ADHD——how do we understand it

ADHD is very genetic and it’s a neurodevelopmental disorder

ADHD is a cluster of executive dysfunctions

However, by learning all the skills that work for you, you can function in a very comfortable way

We are trained ADHD specialists in Cleveland, Columbus, Dayton, and Cincinnati and a Professional Member of Children and Adults with ADHD (CHADD)


There’s a reason in your brain for why you feel this way:

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  • Dorsolateral prefrontal cortex

    • Function 1 is “working memory” and related ADHD symptoms caused by its dysfunction include “often loses things necessary for tasks and activities (e.g. school materials, wallets, keys, smartphones)” and “Is often forgetful in daily activities”.

    • Function 2 is “sustained attention” and related ADHD symptoms include “often has trouble holding attention on tasks or activities” and “easily to be distracted, loses focus, side-tracked)”.

  • Ventromedial prefrontal cortex

    • The ventromedial prefrontal cortex (vmPFC) is a brain region located in the frontal lobe of the brain, specifically in the ventral medial area. It plays an important role in several cognitive and emotional processes, including decision-making, social cognition, and emotional regulation.

    • Decision-making: vmPFC helps us make decisions by integrating information from different sources, such as sensory information, memories, and emotions. The vmPFC also plays a crucial role in evaluating the potential outcomes of different decisions, which helps us to make choices that are more likely to be beneficial for us.

    • Social cognition: it refers to the ability to understand and interact with other people. vmPFC helps us to interpret social cues, such as facial expressions, body language, and tone of voice, and to make judgments about other people's mental states, such as their intentions, beliefs, and emotions.

    • Emotional regulation: it refers to the ability to regulate our own emotions in response to external stimuli. vmPFC helps us to inhibit inappropriate emotional responses, and to regulate our emotions in a way that is appropriate for the situation. For example, the vmPFC may be involved in down-regulating the amygdala, a brain region that is involved in the processing of emotions, in order to prevent overreacting to emotional stimuli.

  • Parietal cortex

    • Function is “orientation of attention” and related ADHD symptoms include “hard to pay attention to chosen places”.

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  • Dorsal anterior cingulate cortex (dACC)

    • Function is “selective attention” and inefficient activation of dACC can cause symptoms such as paying little attention to detail, making careless mistakes, not listening, losing things, being distracted, and forgetting things.

  • Ventral anterior cingulate cortex along with the rest of the areas

    • Function is the “affective and cognitive components of executive control” and this has to do with ADHD’s emotion management issues including “emotion identification, recognition, and expression”. This could be where ADHD, Depression, Anxiety, and Social Anxiety overlap.

ADHD treatment in Cleveland, Cleveland Heights, Akron, Columbus, Cincinnati Ohio
  • The dopamine system (the most important system in ADHD)

    • The dopamine system plays an important part in the planning and initiating of motor responses, activation, switching, reaction to novelty, and processing of reward. It projects from the areas called VTA and substantia nigra to multiple parts of the brain that have to do with attention and motivation and activates these areas. Insufficient dopamine in these areas results in insufficient arousal of them, and the brain will try to overcompensate with its own arousal stimulations, and the hyperactivity symptoms happen due to that. This’s the main reason why medication usually works. The medication stimulates your brain so your brain does not have to do it by itself by making you fidget, seek excitement, and be hyperactive.

    • The noradrenergic system (noradrenaline is also made from Dopamine) influences arousal modulation, signal-to-noise ratios in cortical areas, state-dependent cognitive processes, and cognitive preparation of urgent stimuli. Similar to dopamine, insufficient noradrenaline causes insufficient arousal and then results in inattention and hyperactivity symptoms.

ADHD treatment in Cleveland, Cleveland Heights, Akron, Columbus, Cincinnati Ohio
  • Executive control networks

    • Function 1 includes “planning, goal-directed behavior, inhibition”. These are all very important functions just to live our daily life and related ADHD symptoms can be “disorganized on item management, time management, and task management; lack of motivation and procrastination; and impulse control”.

    • Function 2 includes “flexible adaptation”. The related ADHD symptoms include hyper-focusing, or rigid and obsessive mind (because of lack of flexibilities in basal ganglia especially the putamen and caudate nucleus area which is where the OCD happens at)”.

ADHD treatment in Cleveland, Cleveland Heights, Akron, Columbus, Cincinnati Ohio
  • ventromedial prefrontal cortex, orbitofrontal cortex and ventral striatum.

    • Function is to respond to “anticipation and receipt of reward”. The most important area in this network is called Nucleus Accumbens (NA) and Orbitalfrontal Cortex (OFC). Most people with ADHD have procrastination or lack of motivation issues and it’s mainly due to the underactivation of NA and OFC caused by lack of dopamine which is the reason why medication works in this aspect. On the other side, too much dopamine overstimulates NA, and makes any reason that causes the stimulation becomes extremely rewarding and motivating. A lot of people with ADHD lack of dopamine and they want to find dopamine-generating things to “self-medicate”.

