Background Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by age-inappropriate levels of inattention and/or hyperactivity-impulsivity (HI). ADHD has been related to differences in white matter (WM) microstructure. However, much remains unclear regarding the nature of these WM differences, and which clinical aspects of ADHD they reflect. We systematically investigated if FA is associated with current and/or lifetime categorical diagnosis, impairment in daily life, and continuous ADHD symptom measures.Methods Diffusion-weighted imaging (DWI) data were obtained from 654 participants (322 unaffected, 258 affected, 74 subthreshold; 7-29 years of age). We applied automated global probabilistic tractography on 18 major WM pathways. Linear mixed effects regression models were used to examine associations of clinical measures with overall brain and tract-specific fractional anisotropy (FA).Results There were significant interactions of tract with all ADHD variables on FA. There were no significant associations of FA with current or lifetime diagnosis, nor with impairment. Lower FA in the right cingulum’s angular bundle (rCAB) was associated with higher hyperactivity/impulsivity symptom severity (PFWE=0.045). There were no significant effects for other tracts.Conclusions This is the first time global probabilistic tractography has been applied to an ADHD dataset of this size. We found no evidence for altered FA in association with ADHD diagnosis. Our findings indicate that associations of FA with ADHD are not uniformly distributed across WM tracts. Continuous symptom measures of ADHD may be more sensitive to FA than diagnostic categories. The rCAB in particular may play a role in symptoms of hyperactivity and impulsivity.

White matter microstructure in attention-deficit/hyperactivity disorder: a systematic tractography study in 654 individuals