Brain Scans Point to Different “Biotypes” of ADHD
A new study suggests researchers may be missing important complexity in ADHD (attention-deficit/hyperactivity disorder). Using brain scan data, scientists concluded that ADHD may include three distinct subtypes, each with its own clinical and neural profile. The researchers say identifying these groups more accurately could help people access more targeted treatment and support.
ADHD is a form of neurodivergence that has become more widely recognized in recent years, with diagnosis rates rising in both children and adults. As awareness improves, researchers and clinicians have increasingly questioned whether current diagnostic criteria fully capture how differently ADHD can present across individuals.
Why Diagnosis Can Miss Real-World Variations
One commonly discussed issue is the diagnosis gap between males and females. ADHD was long framed as something that mainly affected young boys, an idea that has since been challenged. What persists is a pattern where early symptoms in girls are often overlooked. Boys may be labeled “disruptive” at school, triggering referrals and evaluation, while girls may be seen as merely “inattentive” and receive little or no support.
The new research suggests there may be additional layers of variation beyond the familiar diagnostic categories, raising the possibility that opportunities for personalized care are being missed.
Three Subtypes Identified in Large Child Cohorts
The study was led by a team at West China Hospital of Sichuan University. Researchers analyzed brain imaging and related biological measures in a “discovery cohort” of 446 children with ADHD and 708 controls. They then tested the findings in a second cohort of 554 children with ADHD and 123 controls.
Based on differences in brain structure, network patterns, and indicators linked to neurochemical signaling, the authors reported three distinct ADHD biotypes:
- Severe combined with emotional dysregulation
- Predominantly hyperactive/impulsive
- Predominantly inattentive
In practical terms, hyperactivity and impulsivity can include behaviors such as excessive talking, interrupting, restlessness, and fidgeting. Inattention can show up as forgetfulness, difficulty maintaining focus, misplacing important items, and struggling to sustain attention over longer periods. A combined presentation includes features of both.
What It Could Mean for Treatment
Many people with ADHD already recognize that symptoms can cluster in very different ways. The study’s argument is that mapping those differences to underlying neurobiology could support more precise, individualized approaches to care.
Today, ADHD treatment often involves stimulant medications such as methylphenidate, commonly known by brand names such as Ritalin. These medications can help many people, but they do not work for everyone, and researchers continue to learn more about how they affect the brain over time.
The authors noted a key limitation: many participants were currently taking or had previously taken ADHD medication. While the team said major effects on the brain scan findings were unlikely, they could not fully rule out some influence. Even with that caveat, the researchers said the results support the idea that ADHD may be better understood as a condition with multiple biological profiles, potentially paving the way for more personalized management.