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The Neuroscience of the ADHD Brain

Nov 2, 2022 | 0 comments

DISCLAIMER:

The information provided here is not intended to be a substitute for professional health and mental health care or consultation. Individuals who believe they may require or benefit from treatment should seek the advice of a psychologist or other licensed mental health professional.

Very Good Counseling is a private practice of licensed mental health therapists who specialize in EMDR.  We provide online mental health services to individuals throughout the State of Florida,  and in-person at our office in Fort Myers, FL. For more information, contact us.

by: <a href="https://vg-counseling.com/robert-g-engle-fort-myers/" target="_blank">Robert Engle, EMDRIA-Approved EMDR Therapist</a>

by: Robert Engle, EMDRIA-Approved EMDR Therapist

Because We Believe You Matter

Robert joined the practice full time in 2022 to help neurodivergent individuals with ADHD, anxiety, and depression find freedom and enjoy life through counseling. He is currently working towards becoming a Certified ADHD Professional (ADHD-CCSP). Trained in EMDR therapy, he excels at understanding the intricacies of ADHD and Trauma.
The National Institute of Health completed a landmark longitudinal study on ADHD since the rapid increase of diagnosis throughout the 1990’s and beyond. The following excerpt is taken from (Hinshaw, S.P. & Arnold, L.E. for the MTA Cooperative Group (2015 Jan–Feb). Attention deficit hyperactivity disorder, multimodal treatment, and longitudinal outcome: Evidence, paradox, and challenge. WIREs Cognitive Science, 6(1):39-52. )

ADHD is “Defined by developmentally extreme and impairing symptoms in the domains of inattention/ disorganization and hyperactivity impulsivity, ADHD—when diagnosed carefully—is associated with highly impairing outcomes in the core domains of academic performance, social relationships, parent-child interactions and family stress, and risk for serious accidental injury.

Thus, ADHD is not simply a societal or psychiatric label for fidgety, bothersome behavior or a sign of a society’s intolerance of behavioral nonconformity. Instead, it represents a lack of full development of self-regulation, frequently accompanied by deficits in key executive functions (e.g., inhibitory control, working memory, planning, and the like) and highly likely to be accompanied by a variety of comorbid conditions (e.g., excessive aggression, depression and anxiety, learning disorders).”

This lack of consistency can be frustrating for friends, parents, teachers, and partners of individuals with ADHD. Since ADHD is a neurodevelopment disorder is can mimic or overlap with other attributes from other learning disabilities, other neurodevelopment diagnosis, anxiety, depression, and have higher rates of co-diagnosed with substance use disorders.

This can lead to misdiagnosis that lead many to being diagnosed as adults with ADHD rather than in childhood when symptoms first arise. As most diagnostic criteria is developed for children and because adults have other diagnosis that mask the symptoms of ADHD, this is believed to be the reason many adults remain under diagnosed.

Yet, we see higher rates of diagnosis of ADHD in elementary to middle school children as this is when most screening happens. These symptoms of ADHD becomes more apparent in part due to the greater demands on executive functioning, more complex social situations, and eventually the beginning of vocational exploration.

The study goes on to sum up this section in a more succinct way stating,

“In other words, when work demands get harder, when emotion regulation is required, and when self-control is at a premium, ADHD tends to rear its head most explosively.”

These outburst are confusing and often don’t seem to correlate to the cause. Often people will assume that a person with ADHD will overreact to things others find tolerable or there anxious and overreacting.

This leads many to label these behavior’s as unwanted or intrusive. The neural pathways that the ADHD brain utilizes is not the same as a neurotypical person. There are certain deficiencies in norepinephrine (neurotransmitter that increases alertness, arousal and attention) which leads to lower levels of focus and higher rates of impulsivity.

This impacts four main areas of the brain:

The frontal cortex (logic, executive function, organization), the limbic system (emotion and attention), the basal ganglia (motor activity, motivation, sensory processing), and the reticular activating system (set of pathways that connect many parts of the brain).

The impacts on these four areas reinforce the reduced ability to focus, organize, regulation of emotions, confusion and misinterpretation in communication, and can lead to hyperactivity in some. The other neurotransmitter that norepinephrine is linked too is dopamine.

Many people think of this as the happy chemical, it controls when we feel pleasure and feel rewarded. This has been popularized on social media as #followthedopamine where teens and adults share how they lack motivation, pleasure and try to hack their way towards being happier and motivated.

Dopamine is a necessary neurochemical that does elicit communication in your brain that centers around movement, reward, attention, and many numerous other functions.

As you may have gathered ADHD is a complex neurological condition that requires extensive testing to verify. Although, this may have also contributed to many not being diagnosed until later in life.

