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Seven years ago, when FRONTLINE first looked at ADHD in its report, Medicating Kids, doctors said they knew very little about the biological underpinnings of the illness. Researchers now say that although no one has nailed down a specific diagnostic marker, they have made significant progress in piecing together the puzzle.

The most striking advances have come through brain imaging technology. Using fMRI scans, researchers can now pinpoint several interesting and possibly crucial differences in the brains of kids with and without the disorder. Doctors now confidently state that the brains of kids with ADHD are smaller by volume, particularly parts of the cerebellum and the basal ganglia. There is also evidence that parts of the gray matter are thinner Ñ an insight that some top researchers think is a critical distinction. The thinner gray matter seems to be localized in a part of the brain called the anterior cingulate, which is a key area for processing emotional and more logical, fact-based information. Researchers stress that this still is not a comprehensive model for the ADHD brain. These discrepancies in structure do not necessarily mean a child will develop the illness. But they are real differences and are part of an emerging answer.

While the science develops, the treatment regimen for ADHD remains fairly consistent. To manage the symptoms, doctors continue to rely heavily on stimulant medications like Ritalin and Adderall. The stimulants, unlike most psychiatric medications, are very well-studied drugs and, at this point, well-trusted by doctors. In fact, of the twelve psychotropic medications approved by the FDA for use in kids, six are stimulants. At the last authoritative count, in a study conducted by the CDC in 2004, the estimates are that 4.4 million children and adolescents have been diagnosed with ADHD. And as of 2003, 2.5 million kids, ages 4-17, are currently receiving medication treatment for the disorder.