Structural Brain Changes and Associated Symptoms of ADHD Subtypes in Children

Attention-deficit/hyperactivity disorder (ADHD) is presumed to be heterogeneous, but the best way to characterize this heterogeneity remains unclear. Although considerable evidence suggests that the 2 different types of ADHD, inattention and combined, have different cognitive and behavioral profiles, and underlying neurobiologies, we currently lack information on whether these subtypes reflect separated brain structure changes. Structural magnetic resonance imaging scans (N = 234), diagnostic, and demographic information were obtained from the ADHD-200 database. Of this sample, 138 were Typically Developing people, 37 were ADHD-Combined, and 59 were ADHD-Inattentive patients. Freesurfer segmentation methods were used to measure cortical thickness, area, and volume, subcortical volume and hipposubfield volume. ADHD-Inattentive patients showed milder clinical symptoms but more serious cognitive injury than ADHD-Combined patients. In addition, dissociable structural brain changes were found in different subtypes of ADHD, particularly in terms of decreased subcortical volume in ADHD-Combined patients compared with Typically Developing people. Clinical symptoms were predominantly related to smaller rh_caudalanteriorcingulate thickness and left-Pallidum volume, whereas verbal IQ injury was correlated strongly with smaller rh_insula area. These findings indicate that there are significant differences in clinical symptoms and gray matter damage between ADHD-Combined and -Inattentive patients. This supports the growing evidence of heterogeneity in the ADHD-Inattentive subtype and the evidence of brain structure differences.