Please seek professional assessment rather than taking social media as guidance for diagnoses. When it comes to diagnoses, typically, more males are diagnosed with ADHD than females and studies believe that how ADHD is expresssed may be biased towards the male presentation.

This had lead to more studies aimed at learning how the female ADHD representation can be better understood and more easily identified.

Medical Treatments

You may be saying to yourself, no I don’t want medications. Or you may have heard of other peoples experience as awful or overwhelming. This is not always the case and many we see whom are medicated make faster progress because they are able to focus better and be

So what is the goal of medication? (We are not recommending medication and anyone interested in medication should talk to a licensed doctor, this is not medical advice.)

The goal of medication in individuals with ADHD is to raise their level of norepinephrine. There are treatments available to help children, teens, and adults increase this chemical and effectively raise there ability to focus.

The first most often used method of treatment is medication and there are 3 main categories of medications: stimulants (Adderall, Ritalin, and Focalin to name a few popular brand names); non-stimulants (Strattera, Catapres, and Intuniv); anti-depressants (Wellbutrin, Norpramin, and Tofranil) due mainly to a large number of individuals with ADHD have difficulty with emotional regulation.

These options should be discussed with the child’s pediatrician or psychiatrist. This is not medical advise but a summary of more popular pharmaceutical treatments.

Non-medicinal methods of treatment for ADHD

Aside from medication there are behavioral interventions and talk therapy to address the behavioral issues, emotional dysregulation, and the issues with executive functioning. Behavioral interventions in the class room and at home coupled by positive reinforcement has been proven greatly improve many of the issues youth and adolescents with ADHD struggle with.

Teaching the parents and teachers how to break down tasks into smaller steps, provide reinforcement, and focus on the child’s own self-regulation of emotions can greatly improve there functioning in various environments.

The Best treatment for ADHD

The Best treatment for ADHD is the combination of medication and therapy as collaborative partners to help these individuals become the best versions of themselves. Although the study above does mention that medication alone when the study first initially concluded in the 1990’s was the most effective course of treatment.

In the most recent review from 2015 found this was not entirely true. In the most recent review of the study with several other assessments added into account the findings are more nuanced as many with ADHD do not have just ADHD but other diagnosis like anxiety and the use of stimulants can increase anxiety in many.

Instead more behavioral and psychosocial treatment menthols are more optimal course of treatment for a person with both ADHD and anxiety. Other treatments like organizational skills training, nutrition, and good communication between parent and teachers can be very effective course of treatment.

The last key finding in this study states that those parents that reduced negative or ineffective discipline were precisely whose children improved the most in positive academic behavior change. Switching the role of the parent to positive reinforcement has one of the strongest positive effect on helping your kids with ADHD become better in the classroom.

Routines

A few additional notes on children and adolescence with ADHD. They will thrive in routines! Routines that you and your therapist can set up to help provide your kids with less reminders of what to do next and alleviate tension around reminding your child.

This routine can be as inclusive as brushing there teeth, combing there hair, or putting there pajamas on. Breaking down each step from bed to school, then from the school bus to bed should be included in your routine.

This provides clear expectations for the children that can help them begin to internalize a routine over time. It also reduces disputes and minimizes frustration. It’s critical to have homework time that allows for multiple breaks.

Most elementary aged kids with ADHD can only focus for about 15 minutes before they need a built in break for 5 minutes to goof off, go outside, have a snack, or even play a quick video game. You can shorten this time with those younger and can extend that time as they get older.

Homework

When it comes to homework always start with the most difficult things first. If they do not like a certain subject get it out of the way first. This helps teach them to prioritize, organize and helps create motivation for them.

When establishing new routines you will likely have to keep a closer eye on them at first, some actually prefer to have you sit with them while they do there homework. As they get older they will become more and more independent.

A Parents and Teachers role

Lastly, you the parents and teachers are the ones on the hook for helping to get these routines to stick. If you think that creating these routines is where your job ends then you will become quickly frustrated when they don’t stick to them without you.

Creating a checklist coupled with a reward system is one of the most effective methods. Having a checklist with a visual layout with pictures for younger children helps them conceptualize the routine more effectively.

Where as a list or sequence of tasks might be all you need for older kids. By helping your kids build these routines there are fewer things to remember and higher likelihood of them not getting frustrated trying to remember.

Also, expect frustrations and derailments. It’s common when trying out a new routine there are certain steps that always get missed or take longer than others. It will take a bit of trail and error to find the right routine for you and your child.

Get Help today

If you need help setting up routines, how to structure reward systems, or how to help emotional regulation, we here at Very Good Counseling specialize in treating ADHD in adults. We would love for you to book a consultation to see if we are a good fit for you and your family.

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