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Center for American Progress
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A look at the Islamophobia network that profoundly misrepresents Islam and American Muslims in the United States.
Advancing Racial Equity and Justice, Faith and Equality, Islamophobia, Racial Equity and Justice, Religious Liberty+2 More
Vice President, Communications
Director, Media Relations
Director, Federal Affairs
Senior Director, Safety and Justice Campaign; Director, State and Local Government Affairs
Senior Manager, State and Local Government Affairs
Download this report (pdf)
Read the report in your web browser (Scribd)
Download individual chapters of the report (pdf):
Video: Ask the Expert: Faiz Shakir on the Group Behind Islamophobia
On July 22, a man planted a bomb in an Oslo government building that killed eight people. A few hours after the explosion, he shot and killed 68 people, mostly teenagers, at a Labor Party youth camp on Norway's Utoya Island.
By midday, pundits were speculating as to who had perpetrated the greatest massacre in Norwegian history since World War II. Numerous mainstream media outlets, including The New York Times, The Washington Post, and The Atlantic, speculated about an Al Qaeda connection and a "jihadist" motivation behind the attacks. But by the next morning it was clear that the attacker was a 32-year-old, white, blond-haired and blue-eyed Norwegian named Anders Breivik. He was not a Muslim, but rather a self-described Christian conservative.
According to his attorney, Breivik claimed responsibility for his self-described "gruesome but necessary" actions. On July 26, Breivik told the court that violence was "necessary" to save Europe from Marxism and "Muslimization." In his 1,500-page manifesto, which meticulously details his attack methods and aims to inspire others to extremist violence, Breivik vows "brutal and breathtaking operations which will result in casualties" to fight the alleged "ongoing Islamic Colonization of Europe."
Breivik's manifesto contains numerous footnotes and in-text citations to American bloggers and pundits, quoting them as experts on Islam's "war against the West." This small group of anti-Muslim organizations and individuals in our nation is obscure to most Americans but wields great influence in shaping the national and international political debate. Their names are heralded within communities that are actively organizing against Islam and targeting Muslims in the United States.
Breivik, for example, cited Robert Spencer, one of the anti-Muslim misinformation scholars we profile in this report, and his blog, Jihad Watch, 162 times in his manifesto. Spencer's website, which "tracks the attempts of radical Islam to subvert Western culture," boasts another member of this Islamophobia network in America, David Horowitz, on his Freedom Center website. Pamela Geller, Spencer's frequent collaborator, and her blog, Atlas Shrugs, was mentioned 12 times.
Geller and Spencer co-founded the organization Stop Islamization of America, a group whose actions and rhetoric the Anti-Defamation League concluded "promotes a conspiratorial anti-Muslim agenda under the guise of fighting radical Islam. The group seeks to rouse public fears by consistently vilifying the Islamic faith and asserting the existence of an Islamic conspiracy to destroy "American values." Based on Breivik's sheer number of citations and references to the writings of these individuals, it is clear that he read and relied on the hateful, anti-Muslim ideology of a number of men and women detailed in this report&a select handful of scholars and activists who work together to create and promote misinformation about Muslims.
While these bloggers and pundits were not responsible for Breivik's deadly attacks, their writings on Islam and multiculturalism appear to have helped create a world view, held by this lone Norwegian gunman, that sees Islam as at war with the West and the West needing to be defended. According to former CIA officer and terrorism consultant Marc Sageman, just as religious extremism "is the infrastructure from which Al Qaeda emerged," the writings of these anti-Muslim misinformation experts are "the infrastructure from which Breivik emerged." Sageman adds that their rhetoric "is not cost-free."
These pundits and bloggers, however, are not the only members of the Islamophobia infrastructure. Breivik's manifesto also cites think tanks, such as the Center for Security Policy, the Middle East Forum, and the Investigative Project on Terrorism—three other organizations we profile in this report. Together, this core group of deeply intertwined individuals and organizations manufacture and exaggerate threats of "creeping Sharia," Islamic domination of the West, and purported obligatory calls to violence against all non-Muslims by the Quran.
This network of hate is not a new presence in the United States. Indeed, its ability to organize, coordinate, and disseminate its ideology through grassroots organizations increased dramatically over the past 10 years. Furthermore, its ability to influence politicians' talking points and wedge issues for the upcoming 2012 elections has mainstreamed what was once considered fringe, extremist rhetoric.
And it all starts with the money flowing from a select group of foundations. A small group of foundations and wealthy donors are the lifeblood of the Islamophobia network in America, providing critical funding to a clutch of right-wing think tanks that peddle hate and fear of Muslims and Islam—in the form of books, reports, websites, blogs, and carefully crafted talking points that anti-Islam grassroots organizations and some right-wing religious groups use as propaganda for their constituency.
Some of these foundations and wealthy donors also provide direct funding to anti-Islam grassroots groups. According to our extensive analysis, here are the top seven contributors to promoting Islamophobia in our country:
Altogether, these seven charitable groups provided $42.6 million to Islamophobia think tanks between 2001 and 2009—funding that supports the scholars and experts that are the subject of our next chapter as well as some of the grassroots groups that are the subject of Chapter 3 of our report.
And what does this money fund? Well, here's one of many cases in point: Last July, former Speaker of the House of Representatives Newt Gingrich warned a conservative audience at the American Enterprise Institute that the Islamic practice of Sharia was "a mortal threat to the survival of freedom in the United States and in the world as we know it." Gingrich went on to claim that "Sharia in its natural form has principles and punishments totally abhorrent to the Western world."
Sharia, or Muslim religious code, includes practices such as charitable giving, prayer, and honoring one's parents—precepts virtually identical to those of Christianity and Judaism. But Gingrich and other conservatives promote alarmist notions about a nearly 1,500-year-old religion for a variety of sinister political, financial, and ideological motives. In his remarks that day, Gingrich mimicked the language of conservative analyst Andrew McCarthy, who co-wrote a report calling Sharia "the preeminent totalitarian threat of our time." Such similarities in language are no accident. Look no further than the organization that released McCarthy's anti-Sharia report: the aforementioned Center for Security Policy, which is a central hub of the anti-Muslim network and an active promoter of anti- Sharia messaging and anti-Muslim rhetoric.
In fact, CSP is a key source for right-wing politicians, pundits, and grassroots organizations, providing them with a steady stream of reports mischaracterizing Islam and warnings about the dangers of Islam and American Muslims. Operating under the leadership of Frank Gaffney, the organization is funded by a small number of foundations and donors with a deep understanding of how to influence U.S. politics by promoting highly alarming threats to our national security. CSP is joined by other anti-Muslim organizations in this lucrative business, such as Stop Islamization of America and the Society of Americans for National Existence. Many of the leaders of these organizations are well-schooled in the art of getting attention in the press, particularly Fox News, The Wall Street Journal editorial pages, The Washington Times, and a variety of right-wing websites and radio outlets.
Misinformation experts such as Gaffney consult and work with such right-wing grassroots organizations as ACT! for America and the Eagle Forum, as well as religious right groups such as the Faith and Freedom Coalition and American Family Association, to spread their message. Speaking at their conferences, writing on their websites, and appearing on their radio shows, these experts rail against Islam and cast suspicion on American Muslims. Much of their propaganda gets churned into fundraising appeals by grassroots and religious right groups. The money they raise then enters the political process and helps fund ads supporting politicians who echo alarmist warnings and sponsor anti-Muslim attacks.
These efforts recall some of the darkest episodes in American history, in which religious, ethnic, and racial minorities were discriminated against and persecuted. From Catholics, Mormons, Japanese Americans, European immigrants, Jews, and African Americans, the story of America is one of struggle to achieve in practice our founding ideals. Unfortunately, American Muslims and Islam are the latest chapter in a long American struggle against scapegoating based on religion, race, or creed.
Due in part to the relentless efforts of this small group of individuals and organizations, Islam is now the most negatively viewed religion in America. Only 37 percent of Americans have a favorable opinion of Islam: the lowest favorability rating since 2001, according to a 2010 ABC News/Washington Post poll. According to a 2010 Time magazine poll, 28 percent of voters do not believe Muslims should be eligible to sit on the U.S. Supreme Court, and nearly one-third of the country thinks followers of Islam should be barred from running for president.
The terrorist attacks on 9/11 alone did not drive Americans' perceptions of Muslims and Islam. President George W. Bush reflected the general opinion of the American public at the time when he went to great lengths to make clear that Islam and Muslims are not the enemy. Speaking to a roundtable of Arab and Muslim American leaders at the Afghanistan embassy in 2002, for example, President Bush said, "All Americans must recognize that the face of terror is not the true faith—face of Islam. Islam is a faith that brings comfort to a billion people around the world. It's a faith that has made brothers and sisters of every race. It's a faith based upon love, not hate."
Unfortunately, President Bush's words were soon eclipsed by an organized escalation of hateful statements about Muslims and Islam from the members of the Islamophobia network profiled in this report. This is as sad as it is dangerous. It is enormously important to understand that alienating the Muslim American community not only threatens our fundamental promise of religious freedom, it also hurts our efforts to combat terrorism. Since 9/11, the Muslim American community has helped security and law enforcement officials prevent more than 40 percent of Al Qaeda terrorist plots threatening America. The largest single source of initial information to authorities about the few Muslim American plots has come from the Muslim American community.
Around the world, there are people killing people in the name of Islam, with which most Muslims disagree. Indeed, in most cases of radicalized neighbors, family members, or friends, the Muslim American community is as baffled, disturbed, and surprised by their appearance as the general public. Treating Muslim American citizens and neighbors as part of the problem, rather than part of the solution, is not only offensive to America's core values, it is utterly ineffective in combating terrorism and violent extremism.
The White House recently released the national strategy for combating violent extremism, "Empowering Local Partners to Prevent Violent Extremism in the United States." One of the top focal points of the effort is to "counter al-Qa'ida's propaganda that the United States is somehow at war with Islam." Yet orchestrated efforts by the individuals and organizations detailed in this report make it easy for al-Qa'ida to assert that America hates Muslims and that Muslims around the world are persecuted for the simple crime of being Muslims and practicing their religion.
