Psychostimulant treatment and the developing cortex in attention deficit hyperactivity disorder.
OBJECTIVE
While there has been considerable concern over possible adverse effects of psychostimulants on brain development, this issue has not been examined in a prospective study. The authors sought to determine prospectively whether psychostimulant treatment for attention deficit hyperactivity disorder (ADHD) was associated with differences in the development of the cerebral cortex during adolescence.


METHODS
Change in cortical thickness was estimated from two neuroanatomic MRI scans in 43 youths with ADHD. The mean age at the first scan was 12.5 years, and at the second scan, 16.4 years. Nineteen patients not treated with psychostimulants between the scans were compared with an age-matched group of 24 patients who were treated with psychostimulants. Further comparison was made against a template derived from 620 scans of 294 typically developing youths without ADHD.


RESULTS
Adolescents taking psychostimulants differed from those not taking psychostimulants in the rate of change of the cortical thickness in the right motor strip, the left middle/inferior frontal gyrus, and the right parieto-occipital region. The group difference was due to more rapid cortical thinning in the group not taking psychostimulants (mean cortical thinning of 0.16 mm/year [SD=0.17], compared with 0.03 mm/year [SD=0.11] in the group taking psychostimulants). Comparison against the typically developing cohort without ADHD showed that cortical thinning in the group not taking psychostimulants was in excess of age-appropriate rates. The treatment groups did not differ in clinical outcome, however.


CONCLUSIONS
These findings show no evidence that psychostimulants were associated with slowing of overall growth of the cortical mantle.
Shaw
Philip
P
Child Psychiatry Branch, Bldg. 10, Center Dr., NIMH, Bethesda, MD 20892, USA. shawp@mail.nih.gov
Sharp
Wendy S
WS
Morrison
Meaghan
M
Eckstrand
Kristen
K
Greenstein
Deanna K
DK
Clasen
Liv S
LS
Evans
Alan C
AC
Rapoport
Judith L
JL
D000293:Adolescent; D000662:Amphetamines / Q000009:adverse effects / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000187:drug effects* / Q000473:pathology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008774:Methylphenidate / Q000009:adverse effects / Q000627:therapeutic use; D010389:Pemoline / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
D000662:Amphetamines; D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D010389:Pemoline
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