ADHD treatment in Cleveland, Cleveland Heights, Akron, Columbus, Cincinnati Ohio
  • Default-mode network (DMN).

    • The DMN consists of the medial prefrontal cortex and the posterior cingulate cortex (medial view) as well as the lateral parietal cortex and the medial temporal lobe (lateral view). "It is best known for being active when a person is not focused on the outside world and the brain is at wakeful rest, such as during daydreaming and mind-wandering. Other times that the DMN is active include when the individual is thinking about others, thinking about themselves, remembering the past, and planning for the future”. This is where ADHD overlaps with, Alzheimer's disease, and Autism Spectrum Disorder.


DSM-5 Core Symptoms for ADHD

1. Inattention

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

  • Often has trouble holding attention on tasks or play activities.

  • Often does not seem to listen when spoken to directly.

  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

  • Often has trouble organizing tasks and activities.

  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

  • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

  • Is often easily distracted

  • Is often forgetful in daily activities

2. Hyperactivity and Impulsivity

  • Often fidgets with or taps hands or feet, or squirms in seat.

  • Often leaves seat in situations when remaining seated is expected.

  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

  • Often unable to play or take part in leisure activities quietly.

  • Is often “on the go” acting as if “driven by a motor”.

  • Often talks excessively.

  • Often blurts out an answer before a question has been completed.

  • Often has trouble waiting their turn.

  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

ADHD treatment in Cleveland, Cleveland Heights, Akron, Columbus, Cincinnati Ohio

How I approach it

  • Diagnose: We’ll start with a biopsychosocial assessment and look at the history of the school, social, relationship, family, and work aspects, due to the fact that ADHD is a developmental disease and it can start from a very early time at your age.

  • Executive Dysfunctioning: Once the diagnosis is made, we’ll go through all the symptoms and dysfunctionings resulting from ADHD, in order to decide which ones are your primary concerns.

    • They could include:

      • lack of attention

      • lack of motivation or procrastination

      • lack of adaptable thinking

      • disorganization/unable to do the planning/disorganized planning

      • lack of self-awareness or self-monitoring

      • lack of self-control or impulse control

      • dysfunctioning in short-term memory or working memory

      • dysfunctioning in time management

      • decision-making issues

      • lack of arousal or activation

      • prefer and overestimate immediate reward instead of delayed reward

      • constant feeling of boredom

    • We’ll learn specific coping skills for each of them.

    • With ADHD treatment, the most important principle is focusing on what works, and what works for the special brain, instead of focusing on what’s right.

  • Co-occurring disorders: Besides the core symptoms of Inattention/Hyperactivity/Impulsivity, and dysfunctionings, ADHD also has the following co-occurring disorders (ranked according to statistics) that are just as bothering and important to address as the above:

  • Specific Areas: Academic issues/Relationship Issues/Social Issues/Self Esteem issues/Work issues/Anger Issues

My articles on important ADHD issues

ADHD Medication (We don’t prescribe medication currently)

Resources for ADHD

  • National Resource Center on ADHD: This organization, funded by the U.S. government, provides information, resources, and support for individuals with ADHD and their families. They have a website (www.help4adhd.org) and a toll-free information line (1-800-233-4050) available to answer questions and provide support.

  • ADHDinAdults.com: The website provides a variety of resources and tools to help individuals understand and manage their ADHD, including articles about the signs and symptoms of ADHD, strategies for coping with ADHD in daily life, and information about different treatment options. The website also includes a self-assessment tool that can help individuals determine whether they may have ADHD. They have a website (https://adhdinadults.com/ask-the-adhd-experts/).

  • Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD): CHADD is a national non-profit organization that provides education, advocacy, and support for individuals with ADHD. They have local chapters across the United States that offer support groups and educational programs. Their website (www.chadd.org) provides a wealth of information and resources for individuals with ADHD and their families.

  • ADDitude Magazine: ADDitude is a national magazine for individuals with ADHD and their families. They have a website (www.additudemag.com) that provides information, resources, and support for individuals with ADHD, including articles, forums, and a directory of ADHD professionals.

  • ADHD Coaches Organization: The ADHD Coaches Organization is a professional association of coaches who specialize in working with individuals with ADHD. They have a directory of certified ADHD coaches on their website (www.adhdcoaches.org) that can provide support and assistance to individuals with ADHD.

  • Clinical Trials: The National Institute of Mental Health (NIMH) has a website (www.clinicaltrials.gov) that provides information on ongoing clinical trials for individuals with ADHD. This can be a useful resource for individuals seeking new and innovative treatments for ADHD.

