Objectives Occipito-temporal connectivity was explored using diffuse tensor imaging (DTI) and its correlation to behavioral symptoms and neurocognitive functions in medication-naı¨ve attentiondeficit/ hyperactivity disorder (ADHD) children and adolescents. Methods Eleven medication-naı¨ve children and adolescents with ADHD (mean age 11.5±.3) and 9 age- and gender-matched healthy volunteers (mean age 11.4±2.5) were measured for mean fractional anisotropy (FA) values with DTI and clinical assessments. The FA values for the region of interest (ROI) which contained both inferior longitudinal fasciculus (ILF) and inferior occipito-frontal fasciculus (IOFF), were compared in ADHD and gender- and age-matched healthy control groups and the relationship between clinical and neurocognitive variables was explored. Results The ADHD group exhibited significantly higher scores on the Korean ADHD Rating Scale (p<0.001), the Korean Conners Parent Rating Scale (p<0.001), the computerized Continuous Performance Test, and the Visual (omission error, commission error, mean time, and variability)(p<0.01), and significantly decreased scores on the Finger Window Test (p<0.01). Mean FA values from the left-side ROI were significantly lower in the ADHD group compared with healthy controls after controlling for age (p<0.05). In the ADHD group, FA values from the left-side of the ROI did not show significant correlation with clinical rating or neurocognitive tests. Conclusion Our results suggest that one of the core pathophysiology hallmarks in child ADHD may be abnormal anatomical connectivity in the occipito-frontal and/or occipito-temporal pathway, both of which are related to visual information processing. To confirm such an anatomical deficit and its association with clinical or neurocognitive symptoms in ADHD, further studies using larger sample sizes are needed
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