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This study examined cerebellum structural alterations, which prior studies suggested may be associated with BD risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We enrolled 151 youth (ages 10\u201318\u2009years) in three groups: psychostimulant\u2010free ADHD youth with a biological parent or sibling with BD (high\u2010risk,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200952, mean age 13.8\u2009\u00b1\u20092.6\u2009years), psychostimulant\u2010free ADHD youth without any first\u2010 or second\u2010degree relative with mood or psychotic disorders (low\u2010risk,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950, mean age 14.1\u2009\u00b1\u20092.5\u2009years), and healthy controls (HC,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200949, mean age 14.6\u2009\u00b1\u20092.4\u2009years). ADHD youth were stimulant\u2010na\u00efve or had no psychostimulant exposure within 3\u2009months prior to enrollment. Region\u2010of\u2010interest (ROI) analyses were conducted on the whole cerebellum and 28 lobules to quantify cerebellar volumes using the SUIT toolbox, and voxel\u2010based morphometry (VBM) analyses were also performed. Exploratory analyses evaluated associations between regional cerebellar volumes and symptom measures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Significant group differences in volume were observed for the whole cerebellum, bilateral lobules VIIIa, right VIIb, and left X. Post hoc comparisons showed that the high\u2010risk group exhibited volume deficits in the whole cerebellum, bilateral lobules VIIIa, and right VIIb, compared with HC and low\u2010risk groups, whereas both high\u2010risk and low\u2010risk groups exhibited left X volume deficits compared to HC. Similar results were obtained using VBM. Among all ADHD youth, significant inverse correlations were observed between significant ROI volumes and Child Behavior Checklist (CBCL) total score and several subscales, including the dysregulation profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Psychostimulant\u2010free ADHD youth with BD familial risk exhibit whole and regional cerebellar volume deficits compared with those without such risk and healthy youth. Inverse associations between regional cerebellar volumes and CBCL total and subscale scores among ADHD youth suggest clinical relevance and may represent a potential BD risk biomarker.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jcpp.70072","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T01:00:33Z","timestamp":1762131633000},"page":"766-776","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Regional cerebellar structural deficits distinguish psychostimulant\u2010free ADHD youth with and without familial risk for bipolar I disorder: a cross\u2010sectional morphometric analysis"],"prefix":"10.1111","volume":"67","author":[{"given":"Biqiu","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Radiology West China Hospital of Sichuan University  Chengdu Sichuan P.R. China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. Rodrigo","family":"Patino","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neuroscience University of Cincinnati College of Medicine  Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology West China Hospital of Sichuan University  Chengdu Sichuan P.R. China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3541-1769","authenticated-orcid":false,"given":"Su","family":"Lui","sequence":"additional","affiliation":[{"name":"Department of Radiology West China Hospital of Sichuan University  Chengdu Sichuan P.R. China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa P.","family":"DelBello","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neuroscience University of Cincinnati College of Medicine  Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert K.","family":"McNamara","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neuroscience University of Cincinnati College of Medicine  Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,2]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Manual for ASEBA school\u2010age forms & profiles","author":"Achenbach 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