Can ADHD subtypes be identified by brain mapping?

The Attention Deficit Hyperactivity Disorder (ADHD) affects children, adolescents, and adults. It is now understood that the disorder does not manifest uniformly across individuals, but that it's possible to identify 3 subtypes:

• Inattentive: where there are difficulties with concentration, sustained attention, thoughts easily wander, and frequent forgetfulness occurs.
• Hyperactive/Impulsive: where there are difficulties controlling one's own behaviors, staying still for long periods of time, and a tendency to act without thinking about the consequences.
• Combined: where there is a combination of the previous subtypes. In other words, signs of inattention are observed, but also constant restlessness.

Thus, because it is a disorder with variable presentation, interventions such as medication may require a trial-and-error process until the most suitable one is found for each clinical case, which can sometimes make the process frustrating for the individual.

A study recently published in JAMA Psychiatry showed how Neuroimaging can facilitate the process of identifying the ADHD subtype and how this can open doors for more effective interventions with a smaller margin for trial and error. 

What does the study tell us?

Published in February 2026, the study Mapping ADHD Heterogeneity and Biotypes by Topological Deviations in Morphometric Similarity Networks, tells us how the joint analysis of specific brain regions can help identify concrete subtypes of the disorder.

Thus, in the 446 children with ADHD involved in the study, priority was given to results obtained through the use of Neuroimaging, without considering symptoms (such as attention or restlessness), as is common in standard clinical diagnostic processes.

This is important because the study shows that this subdivision of the disorder (inattentive, hyperactive/impulsive, and combined) can be made not only based on subjective characteristics, such as symptomatology and behaviors, but also based on biology, enabling more personalized and efficient interventions.

How does this happen?

The study authors identified deviations in specific brain areas of children with ADHD, specifically in the:

• Striatum: linked to reward systems, motor control, and motivation.
• Inferior frontal gyrus: linked to inhibitory control (the ability to curb impulses) and attention
• Orbitofrontal cortex: associated with decision-making and emotional regulation 

The study suggests that, in the brain of a child with ADHD, there may be differences in functioning and in the way these regions connect with each other. Areas such as the inferior frontal gyrus and the orbitofrontal cortex, instead of functioning with closer regions, appear to connect to different parts of the brain as an attempt to compensate for the reduced processing capacity of other regions.

These deviations and changes in functioning may thus be associated with the known symptoms of the disorder: impulsivity, restlessness, inattention, and difficulty controlling emotions.

Regarding the manifestation of ADHD, Dr. Shilan Aslani, who holds a PhD in Neurosciences and is the Manager of NeuroImprove Clinic, explains:

"Children with ADHD often express these difficulties through statements such as, "I couldn't control myself," "I don't know why I did it," or "I really tried to listen, but I just couldn't understand." This article provides clear evidence that these difficulties are not simply the result of poor behaviour, but rather stem from specific alterations in the brain's structure and function that affect the child. As adults, this should encourage us to pause and reflect before reacting impulsively to their symptoms."

Dr. Shilan Aslani - Founder and Clinical Director at NeuroImprove Clinic

What different ADHD subtypes did they find? 

The subtypes or "biotypes" identified by the study appear to reveal alterations in a common area: the Orbitofrontal Cortex, which controls the balance between acting on impulse and making considered decisions and/or purposeful actions.

However, despite this commonality, specific alterations were observed in the neural circuits which lead to the existence of different symptoms and, consequently, to this subdivision.

Biotype 1 (or combined subtype) 

👉 Exhibits the most intense symptoms. With alterations in the medial prefrontal cortex - pallidum connection, this subtype exhibits signs of inattention, hyperactivity, impulsivity, but also emotional dysregulation.

Biotype 2 (or hyperactive-impulsive subtype)

👉 With alterations in the anterior cingulate cortex - pallidum connection, this subtype exhibits signs of greater hyperactivity, impulsivity and difficulties in controlling behavior.

Biotype 3 (or inattentive subtype)

👉 Changes are observed in the superior frontal gyrus, leading to it being difficult to maintain attention and stay focused on a task for long periods of time.

Identifying these biotypes allows for a more detailed understanding of ADHD. Following this, Dr. Shilan Aslani, adds:

"For decades, ADHD was diagnosed primarily using symptom checklists, treating it as a largely homogeneous condition. However, this groundbreaking study demonstrates that, underlying these everyday difficulties, children exhibit distinct functional alterations in brain activity. This article provides further evidence that brain mapping represents the future of ADHD diagnosis. By accurately identifying the specific neural circuit that is altered in each child, we can move towards personalised treatments that target the underlying biological cause rather than simply masking the symptoms. This approach has the potential to transform the lives of countless children by providing them with the support they need to reach their full potential."

Dr. Shilan Aslani - Founder and Clinical Director at NeuroImprove Clinic

Is there a connection with Neurotransmitters?

🔎 An exploratory analysis revealed that each biotype may be linked to different neurotransmitters (as if each had a kind of 'chemical signature'). However, this is preliminary information that still needs to be studied and, therefore, should not be used to define treatments.

How did they support these conclusions?

The results obtained through decoding by Neurosynth (a global database) confirmed that the brain changes observed in each biotype are responsible for the signs and symptomatology observed in children, lending strong validation and credibility to this subdivision.

Why is this study so important?

This type of study demonstrates that, when it comes to diagnoses, it's important to understand the current functioning of the brain and not just focus on symptomatology. Understanding brain activity can facilitate the diagnostic confirmation process and help define the best intervention plan for each individual.

From a professional and clinical perspective, Dr. Filipa Pinho, Neurofeedback Therapist and Case Manager at NeuroImprove Clinic shares her experience:

"As a Neurofeedback and EEG Technician, I work closely with the parents of children with ADHD. They often express concerns about using medication and hope to find an alternative approach. Likewise, many children come to us after having tried medication without achieving the expected outcomes. This trial-and-error process is common and can be both exhausting and discouraging for families and and caregivers who are doing their best to support these children. I believe that this occurs, at least in part, because medication is typically prescribed based on symptom presentation, without knowledge of the child's underlying brain activity pattern."

Dr. Filipa Pinho - Neurofeedback Technician and Case Manager

At NeuroImprove Clinic, we daily support children and adolescents with ADHD, where the assessment process includes performing a qEEG (Quantitative Electroencephalogram) which gives us a clear perspective of the brain's current state. 

The qEEG thus allows us to identify patterns of brain activity associated with ADHD and to intervene in a personalized way, tailored to each child's needs.

Regarding the assessment of brain activity, Dr. Filipa Pinho adds: 

"Neuroimaging shares many similarities with quantitative EEG (qEEG), as both approaches assess patterns of brain dysregulation associated with the symptoms observed. It is highly reassuring to see growing scientific evidence supporting the value of these types of assessments in the diagnosis and treatment of psychological disorders. This evidence strengthens confidence in these approaches, validates our clinical practice, and provides greater reassurance to the individuals and families who seek our support.

Dr. Filipa Pinho - Neurofeedback Technician and Case Manager

The integration between Clinical Psychology and Neurofeedback, allows for a deep understanding of each clinical case and provides the necessary support for them to achieve greater balance, autonomy, and fulfillment in all areas! 🧡

References

Pan, N., Long, Y., Qin, K. (2026). Mapping ADHD Heteroginity and Biotypes by Topological Devations in Morphometric Similarity Networks. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2026.0001