Sadly, the current isolation of American Muslims echoes past witch hunts in our history—from the divisive McCarthyite purges of the 1950s to the sometimes violent anti-immigrant campaigns in the 19th and 20th centuries. New York Mayor Michael Bloomberg has compared the fear-mongering of Muslims with anti-Catholic sentiment of the past. In response to the fabricated "Ground Zero mosque" controversy in New York last summer, Mayor Bloomberg said:
In the 1700s, even as religious freedom took hold in America, Catholics in New York were effectively prohibited from practicing their religion, and priests could be arrested. Largely as a result, the first Catholic parish in New York City was not established until the 1780s, St. Peter's on Barclay Street, which still stands just one block north of the World Trade Center site, and one block south of the proposed mosque and community center. … We would betray our values and play into our enemies' hands if we were to treat Muslims differently than anyone else.
This report shines a light on the Islamophobia network of so-called experts, academics, institutions, grassroots organizations, media outlets, and donors who manufacture, produce, distribute, and mainstream an irrational fear of Islam and Muslims. Let us learn the proper lesson from the past, and rise above fear-mongering to public awareness, acceptance, and respect for our fellow Americans. In doing so, let us prevent hatred from infecting and endangering our country again.
In the pages that follow, we profile the small number of funders, organizations, and individuals who have contributed to the discourse on Islamophobia in this country. We begin with the money trail in Chapter 1—our analysis of the funding streams that support anti-Muslim activities. Chapter 2 identifies the intellectual nexus of the Islamophobia network. Chapter 3 highlights the key grassroots players and organizations that help spread the messages of hate. Chapter 4 aggregates the key media amplifiers of Islamophobia. And Chapter 5 brings attention to the elected officials who frequently support the causes of anti- Muslim organizing.
Before we begin, a word about the term "Islamophobia." We don't use this term lightly. We define it as an exaggerated fear, hatred, and hostility toward Islam and Muslims that is perpetuated by negative stereotypes resulting in bias, discrimination, and the marginalization and exclusion of Muslims from America's social, political, and civic life.
It is our view that in order to safeguard our national security and uphold America's core values, we must return to a fact-based civil discourse regarding the challenges we face as a nation and world. This discourse must be frank and honest, but also consistent with American values of religious liberty, equal justice under the law, and respect for pluralism. A first step toward the goal of honest, civil discourse is to expose—and marginalize—the influence of the individuals and groups who make up the Islamophobia network in America by actively working to divide Americans against one another through misinformation.
Wajahat Ali is a researcher at the Center for American Progress and a researcher for the Center for American Progress Action Fund. Eli Clifton is a researcher at the Center for American Progress and a national security reporter for the Center for American Progress Action Fund and ThinkProgress.org. Matthew Duss is a Policy Analyst at the Center for American Progress and Director of the Center's Middle East Progress. Lee Fang is a researcher at the Center for American Progress and an investigative researcher/blogger for the Center for American Progress Action Fund and ThinkProgress.org. Scott Keyes is a researcher at the Center for American Progress and an investigative researcher for ThinkProgress.org at the Center for American Progress Action Fund. Faiz Shakir is a Vice President at the Center for American Progress and serves as Editor-in-Chief of ThinkProgress.org.
The positions of American Progress, and our policy experts, are independent, and the findings and conclusions presented are those of American Progress alone. A full list of supporters is available here. American Progress would like to acknowledge the many generous supporters who make our work possible.
Policy Analyst
Senior Reporter, ThinkProgress War Room


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"Over the past fifteen or so years, Salt River Project (SRP) has done business with Precision Heavy Haul or (PHH). "
Scott Moore, Salt River Project
It has been my privilege to work directly with PHH on many interstate and intrastate heavy haul moves for our company. PHH demonstrates the utmost professionalism in all aspects of customer service and abilities to transport oversized and heavy weight shipments. PHH has handled high value transformer units as well as gas turbine equipment, for our company. If you have any questions, please feel free to contact me at the following number.

subset: commoncrawl


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Create a Website Account - Manage notification subscriptions, save form progress and more.
We, the San Marcos Fire Department, shall create an organization that is engaged with the community and a crucial part of it. We shall create and preserve an environment that inspires success by trusting and empowering each other to strive for perfection. We shall train to the highest standards and act selflessly in our dedication to community, organization, and each other. We shall support, encourage, and hold each other accountable. We shall take pride and ownership in everything entrusted to us with the protection of our citizens and our members as our top priority.
San Marcos Fire Department is dedicated to providing a well-trained, motivated, and diverse team of professionals who deliver excellence in prevention, educational programs, and emergency response services to our community in a safe, responsible, and efficient manner.
A rating schedule was developed by the Insurance Services Office (ISO). This rating schedule serves insurance companies that cover property and casualty benefits for their clients. ISO representatives use the schedule when surveying a community's fire protection capabilities. The ISO rating for San Marcos is 2/9.
Find more information about ISO click on the Texas Department of Insurance Website or the Texas Addendum to the Fire Suppression Rating Schedule (PDF).


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LOS ANGELES, CA – Kanye West held a press conference this week, vowing to make a musical comeback. Unfortunately he interrupted himself several times throughout the meeting.
West announced at the LA Hilton that he will soon be heading back into the music studio to prepare for his musical comeback. This was Kanye's first public appearance in months, as he has been keeping a low profile after his incident with at the MTV VMAs. Now the self proclaimed "voice of a generation" promises to "bring the best I have to offer."
Kanye said of his career "it's funny how so many rappers get worse as their careers stretch out, but true poets get better." He then shifted dramatically in his chair and said "Hold on Kanye, I'm gonna let you finish." One of his assistants brought out a full length mirror and placed it next to the singer.
Kanye used the mirror to talk to himself, saying, "I hope to follow in the footsteps of great poets like Maya Angelou. While technically I have never read any Maya Angelou, the strength of poetry will be the same." Real Kanye chimed back in saying "I have to say that I am very right here. My next album will be like Maya Angelou, but with a beat that you want to dance to."
Kanye West pulled out a smaller mirror and placed it on the table, saying, "One second, I gonna let you finish. But my next album is more like Nina Simone, who spoke poetry and truth in her songs. She fought for civil rights with her songs, and in a similar vein I'm gonna tell the world how it really is with my music." Looking into the floor length mirror Kanye said "Hold on, I gotta say something here. Nina Simone is amazing and all, but this next album will be like Nina Simone and Maya Angelou doing a duet."
Real Kanye spoke up, saying, "Yeah yeah, I'm gonna get back to both of you. Both of those artists got better as they went on, and their work stands the test of time. That's what I'm going to do, my music will always stand up."
Pulling out a handheld mirror, Kanye looked into it, saying, "These artists documented what was happening in our culture. That's what I'm gonna do. So when the powers that be try to rewrite history you can always look at our works and find truth."
Reporters left the meeting two hours later while Kanye was in an argument with himself over which basketball player more closely resembled his career.


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< Features
Include GNOME 2.30
- Desktop SIG
- Email: email@example.com
Current status
- Targeted release: Fedora 13
- Last updated: 2010-04-06
- Percentage of completion: 100%
GNOME 2.30 has been built in rawhide and F13.
The default mode in nautilus has been changed to browser.
The schedule for Gnome 2.30 looks as follows:
|Feb 10
|2.29.90 beta
|Feb 24
|2.29.91 beta
|Mar 10
|2.29.92 rc
|Mar 31
Detailed Description
The main point of this feature is to ensure that Fedora ships the current version of the Gnome desktop.
Benefit to Fedora
Stay in sync with upstream.
Outstanding issues:
- Keep Gnome packages updated. For a list of affected packages, see http://live.gnome.org/TwoPointTwentynine/Platform and http://live.gnome.org/TwoPointTwentynine/Desktop
- Make sure new enough versions of external dependencies are in Fedora. For a list of external dependencies, see http://live.gnome.org/TwoPointTwentynine/ExternalDependencies
- Make sure new modules and new external dependencies of Gnome 2.30 are packaged
- Follow major upstream changes
- Investigate if we can drop some of the removed modules. At least we should make sure they don't sneak onto a space-constrained live image. Candidates for this are libgnomeprint22, libgnomeprintui22, libgnomeui, gnome-vfs2, gnome-mime-data, hal, eel2.
How To Test
- Open System → About GNOME. Verify that it says "Version: 2.30"
- Verify that important desktop components work as well as they always have:
- the panel
- nautilus
- metacity
Hints about testing basic desktop functionality can be found at Desktop/Testing.
This section will be updated as it becomes more clear what the major test-worthy new features in Gnome 2.30 are. To get some idea what people plan to work on for 2.30, see http://live.gnome.org/RoadMap and http://live.gnome.org/RoadMap/Modules (but no guarantees that anything on those pages will actually appear in 2.30...)
User Experience
Largely unchanged. One noteworthy change is that nautilus defaults to browser mode now.
Depends on upstream Gnome, see the Gnome 2.30 schedule
Contingency Plan
If Gnome 2.30 does not happen in time for Fedora 13, ship a prerelease like 2.29.92 (we've done that before)
See the Gnome 2.30 release notes.
Release Notes
Fedora 13 includes the latest version of the Gnome desktop, 2.30.
For more information about what is new in Gnome, see the Gnome 2.30 release notes.


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Best Online MBA & DBA Programs
What Are Online MBA Programs?
Online Business Administration Graduate programs are offered by online universities and traditional business schools alike. Students can expect to spend some time researching which program best meets their needs. This is because schools offer different courses and areas of emphasis to fit many different people's needs. Plus, there are usually distinct methods of content delivery, focus, and target audience.
Online MBA programs offer students an alternative to going to a campus for their Masters degree in Business Administration. Known for developing business management skills, the MBA is a professional degree. It provides graduate-level courses in vital business practices. Aside from taking courses in finance, marketing and management, students often learn through case study analysis.
How Long are Online MBA Programs?
Full-time online MBA programs take the average student about 18 months to 2 years to complete. Students who opt for a full-time program may be enrolled in 3 to 4 courses per semester. However, this is not the only type. Some schools offer part-time online MBA programs which may take 3 years or more. Additionally, there are schools who offer Accelerated MBA programs online. These may take about one year to complete, and are full-time. In fact, be prepared for an intensive curriculum as more courses are packed into the shorter time frame.
How Many Credits are Online MBA Programs?
