD established in childhood. As expected, we found significantly decreased FA in probands relative to control subjects, regardless of ADHD diagnosis at mean age 41 years, in WM tracts connecting gray matter regions that we found to be abnormal in the same cohorts (21). Fractional anisotropy in probands with childhood ADHD was decreased relative to control subjects without childhood ADHD in a left hemisphere cluster encompassing the sagittal stratum

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