Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. In an attempt to extend earlier neurochemical findings, we organized a magnetic resonance spectroscopy (MRS) study as part of a large, government-funded, prospective, randomized, multicenter clinical trial comparing the effectiveness of specific psychotherapy with counseling and stimulant treatment with placebo treatment (Comparison of Methylphenidate and Psychotherapy Study). We report the baseline neurochemical data for the anterior cingulate cortex (ACC) and the cerebellum in a case–control setting. For the trial, 1,480 adult patients were contacted for participation, 518 were assessed for eligibility, 433 were randomized, and 187 were potentially eligible for neuroimaging. The control group included 119 healthy volunteers. Single-voxel proton MRS was performed. In the patient group, 113 ACC and 104 cerebellar spectra fulfilled all quality criteria for inclusion in statistical calculations, as did 82 ACC and 78 cerebellar spectra in the control group. We did not find any significant neurometabolic differences between the ADHD and control group in the ACC (Wilks’ lambda test: p = 0.97) or in the cerebellum (p = 0.62). Thus, we were unable to replicate earlier findings in this methodologically sophisticated study. We discuss our findings in the context of a comprehensive review of other MRS studies on ADHD and a somewhat skeptical neuropsychiatric research perspective. As in other neuropsychiatric disorders, the unclear nosological status of ADHD might be an explanation for false-negative findings.
Highlights
Attention-deficit hyperactivity disorder (ADHD) is a common and often debilitating disorder that has received increasing public and scientific attention
Previous magnetic resonance spectroscopy (MRS) Findings Regarding ADHD We performed a comprehensive review of the MRS literature on ADHD on the basis of a PubMed search using the search terms “ADHD” and “spectroscopy.” We identified 416 hits that were individually screened for content
Reviews, and case reports, we identified 32 MRS studies on ADHD
Summary
Attention-deficit hyperactivity disorder (ADHD) is a common and often debilitating disorder that has received increasing public and scientific attention. The prevalence rates are estimated at 2–4% (Biederman, 2005; Philipsen et al, 2008). According to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are three presentations of ADHD: the inattentive subtype (iADHD), the hyperactive-impulsive subtype (hADHD), and the combined subtype (cADHD).. The dopaminergic system seems to play a central role in the pathophysiology of ADHD (Philipsen et al, 2008). Treatment options for adult ADHD include pharmacological interventions (Castells et al, 2011) and psychotherapy (Philipsen, 2012). Because evidence of the efficacy of these methods in adults is sparse, the treatment options require further investigation (Volkow and Swanson, 2013)
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