Online MBA programs may require the completion of 30, 36, 42 or more credits. A few factors may affect the number of credits students take.
- Do you have transfer credits?
- Is your previous degree a Bachelor of Business Administration or other business degree?
In each school, MBA credits are earned through core courses and electives. Usually, the required courses are taken in a specific sequence. Electives or concentration areas tailor a Masters in Business Administration to match an area of interest.
Online MBA Courses and Concentrations
Online MBA programs often have challenging courses. These are intended to equip students with 'best practices' for solving problems in real-world business settings. Since courses vary from school to school, looking at syllabi is one way to select a program. The topics should match your interests and goals. The following is a sample of online MBA courses.
- Accounting: How to interpret financial statements, taxation, profit analysis
- Finance: Corporate financial reporting, managing risk
- Management: Leading people, networking, coaching, strategic planning
- Marketing: Pricing, promotions, market research
- International Business: Global marketplace, exchange rate
- Business Technology: Database management, information security
- Business Law: Legal risks for businesses
- Human Resource Management: Hiring and supporting teams
- Business Ethics: Creating a mission statement
MBA concentrations give students the chance to pursue coursework that is relevant to them. A sample of focus areas is listed below.
- General Business
- Management (organizational leadership)
- Finance
- Healthcare Administration
- Project Management
Popular Schools with Online MBA & DBA Programs
Why Consider Online MBA Programs?
Looking for a possible career boost but can't commute to class? Flexible scheduling is one of the reasons working students, executives and entrepreneurs turn to online MBA programs. Most schools offer an asynchronous course delivery. This means students have access to their professor's lectures 24/7. Also, this convenience allows students to self-pace, hit pause or rewind. An added plus for understanding the material.
Aside from 'easy access', a course management system is a portal for other parts of an online MBA program. The platform usually includes a way to upload assignments and take exams. It also serves as a means of contact with fellow classmates and teachers.
FACT: When asked about their education level, 26% of Executive Directors, including Chief Nursing Officers, responded they had earned a graduate degree. (O*Net)
How Do I Earn an Online Masters in Business Administration?
To apply into an online Masters in Business Administration, most schools require a Bachelors degree or higher from an accredited college. This does not have to be an undergraduate business degree. Aside from that, expect that each business school has its own admission checklist. Examples are below.
- Letter of intent
- Professional resume
- Official transcripts
- GMAT / GRE scores
- Admission interview
- Letters of recommendation
- Community service
- List of professional skills
Types of Online MBA Programs
Full-time, part-time and accelerated online Masters in Business Administration programs are not the only types of Online MBA programs available. In fact, there are programs to suit varying levels of education and work experience.
- Online Pre-MBA: Interested in preparing for an MBA? Take courses through online Business Prep programs, also called Pre-MBA.
- Online Executive Masters in Business Administration: Are you an experienced professional? Online EMBA programs are often targeted to those with several years business or supervisory experience.
- Online MBA Flex: Looking for a very flexible program? The Online MBA Flex is a 42-month, part-time program.
Beyond the MBA: Other Options in Business Administration
Want to explore business administration through other online programs?
Online Business Administration Certificates
Online business certificates are shorter and target a few courses in business administration. Some business schools allow the course credits to be transferred to their online MBA program.
Online Master of Science in Management
Masters level programs include the Master of Science in Management. This is an option for masters students who want to focus exclusively on management and apply scientific research to leadership.
Online DBA | Online PhD Business Administration
The Online DBA degree (Doctor of Business Administration)is a professional practice doctorate degree that provides advanced courses and research in professional management, human resources, marketing, and other business-related fields. Like the MBA, students often tailor their program with an area of emphasis.
|Annual Mean Wage
|New York
|Metro Area
|Annual Mean Salary
|Bridgeport-Stamford-Norwalk, CT
|New York-Newark-Jersey City, NY-NJ-PA
|Washington-Arlington-Alexandria, DC-VA-MD-WV
|San Jose-Sunnyvale-Santa Clara, CA
|San Francisco-Oakland-Hayward, CA
Find Accredited Online MBA Programs
As with on campus programs, online Business Schools should be accredited nationally or regionally. This ensures the quality of curriculum, faculty and other norms. There are six regional accreditors that have the stamp of approval from the Department of Education.
You can also look for accredited online MBA programs. This is another layer of 'quality control'. It means that a school curriculum meets standards set forth by the specialized accrediting agency. Also, to keep its status, the program is continually reviewed to include relevant course material. One such accrediting agency is the AACSB, the Association to Advance Collegiate Schools of Business. Two others are the International Assembly for Collegiate Business Education (IACBE) and the Accreditation Council of Business Schools and Programs (ACBSP). Future students can always check an association's website database to make sure their choice graduate school has continued to maintain its accreditation.
GradSchools.com offers 284 Graduate Schools with Online Business Administration Programs
National University
Grand Canyon University
Colorado State University Global
Western Governors University
Regent University
Temple University Fox School of Business
Concordia University
Thomas Edison State College
University of Illinois at Chicago
Green Mountain College
Iona College
Syracuse University


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Tempe, AZ – The Arizona Cardinals continued to fortify their secondary through the free-agent market, with the club agreeing to terms on a one-year contract with cornerback Antoine Cason on Friday.
Cason, who played collegiately at the University of Arizona, comes to the Cardinals following a five-year stint with the San Diego Chargers in which he started a total of 49 games -- including 45 over the past three seasons. He started all 16 contests for the Bolts in 2012, compiling 71 tackles, two interceptions and 12 passes defensed.
The 26-year-old owns 12 career interceptions and 55 pass breakups, in addition to having made 25 tackles on special teams.
Cason will be joining two other newcomers, cornerback Jerraud Powers and safety Yeremiah Bell, in a remade Arizona defensive backfield. The Cardinals also released longtime safety Adrian Wilson along with 2012 starting mate Kerry Rhodes during this offseason.


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Cornell University
PhD. in Mathematics
Norm was 4th at the 2004 USA Weightlifting Nationals! He still trains and competes occasionally, despite his busy schedule.
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Cornell University
PhD. in Mathematics
Norm was 4th at the 2004 USA Weightlifting Nationals! He still trains and competes occasionally, despite his busy schedule.
A polynomial function is a function comprised of more than one power function where the coefficients are assumed to not equal zero. The term with the highest degree of the variable in polynomial functions is called the leading term. All subsequent terms in a polynomial function have exponents that decrease in value by one.
I want to talk about Polynomial functions. Now the definition of a Polynomial function is written on the board here and I want to walk you through it cause it is kind of a little bit theoretical if a polynomial functions is one of the form p of x equals a's of n, x to the n plus a's of n minus 1, x to the n minus 1 plus and so on plus a's of 2x squared plus a of 1x plus a's of x plus a's of 0.
Where the numbers a's of i are constants and n is non negative integer. Now what is a polynomial it's really just a finite sum of power functions. Each of these guys here is a power function right? You've got x to sum integer power times a coefficient some constant.
And there may be so many constants that I need to number them with an index I can't just go a to z assuming that there are 26 of them. So it's always some constant number times x to an integer power. Now the number n you know when we write it in this form with descending power the number n is called the degree of the polynomial that's the highest power of x that you find in the polynomial.
And the term with the highest power of x is called the leading term right. All of these are terms of the polynomial but this is the leading term even if it's not written first. The term with the highest power backs is the leading term. And ace of n the number in front is the leading coefficient. So let's take a look at some examples, I got 5 examples here, f of x equals 12x-5 this is a polynomial right? Constant times x to a power, to the power 1 minus constant times x the power of 0. The leading coefficient here is 12 right the leading term is 12x so the leading coefficient is 12 and the degree, that's the power of the highest power of x is 1 so this is a degree 1 polynomial.
g of x, 2x squared minus 5x+6, this is the leading term, this is the term with a highest power of x, the leading coefficient is 2 and the degree the power of the highest power of x is 2 so quadratic right? Functions that are, polynomial functions with degree 1 or a linear, linear functions and with degree 2 quadratic.
Now what about this one h of x equals 4x cube minus x of the 4. Here the term with the highest power of x is negative x to the fourth, this is the leading term and so the leading coefficient would be minus 1. Don't forget this minus cancels the coefficient, so negative 1 and the degree would be 4. A constant function k of x equals 9, this is still a polynomial because we think of it as 9 times x to the 0, so the leading coefficient would be 9 and if you think of this as 9 times x to the 0 the degree is 0 this is a 0 degree polynomial. All constant functions are 0 degree polynomials.
Now m of x is not written in expanded format it's written in factored form, so we have to figure out what the leading term is going to be. I don't have to multiply this all out I just need to multiply enough to get the leading term which is 3x cubed right? This is going to give me the leading term, the highest power of x. So the leading coefficient will be 3 and the degree will be 3 so that's what we call a cubic polynomial. So remember polynomials are basically just finite sums of power functions right? Constant times x to an integer power and the leading term is really important, the leading terms determines the end behavior of the polynomial as we'll see and so we need to be able to find out the leading coefficient and the degree of the polynomial in order to determine it's shape.


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1. Tap the menu button, then Settings.
2. From the 'Settings' screen, go to 'Applications' by tapping on 'Applications'.
3. From the 'Application settings' screen, go to 'Development' by tapping on 'Development'.
4. On the 'Development' screen tap the check box next to 'Allow mock locations.
How do I disable location mocking settings on my Android device?
1. Tap the menu button, then Settings.


text:
The Cyber Intelligence Sharing and Protection Act (CISPA), a controversial cyber threat information-sharing bill, will be debated on the floor of the U.S. House of Representatives this week, despite continued opposition from some privacy and digital rights advocates.
The House will begin debate on the bill Wednesday at about 10 a.m. Debate will continue into Thursday, when a vote on the legislation is expected, according to the House Intelligence Committee. The committee voted 18-2 last Wednesday to approve the amended bill and send it to the House floor.
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CISPA would allow private companies, including Internet service providers, banks, and e-commerce sites, to share a wide range of customer information they believe is related to cyberthreats with U.S. agencies like the National Security Agency and the Department of Homeland Security.
The bill would give those businesses protections from lawsuits for sharing customer information, but it does not require companies to make reasonable efforts to remove unrelated private information from the cyber threat information they share.
