A study published in JAMA Psychiatry this year analysing 1154 brain scans of children and adolescents offers fresh evidence for reevaluating the medical establishment\u2019s definition of the disorder.<\/p>\n
The researchers grouped three forms of ADHD identified in the imaging into familiar \u2013 and one less familiar \u2013 categories: predominantly inattentive; predominantly hyperactive\/impulsive; and a more severe, combined presentation marked by emotional dysregulation or difficulty managing and responding to emotions in a controlled, appropriate way.<\/p>\n
The findings are part of a broader shift: advances in brain imaging are pushing scientists beyond symptom-based labels toward biologically grounded classifications of neurological conditions \u2013 an approach already reshaping autism research, where a study published last year identified four distinct subtypes.<\/p>\n
ADHD is one of the most commonly diagnosed neurodevelopmental conditions, affecting roughly one in nine US children \u2013 about 11% \u2013 according to the latest data from the Centers for Disease Control and Prevention, a prevalence that is reshaping classrooms and placing growing demands on schools, clinicians and families to provide adequate support and resources. Yet treating it remains complex: while effective medications exist, the condition often overlaps with other disorders and presents in diverse ways, complicating diagnosis and care.<\/p>\n
In the new study, the first two categories map neatly onto the way ADHD is currently diagnosed, dividing along a well-established line between difficulties with focus and problems with hyperactivity and impulse control.<\/p>\n
The third, however, pushes the field into new territory.<\/p>\n
This extreme subtype exhibited the most extensive changes across the brain \u2013 a total of 45 abnormal areas versus 26 each for the other two subgroups.<\/p>\n
Brain imaging suggests this subtype is not just \u201cmore\u201d ADHD \u2013 with a higher degree of changes \u2013 but something meaningfully different. <\/p>\n
ADHD is typically diagnosed through parent and teacher reports, using standardised behavioural questionnaires. But when emotional reactivity is part of the picture, things can become harder to interpret.<\/p>\n
According to lead researcher Nanfang Pan, there was \u201cextensive disruption\u201d across two areas tied to emotion and control: the medial prefrontal cortex and pallidum. This points to a distinct pattern, not simply a greater degree of the same disruption. Differences in the prefrontal cortex may help explain mood swings. Changes in the pallidum, which helps regulate emotional responses and motivation, may help explain the intensity and volatility of those reactions.<\/p>\n
\u201cI was surprised by how cleanly our results came together,\u201d said Pan, a neuroimaging expert with the West China Hospital of Sichuan University and the Turner Institute for Brain and Mental Health at Monash University in Australia. \u201cWe used no clinical information whatsoever in the clustering, and yet the three biotypes that emerged mapped well onto clinically recognised ADHD presentations.\u201d<\/p>\n
\u2018Simmering volcanoes\u2019<\/p>\n
Emotional dysregulation in children has long been a difficult area for clinicians to pin down \u2013 common, consequential and yet ill-defined.<\/p>\n
\u201cThere\u2019s really no diagnosis specific to dysregulation,\u201d says Paul Rosen, director of the ADHD Rapid Assessment Clinic in the Division of Behavioral and Mental Health with Norton Children\u2019s Medical Group in Louisville.<\/p>\n
There are related labels \u2013 disruptive mood dysregulation disorder (DMDD), oppositional defiant disorder (ODD), unspecified mood disorders \u2013 but clinicians often hesitate to use them. The terms can feel blunt, even stigmatising, and don\u2019t always capture what they are seeing.<\/p>\n
ADHD itself is typically diagnosed through parent and teacher reports, using standardised behavioural questionnaires. But when emotional reactivity is part of the picture, things can become harder to interpret.<\/p>\n
A 2014 paper described two patterns of more severe dysregulation among children with ADHD. One group was labelled \u201cirritable\u201d, though Rosen describes them differently.<\/p>\n
\u201cI refer to them as super bouncy ball kids,\u201d Rosen said. \u201cEverything is great until it isn\u2019t, and then five minutes later, it\u2019s like nothing happened. Whatever they are feeling, they are feeling a lot of it.\u201d<\/p>\n
The second group presents a different challenge. These children tend to be more persistently volatile.<\/p>\n
\u201cThey are simmering volcanoes basically,\u201d Rosen said. \u201cWhen things go wrong, they explode. These are kids who will have hour-long meltdowns, throw things and hit and break things.\u201d<\/p>\n
This group, Rosen said, appears to align with the new \u201cextreme\u201d ADHD type in the new study. These children often require more intensive treatment and intervention. Many have additional diagnoses beyond ADHD, including anxiety and depression, and are frequently prescribed multiple medications.<\/p>\n
Melissa DelBello, a professor of psychiatry and pediatrics at the University of Cincinnati, said that while brain imaging holds promise, it is still impractical to conduct such scans broadly in clinical settings because they are too expensive and not yet precise enough at the level of the individual. Still, she sees studies like this as a step toward something more tailored.<\/p>\n
A path for treatments?<\/p>\n
For children with this extreme form of ADHD, standard behavioural strategies may fall short. DelBello said that widely used approaches such as positive reinforcement \u2013 like giving prizes or other trinkets, or extra recess for good behaviour \u2013 do not always have the intended effect.<\/p>\n
\u201cThey are not as sensitive to rewards,\u201d DelBello said.<\/p>\n
They may also be among those for whom stimulant medications \u2013 the first-line treatment for ADHD \u2013 do not always work, though it remains unclear how best to categorise them.<\/p>\n
Identifying \u201cspecific subtypes\u201d of ADHD will make it easier to treat these children effectively, DelBello said.<\/p>\n
F. Xavier Castellanos, a neuroscientist at New York University who has spent decades studying ADHD brain networks, was part of the working group for the DSM-5, the latest diagnostic manual for psychiatric conditions that was first released in 2013 and updated in 2022. At the time, he said, there was pressure to be cautious; the science was not yet strong enough to support major changes to redefine ADHD.<\/p>\n
Now, he said, that may be shifting, and for the next version, he said he would be surprised if an emotional dysregulation subtype was not included.<\/p>\n
\u201cThis idea has been around for maybe 20 years, but it\u2019s becoming more and more credible. And the science is at a point that it looks like we are up to something real,\u201d Castellanos said.<\/p>\n","protected":false},"excerpt":{"rendered":"A study published in JAMA Psychiatry this year analysing 1154 brain scans of children and adolescents offers fresh…\n","protected":false},"author":2,"featured_media":410918,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[211429,1443,3867,13452,179482,1596,38501,1061,796,545,16555,109,226,134,8454,130,111,139,69,21501,32293,383,211428,5662],"class_list":["post-410917","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-211429","tag-about","tag-adhd","tag-adolescents","tag-analysing","tag-brain","tag-breaks","tag-children","tag-diagnosis","tag-extreme","tag-form","tag-ground","tag-growing","tag-health","tag-including","tag-more","tag-new-zealand","tag-newzealand","tag-nz","tag-reveal","tag-scans","tag-study","tag-subtypes","tag-think"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/410917","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/comments?post=410917"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/410917\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media\/410918"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media?parent=410917"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/categories?post=410917"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/tags?post=410917"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}