ADHD to AD4K: A Clearer Picture of ADHD and the Brain
By: Lexi Basciano
One of my favorite ways to unwind is watching The Simpsons. My partner Adam, our pup, and I cram onto the couch, our own Simpsons-like couch gag if you will, and giggle at the fast-paced, blink-and-you-miss-it, quick-witted humor. The episode we watched last night entitled, “Brother’s Little Helper,” features Bart’s Attention Deficit Disorder diagnosis. After a trip to the local laboratory and a comical demonstration on some studious guinea pigs, Bart’s parents agree to let him try an experimental drug. At first, Bart’s academic work ethic and behaviors substantially improve. When his sister Lisa questions his change in behavior, he asks her, “Did you know we only use ten percent of our brains?” To which Lisa and I rolled our eyes in a sort of fourth-wall breaking unison.
Though this “10% brain power” proposition was propagated by none other than a yellow ten-year old cartoon character, it has somehow survived the test of time and leached into public knowledge, including my own. When I heard this myth in grade school, this sounded like the perfect opportunity for me. I remember constantly comparing myself to my overachieving peers and thinking that perhaps they had tapped into their “extra 90% brain power.” If I could only harness an extra 10% or 20% of my brain power, maybe everything would get a little bit easier.
As I progressed though my education journey, this divide between me and my peers only widened. The structure of my life dwindled and my progress followed suit. Studying became excruciating. Was I lazy? Unmotivated? Burnt out? I asked my partner, Adam, for a breakdown of a typical workday for him. Needless to say, I was shocked to learn the differences between our daily experiences. I did my best to illustrate these differences below
It turns out there was a physiological reason for how I was feeling. I learned that I was in fact missing something. While it didn’t have anything to do with brain power, it had everything to do with my brain. I was 25 years old when I was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
What is ADHD?
ADHD is a developmental disorder characterized by an individual’s difficulty with attention, impulsivity, and hyperactivity (U. S. Department of Health and Human Services, n.d.). A developmental disorder is a condition someone is born with and one they will have forever. ADHD is a spectrum (Whalen et al., 2002), meaning some individuals are more affected by their symptoms than others. Since the disorder commonly impacts daily activities, unfortunately individuals with ADHD are frequently perceived negatively by their peers, which significantly affects their wellbeing (Beaton et al., 2022). In actuality, individuals with ADHD need to work much harder to complete the same tasks as their neurotypical (non-ADHD having) peers. There are physiological and chemical reasons for their symptoms and these affect them in their everyday life.
ADHD Brains’ Neurotransmitters
To understand how ADHD brains are different, we need to understand how the brain works typically. The brain is made up of billions of neurons. Neurons communicate with one another electrically through electrical signaling.
The regularity at which neurons fire is influenced by chemical signals in the brain, called neurotransmitters. A neurotransmitter released by one neuron can tell its neighbor to fire or not to fire. Neurotransmitters are called excitatory when they increase the likelihood the next neuron will fire. Those which decrease the likelihood the next neuron will fire are called inhibitory. A balance between excitatory and inhibitory neurotransmitters in the brain is crucial for optimal brain function, and changes in this balance can lead to the breakdown of neurological processes such as thinking, communicating, moving, breathing, or any other function dependent on our brain (which is most things). You know that satisfying feeling you get when you clean your room? Cook a meal? That “job-well done” feeling is due to the release of an excitatory neurotransmitter in your brain called dopamine. People with ADHD have been found to have deficiencies in the dopamine reward pathway in their brains (Volkow et al., 2009), which are thought to lead to difficulties with the reward system pathway in charge of motivating us to start and complete tasks in our everyday life. Challenges with finishing tasks are a hallmark of ADHD and this significantly impacted my daily life in graduate school. It seemed whenever I got close to finishing an assignment, my motivation evaporated.
ADHD and Functional Connectivity
Different parts of the brain play crucial roles for specific functions, such as the amygdala for emotional regulation, and the frontal lobe for decision-making. However, it’s not the case that these parts of the brain turn on and off like light bulbs in a house only when we need them. Instead, parts of the brain are coordinated together in what are called neurological networks. As it turns out, we are always using 100% brains, 100% of the time, even when we are sleeping. Scientists have investigated how different parts of the brain work together by using neuroimaging. Magnetic Resonance Imaging, or MRI, uses large magnets to observe changes in blood flow to different parts of the brain (Plewes & Kucharczyk, 2012). We use this technology to observe what parts of the brain become active together, to identify what are known as functional connectivity networks (van den Heuvel & Hulshoff Pol, 2010). There are different neurological networks for language, movement, attention, and even one for when our mind wanders, (called the Default-Mode-Network). You can think of a functional connectivity network as a football team. In order to score a touchdown, it’s not the case that the running back just runs straight to the endzone (unless of course you’re talking about Saquon Barkley). For a play to be successful, the team’s offense and defense players need to cooperate and coordinate their plays to get the ball to the end zone. In the same way, for us to meet our everyday goals and successfully navigate our environment, different parts of our brain need to work together.