Privacy and digital liberties groups have objected to the provisions in CISPA that would allow companies to share customer information with the NSA. The committee rejected efforts to keep cyber security authority in civilian agency hands, Gregory Nojeim, senior counsel at the Center for Democracy and Technology, said in an email.
"CISPA ... would overturn 20 years of civilian control of the government's cybersecurity efforts for the .com sector and house them in a secretive military intelligence agency," Nojeim added.
The committee did adopt an amendment last week that limited the shared information from being used for national security purposes unrelated to cyber security, and Nojeim praised that decision. But "the failure to ensure continued civilian control of cybersecurity ensures continued opposition of the civil liberties community to CISPA," he added.
The American Civil Liberties Union (ACLU) also maintained its opposition to the bill after last Wednesday's committee vote. "The changes to the bill don't address the major privacy problems we have been raising about CISPA for almost a year and a half," Michelle Richardson, legislative counsel at the ACLU's Washington legislative office, said by email. "CISPA still permits companies to share sensitive and personal customer information with the government and allows the National Security Agency to collect the internet records of everyday Americans."
The sharing of personal information with the NSA will "not protect critical infrastructure from intrusion and attack," she added.
The committee took several steps to protect privacy during votes on amendments, supporters said. The committee accepted an amendment that prohibits companies from counterattacking, or hacking back, cyber attackers after digital rights groups raised concerns that the bill's language could allow such activity.
Another amendment would limit the private sector's use of any cyber security information received to only cyber security uses.
Several tech trade groups praised the legislation. "There is a pressing need to bolster America's ability to prevent cyber attacks," said Robert Holleyman, president and CEO of the BSA, a software trade group, said.
Several amendments made to the bill will protect privacy, Holleyman said in a statement. "BSA firmly believes that increased cyber security does not have to come at the expense of privacy or civil liberties," he added. "On the contrary, increased security can enhance citizens' privacy by preventing private information from ending up in the hands of cyber criminals."
A version of CISPA passed the House by a vote of 248-168 a year ago, but the bill failed to advance through the Senate. President Barack Obama, citing privacy concerns, threatened a veto of that version, and the White House National Security Council has raised concerns about this year's version of the bill.
Grant Gross covers technology and telecom policy in the U.S. government for The IDG News Service. Follow Grant on Twitter at GrantGross. Grant's e-mail address is firstname.lastname@example.com.


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How to Build a Latticework Porch TrellisUpdated: Jun. 13, 2023
Create a beautiful partition of privacy for your front porch.
You might also like: TBD
- Time
- Complexity
- Cost
- Multiple Days
- Intermediate
- $51–100
Porch Trellis overview: Time, tools and materials
Like lace curtains on an interior window, this latticework trellis offers the best of both worlds: It gives the illusion of privacy, but at the same time, it allows a connection between the outdoors and in. And its graceful pattern blends in beautifully with any setting.
At first, you might ask, "Why not use ordinary diamond-shaped lattice for the main structure?" Although this porch lattice project might be easier to assemble using ordinary overlapping garden lattice, it would look clunky and out of proportion. Our porch lattice is constructed with lap joints for a flat, even surface, and its tall rectangular openings are designed to complement the tall oval cutout.
Before you start, measure the height of your porch opening. You may have to adjust our measurements to fit your situation. Although this design works best for homes with front porches, you could adapt it for use in smaller front entries or even as a garden trellis.
Since you'll be painting this porch lattice project, you could use almost any kind of wood. But to ensure its longevity, we recommend a naturally decay-resistant wood like cedar, redwood, cypress or treated pine. We used cedar because it was locally available. Once you decide on wood, buy straight pieces of lumber that are as knot-free as possible. Knots will weaken the lattice, especially at the lap joints.
This project is time-consuming. Plan to spend a day making the jig, routing and cutting the pieces, plus a couple of hours the next day assembling it. You'll spend a third day sanding, priming and painting.
You'll need special router bits, basic tools and router know-how. You should have some router experience under your belt before you try this project. Beyond that, assembling the parts is easy, somewhat like building a fence.
For each router operation pictured, we'll show or describe the type of bit we used. You also need a table saw, jigsaw, router and doweling jig (or a biscuit joiner), along with basic carpentry tools such as a hammer, handsaw, circular saw, framing square, tape measure and drill.
Figure B: Porch Trellis
You can download Figure B and print it. Go to 'Additional Information' below.
Step 1: Mass produce the lap joint dadoes
Photo 1: Rout the dadoes
Lock your 1×6 workpiece into the jig (see jig dimensions below) with wedges. Be sure the jig is screwed to the workbench. Align the center mark of your lap joint with the center of the jig. Set the depth of your top bearing straight flute bit to make a 3/8-in. deep dado.
Cut the lattice pieces and rout the lap joints first. Lap joints can be made several ways, but building this simple jig and using a top-bearing straight flute bit is the most efficient because we also use the same bit for making the oval blanks. Follow the instructions in Fig. A to make your lap joint jig.
You'll notice that in Photo 2 the dadoes for the lap joints are first routed into 1×6 boards and then the boards are ripped (cut lengthwise) into individual strips that make up the lattice. This method will improve your accuracy and make this tedious task go quickly.
To accurately locate your lap joints, mark the centers of joints (see Fig. B) on the 1×6 pieces that make up parts A and B (see Cutting List). Later, you'll align these center marks with the center of the jig. But before you rout these joints, try out your jig. Routing these joints can be a little tricky, so practice on a scrap piece of 1×6.
To begin, screw the jig to your work surface. Tap the wedges (Photo 1) with a hammer to hold the workpiece firmly in the jig. Set your router so the bit will cut half the depth (about 3/8 in.) of the 1×6. Rout along the left side of the jig about 1/2 in. into the workpiece. Pull the router back toward you and then rout slowly against the right side of the jig. You're just establishing the front left and right boundaries of the dado. This is necessary to prevent tear-out of the edges. Now rout along the left side until the router base hits the stop, then move the router from left to right against the stop and pull the router back toward you along the right side of the jig.
You'll find a patch of wood left in the middle; remove this by taking a few more passes. Now that you've got the feel of routing the dadoes, wedge your workpiece into the jig and rout the dadoes for all the pieces. Be sure you tap the wedges into place with a hammer to hold the workpiece firmly against the jig. Any shift in the workpiece will spell disaster.
Figure A: Jig for Routing Lap Joints
Use this simple jig and rout all the lap joints perfectly in less than two hours. Use scrap hardwood to build your jig, and make sure the parts are square. Soft wood like cedar, redwood or pine will wear too quickly and make the joint less accurate with each pass. Screw the jig to your workbench. Leave enough space to the right and left of the jig to slide the long pieces (A) through as you rout the dadoes.
Note: You can download Figure A and print it. Go to 'Additional Information' below.
Step 2: Cut the lattice strips to width
Set your table saw to rip the lattice into three equal 1-3/4 in. strips. Since the 1×6 is 5-1/2 in. wide, you'll get three 1-3/4 in. wide strips from each 1×6 using a 1/8-in. kerf saw blade. Make adjustments if your 1×6 is a hair narrower than 5-1/2 in. Even if your strips end up 1/16 in. narrower, the assembly will still work.
Note: Use caution as you rip the pieces on your table saw. You'll find the workpiece will glide easily through the routed areas and resist a bit where it's not routed, causing a jerky rip. Keep your hands a safe distance from the blade.
Step 3: Assemble the lattice with adhesive and nails
Find some elbow room, preferably a flat area on the floor (Photo 3), to assemble the lattice. Lay out the long pieces (A) with the dadoes facing up.
Tip: Test the depth of your dadoes by assembling two test pieces. They should be flush when you put them together.
Put a dab of construction adhesive in the middle of each bottom dado and tap the shorter pieces (B) into the longer pieces. Next, install the top horizontal strip to keep the spacing uniform from top to bottom. Glue and tap each horizontal strip into place until the lattice is complete.
To firmly bond the lap joints, nail the intersections together with galvanized finish nails. I couldn't find 5/8- in. long galvanized nails, so I nipped my nails to the right length using a side-cutting pliers (Photo 3).
An air nailer that shoots small rust-resistant nails will really speed the process. Use two nails at each lap joint. Make sure all the joints are pinned tightly, then set the assembly aside.
Step 4: Make a frame around the lattice
Rip the frame pieces (C, D and E) 2-1/2 in. wide from 1×6 board. Cut them to length (see Cutting List, below). Also rip 7/8-in. wide shims (Photo 4) from 1×6 board and set them under the lattice.
The shims elevate and center the lattice to the frame, making alignment and nailing easier. Nail the frame sides, top and bottom to each leg of the lattice. Use 4d galvanized box nails. Also nail the intersecting corners of each frame piece.
Step 5: Cut and install the cornice
The curved 1×8 pieces (E) at the top and the outer corbels (F) make up the cornice (Fig. B). Cut pieces E to length. Set them in place as shown in Photo 5.
Measure 50-3/4 in. down from the top of D along the center of the middle strip. Drive a 4d nail 1/2 in. deep at that point. Cut a piece of wire about 5 ft. long. Twist one end of the wire around the nail and the other around a pencil to make a 48-in. arc onto E, as shown.
Cut along your curved mark with a jigsaw, then trace it onto the other 1×8 piece and cut it for the other side. Use the cutout portion to trace the curve onto the 8-in. long corbel pieces (F). Cut the curves of the corbels with a jigsaw. To complete the cornice, nail the pieces you've just cut as shown in Fig. B.
Step 6: Make an oval template from hardboard
Photo 6: Lay out the oval
Make your oval template from 1/4-in. hardboard (often referred to by the brand name Masonite). Mark the focal points of your oval and tie a string or thin wire around the nails.
Photo 7: Scribe the oval
Remove the nail at point C, insert your pencil and scribe the shape. Keep the string (or wire) taut but not so tight as to stretch it.
Remember how it felt when you skipped your first rock across a pond? Well, setting up and then drawing the oval will evoke a similar feeling. You'll soon want to try this new skill on other projects. I'm thinking of using the same technique to lay out an oval-shaped perimeter for a flower garden.
