ADHD brain scan

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By Ryan Koch

Last night I watched a PBS Frontline episode called "The Medicated Child." The show covered many aspects of the unfortunate -- and most likely unnecessary -- phenomenon of prescribing antipsychotic and/or behavioral medications, such as lithium and ritalin, to children as young as 3-years-old who are diagnosed as ADHD or bipolar. Arguments were provided for both sides of the issue, but in the end it seems plain obvious that kids should absolutely not be given meds that have never been fully evaluated to be safe and effective for adolescents and infants. It is also readily apparent that drug companies could care less who they're hurting by encouraging widespread use of these potent medications. This is especially evident when Frontline reveals that drug companies suddenly became interested in testing the effects of behavioral meds on children only when the Clinton administration gave adequate monetary incentive for doing so.

But all of that is another issue having more to do with politics and ethics. A far more intriguing question that I would like to address is: why are children exhibiting behavioral abnormalties? What is the root of all this madness? Surely it's not a deficiency in meds!

When I seek to answer a question like this, I always consider nutrition and physical health to be huge contributers. And I always think of my good buddy, Weston A. Price. This man truly observed something revolutionary about the physical and mental health of primitive populations on poor diets, and it is this radical observation that I thought of immediately when I saw a particular scene in The Medicated Child:

A woman is explaining the inadequate brain activity of a young boy to his family through the use of a color-coded brainscan. One sees the boy's brain and its array of greens, oranges, yellows, and reds. Then, next to that, a "normal" brain is shown with a very different color pattern. The woman points to different areas in the boy's brain and says, "This is abnormal and indicates that there is not very much activity here." Okay, so far very interesting. Then she turns the family's attention to a part of the brain called some fancy scientific name, which is visibly smaller than a normal brain. "That's where the problem is," she tells the family, who all seem very impressed.

My question is: What the heck is so impressive about this diagnoses? Where are the answers as to why this happened in the first place? How is this a satisfying experience in the least bit?

Doctor: "Your son has an abnormal brain. Here are some meds to fix it."

Parents: "Wow, thanks, doc. You're a life saver."

Stop. Hold the phone. Why? Why is his brain abnormal? Just because? Of course not. There are simple answers that are easily overlooked by all of the "experts" because they're used to thinking about things in such a complex fashion. What if, for example, the son is nutritionally deficient? What if he needs an improved diet? While nutrition appears to be the most fundamental root cause of illness -- especially when we see these kids on Frontline eating twinkies and corn dogs and goldfish crackers -- these are questions that are never addressed by the doctors. ADHD caused by too much sugar? Naw, couldn't be! Could it be that these children need more animal fats and proteins in their diets? No way -- that stuff causes heart disease!

It seems like the further we progress scientifically, the more we forget the simple questions and answers. For example, when "experts" are asked why more and more kids are diagnosed as bipolar, the answer is unsatisfying:

Top experts offer a range of reasons. They acknowledge some of the increase is likely due to bipolar being mislabeled; some think "bipolar disorder" has become a catch-all diagnosis for kids with a range of problems. But many experts say the increase is simply because doctors are better at identifying bipolar in children today than they were 10 years ago. They believe these kids have always existed, but that doctors failed to recognize the symptoms of bipolar and called these children oppositional or diagnosed them with ADHD. Some experts also cite evidence of a genetic link behind the rise in childhood bipolar, and some even speculate that environmental factors are playing a role in triggering childhood bipolar. source

First of all, that's quite an assumption that these kinds of kids have "always existed." A quick evaluation of primitive populations will find the opposite to be true. Second, not one of these mainstream experts even speculates the cause may be related to diet. Yet, even if we are to attribute behavioral abnormalities to nutrition, we still don't get a satisfying answer. Even if we instruct families to cut out sugar and other junk foods and add more animal fats/proteins to the diet, and as a result we see dramatic shifts in a child's behavior, we still haven't answered the question of "why does the child have a smaller, more compressed brain structure than a normal brain?" And why is this phenomenon becoming more and more common? Again, we return to nutrition as the root cause, but this time let's focus on the diet the child was raised on and the diet of the parents before conception and during pregnancy. Now we're getting somewhere.

