Cited by 467Attention Deficit Hyperactivity DisorderNeural and Behavioral Psychology StudiesAutism Spectrum Disorder Research

Brain imaging of the cortex in ADHD: a coordinated analysis of large-scale clinical and population-based samples

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Hoogman, Martine, Muetzel, Ryan, Guimaraes, Joao P., Shumskaya, Elena, Mennes, Maarten, Zwiers, Marcel P., Jahanshad, Neda, Sudre, Gustavo +107 more·2019·American Journal of Psychiatry

Abstract

OBJECTIVE: Neuroimaging studies show structural alterations of various brain regions in children and adults with attention deficit hyperactivity disorder (ADHD), although nonreplications are frequent. The authors sought to identify cortical characteristics related to ADHD using large-scale studies. METHODS: Cortical thickness and surface area (based on the Desikan-Killiany atlas) were compared between case subjects with ADHD (N=2,246) and control subjects (N=1,934) for children, adolescents, and adults separately in ENIGMA-ADHD, a consortium of 36 centers. To assess familial effects on cortical measures, case subjects, unaffected siblings, and control subjects in the NeuroIMAGE study (N=506) were compared. Associations of the attention scale from the Child Behavior Checklist with cortical measures were determined in a pediatric population sample (Generation-R, N=2,707). RESULTS: In the ENIGMA-ADHD sample, lower surface area values were found in children with ADHD, mainly in frontal, cingulate, and temporal regions; the largest significant effect was for total surface area (Cohen's d=-0.21). Fusiform gyrus and temporal pole cortical thickness was also lower in children with ADHD. Neither surface area nor thickness differences were found in the adolescent or adult groups. Familial effects were seen for surface area in several regions. In an overlapping set of regions, surface area, but not thickness, was associated with attention problems in the Generation-R sample. CONCLUSIONS: Subtle differences in cortical surface area are widespread in children but not adolescents and adults with ADHD, confirming involvement of the frontal cortex and highlighting regions deserving further attention. Notably, the alterations behave like endophenotypes in families and are linked to ADHD symptoms in the population, extending evidence that ADHD behaves as a continuous trait in the population. Future longitudinal studies should clarify individual lifespan trajectories that lead to nonsignificant findings in adolescent and adult groups despite the presence of an ADHD diagnosis.

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Crossref · 10.1176/appi.ajp.2019.18091033

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  • Children with ADHD have slightly reduced total cortical surface area and smaller subcortical regions, with differences not seen in adolescents or adults and all differences small to very small.

    “An analysis of structural magnetic resonance imaging (MRI) data from 36 cohorts with a total of over 4,100 participants found slightly reduced total cortical surface area in children with ADHD. The same team found some subcortical regions of the brain were smaller in children with ADHD, mainly in frontal, cingulate and temporal regions with some reductions in cortical thickness in temporal regions”

    From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Hoogman et al., 2019

    The Results report slightly smaller total cortical surface area in children with ADHD, especially in frontal, cingulate, and temporal regions, and no significant cortical differences in adolescents or adults. The Discussion describes the effects as small. But the cited paper identifies those regions as cortical, not subcortical; its Introduction only refers to an earlier study of subcortical volumes whose differences were largely restricted to childhood. (LLM, conf=0.88)

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  • ADHD medications are not associated with brain structure deficits but with improved brain function in inferior frontal and striatal regions.

    “Meta-analyses and systematic reviews showed that the medications used to treat ADHD are not associated with observed deficits in brain structure (Hoogman et al., 2017; Hoogman et al., 2019; Lukito et al., 2020; Norman et al., 2016; Spencer et al., 2013), but with improved brain function, most prominently in inferior frontal and striatal regions (Hart et al., 2013; Lukito et al., 2020; Norman et al”

    From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Hoogman et al., 2019

    The Discussion (page unavailable) reports no significant association between psychostimulant medication and cortical dimensions, supporting the structural part of the citation. It cautions against firm conclusions because the study was observational, and the Results note nominally lower frontal surface area among current stimulant users. This source therefore does not establish the broader claim that ADHD medications are not associated with brain-structure deficits; the brain-function clause is attributed to other citations. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • ADHD medication treatment had no effect on brain structure in ENIGMA-ADHD studies of 4,180 patients across 36 cohorts.

    “Medication treatment for ADHD had no effect on brain structure in studies of 4,180 ADHD patients in the ENIGMA-ADHD Working Group set of 36 cohorts from around the world (Hoogman et al., 2017; Hoogman et al., 2019).”

    From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Hoogman et al., 2019

    The Discussion reports no significant association between psychostimulant medication and cortical dimensions, but cautions that the observational design does not justify a firm conclusion that medication had no effect. Materials and Methods says the 36-cohort cortical analysis included 4,180 individuals, of whom 2,246 had ADHD and 1,934 were healthy controls—not 4,180 ADHD patients. (LLM, conf=0.90)

    Experimental — accuracy not yet measured
  • Variability in adult structural findings likely reflects age-related neurodevelopmental trajectories, medication exposure, and the heterogeneity of ADHD across the lifespan.

