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F. Xavier Castellanos, MD; Jay N. Giedd, MD; Wendy L. Marsh; Susan D. Hamburger, MA, MS; A. Catherine Vaituzis; Daniel P. Dickstein; Stacey E. Sarfatti; Yolanda C. Vauss; John W. Snell, PhD; Nicholas Lange, PhD; Debra Kaysen; Amy L. Krain; Gail F. Ritchie, MSW; Jagath C. Rajapakse, PhD; Judith L. Rapoport, MD

Arch Gen Psychiatry. 1996;53(7):607-616.

Abstract
Background
Anatomic magnetic resonance imaging (MRI) studies of attention-deficit hyperactivity disorder (ADHD) have been limited by small samples or measurement of single brain regions. Since the neuropsychological deficits in ADHD implicate a network linking basal ganglia and frontal regions, 12 subcortical and cortical regions and their symmetries were measured to determine if these structures best distinguished ADHD.

Method
Anatomic brain MRIs for 57 boys with ADHD and 55 healthy matched controls, aged 5 to 18 years, were obtained using a 1.5-T scanner with contiguous 2-mm sections. Volumetric measures of the cerebrum, caudate nucleus, putamen, globus pallidus, amygdala, hippocampus, temporal lobe, cerebellum; a measure of prefrontal cortex; and related right-left asymmetries were examined along with midsagittal area measures of the cerebellum and corpus callosum. Interrater reliabilities were.82 or greater for all MRI measures.

Results
Subjects with ADHD had a 4.7% smaller total cerebral volume (P=.02). Analysis of covariance for total cerebral volume demonstrated a significant loss of normal right>left asymmetry in the caudate (P=.006), smaller right globus pallidus (P=.005), smaller right anterior frontal region (P=.02), smaller cerebellum (P=.05), and reversal of normal lateral ventricular asymmetry (P=.03) in the ADHD group. The normal age-related decrease in caudate volume was not seen, and increases in lateral ventricular volumes were significantly diminished in ADHD.

Conclusion
This first comprehensive morphometric analysis is consistent with hypothesized dysfunction of right-sided prefrontal-striatal systems in ADHD.

Author Affiliations
From the Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Md (Drs Castellanos, Giedd, Rajapakse, and Rapoport and Mss Marsh, Hamburger, Vaituzis, Vauss, Kaysen, Krain, and Ritchie); the Department of Neurosurgery, University of Virginia, Charlottesville (Dr Snell); and the National Institute of Neurological Disorders and Stroke, Bethesda (Dr Lange). Mr Dickstein is a medical student, Brown University, Providence, RI, and Ms Sarfatti is an undergraduate student, University of Pennsylvania, Philadelphia.

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