Is the brain of someone with ADHD different at birth from someone without ADHD?
Answering this question sheds light on the legitimacy of ADHD as a disease and on the complexity of the human brain.
To answer the question, we looked at various imaging studies comparing people diagnosed with ADHD to people without ADHD.
Mega-Analysis of ADHD Brain:
The first brain study was published in April 2017 and funded by the National Institute of Health (NIH). It measured differences in the brain anatomy of 1,713 people diagnosed with ADHD and 1,529 people not diagnosed with ADHD. All study patients were between four and 63 years old.
At the time of their MRI scans, 455 people with ADHD were receiving psychostimulant medication, and looking back further, 637 had had the medication in their lifetime (1).
Importantly, the different volumes of the five brain regions (caudate lobe, hippocampus, putamen, and intracranial volume) involved in ADHD patients were present whether or not people had taken medication, suggesting the differences in brain volumes are not a result of psychostimulants (2).
Specifically, “The volumes of the accumbens (Cohen’s d=−0·15), amygdala ( d=−0·19), caudate ( d=−0·11), hippocampus ( d=−0·11), putamen (d=−0·14), and intracranial volume ( d=−0·10) are smaller in individuals with ADHD compared with controls in the mega-analysis” (3). They observed this before ADHD patients went on medication.
So, to answer the question simply: Yes, ADHD patients have differences in their brain structures. The emotional center (amygdala) of the brain is smaller, which could explain ADHD’s association with emotional dysregulation. But how significant are the brain differences? And do they continue through adulthood, or are they just normal developmental differences that go away with age?
ADHD Brain Differences and Aging:
The results for children are promising, but the study’s observations of brain differences in older patients questions the validity of ADHD as a definite brain disorder.
As the researchers explained in the same study, “exploratory lifespan modeling suggested a delay of maturation and a delay of degeneration, as effect sizes were highest in most subgroups of children (<15 years) versus adults (>21 years). Case-control differences in adults were non-significant (all p>0·03).
Brain differences in ADHD persons compared to non-ADHD diagnosed persons lessened as the study participants got older. This complicates the research findings. If the brains are different at a young age but generally normalize over time (no brain region differences in adulthood), is ADHD a brain disorder? Or, are we stamping a pharmaceutical label on the natural process of development, which happens at different speeds for different people?
Stepping further once more, how do we define a brain disorder?
The same way brains develop/mature at different speeds, so does the body, right? For instance, there will always be the underdeveloped child who struggles with youth contact sports. But why is it treated different with education and the brain?
ADHD and Society:
The issue is we’ve created certain institutions (education) that value certain skills (focus, singular tasking, attention) and devalue others (hyperactivity/creativity) to an extent. In simplest words, a teacher won’t pat a student on the back for running around the classroom frantically.
The question then is: is it justified to accommodate the students with unfavorable traits as they relate to the institutions we’ve created?
Either way, the study is significant. It shows that patients with ADHD have underdevelopment in several brain regions at a young age before taking any medication for ADHD. Thus, ADHD medication isn’t solely responsible for changes in the brain, as genetic reasons partly explain ADHD. Interestingly, certain stimulant medication may actually reverse prior abnormalities in the brains of those with ADHD (4).
The genetic basis to ADHD was also enhanced last November when a mega-analysis of over 55,00 persons (ADHD + non-ADHD diagnosed) revealed “genetic variants” that increase the risk of ADHD (4).
ADHD Brain Study Analysis + Random Thoughts:
It’s no secret we live in a extremely hyperactive, chaotic, and multi-tasking centric world today. There is no doubt the pace of life will continue to increase. As a result, we expect ADHD diagnoses to increase.
Tangentially, we’re interested to see how the perception of ADHD changes as we get older and society advances. Soon enough no one will have the patience or focus to complete one task and sit still for a long period of time. As a result, ADHD’s unique/minority identity will weaken as more people are diagnosed with ADHD and put on meds. In turn, the segment of the population without ADHD medication will become abnormal.
Interestingly, for those informed about standardized testing in the USA, we expect the “extra time” label to popularize over time with more students applying for the designation.
The balance of people with and without extra time will shift at a quicker and quicker pace. Those with ADHD will receive the designation and the few without the designation will realize their disadvantage and attempt to receive the “extra time” designation as well.
Soon enough, “requiring extra time” won’t be a designation for the minority. Instead, “not needing more time” will be the stigmatized designation.
First and foremost, it’s time to step back from our one-sided evaluation of “brain differences” in those with brain disorders (ADHD, autism, etc). The existence of anything implies limitation. With every bad side of something there is good to come from it, and vice versa. As Thomas Armstrong explains in Neurodiversity: Discovering the Extraordinary Gifts of Autism, ADHD, the traditional classroom may be one of the worst possible places for a child with ADHD (5). But, that same energetic, enthusiastic child with ADHD is often an exceptional performer in the art classroom or other areas where his/her hyperactivity is acceptable and even advantageous. We shouldn’t stigmatize ADHD; rather, we should appreciate and understand those with ADHD.
Answering the Original Question:
To directly address the title of the post, it’s hard to say whether those with ADHD have different brains. The truth is each persons brain is highly complex and entirely different to any other persons brain. The developmental differences in childhood suggest that their brains may be unique for a period of time (childhood), but these differences seem to subside in adulthood. So, is medication justified for these patients?
We generally recommend creating a healthy lifestyle and avoiding medication if possible, as the long term effects of these medications haven’t been studied. But, we sympathize with those whose daily lives are negatively impacted by ADHD. Our best advice is to consult your doctor for professional advice before deciding on anything health-related.
The good news is as impatience, attention deficiency, and a general lack of focus in everyday life become more common, more time/focus (ironic, we know), and $$ will be spent optimizing ADHD meds. When we say optimizing, we mean reducing the drug’s addictive properties and damaging side effects.
Let us know your thoughts in the comments below!