    “Such variability likely reflects the influence of age-related neurodevelopmental trajectories, medication exposure, and the heterogeneity of ADHD across the lifespan [72].”

    From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [72]

    The Discussion reports that case-control differences attenuated with age and considers different trajectories for people whose ADHD persists or remits, supporting the age-related and heterogeneity components as possible explanations. It reports no significant association between psychostimulant medication and cortical dimensions, however, and cautions against firm conclusions; medication exposure is not established as an explanation for the variability. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • In adults with ADHD, structural findings have been more inconsistent, with some studies showing similar reductions and others reporting no significant group differences.

    “whereas findings in adults have been more inconsistent, with some studies showing similar reductions and others reporting no significant group differences”

    From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [72]

    The Results (page not provided) report no case-control differences in the adult group, supporting the claim that some studies found no significant differences. The Discussion says effects were most pronounced in children and non-significant in adults, but the passages do not identify adult studies showing similar reductions or establish that adult findings were inconsistent. (LLM, conf=0.86)

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Authors
Hoogman, M., Muetzel, R., Guimaraes, J. P., Shumskaya, E., Mennes, M., Zwiers, M. P., Jahanshad, N., Sudre, G., Wolfers, T., Earl, E. A., Soliva Vila, J. C., Vives-Gilabert, Y., Khadka, S., Novotny, S. E., Hartman, C. A., Heslenfeld, D. J., Schweren, L. J. S., Ambrosino, S., Oranje, B., de Zeeuw, P., Chaim-Avancini, T. M., Rosa, P. G. P., Zanetti, M. V., Malpas, C. B., Kohls, G., von Polier, G. G., Seitz, J., Biederman, J., Doyle, A. E., Dale, A. M., van Erp, T. G. M., Epstein, J. N., Jernigan, T. L., Baur-Streubel, R., Ziegler, G. C., Zierhut, K. C., Schrantee, A., Høvik, M. F., Lundervold, A. J., Kelly, C., McCarthy, H., Skokauskas, N., O’Gorman Tuura, R. L., Calvo, A., Lera-Miguel, S., Nicolau, R., Chantiluke, K. C., Christakou, A., Vance, A., Cercignani, M., Gabel, M. C., Asherson, P., Baumeister, S., Brandeis, D., Hohmann, S., Bramati, I. E., Tovar-Moll, F., Fallgatter, A. J., Kardatzki, B., Schwarz, L., Anikin, A., Baranov, A., Gogberashvili, T., Kapilushniy, D., Solovieva, A., El Marroun, H., White, T., Karkashadze, G., Namazova-Baranova, L., Ethofer, T., Mattos, P., Banaschewski, T., Coghill, D., Plessen, K. J., Kuntsi, J., Mehta, M. A., Paloyelis, Y., Harrison, N. A., Bellgrove, M. A., Silk, T. J., Cubillo, A. I., Rubia, K., Lazaro, L., Brem, S., Walitza, S., Frodl, T., Zentis, M., Castellanos, F. X., Yoncheva, Y. N., Haavik, J., Reneman, L., Conzelmann, A., Lesch, K.-P., Pauli, P., Reif, A., Tamm, L., Konrad, K., Oberwelland Weiss, E., Busatto, G. F., Louza, M. R., Durston, S., Hoekstra, P. J., Oosterlaan, J., Stevens, M. C., Ramos-Quiroga, J. A., Vilarroya, O., Fair, D. A., Nigg, J. T., Thompson, P. M., Buitelaar, J. K., Faraone, S. V., Shaw, P., Tiemeier, H., Bralten, J., & Franke, B.
Affiliations
  • Radboud University Nijmegen (NL)
  • The Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands (Hoogman, Guimaraes, Shumskaya, Wolfers, Bralten, Franke); the Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, the Netherlands (Hoogman, Shumskaya, Mennes, Wolfers, Buitelaar, Bralten, Franke); the Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (Muetzel, El Marroun, White, Tiemeier); the Department of...
Venue
American Journal of Psychiatry
Published
2019-07-01
Volume
176
Issue
7
Pages
531-542
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
OpenAlex
W2942374094
Cited by
467
References
51
Citations by year
2026: 54 · 2025: 63 · 2024: 96 · 2023: 61 · 2022: 63 · 2021: 62 · 2020: 47 · 2019: 18 · 2012: 1
FWCI
37.76
Type
journal article
Language
en
Open access
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  • American Journal of Psychiatry (publishedVersion)
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Funders
  • National Science Foundation (81020108022, FP7/2007-2013)
  • U.S. Department of Defense
  • Autism Speaks
  • U.S. Department of Justice
  • Eli Lilly and Company
  • Massachusetts General Hospital
  • Yale University
  • American Academy of Child and Adolescent Psychiatry