To make the oval template, you'll need to buy a 2 x 2-ft. piece of 1/4-in. thick hardboard from a home center. Mark a line down the middle of the width and the length as shown in Photo 6. Pound 1-1/4 in. nails into the hardboard at the locations shown. Twist a piece of 28-gauge wire (we used brightly colored string for photo clarity) around the nails. Keep a consistent firmness on the wire as you trace. Follow the instructions in Photos 6 – 8.
Then carefully cut out your template with a fine-tooth blade in your jigsaw. Make your cut as exact as possible. After cutting out the oval template, sand any irregularities along the edges because, as you later guide your router along the edge, any imperfections will be duplicated.
Figure C: Laying out an oval
Making an oval or ellipse is fool-proof. All you need is a square, a few nails, string and a pencil. Ovals, or ellipses, follow a simple mathematical principle. F1 and F2 are called foci. To make your ellipse, establish the length AB and the width CD. Use half the length (AE or EB) to find the points F1 and F2. It's the same distance from C to F1 as it is from A to E. It's also the same distance from C to F2 as it is from A to E or from E to B.
Note: You can download Figure C and print it. Go to "Additional Information" below.
Step 7: Build the multi-piece oval
Photo 9: Dowel and glue the hexagonal segments
Dowel the pieces that make up the hexagonal blank that will later be transformed into the finished oval.
Tip: Don't take shortcuts here. This is the best way to glue up an oval blank.
Photo 10: Cut out the oval
Cut along the outside and inside of the template. Stay approximately 1/8 in. away from the edge of the template. You'll use a router with a top-bearing guide bit to get the oval blank to match the template exactly. See Photo 11.
Photo 11: Trim with a router
Trim the oval blank using the oval template as a guide. See text for tips on setting the bit and router.
Photo 12: Groove (rabbet) the outer edge
Route the outer edge of each oval blank. The routed edges make a groove to lock the ovals into the lattice.
Cut the pieces (G and H) for the two hexagonal-shaped blanks with your circular saw. The miters are exactly 30 degrees. Butt the pieces together, set your template over the pieces and trace around the template as shown in Photo 9. This tracing will show you where to drill for the dowels. If you have a biscuit jointer, this is the perfect time to use it. It'll give you a strong joint and save time.
If you're using a doweling jig, mark the 3/8-in. dowel locations about 3/4 in. apart and drill them using a self-centering doweling jig as shown. Using Tite-Bond II waterproof glue, glue the pieces together to form two hexagonal blanks. Make sure the joints are tight. Use a band clamp around the perimeter. A band clamp is a web that ratchets tightly around odd shapes. Set each of these assemblies aside on a flat surface to dry.
Once the glue is dry (overnight) nail the template over the blank. Use 3/4-in. common wire nails, one nail per section. Now cut the oval blank with your jigsaw, using the template as your guide, as shown in Photo 10. Cut 1/8 in. from the sides of the template.
Set up your router so the top of your bearing rides along the oval template. Be sure the bit is placed exactly. The bearing needs to ride along the top half of the template for the cutting portion of the bit to cut the wood blank.
Note: If the bit is too low, the wood surface won't cut the top edge of the wood completely. If the bit is too high, it'll jump onto the template surface.
To begin routing the wood blank flush with the template, first clamp the template and blank to the bench, leaving a bit less than half overhanging your bench as shown in Photo 11.
Normally you'd cut counterclockwise around the outside of the template, but that can cause tear-out on the blank. Rout clockwise on the outer side of the template and counterclockwise on the inside. Once you've got it routed, go back over the piece in the opposite direction for a final close shave. Keep the router tight to the top of the template and move slowly!
Now that you've got the two oval blanks cut, stack them. Make sure they're exactly the same. You may have to flip one end for end to match them. Once they're matched, mark the outer surface of each blank. Flip the blank over and rout a 3/8-in. x 3/8-in. rabbet on the outer edge (Photo 12). Here again, go clockwise to avoid tear-out. These rabbets will fit into the lattice once you mark and cut the lattice.
Step 8: Mark and cut the oval hole in the lattice
Lay one of the oval blanks onto the lattice. Make sure the center of the oval intersects with the third horizontal lattice strip from the top and is centered from left to right. Trace the outside of the oval blank. Next, tape two pencils together (Photo 13) with a 1/8-in. shim between them.
Now use this setup to trace your original mark while simultaneously drawing an inner mark. Cut along the inner mark with your jigsaw.
Step 9: Add the keystones, install the oval and paint the project
The wooden keystones on the top and bottom of the oval blank are purely decorative, of course, but give the ovals a distinctive traditional look. To make them, you'll need to resaw a 4-in. wide piece of lumber on your table saw from 3/4 in. to 1/2 in. thick.
For safety, use a 4-ft. long board, push it through the saw, flip it end for end and run the other side through the saw. Take your time. Once the piece is resawed, cut 4-in. long pieces and then mark a 10-degree angle on each side (Fig. B) and cut the angled marks. This cut is easy to make with a 10-in. power miter saw, but a handsaw works fine.
Glue the keystone parts to the top and bottom of each oval blank with construction adhesive. Also nail them to the wood oval surface with a pair of 4d galvanized finish nails, snipped to 1 in. long.
Then stand the lattice up and put the two halves of the oval into the opening. Screw them together with four 1-1/4 in. deck screws to lock the oval into the opening.
While the trellis is propped up, prime and paint it. If you have spray-painting equipment, don't hesitate to use it. I primed and painted everything with a brush and liked the results, but halfway through I wished I'd sprung for that spray equipment last year.
If you're brushing, keep your eye out for runs and catch them as they show up. Use the best exterior latex you can find; it'll last much longer than the cheap stuff.
Tip: If you make your trellis from redwood or cedar, use a stain-blocking primer to eliminate any bleed-through.
I hung the top of the lattice from the outside header of my porch with 3/8-in. eye screws and hooks and secured the bottom with screen door hook and eyes screws. Every situation is different, so explore at your hardware store to find what will work best for you.
Additional Information
- Figure A: Jig detail
- Figure B: Porch trellis
- Figure C: Laying out an oval
- Trellis Shopping List
- Trellis Cutting List
Required Tools for this Porch Lattice Project
Have the necessary tools for this DIY project lined up before you start—you'll save time and frustration.
- Band clamp
- Caulk gun
- Circular saw
- Clamps
- Drill/driver - cordless
- Framing square
- Hammer
- Handsaw
- Jigsaw
- Router
- Side cutting pliers
- Table saw
- Tape measure
- Waterproof glue
Required Materials for this Porch Lattice Project
Avoid last-minute shopping trips by having all your materials ready ahead of time. Here's a list.
- Construction adhesive
- Paint
- Primer


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Figure 1. Maps of t statistics depict significant cortical thinning in attention-deficit/hyperactivity disorder (ADHD). A, Significant cortical thinning in the probands with ADHD (n = 59) vs comparison participants (n = 80). B, Significant cortical thinning in probands with persistent ADHD (n = 17) vs the non-ADHD comparison group (n = 57). The false discovery rate (FDR) threshold depends on the data and is different for the right and left hemispheres. The t statistics at the lowest FDR threshold are projected across each hemisphere for each comparison.
Figure 2. Exploratory uncorrected analyses (P < .05) reveal regions in which probands with remitting attention-deficit/hyperactivity disorder (ADHD) (n = 27) exhibit thicker cortex than in probands with persistent ADHD (n = 17). Peaks and coordinates of clusters are depicted in eTable 7 at the authors' Web site.
Figure 3. Comparison participants (n = 80) exhibit greater gray matter density (left) and cortical thickness (right) in the bilateral dorsal attentional network than in probands (n = 59) with childhood combined-type attention-deficit/hyperactivity disorder. Images are per radiological convention; thus, right is left and left is right. FDR indicates false discovery rate.
Figure 4. Voxel-based morphometry reveals that comparison participants (n = 80) exhibit significantly greater gray matter density (false discovery rate [FDR] < 0.05) in the right ventral caudate, right thalamus, and bilateral cerebellum than in probands (n = 59) with childhood combined-type attention-deficit/hyperactivity disorder. Images are per radiological convention; thus, right is left and left is right.
Customize your JAMA Network experience by selecting one or more topics from the list below.
Proal E, Reiss PT, Klein RG, et al. Brain Gray Matter Deficits at 33-Year Follow-up in Adults With Attention-Deficit/Hyperactivity Disorder Established in Childhood. Arch Gen Psychiatry. 2011;68(11):1122–1134. doi:10.1001/archgenpsychiatry.2011.117
© 2023
Author Affiliations: Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience (Drs Proal, Reiss, Ramos-Olazagasti, Kelly, Milham, and Castellanos and Ms Gotimer) and Anita Saltz Institute for Anxiety and Mood Disorders (Drs Klein and Mannuzza), Child Study Center, New York University Langone School of Medicine, New York, New York; Unitat Recerca en Neurociència Cognitiva, Universitat Autònoma de Barcelona, Barcelona, Spain (Dr Proal); Nathan Kline Institute for Psychiatric Research, Orangeburg, New York (Drs Reiss, Mannuzza, Milham, and Castellanos); Department of Neurosciences and Mental Health, The Hospital for Sick Children, and Department of Medical Biophysics, University of Toronto, Toronto, Ontario (Dr Lerch); State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China (Dr He); and Biospective Inc, Montreal, Quebec (Drs He and Zijdenbos).
Context Volumetric studies have reported relatively decreased cortical thickness and gray matter volumes in adults with attention-deficit/hyperactivity disorder (ADHD) whose childhood status was retrospectively recalled. We present, to our knowledge, the first prospective study combining cortical thickness and voxel-based morphometry in adults diagnosed as having ADHD in childhood.
Objectives To test whether adults with combined-type childhood ADHD exhibit cortical thinning and decreased gray matter in regions hypothesized to be related to ADHD and to test whether anatomic differences are associated with a current ADHD diagnosis, including persistent vs remitting ADHD.
Design Cross-sectional analysis embedded in a 33-year prospective follow-up at a mean age of 41.2 years.
Setting Research outpatient center.
Participants We recruited probands with ADHD from a cohort of 207 white boys aged 6 to 12 years. Male comparison participants (n = 178) were free of ADHD in childhood. We obtained magnetic resonance images in 59 probands and 80 comparison participants (28.5% and 44.9% of the original samples, respectively).