Here we return to good ol' Dr. Price. His study of primitive populations showed that, with inadequate nutrition of the parents in the prenatal period and when provided with a deficient diet postnatally (during the formative years when still growing), a child develops facial, skeletal, and dental deformities. In other words, rather than a child having a nice round face, square jaw, wide nasal passage, and all 32 teeth, the child has a narrow face, sagging cheeks, pinched nostrils, and crooked teeth. All of these changes are due to inadequate nutrition, not genetics. And with these deformities comes an overall more "squished" brain due to poor formation of the skull. This can potentially lead to poor blood flow and, thus, abnormal brain function. Children with ADHD have 3-4% less brain volume than children without ADHD.

To further add to the argument of poor nutrition/poor skeletal development being the cause of behavioral disorders, it's interesting to note that every single child in The Medicated Child exhibited facial deformities. Most kids had overbites, some were mouth breathers, and all had narrow faces. For a visual example, return to the top of this post and observe the child on the DVD cover.
In summary, I theorize that the root of behavioral abnormalities is:

* Inadequate nutrition (animal fats/proteins) of parents prenatally
* Inadequate nutrition of child postnatally, during developmental years
* A combination of the above leads to the child's skeletal deformities, part of which is comprimised brain volume due to underdeveloped skull
* Smaller brain volume, in addition to poor diet, leads to poor brain function and, thus, behavioral abnormalities

All of that being said, with nutritional intervention (nutrient-dense, animal food-rich diet) a child may improve and function well. If this isn't enough, other therapeutic interventions and/or medication (as a last resort) may need to be utilized. In the end, however, it all starts prior to conception with the diet of the parents. If we are to truly resolve these disorders -- and many others -- it is necessary rebuild our children's health generation by generation until we return to the legacy of optimal health left by our primitive ancestors.
For a fascinating article on facial and dental deformities, check out this article: "Is it Mental or is it Dental: Cranial and Dental Impacts on Total Health," by Raymond Silkman, DD.

Brain Scans Reveal Physiology of ADHD

1. Jim Rosack

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High-resolution MRI pictures of the brains of children with ADHD are shedding light on the possible anatomical origins of this complex disorder.

New high-resolution, three-dimensional maps of the brains of children with attention-deficit/hyperactivity disorder (ADHD) indicate significant and specific anatomical differences within areas of the brain thought to control attentional and inhibitory control systems, compared with brain scans of children without ADHD.

The images are thought to be the most advanced to date to reveal the anatomical basis of the disorder. Elizabeth Sowell, M.D., an assistant professor of neurology at the David Geffen School of Medicine at the University of California at Los Angeles, and her colleagues used high-resolution magnetic resonance imaging (MRI) and sophisticated computer analysis to pinpoint more accurately the specific areas of the brain contributing to the symptoms of ADHD.

“Our morphometric procedures allow more precise localization of group differences than do the methods used in previous studies,” Sowell said in a press release. “Our results therefore suggest that the disturbances in prefrontal cortices are localized to more inferior aspects of prefrontal regions than was previously appreciated. Our findings also indicate that prefrontal abnormalities are represented bilaterally, by contrast to the predominantly right-sided findings that were emphasized in other reports.”

Sowell teamed with Bradley Peterson, M.D., the Suzanne Crosby Murphy Associate Professor of Psychiatry at Columbia University and the New York State Psychiatric Institute, to image 27 children (11 girls and 16 boys) with ADHD and compare them with 46 children without ADHD who were matched for age and sex. The results of the study, funded by several NIH grants as well as the Suzanne Crosby Murphy Endowment at Columbia, appear in the November 22, 2003, issue of Lancet.
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Localizing Differences


A three-dimensional, high-resolution MRI image of the brain of a patient with ADHD shows reductions (in yellow and red) in the size of specific areas within the frontal and temporal lobes. (UCLA Laboratory of Neuro Imaging)
Sowell and Peterson observed significant differences in brain structure in the frontal cortices of both sides of the brains of the children with ADHD, with reduced regional brain size mainly confined to small areas of the dorsal prefrontal cortices (see images). Children with ADHD also were observed to have reduced brain size in anterior temporal areas, again on both sides of their brains.

