Brain Scans Indicate 3 Types of ADHD

Brain scans are giving doctors fresh ammunition to argue that ADHD needs a rewrite. A large imaging study of 446 children diagnosed with the disorder, published in JAMA Psychiatry, points to three distinct brain-based "biotypes," including one with a more severe presentation marked by difficulty managing emotions, often resulting in explosive reactions. While the other two biotypes align with what's already in the diagnostic manual—one largely inattentive, one mostly hyperactive and impulsive—the emotional dysregulation observed in the third type is missing from formal ADHD definitions, reports the Washington Post.

Kids in this cluster show abnormalities in 45 brain regions—nearly twice as many as in the two other groups—especially in areas linked to emotion and control. Clinicians say this "extreme" subtype fits children who have long, intense meltdowns and often need more intensive care and multiple medications. "They are simmering volcanoes basically," one expert tells the Post. They are also most at risk of future psychiatric problems, per National Geographic. The study's authors note that the "biotypes" are not diagnostic categories, and that ADHD is diagnosed based on behavior, not brain scans. But their work is likely to fuel calls to formally add emotional dysregulation to future ADHD diagnostic manuals. It could also help with treatment.