Can ADHD Be Seen On A Brain Scan?

Brain scans can reveal very helpful information for strokes, multiple sclerosis, brain tumors, brain traumas, and other brain conditions. Doctors use the findings from these scans to recommend treatments and to evaluate the progression over time.

The diagnosis of ADHD is not always easy to make, as there is no single test available for this condition. Many other conditions like anxiety, depression, sleeping problems, or learning disabilities share similar symptoms. 

Could brain scans be useful to diagnose or evaluate ADHD? This is a relatively new area of research, which shows, so far, a lot of potential.

 While the research is ongoing, there is a special EEG already FDA approved for ADHD, and brain scans may switch from their limited use to mainstream in the future. Let’s review in this article what is known so far about the use of brain tests for ADHD. 

Types of brain scans and findings

There are few types of brain scans commonly used in research for ADHD:  single-photon emission computed tomography scans (SPECTs) and functional MRIs. 

SPECTs. A large study involving over 1700 participants with ADHD and over 1500 in the control group evaluated brain changes associated with ADHD. The study found that those with ADHD have five areas of the brain slightly smaller compared with those without ADHD. Furthermore, those younger than 15 years of age were more affected than the adults over 21 years old by these brain changes. The reduction was seen in the volume of the accumbens, an area of the brain involved in motivation, reward system, and sleep. The amygdala, which is important for regulating  emotions, memory, and the fight-or-flight response) was smaller, too. The third area of the brain that showed lower volume was the caudate, a brain part that plays a major role in learning and attention. The fourth area of the brain undergoing changes was the hippocampus, which is essential for behavioral and emotional response. The fifth part of the brain that suffers changes in those with ADHD is the putamen, which is involved in learning and motor control, including speech articulation, language, reward, cognition, and addiction. 

There is a limited number of  ADHD doctors that offer brain scanning nowadays. Perhaps the most well-known is Dr. Daniel Amen. Although his work is controversial among his colleagues, he may just be ahead of his time.  Dr. Amen points out that brain scans will not give a diagnosis of ADHD, but can be very useful as part of a comprehensive evaluation. He spent decades of research to understand brain function, performed over 86,000 brain scans, and treated numerous patients in his clinics with great success. For example, a scan may show low activity in an area of the brain called the prefrontal cortex. However, this change is not only associated with ADHD but also with head traumas or dementia. Furthermore, brain scans can help customize the treatment plan based on an individual’s unique symptoms, and the seven subtypes of ADHD, which he identified. 

Dr. Amen believes that there are risk factors that contribute to the rise of cases of ADHD. These environmental factors are related to our modern life: processed foods, low exercise, less sun, and overusing electronic devices.  Furthermore, he believes brain scans can also detect brain injuries that can lead to symptoms of ADHD, further advising that football may be the most brain-damaging sport. 

Functional MRI. One study evaluated the MRIs of teenagers with ADHD and those without ADHD. Researchers found that the patterns of the grey matter accurately labeled almost 80% of the participants of the study who already received the diagnosis of ADHD.  

Could brain scans or other tests help diagnose ADHD? 

In 2013, FDA approved a special Electroencephalogram (EEG)  test to help diagnose ADHD called the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, for children and teenagers aged 6-17 years old. This test is not designed to be used alone but in combination with medical and psychological assessment. It can help confirm the diagnosis of ADHD or suggest another condition that may need further testing, like substance abuse or head trauma. This test records the number and type of brain waves and calculates the ratio between theta and beta brain waves which is higher in those with ADHD compared with individuals without ADHD. 

While brain scans may not be available to everyone, there are a few other tests (non-imaging techniques)  that could help aid the diagnosis of ADHD. The Conners Parent-Teacher Rating Scale, which is a questionnaire that can be used by parents and teachers of children who are suspected to have ADHD. For adults, there is another questionnaire called the Wender Utah Rating Scale. The Continuous Performance Tests is a computer test program that could be useful, too. Keep in mind that these tests may be supportive of an ADHD diagnosis only when used along with clinical information. Furthermore, vision and hearing should be checked.

Whether or not the diagnosis of ADHD is clearly confirmed, one thing can be done right away. Optimizing the lifestyle by cutting off processed foods and maintaining a healthy weight, regular exercise, improve sleep hygiene and stress management.