By Elisa Gonçalves de Andrade
People with attention-deficit/hyperactive disorder (ADHD) can be incredibly dedicated. Despite this, they may face a significant obstacle: how their mind works.
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ADHD is a misleading name
ADHD is the most common mental health disorder in kids, with a 7% prevalence worldwide. The symptoms can linger throughout life. It’s estimated that 2.5% of adults live with ADHD. The name ADHD can be misleading as individuals do not experience reduced attention in tasks, but instead show a deficit in shifting their focus from one activity to the other. Moreover, individuals with ADHD can show either inattentiveness, relentless behavior, or both.
Neurodiversity and ADHD
Two people can learn, think, and behave differently. More and more, researchers see this phenomenon as the rule instead of the exception, a framework known as neurodiversity. Because every brain is different from the next, conditions like ADHD do not necessarily need to be fixed, but society does.
For example, someone with ADHD often has an easier time with creative thinking and activities that feed off imagination. On the flip side, they might have a harder time controlling impulses and ignoring distractions. Each one of these traits can become either advantageous or disadvantageous, depending on the situation.
If work or school only value brains that can focus for long stretches of time, then precious creative resources of brains with ADHD can be simply lost in translation. If, however, society becomes more receptive and inclusive to different ways of thinking and behaving, then someone with ADHD can use their unique traits for the collective advantage.
Yellow-Red-Blue abstract painting by Wassily Kandinsky. Original public domain image from Wikipedia. Digitally enhanced by rawpixel.
The brain and ADHD
The cause of ADHD is under intense investigation. Researchers think it’s likely a combination of genetic, psychological, and environmental factors. In the brain, ADHD seems to be associated with a reduction in the size of some of the regions related to memory and the inhibition of movement, such as the hippocampus and the basal ganglia. Delayed prefrontal cortex development, a brain area primarily responsible for “executive functions”, or goal-directed behaviors, is another significant contributor to ADHD.
Researchers suggest the delay in the development of the prefrontal cortex during adolescence could be a window of opportunity for ADHD treatment. While the prefrontal cortex develops, it can more easily adapt to make connections with other brain regions or function better by itself. Physical activity, for instance, can increase blood flow to the brain region, increasing its energy and facilitating executive functions in individuals with ADHD, particularly at younger ages.
ADHD is diverse and can require multiple strategies
Most current research on ADHD is based on male-identifying individuals with hyperactive behavior. The current lack of diversity in research subjects is important when we consider that strategies to manage disadvantageous traits of ADHD may not be applicable to, for example, other genders or individuals without relentless behavior. This brings up an important point: Heterogeneity in ADHD means there is no one-size-fits-all solution, with individuals often adopting many strategies throughout life.
To improve concentration and time management, researchers suggest keeping planners, writing study goals, setting up reminders or taking notes while studying. But remember, motivation may not come easy to a person with ADHD. To address this, the research suggests using external strategies. For example, focusing on a task for short periods and switching to a rewarding activity, such as watching a new episode of your favorite show, is a commonly-used strategy.
Setting goals that have external motivators or rewards can also be a significant push. For example, getting better grades can mean entry into a prestigious medical school. Researchers suggest that a crucial game plan for someone with ADHD is to eventually draw from internal motivators, or the desire to complete an activity because it is interesting, challenging or in line with our values. Internal motivators, more than external rewards, can increase motivation and facilitate tasks that demand more concentration, such as studying.
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Are behavioral changes enough?
The debate whether purely behavioral changes are enough is not yet settled. Generally, upon diagnosis, medications are the frontline of ADHD treatment. Prescriptions will include drugs that can balance the levels of dopamine and norepinephrine in the brain, which are either too high or too low in ADHD. Dopamine and norepinephrine stimulate the activity of neuronal cells, facilitating the communication between different brain regions.
However, roughly one-third of individuals do not respond to or tolerate psychostimulants well. Cognitive-behavioral therapy, a goal-oriented form of psychotherapy, can follow, although studies disagree on which is more effective than the other: medication, therapy or behavioral changes.
All of this goes to say that, as much as we would like to have a straightforward answer to this question: science is not there, yet. In the meantime, individuals with ADHD can think like a researcher and experiment with their own learning. Of all the strategies I mentioned, what could work best for you?
The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder