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Key points
- An imbalance in brain levels of dopamine and norepinephrine are involved in ADHD symptomology.
- The prefrontal cortex integrates information from several brain regions influencing executive functioning.
- Dysregulated emotional responses can lead to ADHD paralysis during stressful, overwhelming situations.
There is a misconception that attention-deficit/hyperactivity disorder (ADHD) can be caused by eating too many sweets or bad parenting. Our kids could do better in school if they just tried harder or were more disciplined. This couldn’t be further from the truth. I have been guilty of saying, “Why can’t you just…” to my ADHD son. Why can’t you just clean your room, start your homework, put your bike away. This was before I understood ADHD as a brain-based disorder. So, what’s going on in a brain that my ADHD son describes as an overstuffed garbage can the lid doesn’t stay on, and everything is falling out all over the floor?
ADHD brains want an increase in dopamine
ADHD occurs in approximately 4 to 7 percent of children in the United States, making it one of the most common neurobiological disorders. Neuroimaging studies suggest a possible difference between the structure and function of the brain in individuals with ADHD compared to those without ADHD, including differences in the size of some brain structures (Faraone et al., 2021; Santos da Silva, 2022).
The underlying neurobiology associated with ADHD is thought to result from an imbalance of certain chemicals in the brain, likely lower levels of dopamine and norepinephrine (for a review see Santos da Silva, 2022). Brain-imaging studies show dopamine-rich areas of the brain, like the frontal cortex, are affected in ADHD. Further evidence to support the role of dopamine in ADHD is the use of psychomotor stimulants to mediate symptoms. Research on ADHD stimulant medications shows an effect on levels of dopamine and norepinephrine in the prefrontal cortex, the brain region implicated in ADHD.
Dopamine’s action in the brain can affect attention and is involved in novelty-seeking/risk-taking behaviors. My ADHD son often engages in challenging activities like martial arts, rock climbing, ice hockey, and skiing expert terrain. High-risk activities put the brain on high alert for the fight-or-flight response, leading to a surge of dopamine and norepinephrine in the brain and increased focus so you don’t get injured (Ratey and Hagerman, 2013).
It is well known that dopamine is involved in the reward circuit of the brain. ADHD brains are constantly seeking optimal stimulation resulting in a surge of dopamine and rewards for engaging in particular activities. I remember my son’s explanation when he was failing a class in high school: “It’s boring, and I don’t want to do it.” Once I understood his ADHD brain, I couldn’t argue with his answer.
Executive functions and the prefrontal cortex
Executive functioning is a neurological process that guides our behavior by enabling us to pay attention to what is most important at the time. Complex problem-solving involves planning, initiating tasks, time management, organization, and emotional control, all executive function skills that are lagging in individuals with ADHD.
The prefrontal cortex is the brain region involved in executive functioning and is responsible for integrating input from several brain regions, which is critical for goal-directed behavior. ADHD expert, Dr. Russell Barkley explains how these networks are related to executive functions. Understanding ADHD behaviors involves understanding the neurological basis of executive function skills.
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Deficits in executive functioning can make it seem like our ADHD kids are ignoring us or just being lazy. For example, my ADHD son’s idea of organizing is to pile things on the floor, his desk, or any other flat surface. So, it may seem like he is just being lazy, but he struggles with organizational skills because they require complex executive function processes like planning, initiating the task for knowing what needs to be organized, and finding a place for something based on how often it is used. When I set out on the task of helping my son to become more organized, I realized the importance of working with his ADHD brain by enlisting his help to find a solution that works for him. Unlike me, my son will never put something away in a bin and then put the bin on a shelf; that involves executive functioning. The bin will be left open on the floor for weeks. The contents of the bin will be emptied out on the floor and left there for the dog to chew on, or, if stacked on some shelf, the bin and its contents will be forgotten completely.
The brain’s protective response: Fight, flight, freeze, or fib
We are all familiar with the fight, flight, or freeze response when our brain perceives a threat. We fight back, run away, or play dead in the face of fear. The limbic system of the brain plays a critical role in assessing dangerous situations and our emotional response to them during these times of stress. When individuals with ADHD, who have difficulty controlling their emotions, feel overwhelmed, they can have a heightened fight, flight, freeze response leading to ADHD paralysis or ADHD shutdown. In other words, they become stuck when their automatic, emotional brain can’t be regulated by their executive function brain. This can manifest in ways like procrastination, ignoring, a lack of motivation or activation, or indecision when presented with too many choices. Neurotypical individuals struggle with these behaviors as well, but for those with ADHD, it’s more challenging to move forward and overcome the feeling of overwhelm due to lagging executive functioning skills.
Another self-preservation behavior you may observe in your ADHD child is lying. Fibbing has been recently added to the fight, flight, freeze behaviors observed in the face of a threat. Lying can protect your child from feeling like they are a disappointment (e.g., when they do poorly in school), help your child avoid negative consequences (e.g., angry parents), and delay feelings of low self-esteem (e.g., they don’t feel like a failure).
The key to understanding ADHD behaviors is to understand the unique ADHD brain. So, when your child justifies a failing grade or not completing their chores with “It was boring, and I didn’t want to do it,” now you know why.
