The brains of children with attention deficit hyperactivity disorder develop more slowly than those of other children but eventually catch up, according to a government study published Monday that suggests ADHD may be a transient condition, at least for some.
Using advanced imaging techniques, scientists found that the cortices of children with ADHD reach peak thickness an average of three years later than children without the disorder.
The cortex is involved in decision-making and supports the ability to focus attention, remember things moment to moment and suppress inappropriate actions -- functions often deficient in children with ADHD.
Dr. Philip Shaw of the National Institute of Mental Health, lead author of the report, published in Proceedings of the National Academy of Sciences, said the results might help explain why many children with ADHD appear to grow out of the disorder and become less impulsive and fidgety as they mature.
Shaw said that although brain development was slower among those with ADHD, it followed a normal pattern, which should reassure parents.
"There has been a debate about whether ADHD is a delay or deviance from normal brain development," he said. "This study comes down strongly in favor of delay."
About 4.4 million school-age children in the U.S. have ADHD, which can lead to poor school performance and behavior problems. Half of children diagnosed with the disorder are treated with stimulants, such as Ritalin, or other medicines.
Researchers used magnetic resonance imaging equipment to scan the brains of 223 children and adolescents with ADHD and 223 youngsters without the disorder. The scans were repeated two, three or four or more times at three-year intervals.
Scientists focused on the cortex, which becomes thicker as the brain builds new connections to process all the things children are learning -- a key milestone in brain development.
They measured cortical thickness at 40,000 points on each scan, creating a detailed map of brain development in the two groups.
In general, they found that the parts of the cortex involved in sensory and motor processing reached peak thickness earlier than the areas responsible for decision-making and other higher-order functions.
In children with ADHD, developmental lags were most pronounced in the prefrontal cortex, which supports attention and working memory, among other things. Half of the cortical points in ADHD children reached peak thickness at an average age of 10.5, contrasted with age 7.5 in children without the disorder.
