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Peer-reviewedCC BY 4.0BMC Psychiatry

Retinal nerve fibre layer, and ganglion cell layer thicknesses in children with ADHD: associations with subtypes and symptom severity

  • Xiu Juan Zhang1,2
  • Xiu Nian Chen1
  • Yuzhou Zhang1
  • Ka Wai Kam1,3
  • Ian C. K. Wong4
  • Wei Zhang5
  • Alvin L. Young1,3
  • Clement C. Tham1,3,6,7,8
  • Chi Pui Pang1,8
  • Li Jia Chen1,3,8
  • Patrick Ip9
  • Jason C. Yam1,3,6,7,8
9 affiliations
  1. 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 4/F Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong SAR, China
  2. 2Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
  3. 3Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
  4. 4Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
  5. 5Tianjin Eye Hospital, Tianjin, People’s Republic of China
  6. 6Hong Kong Eye Hospital, Hong Kong SAR, China
  7. 7Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong SAR, China
  8. 8Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
  9. 9Department of Paediatrics and Adolescent Medicine, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Abstract

Background: To investigate retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thickness in different attention-deficit/hyperactivity disorder (ADHD) subtypes and their association with ADHD symptom severity.

Methods: This is a cross-sectional study included children aged 6–8 years in Hong Kong. ADHD diagnoses were made by psychiatrists based on ICD-10 criteria.

Results: Among 6431 children included in the study, 309 (4.80%) were diagnosed with ADHD and 6122 served as controls. Children with ADHD showed thinner p-RNFL, m-GCL, and p-GCL than controls (P = 0.002; P = 0.03; P = 0.003, respectively). Among the 309 ADHD, 149 were categorized as the combined (C) type, 74 as the Inattentive (IA) type, 39 as the hyperactive/impulsive (HI) type. The ADHD-C subtype exhibited thinner p-RNFL (mean difference [MD] = -2.47, P = 0.03), m-GCL (MD = -1.10, P = 0.03), and p-GCL (MD = -0.85, P = 0.007) than controls. The p-RNFL, m-GCL, and p-GCL thicknesses showed a decreasing trend across ADHD subtypes, being thickest in the ADHD-HI, followed by the IA, and then the C subtype (P = 0.04, P = 0.005, and P = 0.04, respectively). Higher SWAN-combined scores were associated with thinner p-RNFL, m-GCL, p-GCL, and m-RNFL (P = 0.04; P = 0.002; P = 0.005; P = 0.02, respectively).

Conclusion: RNFL and GCL thicknesses varied across ADHD subtypes. The combined subtypes exhibited thinner measurements than controls. An overall trend toward thinner RNFL and GCL thicknesses was observed across subtypes. RNFL and GCL thicknesses were negatively associated with severity of combined ADHD symptoms.

Clinical trial number: Not applicable.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12888-026-08422-1.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026retinal,
  title = {{Retinal nerve fibre layer, and ganglion cell layer thicknesses in children with ADHD: associations with subtypes and symptom severity}},
  author = {Xiu Juan Zhang and Xiu Nian Chen and Yuzhou Zhang and Ka Wai Kam and Ian C. K. Wong and Wei Zhang and Alvin L. Young and Clement C. Tham and Chi Pui Pang and Li Jia Chen and Patrick Ip and Jason C. Yam},
  journal = {BMC Psychiatry},
  year = {2026},
  month = aug,
  doi = {10.1186/s12888-026-08422-1},
  url = {https://doi.org/10.1186/s12888-026-08422-1},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Retinal nerve fibre layer, and ganglion cell layer thicknesses in children with ADHD: associations with subtypes and symptom severity
AU  - Xiu Juan Zhang
AU  - Xiu Nian Chen
AU  - Yuzhou Zhang
AU  - Ka Wai Kam
AU  - Ian C. K. Wong
AU  - Wei Zhang
AU  - Alvin L. Young
AU  - Clement C. Tham
AU  - Chi Pui Pang
AU  - Li Jia Chen
AU  - Patrick Ip
AU  - Jason C. Yam
PY  - 2026
DA  - 2026/08/07
JO  - BMC Psychiatry
DO  - 10.1186/s12888-026-08422-1
UR  - https://doi.org/10.1186/s12888-026-08422-1
AB  - Background: To investigate retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thickness in different attention-deficit/hyperactivity disorder (ADHD) subtypes and their association with ADHD symptom severity.  Methods: This is a cross-sectional study included children aged 6–8 years in Hong Kong. ADHD diagnoses were made by psychiatrists based on ICD-10 criteria.  Results: Among 6431 children included in the study, 309 (4.80%) were diagnosed with ADHD and 6122 served as controls. Children with ADHD showed thinner p-RNFL, m-GCL, and p-GCL than controls (P = 0.002; P = 0.03; P = 0.003, respectively). Among the 309 ADHD, 149 were categorized as the combined (C) type, 74 as the Inattentive (IA) type, 39 as the hyperactive/impulsive (HI) type. The ADHD-C subtype exhibited thinner p-RNFL (mean difference [MD] = -2.47, P = 0.03), m-GCL (MD = -1.10, P = 0.03), and p-GCL (MD = -0.85, P = 0.007) than controls. The p-RNFL, m-GCL, and p-GCL thicknesses showed a decreasing trend across ADHD subtypes, being thickest in the ADHD-HI, followed by the IA, and then the C subtype (P = 0.04, P = 0.005, and P = 0.04, respectively). Higher SWAN-combined scores were associated with thinner p-RNFL, m-GCL, p-GCL, and m-RNFL (P = 0.04; P = 0.002; P = 0.005; P = 0.02, respectively).  Conclusion: RNFL and GCL thicknesses varied across ADHD subtypes. The combined subtypes exhibited thinner measurements than controls. An overall trend toward thinner RNFL and GCL thicknesses was observed across subtypes. RNFL and GCL thicknesses were negatively associated with severity of combined ADHD symptoms.  Clinical trial number: Not applicable.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12888-026-08422-1.
SN  - 1471-244X
ER  -