Psychological Medicine

Original Articles

Towards further understanding of the co-morbidity between attention deficit hyperactivity disorder and bipolar disorder: a MRI study of brain volumes

J. Biedermana1 c1, N. Makrisa1, E. M. Valeraa1, M. C. Monuteauxa1, J. M. Goldsteina1, S. Bukaa1, D. L. Boriela1, S. Bandyopadhyaya1, D. N. Kennedya1, V. S. Cavinessa1, G. Busha1, M. Aleardia1, P. Hammernessa1, S. V. Faraonea1 and L. J. Seidmana1

a1 Clinical and Research Program in Pediatric Psychopharmacology, Psychiatry Department, Massachusetts General Hospital, Boston, MA, USA


Background Although attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BPD) co-occur frequently and represent a particularly morbid clinical form of both disorders, neuroimaging research addressing this co-morbidity is scarce. Our aim was to evaluate the morphometric magnetic resonance imaging (MRI) underpinnings of the co-morbidity of ADHD with BPD, testing the hypothesis that subjects with this co-morbidity would have neuroanatomical correlates of both disorders.

Method Morphometric MRI findings were compared between 31 adults with ADHD and BPD and with those of 18 with BPD, 26 with ADHD, and 23 healthy controls. The volumes (cm3) of our regions of interest (ROIs) were estimated as a function of ADHD status, BPD status, age, sex, and omnibus brain volume using linear regression models.

Results When BPD was associated with a significantly smaller orbital prefrontal cortex and larger right thalamus, this pattern was found in co-morbid subjects with ADHD plus BPD. Likewise, when ADHD was associated with significantly less neocortical gray matter, less overall frontal lobe and superior prefrontal cortex volumes, a smaller right anterior cingulate cortex and less cerebellar gray matter, so did co-morbid ADHD plus BPD subjects.

Conclusions Our results support the hypothesis that ADHD and BPD independently contribute to volumetric alterations of selective and distinct brain structures. In the co-morbid state of ADHD plus BPD, the profile of brain volumetric abnormalities consists of structures that are altered in both disorders individually. Attention to co-morbidity is necessary to help clarify the heterogeneous neuroanatomy of both BPD and ADHD.

(Received March 20 2007)

(Revised July 11 2007)

(Accepted July 17 2007)

(Online publication October 15 2007)


c1 Address for correspondence: J. Biederman, M.D., Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Fruit Street, Warren 7, Boston, MA 02114, USA. (Email: