Structural MRI Shows Only Modest Brain Measure Differences in Children With ADHD
Uit onderzoek verschenen in de Lancet Psychiatry maart 2022 door Bernanke e.a. lijken op basis van neuroimaging data van 10.763 kinderen in de leeftijd van 9-10 jaar van de Adolescent Brain and Cognitive Development Study (ABCD Studie) de verschillen tussen kinderen met ADHD en zonder vrij beperkt te zijn.
Ze konden maar geringe aantal (11) significante verschillen vinden op basis van 79 hersen metingen van onder andere de corticale dikte, corticale gebieden en de subcorticale volume. Het onderzoek is op basis van de grootste kinder hersenonderzoek imaging studie van de Verenigde Staten. Het bestand waarop de data zijn gebaseerd bestaat uit 5592 jongens en 5139 meisjes waarvan 949 met de diagnose ADHD en 9787 zonder diagnose.
Verschillen die werden gevonden bestonden met name uit afname in diverse hersengedeeltes bij kinderen met ADHD. De verschillen zijn echter gering en effect sizes variëren tussen 0,11 – 0,06. Als mogelijke verklaring van de beperkte verschillen worden o.a. de leeftijd van de kinderen genoemd, of doordat er kinderen waren onderzocht met een minder ernstige vorm van ADHD.
De onderzoekers adviseren op basis van hun bevindingen dat er mogelijk andere MRI technieken, nieuwe statistische methodieken of andere diagnostische classificaties nodig zijn om ADHD goed te kunnen vaststellen
Joel Bernanke (lead author), geeft onder andere aan:
“Structural neuroimaging research has identified a variety of abnormalities in cortical and subcortical structures in children with ADHD. However, studies to date have not employed large, non-referred samples, complete with data on potential confounding variables,”
“Future studies might need to incorporate other MRI modalities, novel statistical approaches, or alternative diagnostic classifications,” researchers advised, “particularly for research aimed at developing ADHD diagnostic biomarkers.”
Volgens Jonathan Posner (senior author, the Duke University Department of Psychiatry & Behavioral Sciences, Durham, NC): “It’s important to note that ADHD can be impairing,” “Treatments help with that. And while we don’t have good evidence of structural differences appearing in MRI scans, that could well speak to the limitations of the technology, not of ADHD being outside of biology.”
Abstract
Background: Structural neuroimaging research has identified a variety of abnormalities in cortical and subcortical structures in children with ADHD. However, studies to date have not employed large, non-referred samples, complete with data on potential confounding variables. Here, we tested for differences in structural MRI measures among children with and without ADHD using data from the Adolescent Brain and Cognitive Development (ABCD) Study, the largest paediatric brain imaging study in the USA.
Methods: In this cross-sectional study, we used baseline demographic, clinical, and neuroimaging data from the ABCD Study, which recruited children aged 9-10 years between Sept 1, 2016, and Aug 31, 2018, representative of the sociodemographic features of the US population. ADHD was diagnosed by parent report of symptoms. Neuroimaging data underwent centralised quality control and processing by the ABCD team. Linear mixed effects models were used to estimate Cohen’s d values associated with ADHD for 79 brain measures of cortical thickness, cortical area, and subcortical volume. We used a novel simulation strategy to assess the ability to detect significant effects despite potential diagnostic misclassification.
Findings: Our sample included 10 736 participants (5592 boys, 5139 girls; 5692 White, 2165 Hispanic, 1543 Black, 221 Asian, and 1100 of other race or ethnicity), of whom, 949 met the criteria for ADHD and 9787 did not. In the full model, which included potential confounding variables selected a priori, we found only 11 significant differences across the 79 brain measures after false discovery rate correction, all indicating reductions in brain measures among participants with ADHD. Cohen’s d values were small, ranging from -0·11 to -0·06, and were not meaningfully changed by using a more restrictive comparison group or alternative diagnostic methods. Simulations indicated adequate statistical power to detect differences even if there was substantial diagnostic misclassification.
Interpretation: In a sample representative of the general population, children aged 9-10 years with ADHD differed only modestly on structural brain measures from their unaffected peers. Future studies might need to incorporate other MRI modalities, novel statistical approaches, or alternative diagnostic classifications, particularly for research aimed at developing ADHD diagnostic biomarkers.
Bernanke J, Luna A, Chang L, Bruno E, Dworkin J, Posner J. Structural brain measures among children with and without ADHD in the Adolescent Brain and Cognitive Development Study cohort: a cross-sectional US population-based study. Lancet Psychiatry. 2022;9(3):222-231. doi: 10.1016/S2215-0366(21)00505-8. https://pubmed.ncbi.nlm.nih.gov/35143759/
Bron: Psych Congress Network
