Whether it’s a rhythmic tap of the fingers, incessant twirling of a strand of hair, or the satisfying chew on the end of a pencil, many of us can’t get through an assignment without some level of fidgeting.

Justin Fernandez, associate professor at the Auckland Bioengineering Institute in New Zealand, has long wondered if these seemingly quirky and random movements actually served some sort of greater purpose. He decided to put volunteers to the test inside an MRI machine to find out how fidgeting affects the brain when a person is trying to concentrate.

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“For a lot of people there's this stigma associated with fidgeting,” Fernandez says. “You sometimes feel uncomfortable if you're sitting next to someone on the train or the bus, and they’re fidgeting. But perhaps people fidget for a purpose and maybe it helps people with ADHD to concentrate.”

Fidgeting is often seen in people with ADHD, a neurodevelopmental disorder characterized by above average levels of hyperactive and impulsive behavior. ADHD is often first diagnosed in children using a psychology test. However, there has been an increase in cases diagnosed in adults [1].

As far as Fernandez is aware, that test has never been coupled with MRI technology. Fernandez specializes in studying the way the musculoskeletal system moves — covering everything from sports performance to forensics. Fidgeting, which is a fine motor skill, falls under his area of expertise.

“If we could find objective evidence showing the executive function on the brain increases activation when a person fidgets, then that would be a solid start for a further study into how MRI machines could be used to diagnose ADHD,” he says.

Fernandez worked with Dr. Samantha Holdsworth, director of the Mātai MRI Research Institute in New Zealand, and Dr. Jerome Maller, MRI Clinical Science Specialist with GE Healthcare, which has a close relationship with the institute, to design the experiment.

Mātai was an ideal place, because in late 2020, the institute installed GE Healthcare’s SIGNA^TM Premier XT MRI machines. These machines are able to capture super-fast sequences showing the rapid functional changes that happen in the brain, including the split second process of what happens when someone is trying to concentrate and make a decision. This latest technology could allow the team to observe and analyze the brain working in ways that have never been seen before.

“From my perspective the most important aspect about the research being done with MRI is the ability to explore and illuminate the inner workings of our bodies in fine detail, and the outcomes of those investigations that are clinically translatable to make our lives better and healthier,” says Maller.

Fernandez’s hypothesis presented some unique challenges. Mainly, as anyone who has ever done an MRI screening knows, you have to remain very still for proper imaging — a problem when you’re trying to check for the effects of wiggling. Fernandez ended up designing constraints inside the machine that would encourage people to stay still so the machine could capture their brain imagery, but also allow them to naturally fidget as they got comfortable during the test.

“What we did was we put little supports on [the volunteers’] joints, on their arms and underneath their knees, so that they were able to fidget their extremities without vibration ricocheting all the way up to their head,” he says.

Fernandez needed something that would test volunteers’ decision-making skills, but that was also simple enough to use inside an MRI machine. Before volunteers entered the MRI, they were shown a simple quiz on a computer to make sure they knew what to expect. Once inside the machine, volunteers had a seemingly easy task: They were shown a screen with random arrows pointing in one direction and, using foot pedals, they would tap whether the arrow was pointing left or right.

“The great thing about it is it doesn’t have alphanumeric numbers or letters or anything,” Fernandez says. “It doesn’t allow the other parts of your brain to fire up so that the path associated with logic and alphanumeric and lexical challenges like that, none of that part of the brain is activated.”

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Six adults volunteered to be a part of Fernandez’s test group, including one person who had previously been diagnosed with ADHD. As each person took the test inside the machine, Fernandez watched images of their brains validate his hypothesis in real-time.

Every person showed increased blood flow to the prefrontal cortex, the part of the brain that helps with concentration when a person is faced with a decision. There’s typically some blood flow to the area in neurotypical people, but Fernandez saw an increased amount when they were concentrating on the test — and when they were fidgeting.

There were also big changes in the prefrontal cortex of the brain belonging to the person with ADHD. The area is typically “completely underactive” and dark in a person with the disorder, but when they fidget during the test, that person’s prefrontal cortex showed increased activity that looked similar to the baseline blood flow in a neurotypical brain.

“It was our big eureka moment,” he says.

Moving forward, Fernandez says he hopes to expand the research he conducted with GE to include a larger sample of adults, and potentially in the future, children as young as 12. He sees the future potential of using GE’s MRI machines as a way to diagnose or at least better understand ADHD.

“What we're trying to do is to clearly identify if there are these very distinct markers of someone with ADHD and establish almost like an ADHD brain atlas saying, ‘These are characteristics of a person with ADHD on all these different MRI sequences,’” Fernandez says.

In the future, he envisions a clinician could give a behavioral diagnosis of ADHD and then send someone for an MRI for a test to confirm the diagnosis: “A report would come back and say, well, the likelihood of you being having ADHD is within this realm, whether high or low, and that would help better inform the diagnosis.”

[1] Trends in the Prevalence and Incidence of Attention-Deficit/Hyperactivity Disorder Among Adults and Children of Different Racial and Ethnic Groups

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