A Look Inside the ADHD Brain

GoodTherapy | A Look Inside the ADHD Brain

Dr. Steven D. Graham is a licensed psychologist in Tampa, FL

What would you see inside the brains of people with untreated ADHD? Would the brain function and look different from a non ADHD brain? If so, how? This article will discuss the neurocognitiveFunctioning of the ADHD brain.

First, let’s clarify what ADHD is. Some mental health professionals still utilize the term “ADD.” What we used to believe was that someone had either an attention disOrder or a hyperactivity/impulsivity disorder, or sometimes both; “ADD” was shorthand for ADHD without the hyperactivity. Now, we know that ADHD is one disorderSometimes the inattention is obvious, other times it seems like hyperactivity or impulsivity. Both of these symptoms are common.

Our Brains Are able to Heal!

Neurocognition is the study of what happens in our brains, nervous systems, and how it affects our thinking. You may imagine that if something is different or “wrong” in the brain, then the situation is hopeless. In years past, neurologists would shrug off and say that they couldn’t do much if something was wrong in our brains. What we have seen over the past 30+ years is the phenomenon of neuroplasticity, our brain’s amazing ability to repair, re-route, and restore functioning. Our brains are able to heal themselves! Although this can take time, sometimes we see improvements in brain function within a few weeks after starting treatment. We also have some ways to assist this process, which will be covered in future issues.

This is good news for all of us, since many of us sustain some type of brain injury, including life’s traumas that come our way. Once our brains start to heal, our ability to think and process information will improve. It is possible to improve our ability to take in information, encode and decode information, as well as how we store and retrieve data. It is possible to enrich our decision-making and sound judgment. It is amazing to observe how ADHD individuals often discover their own solutions and tools to help them succeed in their lives.

People with ADHD can be labeled narcissistic (or bipolar), histrionic, or any other disorder by people who are frustrated with their behaviors, as well as professionals who are ill-informed. The person with ADHD feels invisible and misunderstood. This only makes them feel more isolated.

What are the Causes of These Particular Symptoms

While it is one thing to describe ADHD symptoms, I believe it is equally important to understand how the brain produces these symptoms. It’s obvious that I won’t be able explore every aspect of ADHD brain in this article. I will instead focus on the most important. According to the latest research,* the prefrontal cortex (PFC) in an ADHD brain is underactive. The PFC is responsible for the following: Executive centerThe brain is where we plan, organize and strategize, prioritize, exercise restraint and make good decisions. Now, I want to examine three more differences in ADHD brain.

Brain and Brain-Parts Size

Functional imaging shows that UntreatedADHD brain is smaller and more fragile than non-ADHD brains. This is because ADHD brain matures slower than non-ADHD brains. The ADHD brain is also slower than non-ADHD brains. amygdala(which processes fear, threats, and the Hippocampus(Responsible in a great deal learning and memory), both of the Linguistic systemThe emotional center of the brain, also known as, tends to be smaller. This means that regulation of oneself might be difficult without additional help. (This information is from the largest ever worldwide review of ADHD patient scans, conducted in 2018 by Radboud University Nijmegen Medical Centre. Many people with ADHD don’t seem to be afraid. They may take unnecessary risks, engage in dangerous sports or activities, and others may be fearful or have one or more anxiety disorders.

Neurotransmitters and the Communication System of the Brain

The abnormally low levels in neurotransmitters within the PFC is perhaps the most important finding concerning ADHD. This impacts a person’s ability to bypass urges or exercise discipline or make difficult choices. As we have already mentioned, the PFC, which is the executive center of our brain, is responsible for planning, deciding and prioritizing, organizing, as well as resisting impulses. It allows us to escape the vicious cycle of stimulus-response. The important step between thinking and doing is adding this important step.

Our nervous system uses neurotransmitters in order to communicate with nerve cells. The PFC’s two most important neurotransmitters are dopamineAnd norepinephrine. We feel bored and unmotivated if we don’t get enough dopamine. Sometimes life can seem boring. Dopamine is often associated with feeling rewarded. I will find other ways to get my dopamine, if I don’t have enough naturally. That is why I feel attracted to things that are novel, stimulating, and fun.

Norepinephrine, however, is associated wit alertness and arousal. It can also speed up my reaction times. Attention and focus can be slowed down if there is not enough norepinephrine. Taken together, these low levels of dopamine and norepinephrine (along with the other developmental challenges of the brain noted above) impair one’s ability to be still, to self-regulate, to concentrate, and to make sensible choices.

Dopamine can be released in two ways

Let’s dive just a little deeper into dopamine. We have discovered that dopamine is released in one of two ways: by and by. Tonic releaseBy phasic release. Tonic release is the normal supply of dopamine that is continuously released in the brain. Phasic release is the process of getting dopamine out of the environment. ADHD brain Tonic release performs below averageWhile Phasic Release outperforms. In other words, the non-ADHD brain has a steady, ongoing supply of dopamine, especially to the PFC. For ADHD-brain, the steady or tonic release of dopamine is not efficient.

Phasic release is a process that occurs when there is an environmental stimulus. It boosts the dopamine level in the PFC. In other words, if I am not getting enough tonic release of dopamine on a regular basis, then I am especially sensitive to anything environmental — phasic — which will produce dopamine. This means that if the brain is dopamine-hungry it will find dopamine wherever it can. If this happens naturally (as in the non ADHD brain), we are easily rewarded and satisfied. If it occurs by external stimuli (as in ADHD brain), we will seek out arousal or reward wherever we can.

How It All Works Together

In summary, if we look at these three aspects of the brain and brain functioning — 1) brain and brain-part size, 2) neurotransmitter activity, and 3) less-than-adequate tonic release of dopamine — we begin to understand why someone might be hyperactive/impulsive along with inattentive. First, we can see how ADHD patients may have impaired fear-response. It is also possible to see that the hippocampus may be affected. This could affect my ability to store information and retrieve it.

Second, if my PFC doesn’t receive enough dopamine or epinephrine, I will feel unmotivated and less able to delay gratification. If I don’t spice things up, my life will feel dull. Third, if my tonic adrenaline release system is dysfunctional, then I will rely heavily on my ability and environment to increase the phasic production of adrenaline. This will leave you distracted and unable to find dopamine-producing stimuli.

This brief overview should help you understand why ADHD symptoms exist. Function is greatly improved when we concentrate on enhancing the healthy release dopamine/norepinephrine within the PFC. We are also discovering ways to improve the size and action both of the amygdala as well as the hippocampus through non-pharmaceutical and pharmaceutical means.

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*See CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), founded in 1987, http://chadd.org. You can also find Dr. Daniel Amen’s research at www.amenclinics.com. In his Healing ADD: The Breakthrough program that allows you to see and heal the 7 Types Of ADDDr. Amen has actual SPECT images from ADHD patients his clinic has treated.