“ADD/ADHD… isn’t that what parents say when their kids are out of control?”
Actually, ADHD is a very real physiological brain disorder. So let’s start with the basics: ADD and ADHD refer to the same thing. The scientific community has yet to agree on one term, but here I will use ADHD, as that is what my doctor and coach both use.
Let’s break down the term into its components:
Attention Deficit Hyperactivity Disorder
This disorder manifests in 3 broadly defined ways (there is a spectrum):
1) Inattentive Type
2) Hyperactive Type
3) Inattentive-Hyperactive Type
So… not all people who have ADHD have the hyperactivity component?
Essentially, ADHD interrupts a person’s “executive functions.” These include things like concentration and focus, motivation and effort, hyperactivity and impulsivity, memory and the ability to learn from one’s mistakes, organization, and social skills. 
What are Executive Functions?
In laymen’s terms, “executive functions” are the skills we use to organize and then act on information . Or stated another way, executive functions determine “how we behave toward our future goals and what mental abilities we need to accomplish them” . Here they are broken down into 8 skills:
- Impulse Control / Self-Restraint / Inhibition
- Emotional Control / Self-Regulation
- Flexible Thinking
- Working Memory (Verbal & Non-verbal)
- Self-Monitoring / Self-Awareness
- Planning & Prioritizing / Problem Solving
- Task-Initiation / Self-motivation
What is the unique physiology of the ADHD brain?
It’s all about DOPAMINE. At least, that’s what the current research tells us. Well, oxygen and dopamine. Well, brain structure, oxygen and dopamine. Science is complicated. In patients with ADHD, imaging studies have shown that:
- Dopamine levels are lower, but rise with stimulant medication
- Oxygen levels in certain areas of the brain are lower
- Certain brain structures have lower volume 
Executive functions are regulated by the prefrontal cortex of our brains. Dr. Russell Barkley states that these skills are all related to 4 “circuits” in our brains: the WHO, WHAT, WHEN, WHY circuits .
– The “What” Circuit: (frontal lobe –> the basal ganglia) linked to working memory, so it’s in this circuit that what we think starts to guide what we do. This is particularly true when it comes to plans, goals, and the future.
– The “When” Circuit: (prefrontal area –> cerebellum) the timing circuit of the brain — it coordinates not just how smooth behavior will be and the sequence of behavior, but also the timeliness of your actions and when you do certain things, critical to time management.
– The “Why” Circuit: (frontal lobe through anterior cingulate –> amygdala) — AKA this “hot” circuit is linked to our emotions — it’s where what we think controls how we feel, and vice versa. It’s the final decision maker in all our plans. This is the circuit that eventually chooses among the options based on how we feel about them and their emotional and motivational properties.
– The “Who” Circuit: (frontal lobe –> very back of the hemisphere) Home of self-awareness — it’s where we’re aware of what we do, how we feel (both internally and externally), and what’s happening to us .
Executive functions develop over time, throughout childhood and into adulthood. Those with ADHD or other executive function disorders are noticeably behind in one or more of these areas, often presenting as the behaviors of much younger people.
Is ADHD genetic?
Since this is inherently a physiological problem, YES! Absolutely. If one or both of your biological parents has ADHD, you have a higher risk of also having it. More specifically, many studies have linked the ADGRL3 gene to ADHD. Recent research has uncovered more about that pathway.
Ugh. This sounds awful! Is ADHD all bad?
Like all things in life, there is a flip side to ADHD. There are some advantages that we ADHDers have! Here is one of my favorite infographics that represents just some of them!
Could I have ADHD?
If you are concerned that you or a loved one might have ADHD, I encourage you to read more about it and also to contact an ADHD specialist for a thorough evaluation.
KEEP IN MIND: ADHD presents differently in everyone! There are significant differences in childhood and adult presentation, as well as presentation in women vs. men (highly undiagnosed in women).
Here are some good places to start your reading:
Do you have questions about ADHD? Contact me and I will do my best to answer them!
- Frank, Michelle. ADHD: The Facts. Attention Deficit Disorder Association. (n.d.) Retrieved from https://add.org/adhd-facts/.
- Morin, Amanda. At a Glance: 8 Key Executive Functions. (n.d.) Retrieved from https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/key-executive-functioning-skills-explained.
- Barkley, Russell. 7 Executive Function Deficits Tied to ADHD. (n.d.) Retrieved from https://www.additudemag.com/7-executive-function-deficits-linked-to-adhd/.
- Frye, Devon. Another Piece of the Puzzle? New Research Zeroes In On the Specific Genetic Components of ADHD. (Jan 2017) Retrieved from https://www.additudemag.com/new-gene-mutation-linked-to-adhd-development/.
- Mason, Oren and Rosier, Tamara. Face It — People with ADHD Are Wired Differently. (n.d.) Retrieved from https://www.additudemag.com/current-research-on-adhd-breakdown-of-the-adhd-brain/.