BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is associated with structural abnormalities in total gray matter, basal ganglia, and cerebellum. Findings of structural abnormalities in frontal and temporal lobes, amygdala, and insula are less consistent. Remarkably, the impact of comorbid oppositional defiant disorder (ODD) (comorbidity rates up to 60%) on these neuroanatomical differences is scarcely studied, while ODD (in combination with conduct disorder) has been associated with structural abnormalities of the frontal lobe, amygdala, and insula. The aim of this study was to investigate the effect of comorbid ODD on cerebral volume and cortical thickness in ADHD. METHODS Three groups, 16 ± 3.5 years of age (mean ± SD; range 7-29 years), were studied on volumetric and cortical thickness characteristics using structural magnetic resonance imaging (surface-based morphometry): ADHD+ODD (n = 67), ADHD-only (n = 243), and control subjects (n = 233). Analyses included the moderators age, gender, IQ, and scan site. RESULTS ADHD+ODD and ADHD-only showed volumetric reductions in total gray matter and (mainly) frontal brain areas. Stepwise volumetric reductions (ADHD+ODD < ADHD-only < control subjects) were found for mainly frontal regions, and ADHD+ODD was uniquely associated with reductions in several structures (e.g., the precuneus). In general, findings remained significant after accounting for ADHD symptom severity. There were no group differences in cortical thickness. Exploratory voxelwise analyses showed no group differences. CONCLUSIONS ADHD+ODD and ADHD-only were associated with volumetric reductions in brain areas crucial for attention, (working) memory, and decision-making. Volumetric reductions of frontal lobes were largest in the ADHD+ODD group, possibly underlying observed larger impairments in neurocognitive functions. Previously reported striatal abnormalities in ADHD may be caused by comorbid conduct disorder rather than ODD.

中文翻译：

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注意缺陷/多动障碍伴对立违抗障碍的结构性脑异常

背景注意力缺陷/多动障碍（ADHD）与总灰质、基底神经节和小脑的结构异常有关。额叶和颞叶、杏仁核和脑岛结构异常的发现不太一致。值得注意的是，共病对立违抗障碍 (ODD)（共病率高达 60%）对这些神经解剖学差异的影响几乎没有研究，而 ODD（与行为障碍相结合）与额叶、杏仁核、和绝缘体。本研究的目的是研究共病 ODD 对 ADHD 脑容量和皮质厚度的影响。方法 三组，16 ± 3.5 岁（平均值 ± SD；范围 7-29 岁），使用结构磁共振成像（基于表面的形态测量）对体积和皮质厚度特征进行了研究：ADHD + ODD（n = 67），仅 ADHD（n = 243）和对照受试者（n = 233）。分析包括主持人的年龄、性别、智商和扫描站点。结果 ADHD+ODD 和 ADHD-only 显示总灰质和（主要是）额叶脑区的体积减少。发现主要是额叶区域的逐步体积减少（ADHD + ODD <仅 ADHD < 对照受试者），并且 ADHD + ODD 与几种结构（例如楔前叶）的减少独特相关。一般而言，在考虑 ADHD 症状严重程度后，发现仍然显着。皮质厚度没有组间差异。探索性体素分析显示没有组差异。结论 ADHD+ODD 和 ADHD-only 与对注意力、（工作）记忆和决策至关重要的大脑区域的体积减少有关。ADHD+ODD组的额叶体积减少最大，可能是观察到的神经认知功能受损更大的潜在原因。先前报道的 ADHD 纹状体异常可能是由共存的品行障碍而不是 ODD 引起的。