University of Amsterdam study: MRI scans show how ADHD medication affects brain structure in children

19 Aug

The National Institute of Mental Health defined ADHD:

Attention-Deficit/Hyperactivity Disorder
Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
• Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
• Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
• Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Signs and Symptoms
Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.
In preschool, the most common ADHD symptom is hyperactivity.
It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:
• are more severe
• occur more often
• interfere with or reduce the quality of how they functions socially, at school, or in a job….


What Is Attention Deficit Hyperactivity Disorder?                               

Attention-Deficit/Hyperactivity Disorder

What Is ADHD?                                                                         

What is ADHD?

Lois Zoppi, BA Reviewed by Kate Anderton, B.Sc. (Editor) reported in the Medical Life Sciences News article, MRI scans show how ADHD medication affects brain structure in children:

Attention deficit/hyperactivity disorder (ADHD) affects an increasing number of people worldwide, with an estimated 6.1 million children were living with ADHD in 2016, according to the National Survey of Children’s Health.
Now, MRI scans have revealed that children taking the common medication methylphenidate experience alterations in the distribution of white matter in the brain. This has led to the researchers warning doctors not to over-prescribe the medication and only use it when it is absolutely necessary, as the long-term effects of the medication are not yet known.
Methylphenidate is a stimulant medication commonly prescribed for ADHD and works by blocking norepinephrine and dopamine transporters. Deficits in the prefrontal cortex are associated with ADHD symptoms, and increased dopamine and norepinephrine levels in the prefrontal cortex may have beneficial effects on the condition.
White matter is tissue found in the deepest part of the brain and facilitates quick thinking, learning, co-ordination between different parts of the brain, and the ability to walk and balance. The effects of methylphenidate on white matter, and by extension brain development, is not fully understood….
To chart any changes seen in the participants’ brains, they all underwent an MRI scan one week before their treatment began, and one week after their treatment stopped. Changes were found in the left hemisphere of the brain, with approximately double the rate of fractional anisotropy (nerve fiber density, size, and myelination).
The results suggest that the brain is susceptible to structural changes while it is still developing during childhood and adolescence, with the authors writing:
“The adolescent brain is a rapidly developing system maintaining high levels of plasticity. For instance, the maturation and development of white matter continues well into adulthood.”
“The results show that ADHD medications can have different effects on the development of brain structure in children versus adults. In adult men with ADHD, and both boys and adult men receiving placebo, changes in FA [fractional anisotropy] measures were not present, suggesting that the effects of methyphenidate on brain white matter are modulated by age,” Reneman said.
Reneman warned that they “do not yet know whether these effects are reversible or not and whether they are related to functional or behavioral changes over a longer period of time.”
“What our data already underscores is that the use of ADHD medications in children must be carefully considered until more is known about the long-term consequences of prescribing methylphenidate at a young age,” she said.
The study highlights the key results it produced through its experiments.
“In boys with attention-deficit/hyperactivity disorder (ADHD), four months of treatment with methylphenidate (MPH) was associated with increased white matter fractional anisotropy (FA) after 16 weeks.
“In adult men with ADHD and in both boys and adult men receiving placebo, changes in FA measures were not present, suggesting that the effects of MPH on brain white matter are modulated by age….”


Journal reference:
Bouziane, C., et al. (2019). White Matter by Diffusion MRI Following Methylphenidate Treatment: A Randomized Control Trial in Males with Attention-Deficit/Hyperactivity Disorder. RSNA Radiology.

Here is the abstract and key results:

Original ResearchFree Access
White Matter by Diffusion MRI Following Methylphenidate Treatment: A Randomized Control Trial in Males with Attention-Deficit/Hyperactivity Disorder
Cheima Bouziane*, Olena G. Filatova*, Anouk Schrantee, Matthan W. A. Caan, Frans M. Vos, Liesbeth Reneman
* C.B. and O.G.F. contributed equally to this work.
Author Affiliations
Published Online:Aug 13 2019
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Methylphenidate (MPH) is highly effective in treating attention-deficit/hyperactivity disorder (ADHD). However, not much is known about its effect on the development of human brain white matter (WM).
To determine whether MPH modulates WM microstructure in an age-dependent fashion in a randomized double-blind placebo-controlled trial (Effects of Psychotropic Medication on Brain Development–Methylphenidate, or ePOD-MPH) among ADHD referral centers between October 13, 2011, and June 15, 2015, by using diffusion-tensor imaging (DTI).
Materials and Methods
In this prospective study (NTR3103 and NL34509.000.10), 50 stimulant treatment–naive boys and 49 young adult men diagnosed with ADHD (all types) according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria were randomized to undergo treatment with MPH or placebo for 16 weeks. Before and 1 week after treatment cessation, study participants underwent MRI, including DTI. The outcome measure was change in fractional anisotropy (FA), which was assessed in three regions of interest (ROIs), as well as in a voxel-based analysis in brain WM. Data were analyzed by using intention-to-treat linear mixed models for ROI analysis and a permutation-based method for voxel-based analysis with family-wise error correction.
Fifty boys (n = 25 MPH group, n = 25 placebo group; age range, 10–12 years) and 48 men (n = 24 MPH group, n = 24 placebo group; age range, 23–40 years) were included. ROI analysis of FA yielded no main effect of time in any of the conditions. However, voxel-based analysis revealed significant (P < .05) time-by-medication-by-age interaction effects in several association tracts of the left hemisphere, as well as in the lateral aspect of the truncus of the corpus callosum, due to greater increase in FA (standardized effect size, 5.25) in MPH-treated boys. Similar changes were not present in boys receiving a placebo, nor in adult men.
Four months of treatment with methylphenidate affects specific tracts in brain white matter in boys with attention-deficit/hyperactivity disorder. These effects seem to be age dependent, because they were not observed in adults treated with methylphenidate.
© RSNA, 2019
Online supplemental material is available for this article.
Download as PowerPointOpen in Image Viewer
This randomized clinical trial on the influence of methylphenidate on brain development using diffusion-tensor MRI found fractional anisotropy to increase in specific brain areas of boys with attention-deficit/hyperactivity disorder but not in young adult men or boys receiving a placebo.
Key Results
• ■ In boys with attention-deficit/hyperactivity disorder (ADHD), 4 months of treatment with methylphenidate (MPH) was associated with increased white matter fractional anisotropy (FA) after 16 weeks (standardized effect size of 5.25 at whole-brain voxel-based analysis)
• ■ In adult men with ADHD and in both boys and adult men receiving placebo, changes in FA measures were not present, suggesting that the effects of MPH on brain white matter are modulated by age.

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Reference Links:

Edge Foundation ADHD Coaching Study Executive Summary

Click to access Edge-Foundation-ADHD-Coaching-Research-Report.pdf

Edge Foundation ADHD Coaching Study Full Report

Click to access Edge-Foundation-ADHD-Coaching-Research-Report.pdf

ADHD and College Success: A free guide

ADHD and Executive Functioning

Executive Function, ADHD and Academic Outcomes

Click to access efacoutcomes.pdf

Louisiana study: Fit children score higher on standardized tests

Studies: ADHD drugs don’t necessarily improve academic performance

ADHD coaching to improve a child’s education outcome

An ADHD related disorder: ‘Sluggish Cognitive Tempo’

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