Assessment of glymphatic function in children and adolescents with attention-deficit/hyperactivity disorder and its presentations

Psychiatry Res. 2026 Nov 10;367:117590. doi: 10.1016/j.psychres.2026.117590. Online ahead of print.

ABSTRACT

OBJECTIVE: Although attention-deficit/hyperactivity disorder (ADHD) exhibited impairments in the glymphatic system of the brain, changes in the glymphatic system in the clinical presentations of ADHD remain unknown. This study aimed to use multimodal magnetic resonance imaging (MRI) to assess the function of the glymphatic system in ADHD and its presentations.

METHODS: T1 structural MRI and functional MRI data from 137 neurotypical controls (NCs) and 119 patients with ADHD were collected from the ADHD200 dataset, including 61 cases of ADHD-combined type, 5 cases of ADHD-hyperactive/impulsive type, and 53 cases of ADHD-inattentive type. To assess glymphatic function, choroid plexus (CP) volume and coupling of blood-oxygen-level-dependent signals and cerebrospinal fluid signals (BOLD-CSF) were calculated. A general linear model was used for group comparisons between NC and ADHD, as well as among NC and different ADHD presentations, controlling for age, sex, site effects and head motion. Correlation analysis was performed to elucidate the relationships between glymphatic functional indicators and clinical scales.

RESULTS: Compared to NCs, no significant differences in CP volume and BOLD-CSF coupling were observed between the overall ADHD group and NC. However, BOLD-CSF coupling was significantly enhanced in the ADHD-inattentive group (all p ≤ 0.004). Additionally, negative trends were found between BOLD-CSF coupling and full scale IQ-2 subtest score for ADHD-inattentive group (r = -0.68 ∼ -0.51).

CONCLUSIONS: ADHD-inattentive patients demonstrated increases in BOLD-CSF coupling, suggesting that ADHD-inattentive may involve a different brain waste clearance pattern compared to other ADHD presentations.

PMID:43025277 | DOI:10.1016/j.psychres.2026.117590