Adapted from an article from ADDitude Magazine written by Larry Silver, M.D.
You or someone you love, teach or work with has ADHD. You know what this means on the outside, but do you really understand what is going on inside the brain of someone with ADHD? Why you or they can’t just “snap out of it?” Understanding the science can lead to a greater understanding of the person and what can help. Here’s what you need to know.
How Neurotransmitters Work and Brain Anatomy
There are millions of cells, or neurons, densely packed into various regions of the brain. Each region is responsible for a particular function. Some regions interact with our outside world, interpreting vision, hearing, and other sensory inputs to help us figure out what to do and say. Other regions interact with our internal world — our body — in order to regulate the functions of our organs.
For the various regions to do their jobs, they must be linked to one another with extensive “wiring.” Of course, there aren’t really wires in the brain. Rather, there are myriad “pathways,” or neural circuits, that carry information from one brain region to another.
Information is transmitted along these pathways via the action of neurotransmitters (scientists have identified 50 different ones, and there may be as many as 200). Each neuron produces tiny quantities of a specific neurotransmitter, which is released into the microscopic space that exists between neurons (called a synapse), stimulating the next cell in the pathway — and no others.
How does a specific neurotransmitter know precisely which neuron to attach to when there are so many other neurons nearby? Each neurotransmitter has a unique molecular structure — a “key,” if you will — that is able to attach only to a neuron with the corresponding receptor site, or “lock.” When the key finds the neuron bearing the right lock, the neurotransmitter binds to and stimulates that neuron.
Neuroscientists have found that deficiencies in specific neurotransmitters underlie many common disorders including: anxiety, mood disorders, anger-control problems, and obsessive-compulsive disorder.
ADHD was the first disorder found to be the result of a deficiency of a specific neurotransmitter — in this case, norepinephrine — and the first disorder found to respond to medications to correct this underlying deficiency. Like all neurotransmitters, norepinephrine is synthesized within the brain. The basic building block of each norepinephrine molecule is dopa; this tiny molecule is converted into dopamine, which, in turn, is converted into norepinephrine.
A Four-Way Partnership
ADHD seems to involve impaired neurotransmitter activity in four functional regions of the brain:
Frontal cortex – This region orchestrates high-level functioning: maintaining attention, organization, and executive function. A deficiency of norepinephrine within this brain region might cause inattention, problems with organization, and/or impaired executive functioning.
Limbic system – This region, located deeper in the brain, regulates our emotions. A deficiency in this region might result in restlessness, inattention, or emotional volatility.
Basal ganglia – These neural circuits regulate communication within the brain. Information from all regions of the brain enters the basal ganglia, and is then relayed to the correct sites in the brain. A deficiency in the basal ganglia can cause information to “short-circuit,” resulting in inattention or impulsivity.
Reticular activating system – This is the major relay system among the many pathways that enter and leave the brain. A deficiency in the RAS can cause inattention, impulsivity, or hyperactivity.
These four regions interact with one another, so a deficiency in one region may cause a problem in one or more of the other regions. ADHD may be the result of problems in one or more of these regions.
Trial and Error
We don’t know which brain region is the source of ADHD symptoms. Nor can we tell whether the problem lies with a deficiency of norepinephrine itself or of its chemical constituents, dopa and dopamine. Thus, doctors must rely on clinical experience to determine which medication to try for each child, and at what dosage.
Someday, when our knowledge of the brain is greater, the diagnosis and treatment of ADHD will be more nuanced. Instead of diagnosing simply “ADHD,” and prescribing a stimulant, we might be able to say, “Billy’s ADHD is caused by a deficiency of dopa in the frontal cortex, so he needs medication A,” or “Mary has a type of ADHD caused by a deficiency of dopamine in the limbic system, so she needs medication B,” or “José has ADHD caused by a deficiency of norepinephrine in the reticular activating system, and he needs medication C.”
What do ADHD medications do? In simple terms, they raise the level of norepinephrine within the brain. (Stimulants work by causing the brain to synthesize more norepinephrine; nonstimulants by slowing the rate at which norepinephrine is broken down.) Once the level of neurotransmitter is where it should be, the brain functions normally. The individual becomes less hyperactive, inattentive, and/or impulsive. Once the drug wears off, the level falls — and symptoms return.
BONUS: Ten Tips for Living with ADHD
Life for those with ADHD – and for those living with those with ADHD – can be challenging, to say the least. Of course, not all of it is negative but, let’s face it, without care, planning, structure, support and a lot of patience on the parts of everyone involved, life in an ADHD household can be hectic, chaotic and emotionally charged.
Try these tips to help make life in your ADHD household more balanced, organized, and positively charged!
- Provide an abundance of positive feedback and reinforcement and search for ways to use other positive behavior strategies regularly
- Build confidence through competence by working towards greater autonomy for your child
- Work with your child instead of just in service of your child so that your relationship is a partnership regarding solution building for managing ADHD symptoms
- Learn and utilize effective communication styles
- Educate yourself and your child about ADHD, including executive function deficient influences, medication options and strategies for managing symptoms
- Improve the possibilities for success by providing or supporting routines, structures and a system of supervision that maximize the use of your child’s strengths and minimize the opportunities for derailment
- Avoid negative interactions
- When considering punishment, try to be wise by utilizing natural and/or logical consequences and employ only when necessary
- Take care of yourself first so that you remain fresh and able to handle difficult situations as they arise
- Use professionals to help support the goals of your family – from experienced medication managers and therapists to professional coaches and teachers/tutors
Now that you have both tips for living with ADHD and basic information neuroscience has to offer about the brain, ADHD and various pharmaceutical measures, you can have an informed conversation with your doctor, psychiatrist or other medication manager. Whether you decide to try medications or not, what experts know for sure is that professional coaching with a certified, experienced ADHD coach can make an enormous impact on the well-being, happiness and daily productivity of someone with ADHD. I encourage you to contact me at Kimberly@kimberlyputmancoaching.com or 512-298-9021 to discuss how we can work together to help you or your loved one implement life changing strategies for ADHD management.