  • Oregon Health and Science University
  • University of Wisconsin-Milwaukee
  • Ohio State University
  • Leon Levy Foundation (R01MH083246)
  • Cincinnati Children's Hospital Medical Center
  • Florida International University
  • Brandeis University
  • Johns Hopkins University
  • University of Pittsburgh
  • University of Cincinnati
  • McGill University
  • Virginia Commonwealth University
  • Sunovion
  • Health Research Board (FP7/2007-2013)
  • Children’s Hospital of Wisconsin Research Institute
  • Children's Hospital Foundation
  • Murdoch Children's Research Institute
  • Royal Children's Hospital Foundation
  • Amsterdam University Medical Centers
  • Instituto D'Or de Pesquisa e Ensino
  • York University
  • National Institute for Health and Care Research (NF-SI-0616-10040)
  • King's College London (278948)
  • University of Oxford
  • European Commission (643051, 602450, 2007–2013, Eat2beNICE, FP7 2007-2013, 278948, HORIZON2020, 728018, FP7/2007, 667302, 602805)
  • Deutsche Forschungsgemeinschaft (KFO 112, IRTG1328, RE1632/5‐1, TRR‐58, Z02, RE1632/5‐1, KFO125, 602805, FP7/2007–2013, Eat2beNICE, 728018, 667302, SFB TRR 58)
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (FP7/2007-2013, 32362, 130237, 136249)
  • Rijksuniversiteit Groningen
  • National Natural Science Foundation of China (8100059, 30970802, FP7/2007-2013, FP7/2007, 81020108022)
  • ZonMw (60-60600-97-193, 912.11.021)
  • Radboud Universiteit
  • Vrije Universiteit Amsterdam (FP7/2007-2013, 278948)
  • Generalitat de Catalunya
  • Nederlandse Organisatie voor Wetenschappelijk Onderzoek (91776384, 400.17.602, 602805, 433‐09‐242, 175.010.2007.010, 453-10-005, FP7 2007-2013, VICI 453-10-005, 05613015, 016‐130‐669, 728018, 433‐09‐229, 667302, 60-60600-97-193)
  • Accare
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  • Universitat de València
  • Universitair Medisch Centrum Utrecht
  • Shire
  • Stavros Niarchos Foundation (R01MH083246)
  • Universitetet i Bergen
  • Universitair Medisch Centrum Groningen
  • Universidade de São Paulo
  • Universitat de Barcelona
  • Radboud Universitair Medisch Centrum
  • Universität Zürich
  • Otsuka Pharmaceutical
  • RWTH Aachen University
  • European College of Neuropsychopharmacology
  • Julius-Maximilians-Universität Würzburg
  • Haukeland Universitetssjukehus
  • Universitat Autònoma de Barcelona
  • State Key Laboratory of Cognitive Neuroscience and Learning
  • Servier
  • H. Lundbeck A/S
  • National Institutes of Health (5r01mh099064-05, FP7/2007-2013, K99-R00, 5t32mh067763-10, R21TR003103, Consortium grant U54 EB020403, RR15241, MH099064, K99/R00 MH091238, MH091238, HD24061, P41 RR15241, T32MH67763, EB020403, RR-00052, MH086654, UL1TR002369)
  • University of Illinois at Urbana-Champaign
  • Oregon Clinical and Translational Research Institute
  • Intellectual and Developmental Disabilities Research Center (HD-24061)
  • University of California, San Diego (R01MH085328)
  • University of California, San Francisco
  • University of California, Irvine
  • College of Medicine, University of Cincinnati
  • Medical Research Council (G03001896)
  • National Health and Medical Research Council (384419, 384419 and 569533, 569533)
  • Universitat Politècnica de València
  • Melbourne School of Psychological Sciences
  • National Institute of Mental Health (MH086654, R01 MH 62873, K23MH087770, MH091238, R01-MH099064, K99MH091238, R01MH115357, MH115357, R01MH094639, K99/R00, R01MH081803, R01 MH86654, R01MH083246, R01MH085328, R01MH062873, R00MH091238, M01 RR00052, R01MH078160, T32MH-067763, U01MH099059, R01MH086654, MH099064)
  • National Institute on Drug Abuse (HHSN271200800009C, U01DA041148)
  • National Institute of Nursing Research
  • National Institute of Neurological Disorders and Stroke (R01NS048527)
  • National Institute of Biomedical Imaging and Bioengineering (U54EB020403)
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  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (P30HD024061)
  • Cilag
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords
attention deficit hyperactivity disorder, cortical surface area, cortical thickness, brain structure, frontal cortex, family influence, endophenotypes, attention deficits, children, adolescents, adults
MeSH terms
Adolescent, Adult, Age Factors, Attention Deficit Disorder with Hyperactivity, Cerebral Cortex, Child, Child, Preschool, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Psychiatric Status Rating Scales, Sex Factors, Case-Control Studies, Young Adult, Neuroimaging

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