Scanning for links

ADHD may be associated with iron deficiency in the brain. In these brain scans, the presence of iron is indicated by the color yellow. ADHD patients who are not medicated show more red, and less yellow, in these scans.

There is no precise diagnosis. There is no cure. There is no way to scientifically prove that a disorder allegedly affecting more than 6 million Americans even exists.

Joseph Helpern and his colleagues at the Medical University of South Carolina have made significant progress studying attention deficit hyperactivity disorder through innovations in magnetic resonance imaging (MRI).

Still, he’ll be the first to tell you that there’s so much they don’t know about ADHD.

He hopes that will change. Helpern believes MRI testing will one day be the tool for doctors to diagnose ADHD.

Helpern, with his colleague Jens Jensen, invented two MRI techniques that show a potential link between iron levels in the brain and ADHD.

“Maybe, and I’m just dreaming about someday, you can bring a kid in that you think has ADHD, and then we’ll send him for an iron image, and if the iron images are normal, then maybe we’ll know that the psychostimulants are not going to help,” Helpern said. “We avoid putting kids (that don’t need them) on psychostimulants.”

To date, there is no method to clinically diagnose ADHD. In fact, some patients fake symptoms associated with the disorder as a means to obtain the potentially addictive medication.

Meanwhile, ADHD has become one of the most common childhood disorders, and diagnoses continue to rise in both children and adults.

In a 2011 federal study, 15.7 percent of South Carolina children had been diagnosed with ADHD, tying this state with Indiana as the fourth highest for diagnoses in the United States. Nearly 80 percent of children diagnosed with ADHD in South Carolina have been prescribed drugs to treat their symptoms.

“Six percent of kids in the United States are on drugs for ADHD,” Helpern said. “I mean, maybe it’s what we have to do, but boy, something is strange about that.”

Part of what makes ADHD a controversial disorder is the treatment. The most prevalent ADHD medications are prescription stimulants, such as Adderall, Ritalin and Vyvanse. These are Schedule II drugs that the Drug Enforcement Agency deems dangerous with “a high potential for abuse.” Cocaine, methamphetamine, Vicodin and OxyContin are also Schedule II drugs.

Helpern, the vice president of radiology research at MUSC, has seen first hand how destructive both ADHD and its medications can be to a person’s life. He is personally invested in this ADHD research.

Similarly, his post-doctoral student, Vitria Adisetiyo, started her work in ADHD after tutoring low-income children and teenagers that struggled with developmental disorders such as ADHD.

“As a neuroscience major, this made me want to understand what was going on in these kids’ brain and how we can do a better job of helping them,” she said.

When Adisetiyo got an opportunity to study the disorder using imaging techniques in graduate school, she was immediately on board.

Her work has involved conducting studies, often with Helpern, using his developments in MRIs.

According to Helpern, the scientific community has, for a long time, tried to find a link between ADHD and iron levels. Iron is needed to create dopamine, and dopamine deficiency is suspected to cause ADHD symptoms. Studies of iron levels in the blood, however, have come up short. But iron’s presence in the brain isn’t the same as iron levels in the bloodstream.

One of Helpern’s studies showed, through MRI images, that patients diagnosed with ADHD have lower than normal iron levels in their brains and that prescription stimulants appear to help bring the iron up to normal levels.

In another study, his results indicated that the brain’s microstructures develop at a different time for patients who have ADHD than those who don’t, and that finding may be linked to iron deficiency in the brain, as well.

However, Helpern said he can’t confidently say that such a relationship exists between iron and ADHD. But he thinks that his research shows the relationship is a possibility.

“The good news is that we are developing the tools to give us information,” he said. “The bad news is that we don’t know what it means yet.”

More studies need to be done, he said. But funding is very limited, even for Helpern, who was invited to the White House last summer as part of an initiative to help other scientists better understand how the brain works.

Helpern’s student Adisetiyo is seeking money on Donor’s Cure to further their ADHD research. She wants to find out what psychostimulant medications do to the brain, specifically when they’re used recreationally or for enhanced work performance by non-ADHD users.

Their past findings show that psychostimulants may be effective because they bring ADHD brains to normal iron levels. But these studies also open the door to more questions about the drugs.

A 2014 study by the U.S. Dept. of Health and Human Services showed about 1 million Americans used psychostimulants for nonmedical or abusive purposes.

“Currently, we know the medications work on behavior but don’t understand what it’s doing to the brain over time,” Adisetiyo said. “Having these (study) results would raise awareness to the potential risk in taking psychostimulants without a clinical diagnosis, in seeing if they are changing the normal brain to something abnormal.”

Reach Brooks Brunson at 843-937-5581.