Main Outcome Measures Whole-brain voxel-based morphometry and vertexwise cortical thickness analyses.
Results The cortex was significantly thinner in ADHD probands than in comparison participants in the dorsal attentional network and limbic areas (false discovery rate < 0.05, corrected). In addition, gray matter was significantly decreased in probands in the right caudate, right thalamus, and bilateral cerebellar hemispheres. Probands with persistent ADHD (n = 17) did not differ significantly from those with remitting ADHD (n = 26) (false discovery rate < 0.05). At uncorrected P < .05, individuals with remitting ADHD had thicker cortex relative to those with persistent ADHD in the medial occipital cortex, insula, parahippocampus, and prefrontal regions.
Conclusions Anatomic gray matter reductions are observable in adults with childhood ADHD, regardless of the current diagnosis. The most affected regions underpin top-down control of attention and regulation of emotion and motivation. Exploratory analyses suggest that diagnostic remission may result from compensatory maturation of prefrontal, cerebellar, and thalamic circuitry.
Volumetric studies in children with attention-deficit/hyperactivity disorder (ADHD) have consistently found global reductions of total brain volume, with the prefrontal cortex, anterior and posterior cingulate cortex, basal ganglia, cerebellum, and parietotemporal regions particularly affected relative to typical development in healthy children.1-4 These findings are consistent with a model of ADHD as a disorder of frontal-striatal-cerebellar circuitry. The diagnosis of ADHD requires onset in childhood, but persistence of ADHD into adulthood is now well documented.4,5 This longitudinal course combined with smaller brain volumes in children with ADHD have raised questions about brain development into adulthood.
A sparse literature on brain anatomy in adults with ADHD also reports decreased volumes in the orbitofrontal cortex,6 anterior cingulate cortex (ACC),7,8 dorsolateral prefrontal cortex,7 superior frontal cortex, and cerebellum.9 Complementary analyses of cortical thickness10 reveal overall decreased cortical thickness in children10-13 and adults with ADHD, with reductions in ACC, medial frontal regions, and parietotemporo-occipital cortex.11-13 Recently, Almeida et al14 found cortical thinning in the right frontal lobe of children, adolescents, and adults with ADHD.
Investigations of structural brain abnormalities in adults, for want of a better method, have relied on adults' retrospective recall of their childhood status.6-9,15-19 The documented inaccuracies of such reports20 highlight the advantage of assessing brain anatomy in individuals with established childhood-onset ADHD prospectively followed up into adulthood. In addition, clinical ADHD remits in a substantial proportion of individuals followed up into adulthood21,22; however, to our knowledge, the neurobiological mechanisms of remission have not been previously examined in middle adulthood.
We report cortical thickness and voxel-based morphometry (VBM) analyses in the largest sample to date of adults with childhood ADHD diagnoses (mean age, 8.3 years) consistent with DSM-IV. Follow-up assessments occurred at the mean ages of 18.4, 25.0, and 41.2 years (18FU, 25FU, and 41FU, respectively). At the 18FU, a comparison group free of childhood ADHD and matched for age, sex, ethnicity, and childhood social class was recruited.21,23-26 Systematic diagnostic assessments at each follow-up were conducted by interviewers blinded to history and group membership. At the 41FU, we conducted anatomic brain magnetic resonance imaging (MRI) in probands with childhood ADHD and a comparison group. We performed analyses based on childhood diagnosis and current diagnostic status in adulthood. Our primary aims were (1) to test whether adults with a childhood diagnosis of combined-type ADHD (probands), relative to the comparisons group, exhibit cortical thinning and decreased gray matter (GM) volume in regions hypothesized to be related to ADHD11-13,17 and (2) to assess whether anatomic differences are associated with a current ADHD diagnosis.
The ADHD group originally included 207 white boys aged 6 to 12 years who were referred to a research clinic from 1970 to 1977 (mean age, 8.3 years). Briefly, they were referred by schools because of behavioral problems and had elevated parent and teacher ratings of hyperactivity, an IQ of at least 85, and a diagnosis of hyperkinetic reaction of childhood.27,28 Children with a pattern of aggressive or antisocial behavior were excluded to rule out comorbid conduct disorder. Further details of proband characteristics appear in previous publications.26,29 These participants underwent assessment at mean (SD) ages of 18.4 (1.3), 25.0 (1.3), and 41.2 (2.7) years. Comparison male participants (n = 178) were recruited at the 18FU. Medical center pediatric medical records were reviewed for children undergoing routine physical examinations from 1970 through 1977 at 6 through 12 years of age, group matched for the probands' race, childhood socioeconomic status, and geographical residence. Parents of suitable children (by then adolescents) were telephoned, informed of the study, and recruited, conditional on parent interest and no reported teacher complaints about their child's behavior in elementary school. The refusal rate was low (about 5%).
On average, 33 years after the initial childhood diagnosis, clinical data were obtained for 135 male probands (65.5% of the original sample, 70.3% of those living) and 136 male comparison participants (76.4% of those recruited in adolescence, 78.6% of those living). Major DSM-IV disorders and multiple aspects of function were assessed for the interval from the 25FU to the 41FU by trained clinicians blinded to all antecedent data. A special interview, the Assessment of Adult Attention-Deficit/Hyperactivity Disorder, was developed for diagnosing DSM-IV ADHD in adults (the Instrument and a supplementary Description are available at the authors' Web site at http://www.AboutOurKids.org/Research/Research_Publications/Proal_et_al_2011). Current ADHD was defined as meeting DSM-IV criteria during the preceding 6 months. Participants were invited to take part in an anatomic MRI study. Owing to refusals and MRI exclusions (Table 1), we obtained MRIs in 59 ADHD probands and 80 comparison participants. Nearly all probands (57 [97%] of those scanned) were treated with methylphenidate hydrochloride in childhood from ages 6 to 12 years for an average of 2.2 years.30 eTable 1, available at the authors' Web site, gives further details of childhood medication treatment, including thioridazine hydrochloride.26) All participants provided written informed consent as approved by the New York University Langone School of Medicine institutional review board.
To test whether cortical thickness differed as a function of current ADHD, we subdivided probands into the following 3 subgroups: (1) those who met diagnostic criteria for DSM-IV ADHD at the 41FU (persistent ADHD group; 17 participants, including 7 with predominantly inattentive, 6 with predominantly hyperactive/impulsive, and 4 with combined-type ADHD); (2) those who did not (remitting ADHD group; 26 participants); and (3) those diagnosed as having ADHD not otherwise specified (ADHD-NOS group; 16 participants) (see the supplementary Methods available at the authors' Web site). The comparison group was dichotomized into individuals who did not meet criteria for any type of ADHD (non-ADHD comparison group; 57 participants) and those who were diagnosed with ADHD-NOS (comparison group with ADHD; 23 participants). Although all probands and all comparison participants were included in initial vertexwise and VBM analyses, subgroup analyses focused on current diagnostic status. Accordingly, probands and comparison participants with current ADHD-NOS, which is not well-defined and did not differ between groups (16 of 59 [27%] and 23 of 80 [29%], respectively), were excluded from subgroup analyses.
We obtained 41 anatomic T1-weighted images in 20 ADHD probands and 21 comparison participants using a scanner with an 8-channel head coil (3T Siemens Trio; Siemens Medical Solutions USA Inc, Malvern, Pennsylvania) and 98 scans in 39 ADHD probands and 59 comparison participants using a scanner with a single-channel head coil (3T Siemens Allegra; Siemens Medical Solutions USA Inc). Proportions did not differ significantly across scanners, (χ21 = 0.96, P = .33), with the following parameters: repetition time, 2100 milliseconds; flip angle, 12°; slice thickness, 1.5 mm; inversion time, 1100 milliseconds; matrix, 192 × 256; and field of view, 172.5 mm. The only parameter that differed was echo time, which was 3.87 milliseconds on the Trio scanner and 3.90 milliseconds on the Allegra scanner.
Structural MRIs were preprocessed through the fully automated CIVET–Montreal Neurological Institute (MNI) pipeline.31-34 The initial preprocessing step was to mask MRI native images using an automated brain extraction method.35 Data were corrected for nonuniformity artifacts and registered to stereotactic space (MNI152) using a 9-parameter linear transformation. Voxelwise tissue type classification was performed using a neural network classifier followed by a partial volume estimation step.33,36
For VBM, the classified tissue maps were blurred with a gaussian kernel of 10 mm full width at half maximum. Cortical thickness measures were assessed using a fully automated algorithm that defines the distances between a set of vertices at the white matter (WM) surface and then expands outward to find the intersection with GM to generate surface meshes that represent WM and GM interfaces.37 A total of 40 962 linked vertices were calculated per hemisphere. Each individual cortical thickness map was blurred using a 30-mm surface-based diffusion-smoothing kernel to reduce noise while preserving anatomic location, as this method produces less volumetric blurring than the equivalent gaussian kernel.38
We obtained a single global cortical thickness value for each participant by averaging across all 81 924 vertices. Linear regression models controlled for age at the time of imaging and for the scanner model (Trio vs Allegra).
Following the study aims, group analyses tested for regional differences in cortical thickness and GM density between (1) all adults with a childhood diagnosis of combined-type ADHD and all comparison groups; (2) persistent ADHD vs the non-ADHD comparison group; (3) remitting ADHD vs the non-ADHD comparison group; and (4) participants with persistent vs those with remitting ADHD. For each comparison, we regressed cortical thickness at each of 81 924 vertices or whole-brain GM density on group, controlling for age at the time of imaging and for the scanner model. The software package mni.cortical.statistics (Brain Imaging Centre, MNI; http://www.bic.mni.mcgill.ca) for the R environment39 was used for cortical thickness analyses, and the FMRIB Software Library (available at http://www.fmrib.ox.ac.uk) tool Feat, for VBM. Results were thresholded using a false discovery rate (FDR) of 0.05.40,41 Maps of t statistics for group effects on cortical thickness at each vertex or GM density at each voxel were projected onto an average brain template revealing clusters that differed significantly between groups. We retained clusters comprising at least 50 contiguous vertices for cortical thickness42 and 5 voxels for VBM.
