Elsevier

Biological Psychiatry

Volume 68, Issue 4, 15 August 2010, Pages 352-358
Biological Psychiatry

Archival Report
Increased Echogenicity of the Substantia Nigra in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

https://doi.org/10.1016/j.biopsych.2010.01.013Get rights and content

Background

Recent neurobiological models on attention-deficit/hyperactivity disorder (ADHD) as well as findings from imaging studies suggest a crucial involvement of dopaminergic midbrain nuclei, especially the substantia nigra (SN), in the pathogenesis of ADHD symptoms. The current study aimed to investigate whether alterations in the sonographic features of the SN could serve as a biological marker in ADHD patients.

Methods

The current study employed transcranial sonography in 29 children and adolescents with ADHD and 27 healthy control participants to assess midbrain abnormalities in ADHD.

Results

The ADHD patients showed an increase in echogenic size of the SN that was correlated with symptoms of inattention, hyperactivity, and impulsivity but not oppositional or dissocial symptoms. Hyperechogenicity, defined as echogenic size above the 90th percentile in the control group, was present in 48% of ADHD patients.

Conclusions

Our findings indicate an increased vulnerability of the nigrostriatal system in ADHD. Transcranial sonography could be successfully used in the future to explore whether ADHD patients with distinct SN hyperechogenicity constitute a specific subgroup or whether hyperechogenicity relates functionally to differences in reward processing, learning, and motor function.

Section snippets

Participants

Seventy-two children and adolescents (ages 6–17) participated in the current study. Children and adolescents with an established or tentative ADHD diagnosis (n = 40) were recruited from the Department of Child and Adolescent Psychiatry from the University of Magdeburg as well as local support groups. Twenty-five had participated in earlier studies, where all participants and their parents were interviewed with a German translation of the Revised Schedule for Affective Disorders and

Results

The ADHD youth showed a significantly larger median SN echogenic size with respect to the greater value of bilateral measurement than healthy control children (Mann–Whitney U test, Z = −3.569, p < .001). The median value was 4.0 (range 2.0; 8.0) mm2 in healthy control participants and 10.0 (range 7.0; 16.0) mm2 in ADHD patients (Figure 3). Results did not change when ADHD patients were segregated according to inattentive, combined, and subsyndromal subtype (ADHD/combined: Mann–Whitney U test, Z

Discussion

With transcranial ultrasound, we could demonstrate that ADHD children and adolescents showed an increase in SN echogenic size that is correlated with symptom severity of inattention, hyperactivity, and impulsivity.

One of the few TCS studies investigating SN echogenic size in children (36) showed that hyperechogenicity, derived from adult normative data, was common in infants during their first year of life but decreased during childhood and adolescence, implying that a decrease in echogenicity

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    Authors KK and HCF contributed equally to this work.

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