  • Online support groups: There are many online support groups for individuals with ADHD, where you can connect with others who are experiencing similar challenges and offer support and advice. Some popular online support groups include ADDitude's ADHD Community and CHADD's ADHD Online Support Group.

  • Apps and Tools: There are many apps and tools available that can help individuals with ADHD manage their symptoms, including focus and productivity tools, time management tools, and memory aids. Some popular apps for ADHD include Finch, Forest, Todoist, and Evernote.

  • Click to check more Local ADHD resources in Cleveland, Cleveland Heights, Columbus, and Cincinnati.

Book an appointment with our ADHD Specialists right now!

I am a parent of a kid with ADHD, what can I do or learn & what can I expect from ADHD treatment or therapy for children:

  1. Educate Yourself:

    • Example: Attend workshops, conferences, or online courses on ADHD. Read books and articles written by experts in the field.

    • Resources:

    • Books:

      • "Driven to Distraction" by Edward Hallowell and John Ratey

      • "Smart but Scattered" by Peg Dawson and Richard Guare

  2. Establish a Routine:

    • Example: Create a visual schedule for morning and evening routines. Stick to consistent meal and bedtimes.

    • Resources:

      • Visual Schedule Printables

    • Books:

      • "The Organized Mind" by Daniel J. Levitin

  3. Clear Instructions:

    • Example: Instead of saying, "Clean your room," break it down: "Pick up toys first, then put clothes in the hamper."

    • Resources:

      • ADDitude Magazine - How to Give Clear Instructions to Kids with ADHD

    • Books:

      • "Taking Charge of ADHD" by Russell A. Barkley

  4. Use Visual Aids:

    • Example: Use a timer to visually show how much time is left for an activity.

    • Resources:

    • Books:

      • "The ADHD Workbook for Kids" by Lawrence Shapiro

  5. Positive Reinforcement:

    • Example: Create a reward system for completing tasks, and celebrate achievements.

    • Resources:

      • Token Economy Systems

    • Books:

      • "The Explosive Child" by Ross W. Greene

  6. Set Realistic Expectations:

    • Example: Break down homework into smaller segments, and take breaks between tasks.

    • Resources:

      • Tips for Setting Realistic Expectations

    • Books:

      • "Your Defiant Child" by Russell A. Barkley and Christine M. Benton

  7. Encourage Movement:

    • Example: Allow short breaks for physical activities like jumping jacks or stretching.

    • Resources:

      • Sensory Diet Activities

    • Books:

      • "The Out-of-Sync Child" by Carol Stock Kranowitz

  8. Provide a Optimal Space:

    • Example: Create a designated homework area with minimal distractions.

    • Resources:

      • Creating a Homework Haven

    • Books:

      • "Fidget to Focus" by Roland Rotz and Sarah D. Wright

  9. Build Self-Esteem:

    • Example: Encourage activities where the child excels, fostering a sense of accomplishment.

    • Resources:

      • 10 Ways to Boost Your Child's Confidence

    • Books:

      • "The Self-Esteem Workbook for Teens" by Lisa M. Schab

  10. Effective Communication:

    • Example: Regularly communicate with teachers, caregivers, and therapists to ensure a consistent support system.

    • Resources:

      • Collaborating with Your Child's School

    • Books:

      • "The ADHD Effect on Marriage" by Melissa Orlov and Edward Hallowell

  11. Teach Coping Strategies:

    • Example: Teach deep-breathing exercises or mindfulness to manage impulsivity.

    • Resources:

      • Mindfulness for Kids

    • Books:

      • "Mindful Games" by Susan Kaiser Greenland

  12. Medication Management:

    • Example: Ensure the child takes medication as prescribed, and monitor any side effects.

    • Resources:

      • ADHD Medications Guide

    • Books:

      • "Straight Talk about Psychiatric Medications for Kids" by Timothy E. Wilens

  13. Social Skills Training:

    • Example: Role-play social situations and provide guidance on appropriate behaviors.

    • Resources:

      • Social Skills Activities for Kids with ADHD

    • Books:

      • "Social Skills Activities for Kids" by Darlene Mannix

  14. Involve Parents:

    • Example: Regularly communicate with parents to share insights and discuss strategies.

    • Resources:

      • Parenting a Child with ADHD

    • Books:

      • "Parenting Children with ADHD" by Vincent J. Monastra

  15. Seek Professional Support:

    • Example: Collaborate with psychologists, special educators, and therapists to create a comprehensive plan.

    • Resources:

      • American Academy of Child and Adolescent Psychiatry - ADHD Resource Center

    • Books:

      • "The ADHD Book of Lists" by Sandra F. Rief

Book an appointment with our ADHD Specialists right now!

References:

Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., ... & Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature reviews Disease primers, 1(1), 1-23.

Stahl, S. M. (2021). Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

https://en.wikipedia.org/wiki/Default_mode_network#cite_note-5