articles

Winter 1996 Volume 5, Number 1 

BY JOSEPH BIEDERMAN M.D. AND STEPHEN FARAONE PH.D.

cont.

In the brain, ADHD is commonly associated with malfunction of frontal networks, but research on its underlying neuropsychology has so far failed to produce consistent results. Our studies found that boys with ADHD were significantly more impaired on neuropsychological tests that explore frontal lobe functioning, and those with a family history of ADHD were most impaired.

The ADHD children performed worse on various tasks of attention, executive function, learning and memory. ADHD children with learning disabilities showed motor impairment and had extremely slow reading speed, suggesting irregularities in communication between brain structures that deal with reading material. These neuropsychological impairments in the children we studied could not be attributed to co-morbid psychiatric conditions, learning disabilities or medication, and we concluded that they were features of ADHD and not of its complications.

For many years ADHD was considered a childhood diagnosis that was outgrown in adulthood. However, in recent years many adults have sought help for ADHD. Unfortunately, their effective treatment has been hindered by concerns about the validity of retrospectively-diagnosed ADHD in adults.

To address this issue, we demonstrated the validity of adult ADHD by showing:

1) that its psychiatric and neuropsychological features mirror the well known correlates of childhood ADHD

2) that the children of ADHD adults are at very high risk for ADHD

3) that in carefully designed studies, adult ADHD shows the same therapeutic response to ADHD medications as does the childhood form.

In summary, our child and adult studies furnish converging evidence that ADHD is a persistent disorder associated with multiple impairments. We are beginning to learn about its cause and to trace it in the brain, but more work is needed to determine how genes and environment interact to create brain dysfunction in ADHD. *

Dr. Biederman is Chief, Joint Program, and Dr. Faraone is Director of Research, Pediatric Psychopharmacology at Massachusetts General Hospital.

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