To test whether childhood or current ADHD was associated with significant differences in specific regions, we performed post hoc region-of-interest–based analyses. For each participant, we computed the mean cortical thickness or GM density within each cluster exhibiting significant (FDR < 0.05) group differences in primary analyses by averaging across all vertices or voxels within each cluster. We then compared the diagnostic subgroups of probands (participants with persistent and those with remitting ADHD) and the comparison group without current ADHD, Bonferroni corrected for the number of clusters. For completeness, eTable 2 (available on the authors' Web site) contains means and SDs for the subgroups with current ADHD-NOS.
To further investigate primary hypotheses for which no vertices with FDR of less than 0.05 were found, we reexamined subgroup differences heuristically using an uncorrected threshold of P < .05 with a cluster threshold of 50 vertices.42 Because of significant between-group differences in IQ, we confirmed cortical thickness results by also adjusting for IQ.
Table 1 summarizes the derivation of the sample. A larger proportion of comparison participants (80 of 178 [44.9%] originally enrolled participants) than probands (59 of 207 [28.5%]) had analyzable MRIs. This discrepancy reflects a significantly higher rate of unavoidable factors in probands (55 of 207 [26.6%]) (ie, deaths, incarcerations, and MRI exclusions) than in comparison participants (22 of 178 [12.4%]) (χ21 = 12.08; P < .001). By contrast, rates of refusal and failure to schedule or to locate study participants did not differ significantly (93 of 207 probands [44.9%] vs 76 of 178 comparison participants [42.7%]). Accordingly, results are based on anatomic images from 59 ADHD probands and 80 comparison participants.
We compared diagnoses and demographic information at the 18FU of participants who underwent scanning and those who did not (data were available for 57 of 59 probands and for all 80 comparison participants; see eTable 3, available at the authors' Web site). Within the proband and comparison groups, individuals who did and did not undergo scanning did not differ significantly on prevalence of ADHD, antisocial personality disorder, mood or anxiety disorders, any DSM-III disorders, age at referral, IQ, socioeconomic status, or Teacher Conners Hyperactivity Factor score. However, probands undergoing scanning had significantly higher rates of alcohol and nonalcohol substance use disorder and any substance use disorder than did probands who did not undergo scanning (see eTable 3, available at the authors' Web site).
Probands and comparison participants did not differ significantly in age at the time of imaging or in lifetime prevalence of substance abuse or dependence (Table 2). As expected, probands and comparison participants differed significantly in IQ in childhood and 41FU assessments (see eTable 5, available at the authors' Web site, for demographics of subgroups based on current diagnosis and for current substance use and comorbid diagnoses).
Surfacewide mean cortical thickness was significantly lower in probands (n = 59) than in comparison participants (n = 80) (mean [SD], 3.18 [0.11] and 3.24 [0.11] mm, respectively; P < .001 in regression controlling for age and scanner; Cohen d = 0.54). At the 41FU, probands with persistent ADHD differed significantly from the non-ADHD comparison group (3.14 [0.13] and 3.25 [0.10] mm, respectively; P < .001; Cohen d = 1.02). The remitting ADHD group (3.20 [0.11] mm) also differed from the non-ADHD comparison group in overall cortical thickness (P = .04; Cohen d = 0.48). However, participants with persistent ADHD and those with remitting ADHD did not differ significantly (P = .10; Cohen d = 0.51).
Figure 1A displays the multiple clusters of vertices (detailed in Table 3) for which the cortex was significantly thinner (surfacewide FDR < 0.05) in ADHD probands; the largest cluster extended from the right precuneus to the precentral gyrus. Other right hemisphere clusters were located in the inferior parietal lobe, temporal pole, and insula. Left hemisphere clusters were located in the superior frontal gyrus/frontal pole, precentral gyrus, insula, temporal pole, and cuneus. There was no instance in which cortical thickness was significantly increased in probands. As shown in eFigure 1 and eTable 6 (available at the authors' Web site), after covarying for IQ (in addition to scanner and age), significant cluster centers remained largely unchanged in location, but the clusters were less extensive.
To assess associations with current ADHD diagnosis, we performed vertexwise comparisons among the different diagnostic subgroups. The 17 individuals with persistent ADHD differed significantly from the 57 non-ADHD comparison participants in most but not all the regions identified in the initial inclusive analyses (Table 3 and Figure 1B). In addition, this analysis revealed thinner cortex related to persistent ADHD in the left medial occipital cortex and right subgenual ACC. When we used FDR < 0.05 as a threshold, participants with remitting ADHD (n = 26) did not differ significantly from the non-ADHD comparison group; participants with persistent ADHD and those with remitting ADHD also did not differ in any region at this threshold. There were no vertices at which cortical thickness was significantly associated with lifetime or current substance abuse diagnoses, dimensional measures of substance abuse, lifetime smoking history, or thioridazine treatment, and there were no significant interactions between group and scanner for any cortical or VBM measures.
To examine potential differences associated with remission from childhood ADHD, we focused on the clusters in which ADHD probands exhibited significantly thinner cortex than comparison participants (FDR < 0.05). Participants with remitting ADHD and those with persistent ADHD had a thinner cortex than did those in the non-ADHD comparison group, with medium to large effect sizes. Average effect sizes between individuals with persistent ADHD and the non-ADHD comparison group (Cohen d = 0.73) were larger than for participants with remitting ADHD (Cohen d = 0.52), although all confidence intervals overlapped (data not shown); individuals with persistent ADHD and those with remitting ADHD did not differ significantly from each other in any cluster at FDR < 0.05 (Table 3).
When vertexwise results were thresholded at P < .05 (uncorrected), we observed a thinner cortex for participants with persistent ADHD vs those with remitting ADHD in the insula, bilateral temporal cortex including the right temporal pole, left occipital Brodmann area (BA) 19, orbitofrontal cortex, and medial ACC (Figure 2; see also eTable 7, available at the authors' Web site). There were no regions exceeding our cluster size threshold of 50 vertices in which participants with remitting ADHD exhibited thinner cortex than those with persistent ADHD.
In the clusters that differentiated individuals with persistent ADHD from those with remitting ADHD in exploratory vertexwise analyses, participants with persistent ADHD differed markedly from the non-ADHD comparison group (average Cohen d = 0.75), whereas individuals with remitting ADHD did not (average Cohen d = 0.03; t9 = 8.26; P < .001). Relative to comparison participants, those with remitting ADHD had (nonsignificantly) greater cortical thickness in the left superior temporal gyrus extending to the insula and orbitofrontal cortex, left parahippocampus, left ACC, and left medial occipital cortex (see eTable 7, available at the authors' Web site).
As shown in Table 4 and Figure 3, GM density was significantly greater (FDR < 0.05) for comparison participants than for the ADHD probands in many of the same regions identified through cortical thickness analyses, as well as in subcortical regions inaccessible to cortex-based measures. Figure 4 displays decreased GM in probands in the right caudate, right thalamus, and bilateral cerebellar hemispheres. Voxel-based morphometric analyses of diagnostic subgroups or of medication treatment in childhood with methylphenidate or thioridazine did not yield significant results, even with more lenient thresholds (FDR ≤ 0.2).
In a prospective 33-year longitudinal follow-up of 59 probands (mean age, 41.2 years) with established ADHD in childhood and 80 prospectively enrolled non-ADHD comparison participants, we found an overall significant reduction in mean cortical thickness in the probands. Beyond this global difference, the greatest cortical thinning associated with childhood ADHD was located in the bilateral parietal lobes, temporal poles, insula, precentral gyri, frontal poles, and right precuneus. No cortical region was significantly thicker in probands than in comparison participants. Although less sensitive,44 VBM also revealed significantly decreased GM in probands vs comparison participants in the right precentral, bilateral parietal, left temporal, and right cuneus. In addition, VBM detected decreased GM in probands in the caudate, thalamus, and cerebellar hemispheres.
With respect to current adult diagnosis, probands with persistent ADHD differed the most from those in the non-ADHD comparison group in the same cortical regions identified in our primary analyses, as well as in additional clusters in the left medial occipital cortex and subgenual ACC. Probands with remitting ADHD did not differ significantly from those with persistent ADHD when analyses were corrected for full-brain comparisons. In exploratory uncorrected analyses, probands with persistent ADHD exhibited reduced cortical thickness relative to those with remitting ADHD in the bilateral medial occipital lobes, temporal lobes extending to the insula, and left parahippocampus.
Our results extend previous volumetric and cortical thickness findings in ADHD. First, consistent with the decreased total cerebral volume in ADHD,2-4 our observation of reduced global cortical thickness in probands with ADHD confirms previous reports.12,13,17 Furthermore, although we found less frontal and prefrontal cortical thinning in ADHD than were found in previous studies,11-14,17,45 we confirmed a thinner cortical mantle in the occipitoparietal,11,12,17 temporal cortex, and precentral regions12,13 in ADHD. In subcortical analyses, we also confirmed anatomic abnormalities in the caudate,3,46,47 thalamus,48,49 and cerebellum3 in ADHD.
Studies of cortical thickness in adults with ADHD have focused on specific regions associated with executive function and attentional control.50,51 Makris et al8 selected 9 parcellation units (from 48) per hemisphere and found thinner cortex related to ADHD in the prefrontal and cingulate cortex and inferior parietal lobe, albeit without correcting for multiple comparisons. A cross-sectional study of children, adolescents, and adults found that individuals with ADHD, regardless of age, had a significantly thinner right superior frontal cortex than controls.14 In the adults with ADHD, the specific reduction, with correction for multiple comparisons limited to the frontal lobe, was localized to BA9. In contrast, we did not find group differences in much of the prefrontal cortex but found widespread cortical thinning in the bilateral parietal-temporal cortex. We found similar results in analyses that included all participants, as well as in those limited to probands with persistent ADHD vs the non-ADHD comparison group. The latter contrasts are comparable to those of studies in adults that define group membership by current diagnostic status.14,17
Studies of cortical thickness in children with ADHD are more numerous than those in adults11-13,28,42,52,53 and typically have examined the entire cerebrum, although nearly all (except Shaw et al13) report results uncorrected for multiple comparisons. Thinner cortex has been reported in children with ADHD in the prefrontal and precentral regions,11,13 parietal and temporal lobes,11,12 and inferior frontal gyrus bilaterally.54 In our main analyses, we applied FDR full-brain correction for multiple comparisons and observed significant differences whether groups were defined by the initial childhood history or by the current adult diagnoses. We speculate that the robustness of our results reflects having established the diagnosis of ADHD in childhood as well as our medium to large sample sizes.
