Understanding how the wiring differs in a brain with ADHD and what improves functioning is critical to help those struggling because of their brain’s uniqueness.
Put simply, ADHD significantly affects executive function.
Executive functioning is a set of cognitive processes, including planning, prioritizing, impulse control, flexibility, time management and emotional regulation, that help people achieve long-term goals.
In addition to the prefrontal cortex, ADHD affects other areas of the brain, including the basal ganglia, an area that regulates communication within the brain, and the cerebellum, which is responsible for movement and balance. All three work together regulating attention, executive functionmotor activity and impulse control.
ADHD affects the prefrontal cortex, basal ganglia and cerebellum. Entesar Ali Saber, et al. , CC BY
Studies show that people with ADHD have more dopamine transportersin the brain. Think of transporters as vacuums that suck dopamine back up into the neuron, making it less available.
ADHD affects the presence of dopamine and norepinephrine. Nikpapag/Wikimedia Commons , CC BY-SA
Diagnosing ADHD
Nearly everyone with or without ADHD show some symptoms such as forgetfulness. For instance, when you can’t tolerate sitting in a meeting for one moment longer or you can’t remember why you came into a room.
If you struggle with ADHD, you have at least five to six symptoms in the inattentive, hyperactive or impulsive categories, such as forgetfulness, trouble sitting still, losing items and getting easily distracted.
For a formal diagnosis, ADHD symptoms need to have been present before the age of 12, something that can be determined in childhood or, as in my case, much later.
The American Academy of Pediatrics provides evidence-based guidelines for the treatment of ADHD in children and teens.
The first U.S. guidelines for the treatment of adult ADHD are expected to be released in fall 2024.
If patients are 6 or older, stimulant or nonstimulant medications may be used, along with behavioral therapy.
Stimulants are divided into two drug classes: amphetamines, such as Adderall and Vyvanse, and methylphenidates, such as Concerta, Ritalin and Focalin.
Nonstimulants such as Strattera are recommended if patients cannot tolerate or prefer not to take stimulant medications.
Stimulants block the dopamine and norepinephrine transporters, preventing them from depleting those neurotransmitters, so more dopamine is available to activate key areas of the brain.
Amphetamines also increase the release of dopamine and norepinephrine from neurons. These increased levels allow the brain to find challenging tasks, such as doing homework, more rewarding. Because more dopamine is available, the brain’s desire for stimulating rewards decreases.
Methylphenidates are typically the drug of choice for children, while amphetamines are most effective in adults.
For this reason, it’s important for providers to check ferritin levels and not serum iron, which is often used incorrectly to diagnose iron deficiency.
Taking steps forward
If you think your child or you may have ADHD, speak with a health care provider who is familiar with ADHD treatment. For school accommodations, the first place to start is with your provider.
Research is still ongoing, but high intake of processed foods may worsen ADHD symptoms.
Though overwhelming, I’m happy to say that living with ADHD can be rewarding.
ADHD comes with multiple benefits: We are resilient, unconventional and creative. We have intense energy that, once harnessed, can be used for incredible good.
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