Putamen Lesions and the Development of Attention-Deficit/Hyperactivity Symptomatology

Jeffrey E. Max*, Peter T. Fox, Jack L. Lancaster, Peter Kochunov, Katherine Mathews, Facundo F. Manes, Brigitte A M Robertson, Stephan Arndt, Donald A. Robin, Amy E. Lansing

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

84 Citations (Scopus)


Objective: To investigate the association between focal stroke lesions of the putamen and either attention-deficit/hyperactivity disorder or traits of the disorder (ADHD/Traits). Method: Twenty-five children with focal stroke lesions were studied with standardized psychiatric assessments and anatomic brain magnetic resonance imaging. The pattern of lesion overlap in subjects with ADHD/Traits was determined. Results: Fifteen of 25 subjects had ADHD/Traits. The densest area of overlapping lesions (n=7) in subjects with ADHD/Traits included the posterior ventral putamen. The median lesion volume was 9.7 cm 3, and the distribution was highly skewed. Lesion volume was not associated with ADHD/Traits. Therefore the following analyses focused on the 13 subjects with lesions < 10 cm 3: ADHD/Traits were exhibited in 6/7 subjects with putamen lesions versus 2/6 with no putamen lesions (Fisher exact test p=.1). Half (4/8) of the subjects with ADHD/Traits had overlapping lesions encompassing the posterior ventral putamen. None of the 5 subjects without ADHD/Traits had lesions in this empirically derived region of interest (Fisher exact test p=.1). Conclusions: Lesions within the dopamine-rich ventral putamen, which is part of the ventral or limbic striatum, tended to increase the risk of ADHD/Traits. ADHD/Traits may therefore be a disinhibition syndrome associated with dysfunction in this cortical-striato-thalamocortical loop.

Original languageEnglish
Pages (from-to)563-571
Number of pages9
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number5
Publication statusPublished - May 2002
Externally publishedYes


  • Attention-deficit/hyperactivity disorder
  • Childhood stroke
  • Putamen

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