From ... in Psychology — Jun 19, 2024

NIH Study Shows People With ADHD Have Altered Brains

Editor's Note: This article is a reprint.

It was originally published March 2, 2017. Attention deﬁcit hyperactivity disorder (ADHD) has long been diagnosed primarily by subjective measures. A child's health care providers, parents and, often, teachers typically contribute behavioral observations about the child and, if he or she ﬁts the established criteria for ADHD — generally speaking, a persistent pattern of inattention and/or hyperactivity- impulsivity that interferes with functioning or development — a diagnosis may be made. Without an objective test or measure, the potential for overdiagnosis or misdiagnosis is high. By some estimates, up to 20% of children with ADHD are misdiagnosed. This is only compounded by the fact that many ADHD symptoms are experienced by non-ADHD children at some point or another — and the fact that many other conditions, including sleep disorders, anxiety, depression and certain learning disabilities, can have similar symptoms.

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Uncovering objective measures by which to gauge ADHD in children (and adults) could therefore help immensely, and research funded by the National Institutes of Health (NIH) may help to do just that. Not only that, but the ﬁndings suggest ADHD is not simply a behavioral issue but rather stems from a brain disorder.

Researchers from Radboud University in the Netherlands analyzed MRI scans from more than 3,200 people, more than half of whom had ADHD. The brains of people with ADHD turned out to be smaller overall as well as in ﬁve speciﬁc brain regions: the nucleus, putamen, nucleus accumbens, amygdala and hippocampus. The differences in volume were slight and seemed to become less magniﬁed by adulthood, which suggests ADHD may be characterized by delayed development in certain brain regions. The biggest size difference occurred in the amygdala, which is associated with emotions and hasn't previously been widely linked to ADHD. Dr. Jonathan Posner, an assistant professor in the department of psychiatry at Columbia University, who was not involved in the study but wrote an accompanying editorial, suggested to CNN that this may explain why children with ADHD may have emotional symptoms, such as poor tolerance for frustration. "Those types of symptoms aren't given as much focus or attention as the cognitive symptoms seen in ADHD," he said, but, "These ﬁndings would suggest that it's possible … there's actually a more primary disturbance in emotional processing." Also of note, the use of ADHD medications did not seem to affect the results. While previous studies have also linked size differences in brain volume to ADHD, they included small samples sizes leading to inconclusive results. The featured study, however, was much larger. Martine Hoogman, Ph.D., of the department of human genetics at Radboud University Medical Center in Nijmegen, the Netherlands, told WebMD:

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"These differences are very small — in the range of a few percent — so the unprecedented size of our study was crucial to help identify these. Similar differences in brain volume are also seen in other psychiatric disorders, especially major depressive disorder."

It's too early to say what the size difference may mean, or whether one day MRI scans could be used to help diagnose ADHD. Graham Murray, a lecturer in psychiatry at Cambridge University in England, told Time: "Having less brain in several regions sounds bad but it's not as simple as that … The brain is very good at adapting … Just because you have less brain volume doesn't condemn the child to not being able to function well." What many experts did concur with is that the ﬁndings help further the notion that ADHD originates from brain systems and may lead to alterations in brain function and structure. Ultimately, this should help to reduce stigma for those affected and dampen myths that ADHD is the result of lazy, misbehaved kids or poor parenting. "It is a bit distressing that kids are still getting feedback that they are misbehaving or that [ADHD] is not real," Toronto pediatric neurologist Dr. Evdokia Anagnostou told CBC News. "If anything comes out of this very large study, it's that this is a brain disorder." Past research has also suggested that use of an MRI technique called magnetic ﬁeld correlation imaging could help with ADHD diagnosis. In that case, the procedure was able to detect low brain iron levels, which was associated with ADHD in children who had not been treated with psychostimulant drugs.

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Among preschool-aged children (4 to 5 years), behavior therapy is the ﬁrst-line treatment recommended for ADHD, according to the American Academy of Pediatrics (AAP). However, data from the U.S. Centers for Disease Control and Prevention (CDC) revealed that about 23.6% of preschoolers (3 to 5 years old) with ADHD were taking medication. Further, only 58.3% of 3- to 5-year olds with ADHD received behavior therapy, despite it being the recommended go-to treatment. By age 6, the so-called "best practice guidelines" for ADHD include treatment with both medication and behavior therapy. Many people, parents included, often assume that medicating kids with ADHD will make their symptoms disappear and their grades improve, but this isn't necessarily the case. In a study that analyzed the effects of drug versus behavioral treatment on homework performance in children with ADHD, the drug treatment led to no signiﬁcant improvements in homework completion or accuracy compared to placebo. The behavioral therapy, however, led to children ﬁnishing up to 13% more homework problems and increased accuracy by 8%. Meanwhile, research published in The Cochrane Database of Systematic Reviews found that expectations of the drug methylphenidate (brand names Ritalin, Concerta, Medikinet and Equasym) "are probably greater than they should be." While they found some evidence of beneﬁt, it was based on "very low-quality evidence." Taking the drug was also associated with an increased risk of sleep problems and appetite loss.

While ADHD may, in fact, be a brain disorder, many factors are likely involved, including poor nutrition and environmental toxins, the latter two of which can have a profound inﬂuence on your brain health.