Broadly, our results implicate disruptions in large-scale neural systems involved in the regulation of both attention and emotion in adults with childhood ADHD. We found convincing converging anatomic evidence implicating the dorsal attentional network51 and distributed regions within limbic circuits that were thinner in ADHD probands than in comparison groups. Similar findings were obtained when we contrasted probands with persistent ADHD and the comparison group without ADHD. However, we failed to observe hypothesized group differences in prefrontal regions.1,3
First, we found widespread thinner cortex and decreased GM density in bilateral parietal and precentral regions, overlapping areas of the dorsal attentional network. The bilateral dorsal network, which mediates goal-directed, top-down executive control processes, interacts with a right-sided ventral system (stimulus-driven, bottom-up) during attentional functioning,1,51 particularly in redirecting attention. The core areas constituting the dorsal attentional network include the intraparietal sulcus and the conjunction of the precentral and superior frontal sulcus (frontal eye fields),51 which were particularly affected in the ADHD probands. Strikingly, we also observed significantly thinner cortex in the precuneus and superior parietal lobe, which along with the dorsal network core regions are implicated in top-down processing of shifting of attention.55 These findings are consistent with studies of ADHD that report abnormal patterns of activation in parietal regions48 during working memory,56-58 attentional,59-61 or response inhibition62,63 tasks.
We also found occipital cortical thinning in probands with persistent ADHD vs the non-ADHD comparison group. The occipital cortex has been recently found to interact with the dorsal network in maintaining attention55 and in suppressing responses to irrelevant stimuli.64,65 Individuals with ADHD are easily distracted when required to ignore extraneous signals.66,67 Top-down control deficits when responding to irrelevant stimuli are associated with impaired working memory.68,69 Abnormal activation of the occipital cortex has been found in youth70 and adults71-73 with ADHD during working memory tasks. Similarly, in a meta-analysis48 of functional imaging studies, children and adolescents with ADHD showed activation decreases in the left middle occipital gyrus (BA19) compared with controls. In addition, a recent VBM study in adults with ADHD found significant bilateral reduction of GM volume only in the early visual cortex.74
Our VBM analysis revealed cerebellar, thalamic, and striatal GM deficits in ADHD. Cerebellar involvement in ADHD is well established, with findings in children reported mostly in the vermis1-4,75 and in adults in the hemispheres, as in this sample.56,76,77 Early anatomic studies of ADHD did not specifically examine thalamic nuclei, although thalamic hypoactivation emerged in an unbiased meta-analysis.48 Recently, several studies have identified thalamic abnormalities in children and adolescents49,78 and in adults with ADHD.60,79
Second, our analyses revealed thinner cortex in probands, and particularly those with persistent ADHD, across multiple limbic regions, such as the temporal poles (BA38), insula (BA13), and subgenual ACC (BA25). The insula and ACC play important roles in sensorimotor, emotional, and cognitive function.80,81 Specifically, subgenual ACC is implicated in emotional processing and pain perception.82 In humans, subgenual ACC is functionally connected with multiple limbic regions, including the temporal poles83 and insula.84 In turn, the insula, along with participating in performance of demanding tasks,85 is clearly also related to affective processing.86 Abnormal activations in insula and subgenual ACC were reported in a meta-analysis of ADHD functional imaging.48
Cortical thickness studies in ADHD have downplayed findings in the temporal pole, which have been reported but not discussed.11-13 The temporal pole (BA38) is classified as a paralimbic region, based on its interconnections with the amygdala and orbitofrontal cortex, and is implicated in social and emotional processes.87 Altered activation in temporal pole is associated with deficits in face recognition88-95 and mentalizing, that is, the theory of mind.96-99 The temporal poles have been proposed as a channel for the integration of emotion and perception, playing an important role in emotional and social functions.87
Our findings are consistent with pathophysiological models of ADHD highlighting not only cognitive executive functions ("cool" processes) but also emotional and motivational deficits ("hot" processes).100 Anatomic spiraling circuits begin with emotional and motivational pathways that influence the cool cognitive processes, which in turn control motor responses.101 We observed thinner cortex in regions subserving emotional regulation (the temporal pole, insula, parahippocampus, and subgenual ACC) and top-down attentional regulation (the dorsal attentional network and medial occipital cortex). Furthermore, our exploratory analyses suggest that thinner cortex and diminished GM in the dorsal attentional network and limbic relay regions is related to the trait of having had ADHD in childhood, regardless of current diagnostic status.
Third, the lack of proband-comparison differences in the prefrontal cortex or the ACC was unexpected.7,8,16-18 To better understand possible differences between persistent and remitting ADHD, we performed uncorrected exploratory analyses. In regions in which we found suggestive differences, we observed remarkable congruence between probands with remitting ADHD and comparison groups in the left superior temporal gyrus, ACC, parahippocampus, and occipital cortical thickness as well as in thalamus and cerebellum GM density. We cannot rule out that probands with remitting ADHD may have differed from those with persistent ADHD in these regions since childhood, but the most parsimonious explanation is offered by the hypothesis that remission entails compensatory processes11,102 underpinned by prefrontal cortical maturation. Although we found supporting evidence of ACC and orbitofrontal involvement in diagnostic remission of ADHD, our data also suggest superior temporal, medial occipital, and thalamocerebellar involvement in remission.
Our findings must be interpreted in light of several limitations. First, despite our prospective longitudinal design, we examined brain imaging data only cross-sectionally in middle adulthood. Nevertheless, this is the largest sample of children with ADHD followed up into adulthood, obviating the unreliability of retrospective recall of childhood symptoms. In addition, we report on the largest sample to date of adults with confirmed childhood ADHD who underwent remission. We were able to analyze imaging data from only 28.5% of the original ADHD proband group and 44.9% of the original comparison participants. However, these probands and comparison participants did not differ from the original sample, and the probands studied did not differ significantly from those excluded on nearly all clinical and demographic variables except for significantly higher rates of substance use disorders at the 18FU in probands who underwent scanning. Nevertheless, we did not observe significant relationships between brain anatomic measures and substance use disorders. Finally, as is generally the case, our probands had significantly lower IQ scores than the comparison participants in childhood or adolescence and in adulthood. The issue of whether to covary for IQ in disorders such as ADHD is not settled.103 As shown in eFigure 1 (see also eTable 7, available at the authors' Web site), our principal findings of persistent differences in brain anatomy survived covarying for IQ even with conservative full-brain correction.
We were surprised by the rate of ADHD-NOS diagnosed in comparison participants, which was comparable to the rate in probands. We speculate that secular changes in the general public's awareness of ADHD may have contributed. Although we cannot rule out instrument-related error (see the supplementary Instrument available on the authors' Web site), the use of similar approaches did not yield high rates of ADHD symptoms in comparison participants in 2 previous blinded assessments.21,23 Nevertheless, analyses excluding ADHD-NOS did not alter results appreciably.
We limited study participants to white boys because the number of originally diagnosed girls with ADHD was too small for meaningful statistical comparisons. Thus, our results may not be generalizable to ADHD in women or to other racial or ethnic groups. However, this constraint avoided potential confounds from possible sex, ethnic, or socioeconomic differences. Exclusion of conduct disorder comorbidity (see the supplementary text, available on the authors' Web site) in childhood also averted confusion as to the origin of the deficits found in cortical thickness or GM density.
We cannot comment on cortical thickness or GM density in ADHD in the absence of medication treatment because all but 4 of the probands who underwent scanning were treated with methylphenidate as children. We also did not detect significant effects of childhood treatment with stimulants or thioridazine in cortical thickness or VBM analyses. Medication treatment has been reported to affect cortical thickness,42 although the durability of such effects is unknown, and treatment had been discontinued for all study participants for several decades.
For logistical reasons, we used 2 scanners. Fortunately, scans were approximately counterbalanced across probands and comparison participants, and there were no significant main effects or interactions related to scanner type. Secondary analyses (eFigure 2) also showed that we obtained comparable results when we examined only the 98 scans obtained on the Allegra scanner. Finally, the analyses presented herein were limited to cortical thickness and VBM; ongoing analyses will examine WM structure using diffusion tensor imaging.
In this first study of childhood ADHD prospectively examined in adulthood, we found thinner overall cortex in probands with childhood ADHD that was even more pronounced in those with persistent ADHD. Beyond this global effect, we also detected significant reductions in cortex thickness in the parietal, temporal, and posterior frontal regions corresponding to the dorsal attentional network and limbic areas. These findings were largely echoed by VBM, which in addition highlighted decreased GM in the caudate. These regions underpin the top-down control of attention and the regulation of emotion and motivation and were comparably diminished in probands with remitting ADHD or persistent ADHD. Thus, these differences seem to primarily reflect the childhood diagnosis of ADHD. By contrast, probands with remitting ADHD tended to differ from those with persistent ADHD in the medial occipital cortex, temporal pole, insula, orbitofrontal cortex, parahippocampus, and frontal pole and subcortically in the cerebellum and thalamus. This supports the suggestion that symptom amelioration and diagnostic remission may result in part from compensatory maturation of frontal-thalamic-cerebellar circuits.102,104
Correspondence: F. Xavier Castellanos, MD, Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, New York University Langone School of Medicine, 215 Lexington Ave, 14th Floor, New York, NY 10016 (firstname.lastname@example.com).
Submitted for Publication: September 13, 2010; final revision received March 3, 2011; accepted April 15, 2011.
Financial Disclosure: None reported.
Previous Presentations: This study was presented at the 16th Meeting of the Organization for Human Brain Mapping; June 9, 2010; Barcelona, Spain; and at the Third International Congress on ADHD; May 29, 2011; Berlin, Germany.
Supplementary materials are available on the authors' Web site at http://www.AboutOurKids.org/Research/Research_Publications/Proal_et_al_2011.
Additional Contributions: We thank the participants and their families who have contributed to this research over the decades. Christine Cox, PhD, provided a careful reading of an earlier version of the manuscript. Pierre Bellec, PhD, Yasser Aleman, PhD, and Joost Janssen, PhD, provided helpful discussions regarding methods.