In addition, substantial increases were noted in the volume of gray matter in large areas of the posterior temporal and inferior parietal cortices of children with ADHD, compared with children in the control group. These regions have previously been identified as areas of the brain controlling attention and impulse control.


A three-dimensional, high-resolution MRI image of the brain of a patient with ADHD shows regional increases in the density of gray matter. Areas in yellow and red average between 10 percent and 24 percent more gray matter than those of the average control subject. (UCLA Laboratory of Neuro Imaging)
“Disordered impulse control is often the most clinically debilitating symptom in children with ADHD,” noted Peterson in the press release. “These findings may help us to understand the sites of action of the medications used to treat ADHD, particularly stimulant medications. In conjunction with other imaging techniques, these findings may also help us develop new therapeutic agents, given our knowledge of the cellular and neurochemical makeup of the brain regions where we detected the greatest abnormalities.”
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Building Complex Images

All of the children were imaged using the same MRI scanner at Yale University. The basic images were then processed at the UCLA Laboratory of Neuro Imaging using complex computer systems to build three-dimensional surface maps of each subject’s brain. The researchers then painstakingly identified on each brain image a series of 80 standardized anatomical landmarks, which were used to create a composite average for both the ADHD group and the control group. In this way, each child’s brain could be matched spatially, preserving differences in brain size and shape.

The resulting three-dimensional map of each child’s brain was indeed high resolution, representing more than 65,000 individual points on the surface of the cortex. The points on each subject’s brain were then compared with the average composite image created for both the ADHD group and the control group.

The researchers assessed differences in boys and girls, individually as well as combined, since recent studies have suggested that abnormalities in brain activity and structure may differ between boys and girls with ADHD. However, no significant differences were found. The researchers cautioned, however, that because their sample size was fairly small, differences may not have been appreciable.

The majority of the children with ADHD imaged in this study were taking stimulant medications at the time of imaging or had taken stimulant medications in the past. Sowell notes that it is not possible to determine with any significant certainty whether the anatomical differences they observed are due, in part or whole, to medication. However, other research has noted no anatomical changes associated with intermediate-term use of stimulant medications by children and adolescents with ADHD.

The reductions in size of prefrontal regions observed by Sowell and her colleagues are consistent with other reports of reduced frontal lobe volumes in children with ADHD. The more advanced imaging methods and analysis used in the current study, however, suggest that those reductions are localized to more inferior aspects of the prefrontal regions than was previously realized. Taken together, the evidence base continues to build, supporting smaller and hypo-functional lateral prefrontal cortices in children with ADHD.

Sowell and her coauthors also noted that “while we measured gray-matter density at the cortical surface, arguably a reduction of white matter in the same region could result in an apparent abundance of gray matter.” The authors emphasized that, in fact, total white matter volume was reduced in the children with ADHD, but only at a level of significance suggesting a trend.

Lastly, the team attempted to correlate the severity of symptoms in the children with ADHD with the anatomical abnormalities they discovered. They found that children with lesser volumes of gray matter generally were more inattentive, whereas children with significantly larger frontal lobes had higher levels of hyperactivity.

“ADHD,” Sowell and Peterson concluded in the study, “is almost certainly a disorder of heterogeneous etiologies that have correspondingly heterogeneous neuro-anatomical underpinnings.”

They noted that their sample size was too small to permit a complete ADHD subgroup analysis; however, they called for further studies to confirm differing anatomical and functional disturbances in different areas of the brain’s action-attentional network.
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An abstract of “Cortical Abnormalities in Children and Adolescents With Attention-Deficit Hyperactivity Disorder” is posted online at ?