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Hippocampus and Amygdala Morphology in Attention-Deficit/Hyperactivity Disorder
Kerstin J. Plessen, MD;
Ravi Bansal, PhD;
Hongtu Zhu, PhD;
Ronald Whiteman, BA;
Jose Amat, MD;
Georgette A. Quackenbush, MA;
Laura Martin, BS;
Kathleen Durkin, MS;
Clancy Blair, PhD, MPH;
Jason Royal, DMA;
Kenneth Hugdahl, PhD;
Bradley S. Peterson, MD
Arch Gen Psychiatry. 2006;63:795-807.
Context Limbic structures are implicated in the genesis of attention-deficit/hyperactivity disorder (ADHD) by the presence of mood and cognitive disturbances in affected individuals and by elevated rates of mood disorders in family members of probands with ADHD.
Objective To study the morphology of the hippocampus and amygdala in children with ADHD.
Design A cross-sectional case-control study of the hippocampus and amygdala using anatomical magnetic resonance imaging.
Settings University research institute.
Patients One hundred fourteen individuals aged 6 to 18 years, 51 with combined-type ADHD and 63 healthy controls.
Main Outcome Measures Volumes and measures of surface morphology for the hippocampus and amygdala.
Results The hippocampus was larger bilaterally in the ADHD group than in the control group (t = 3.35; P<.002). Detailed surface analyses of the hippocampus further localized these differences to an enlarged head of the hippocampus in the ADHD group. Although conventional measures did not detect significant differences in amygdalar volumes, surface analyses indicated the presence of reduced size bilaterally over the area of the basolateral complex. Correlations with prefrontal measures suggested abnormal connectivity between the amygdala and prefrontal cortex in the ADHD group. Enlarged subregions of the hippocampus tended to accompany fewer symptoms.
Conclusions The enlarged hippocampus in children and adolescents with ADHD may represent a compensatory response to the presence of disturbances in the perception of time, temporal processing (eg, delay aversion), and stimulus seeking associated with ADHD. Disrupted connections between the amygdala and orbitofrontal cortex may contribute to behavioral disinhibition. Our findings suggest involvement of the limbic system in the pathophysiology of ADHD.
Author Affiliations: Columbia College of Physicians and Surgeons and the New York State Psychiatric Institute, New York (Drs Plessen, Bansal, Zhu, Amat, Royal, and Peterson; Mr Whiteman; and Mss Quackenbush, Martin, and Durkin); Center for Child and Adolescent Mental Health (Dr Plessen) and Department of Biological and Medical Psychology (Dr Hugdahl), University of Bergen, and Division of Psychiatry, Haukeland University Hospital (Drs Plessen and Hugdahl), Bergen, Norway; and Human Development and Family Studies, Pennsylvania State University, State College (Dr Blair).
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