In 2017 the largest-ever brain imaging study on ADHD was published (which can be found here: https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(17)30049-4.pdf ).
The study concluded, after studying the MRI scans of more than 3,200 people, that the ADHD brain structure is different than the brain structure of those who do not have it. In other words, the struggle is real!
ADHD is a neurodevelopmental disorder, but what exactly does neurodevelopmental mean?
Neurodevelopment is the brain’s ability to develop the neurological pathways that are responsible for the brain functioning the way that it’s supposed to in areas such as focus, memory, social skills, etc. Neurological pathways are connected neurons that send signals from one part of the brain to another, and neurodevelopment is directly connected to how the brain develops during pregnancy, infancy, and early childhood.
Neurodevelopmental disorders occur when both complex- and I do mean COMPLEX- genetic and environmental factors come together, changing brain development.
These are some of the ways in which ADHD brain structure differs:
Lower density of gray matter
Differences in the structure of the white matter
Lower than normal total brain volume
Reduced size of some parts of the brain
Slower-than-normal cortical maturation up to adult life
Reduced cortical thickness in adults, especially of the cortical network responsible for focused attention
One significant area of the brain where structural anomalies play a role in ADHD is in the frontal lobe which is, as its name suggests, located under the frontal skull bones and near the forehead.
The frontal lobe is the part of the brain that controls executive functions, which are the cognitive and mental abilities that help an individual engage in doing work and completing tasks- AKA getting sh*t done!
These are also known as HIGHER ORDER functions – the ones that allow human beings to be…human beings.
Active and conscious thinking
Decision-making and planning
Many people who have ADHD might struggle in several of these areas which looks like:
Frequently losing things
Having difficulty managing time
Habitually running late
Feeling chronically disorganized and overwhelmed
Difficulty with task completion
Poor impulse control
Lack of motivation
...any of these sound familiar? Having significant difficulties in any of these areas can make the demands of daily functioning feel REALLY overwhelming; struggling with more than one can make life feel impossibly challenging.
Another factor in ADHD is a deficiency in some neurotransmitters, which are the body’s chemical messengers and a central part of the communication system between the brain and the rest of the body.
ADHD was the first disorder discovered to be the result of the lack of a specific neurotransmitter - in this case, norepinephrine. Norepinephrine plays a role in an individual’s ability to concentrate. Its chief function is to yell at your brain, “Get ready for action, WAKE UP and pay attention!”
You can see how low levels of norepinephrine can make it difficult with those with ADHD to pay attention.
Dopamine is another notable neurotransmitter involved in ADHD, which also plays an important role in attention and thinking. These two neurotransmitters work together closely and contribute to increasing focus, alertness, effort and motivation.
It is always so upsetting when my adult clients tell me that the people around them- often the people that they love the most- dismiss ADHD and say that it’s an excuse for being lazy or deny that it even exists. Because of this they pursue treatment alone, not talking about it with their friends and family.
The consequences of ADHD and the stigma surrounding it can cause so much shame and pain for those who suffer from it.
For those of you who need to hear it right now- you are not lazy, stupid, or flakey.
ADHD brains are wired differently from the “neurotypical” brains. There are a lot challenges that come with ADHD, but there are also important strengths that come with it. It’s important to not only focus on what isn’t working and how you want it to be different but to also celebrate what goes well and harness the strengths that do exist.
Loren Bahor, MSW, LCSW-A is a neurodivergent therapist who specializes in providing support for clients experiencing neurodivergence, particularly ADHD. Please reach out to firstname.lastname@example.org today to get scheduled with her and start receiving support.