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There do appear to be many environmental and lifestyle factors that inﬂuence both the diagnosis of this disease (as well as trigger ADHD-like symptoms) and its progression or healing. For instance: Children with higher levels of the endocrine-disrupting chemical bisphenol A (BPA), for instance, are more likely to be diagnosed with ADHD Children exposed to higher levels of organophosphate pesticides may have a twofold to threefold increased risk of being diagnosed with ADHD Exposure to tobacco smoke in utero is also associated with ADHD Eating an unhealthy diet during pregnancy may increase ADHD symptoms in youth Drinking sugar-sweetened beverages like soda is associated with ADHD Gluten sensitivity may be common in children with ADHD, and a gluten-free diet has been shown to signiﬁcantly improve behavior in kids Artiﬁcial food coloring and other food additives, such as preservatives, are associated with increased hyperactivity in children

Considering the risks of ADHD drugs, and their lackluster performance in improving symptoms, there's good reason to look outside of the pharmaceutical box when it comes to ADHD treatment. Behavioral therapy, as mentioned, is a good start, but there are many other natural options to add to your arsenal as well, like vetiver oil (vetiver is a type of Indian grass). In one study, when children inhaled the oil three times a day for 30 days they had improved brain wave patterns and behavior and did better in school. Eighty percent of the children also improved when using cedarwood essential oil similarly.

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Improvements in brain activity were revealed via electro-encephalograph (EEG), which measures electrical impulses moving through the brain. This allowed researchers to determine whether the children's brains were functioning primarily in a beta (i.e., alert) state or a theta state (i.e., lack of focus). Improvements in beta-theta ratios were noted following the use of vetiver essential oil, while parents also noted improvements in symptoms. Another study, published in the Journal of Intercultural Ethnopharmacology, also showed vetiver essential oil to have particular promise for ADHD. The animal study revealed changes in brain activity suggestive of increased alertness, while research on human subjects revealed faster reaction times and stimulation of sympathetic nerve activity following inhalation.

If your child is struggling with ADHD or ADHD-like symptoms, I recommend consulting with a holistic physician who is experienced in treating ADHD using natural methods. You'll want to be sure, however, that your child is getting regular physical activity on a daily basis. This simple intervention has been compared to medication for ADHD , as it leads to improvement in executive control, which is the ability to maintain focus, working memory and cognitive ﬂexibility (or switching between tasks). Executive functioning is often impaired in children with ADHD. In addition, even participating in before- and after-school physical activity programs has been found to reduce inattention and moodiness among young children at risk of ADHD, as well as improve math and reading test scores. Other research revealed that 26 minutes of physical activity each day helped to signiﬁcantly reduce ADHD symptoms in grade-schoolers.

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Your brain health is intricately connected to what you eat, which is why addressing dietary factors is so important for children facing ADHD-like symptoms, whether he or she has been diagnosed with ADHD or not. As researchers continue to learn more about how ADHD may alter your brain (or an altered brain may lead to ADHD), I strongly recommend addressing the following factors: • Too much sugar — High-sugar foods and starchy carbohydrates lead to excessive insulin release, which can cause falling blood sugar levels, or hypoglycemia. Hypoglycemia, in turn, causes your brain to secrete glutamate in levels that can cause agitation, depression, anger, anxiety and panic attacks. Besides that, sugar promotes chronic inﬂammation in your body, and many studies have demonstrated the connection between a high-sugar diet and worsened mental health . • Gluten sensitivity — The evidence suggesting that gluten sensitivity may be at the root of a number of neurological and psychiatric conditions, including ADHD, is quite compelling. One study went so far as to suggest celiac disease should be added to the ADHD symptom checklist. • An unhealthy gut — As explained by Dr. Natasha Campbell-McBride, a medical doctor with a postgraduate degree in neurology, toxicity in your gut can ﬂow throughout your body and into your brain, where it can cause symptoms of autism, ADHD, dyslexia, dyspraxia, depression, schizophrenia and other mental disorders. Reducing gut inﬂammation is imperative when addressing mental health issues, so optimizing your child's gut ﬂora is a critical step. This includes not only avoiding processed, reﬁned foods but also eating traditionally fermented foods, such as fermented vegetables and fermented dairy products like keﬁr. If you cannot get your child to eat fermented foods on a regular basis, a high-quality probiotic supplement may be highly beneﬁcial in correcting abnormal gut ﬂora that may contribute to brain dysfunction.

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• Animal-based omega-3 fat deﬁciency — Kids low in omega-3 fats may be signiﬁcantly more likely to be hyperactive, struggle with learning disorders and display behavioral problems. A clinical study published in 2007 also examined the effects of krill oil on adults diagnosed with ADHD. In that study, patients improved their ability to concentrate by an average of over 60% after taking a daily 500-milligram (mg) dose of krill oil for six months. They also reported a 50% improvement in planning skills and a close to 49% improvement in social skills. • Food additives and GE ingredients — A number of food additives are thought to worsen ADHD, and many have subsequently been banned in Europe. Potential culprits to avoid include Blue No. 1 and No. 2 food coloring; Green No. 3; Orange B; Red No. 3 and No. 40; Yellow No. 5 and No. 6; and sodium benzoate, a preservative. Research also shows that glyphosate , the active ingredient in Monsanto's Roundup herbicide, used in large quantities on genetically engineered Roundup Ready crops, limits your body's ability to detoxify foreign chemical compounds. As a result, the damaging effects of those chemicals and environmental toxins are magniﬁed, and may result in a wide variety of diseases, including brain disorders that can affect behavior.

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NIH Study Shows People With ADHD Have Altered Brains

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