Brain structural deficits and working memory fMRI dysfunction in young adults who were diagnosed with ADHD in adolescence.

Andres Roman-Urrestarazu,Päivi Lindholm,Jouko Miettunen,Jennifer H Barnett,Peter B Jones,John Suckling,Hanna Ebeling,Tuula Hurtig,Graham K Murray,Vesa Kiviniemi,Juha Nikkinen,Juha Veijola,Erika Jääskeläinen,Irma Moilanen,Pirjo Mäki

doi:10.1007/s00787-015-0755-8

Andres Roman-Urrestarazu, Päivi Lindholm + Show 13 more

Open Access

https://doi.org/10.1007/s00787-015-0755-8

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Abstract

When adolescents with ADHD enter adulthood, some no longer meet disorder diagnostic criteria but it is unknown if biological and cognitive abnorma lities persist. We tested the hypothesis that people diagnosed with ADHD during adolescence present residual brain abnormalities both in brain structure and in working memory brain function. 83 young adults (aged 20–24 years) from the Northern Finland 1986 Birth Cohort were classified as diagnosed with ADHD in adolescence (adolescence ADHD, n = 49) or a control group (n = 34). Only one patient had received medication for ADHD. T1-weighted brain scans were acquired and processed in a voxel-based analysis using permutation-based statistics. A sub-sample of both groups (ADHD, n = 21; controls n = 23) also performed a Sternberg working memory task whilst acquiring fMRI data. Areas of structural difference were used as a region of interest to evaluate the implications that structural abnormalities found in the ADHD group might have on working memory function. There was lower grey matter volume bilaterally in adolescence ADHD participants in the caudate (p < 0.05 FWE corrected across the whole brain) at age 20–24. Working memory was poorer in adolescence ADHD participants, with associated failure to show normal load-dependent caudate activation. Young adults diagnosed with ADHD in adolescence have structural and functional deficits in the caudate associated with abnormal working memory function. These findings are not secondary to stimulant treatment, and emphasise the importance of taking a wider perspective on ADHD outcomes than simply whether or not a particular patient meets diagnostic criteria at any given point in time.

Highlights

Attention deficit/hyperactivity disorder (ADHD) [1,2,3,4] was initially thought to abate in adolescence but increasing evidence indicates that ADHD frequently persists through to adulthood [3, 4]
Among the 6622 respondents to the survey, a subset of 457 possible cases and general population controls were identified based on their questionnaire scores, and these adolescents were evaluated for ADHD during 2002–2003 in a clinical evaluation, including a structured interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version, K-SADS-PL) [24, 26,27,28, 31]. 105 cases were diagnosed having current, definite ADHD according to DSM-IV at the age of 16–18
Our findings indicate that in adulthood, people diagnosed with ADHD in adolescence show impairments in working memory function, with a bilateral failure to activate the caudate increasingly with higher working memory loads: this may contribute to the memory deficits in ADHD

Summary

Introduction

Attention deficit/hyperactivity disorder (ADHD) [1,2,3,4] was initially thought to abate in adolescence but increasing evidence indicates that ADHD frequently persists through to adulthood [3, 4]. Of those diagnosed during childhood, about 30–60 % show symptoms during adulthood [3, 5, 6]. Differences in referral and diagnostic practices in different clinical and research centres mean that study recruitment biases may contribute to the heterogeneity of findings in the condition

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