The American Journal of Psychiatry

American Psychiatric Association

VOL. 167, No. 8

Basal Ganglia Surface Morphology and the Effects of Stimulant Medications in Youth With Attention Deficit Hyperactivity Disorder
Loren J. Sobel, M.D., M.S.; Ravi Bansal, Ph.D.; Tiago V. Maia, Ph.D.; Juan Sanchez, M.S.; Luigi Mazzone, M.D.; Kathleen Durkin, M.S.; Jun Liu, Ph.D.; Xuejun Hao, Ph.D.; Iliyan Ivanov, M.D.; Ann Miller, M.D., Ph.D.; Laurence L. Greenhill, M.D.; Bradley S. Peterson, M.D.

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Abstract

Objective Disturbances in the basal ganglia portions of cortico-striato-thalamo-cortical circuits likely contribute to the symptoms of attention deficit hyperactivity disorder (ADHD). The authors examined the morphologic features of the basal ganglia nuclei (caudate, putamen, and globus pallidus) in children with ADHD.

Method A total of 104 individuals (combined-type ADHD patients: N=47; healthy comparison subjects: N=57), aged 7 to 18 years, were examined in a cross-sectional case-control study using anatomical magnetic resonance imaging. Conventional volumes and the surface morphology for the basal ganglia were measured.

Results Overall volumes were significantly smaller only in the putamen. Analysis of the morphological surfaces revealed significant inward deformations in each of the three nuclei, localized primarily in portions of these nuclei that are components of limbic, associative, and sensorimotor pathways in the cortico-striato-thalamo-cortical circuits in which these nuclei reside. The more prominent these inward deformations were in the patient group, the more severe the ADHD symptoms. Surface analyses also demonstrated significant outward deformations of all basal ganglia nuclei in the ADHD children treated with stimulants compared with those ADHD youth who were untreated. These stimulant-associated enlargements were in locations similar to the reduced volumes detected in the ADHD group relative to the comparison group. The outward deformations associated with stimulant medications attenuated the statistical effects of the primary group comparisons.

Conclusions These findings potentially represent evidence of anatomical dysregulation in the circuitry of the basal ganglia in children with ADHD and suggest that stimulants may normalize morphological features of the basal ganglia in children with the disorder.