Editors' ChoicePsychiatry

Neurodevelopment and risk for ADHD and depression

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Science Translational Medicine  22 Jan 2020:
Vol. 12, Issue 527, eaba2913
DOI: 10.1126/scitranslmed.aba2913

Abstract

Childhood brain connectivity predicts psychiatric difficulties four years later.

The majority of psychiatric disorders onset during childhood or adolescence. Early intervention and prevention are essential for mental health but identifying risk prior to the onset of psychopathology has proven challenging. Mapping trajectories of neurodevelopment that are associated with psychiatric symptoms has the potential to enhance the early identification of risk.

In a longitudinal study of 94 children, Whitfield-Gabrieli and colleagues examined whether specific patterns of brain connectivity predicted individual children’s trajectories of attentional and internalizing problems. Children completed a resting-state functional MRI scan measuring the strength of coupling between different areas of the brain at age 7 and again at age 11. Individual differences in functional connectivity of the dorsolateral prefrontal cortex, which is involved in cognitive control, predicted subsequent change in symptoms associated with attention deficit hyperactivity disorder (ADHD) and depression. Specifically, weaker positive functional connectivity between the dorsolateral prefrontal cortex and the medial prefrontal cortex at age 7 was associated with a decrease in ADHD symptoms by age 11, whereas weaker positive functional connectivity between the dorsolateral prefrontal cortex and the subgenual anterior cingulate cortex was associated with an increase in mood-related symptoms by age 11. Of note, brain connectivity at age 7 predicted mood-related difficulties at age 11 better than baseline symptoms themselves, which was validated in an independent sample with familial risk for depression. Although the prediction model will need to be tested in larger independent samples, these results suggest the potential utility of connectivity patterns as a biomarker of symptom trajectories.

Major strengths of the study are the longitudinal design and the identification of risk in a community sample that was not specifically selected based on psychiatric risk. Although brain-based measures have effectively predicted clinical outcomes in pediatric samples identified based on factors such as a family history of depression, developing approaches for early risk identification in more representative samples is an important goal. A limitation of the current work is the lack of information about which children eventually developed psychiatric disorders in this sample. Studies that additionally capture transitions into adolescence will be essential for optimizing prediction and for testing how interventions may reshape prefrontal network connectivity.

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