It turns out ADHD brains work a bit differently than neurotypical ones. Scientists have used neuroimaging technology on ADHD folks and have found their functional connectivity may be more diffuse and less regulated than in neurotypicals, potentially due to differences in their early neurological development (Hoekzema et al., 2014). These differences are not due to any sort of injury. The interactions between different brain regions in their functional connectivity networks are disrupted (Konrad & Eickhoff, 2010). In other words, their “football team” doesn’t cooperate as well.
How Do these Differences Affect Behavior in ADHD Folks?
Individuals with these brain differences frequently have difficulties with executive functioning. Executive functioning is a fancy term for the adaptive thinking abilities used to solve problems and meet our goals in our ever-changing environment (Rabinovici et al., 2015). You use executive functioning every day, especially for tasks which require organization and planning. Some examples are: planning a trip to the grocery store, keeping track of school assignments, and following a recipe.
There are different components of executive functioning, including working memory, inhibition, and set-shifting. Working memory is a system used for temporarily storing, processing, and manipulating information (Baddeley, 1992). Working memory is important for taking down a friend’s phone number as they say it. Folks with ADHD may have difficulties with working memory, and this could look like trouble with blocking out distractions, keeping track of assignment due dates and meetings, and staying organized in the workplace. A second aspect of executive functioning, inhibition, is the ability to restrain an automatic behavior. When you were a kid in gym class, did you ever play the game red-light, green-light? Players at one end of the gym need to run to the goal line at the other end; however, they can only run forward when the teacher says “Green light” and need to stop when they say “Red light.” An individual with ADHD may struggle to restrain running forward for a “red light.” In adulthood, difficulties with inhibition may manifest as impulsive shopping or abruptly interrupting someone during class or conversation. A third aspect, set-shifting, is the ability to change behavior to meet new goals. When we have a problem in everyday life and our first solution doesn’t work, neurotypicals are likely to try a different approach. ADHD folks on the other hand are more likely to try the same approach many times despite an unsuccessful outcome. Behaviorally, this can look like rigid thinking. For me, this manifests as always driving the same route to work every day, even though a different, shorter route would be faster and have less traffic.
Just Keep Stimming!
Because folks with ADHD have fewer stimulants in their brains, they will often exhibit what’s called stimulation-seeking behavior, or stimming. Stimming is a repetitive, self-soothing movement behavior. Some examples are nail biting, foot tapping, fidgeting, hair twirling, and spinning in circles. Stimming can also be visual or auditory sensation seeking behaviors. Studies show that these stimming behaviors can help ADHD individuals to focus. For example, listening to white noise has been shown experimentally to improve cognitive performance in ADHD folks (Söderlund et al., 2007). Fidget toys can also help with sensation-seeking behaviors. I have a few quiet ones I use during class to keep me focused.
Break it Down!
Differences in the dopamine reward pathway can lead to motivational challenges, which could manifest as task paralysis, or difficulty with starting and completing tasks. Personally, this symptom was one of the hallmarks that led me to seek a diagnosis. Task paralysis feels like a constant internal conflict. On the outside, I may be doom-scrolling on my phone, but on the inside my brain is an anxiety fire, thinking about a hundred things I need to do all at once, with no idea how to start any one of them. One way to tackle this is by breaking large tasks down into smaller chunks. This can help to make a large task seem less overwhelming. If you, or a student of yours, are having trouble starting or finishing large tasks, try breaking them down into smaller chunks. There are many tools online that are useful for this. I like to use https://goblin.tools/.
An ADHD diagnosis was the 356th item on my list of things I expected to happen to me during graduate school. While this part of myself was difficult to accept at first, a clearer picture of how my brain works has been tremendously helpful in my success moving forward. All my life I’d been forcing myself to do things a certain way, the “neurotypical way” if you will. I was so burnt out from running up the down escalator. Now, instead of working against my brain, I’m working towards adapting my approach to live my life in my own way. It’s how I am moving up to 4K resolution.
References
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Beaton, D. M., Sirois, F., & Milne, E. (2022). Experiences of criticism in adults with ADHD: A qualitative study. PLOS ONE, 17(2), e0263366. https://doi.org/10.1371/journal.pone.0263366
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Lexi Basciano (B.S.) is a PhD candidate at Arizona State University’s Speech and Hearing Sciences program. Her research interests involve understanding the neurological underpinnings supporting successful motor control of speech and how these processes are related to our sense of agency. She looks forward to watching The Simpsons every night with her loving partner Adam and their charming Boston terrier Jojo.