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The ADHD Brain

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood neuropsychiatric disorders, and it often persists into adulthood. ADHD is primarily characterized by struggling with inattention, hyperactivity, and impulsivity. For some individuals it may be one key dysfunction or a combination of all. For developing minds, ADHD is also associated with functional impairments across multiple academic and social areas and can impact daily life and future success. Overall, there is conclusive evidence that ADHD is associated with globally decreased brain volumes when compared to peers with neurotypical brain development. This volume difference appears to be resulting from early genetic, environmental and developmental milestone factors. The connection between the prefrontal cortex and ADHD has long been established. Research studies suggest that the key areas of involvement include dysfunction of the frontal–striatal–cerebellar circuits and the default mode network. Why does the frontal-striatal-cerebellar circuit matter? The frontal-striatal-cerebellar circuits are a combination of brain pathways that have commonly shown dysfunction in individuals who suffer from ADHD. It is characterized by improper communication between two or more regions contributing to neurological dysfunction. Within these pathways there are 3 main areas: 1. Frontostriatal circuits- connect your frontal lobe regions with the basal ganglia to regulate your motor, cognitive, and behavioral functions within the brain. 2. Orbitofronto-striatal loops have been related to reward processing. 3. Fronto-cerebellar circuits have been implicated in timing. What is the default mode network?

The default mode network (DMN) also known as resting-state network and has received growing interest in the study of ADHD pathophysiology. Studies have found that people with ADHD have atypical connectivity in the default mode network. This can help explain why distractibility, attention and cognitive control are impacted with ADHD. The three main areas of the brain involved with DMN include: 1. Ventral medial prefrontal cortex (VMPC) is a critical element in receiving sensory information from the external world and the body and conveying that information to other structures in the brain. The input from this region impacts social behavior, mood control, and motivational drive. 2. Dorsal medial prefrontal cortex (DMPC) association with self-referential judgments- when information is processed with reference to self. 3. Posterior cingulate cortex - the recollection of prior experiences. In ADHD there can be a dysfunction or disconnection between brain regions that support this “default mode network”. In studies comparing brains of individuals with ADHD against the average population, significantly decreased functional connectivity is found in numerous brain regions but an increased connectivity was found in the default mode network. The DMN is a large network of brain regions that are associated with mind wandering and daydreaming. Persistent DMN activity, such as found in those who suffer from ADHD interferes with active task performance and can show up as increased reaction time and increased frequency of errors/mistakes during a task. Can you outgrow ADHD? During the course of normal brain development at younger ages, the default network becomes significantly more integrated as an individual reaches adulthood which is why symptoms of ADHD change throughout life and become more manageable. Certain regions of the brain cortex show changes with adolescence. Specifically, findings in gray matter and white matter tracts (pathways in the brain) start to normalize and grow in adolescence explaining why the symptoms of hyperactivity of ADHD tends to diminish during this time. While a portion of individuals can outgrow the symptoms of ADHD, approximately 60% of those children have lifelong struggles with ADHD even into adulthood. This is why it is imperative to use the concepts of neuroplasticity (our ability to change our brain) to train these dysfunctional regions of the brain for optimal functioning. Typical Treatment for ADHD vs Holistic Treatment Psychostimulants in adolescents with ADHD have shown to suppress the overactive default-mode activity during assigned tasks. Therefore it appears that these drugs may improve symptoms related to ADHD by normalizing activity within a circuit related to the DMN but not without its own risks of dependence and side effects. When using the concepts of neuroplasticity and “brain training” the changes are long term and have a compounding effect on all aspects of brain function globally. Any level of brain training is an investment in your brain function for LIFE. How do I train my Default Mode Network?

An unmanaged or overactive DMN can make your life miserable. It can keep you awake at night with anxious ruminations over daily events and upcoming tasks and can make it difficult to succeed in work, school and personal life because it is difficult to keep focused and maintain a clear mind. Spending too much time daydreaming and overthinking daily activities of life can impact an individual's ability to accomplish tasks and to meet the expectations of life. One way to retrain this default mode network is by the practice of exteroceptive meditation. Meditation strengthens your “selective attention”, the ability to focus on one thing and tune others out, as well as your ability to sustain a constant level of attention. When practicing meditation, not only does it reduce the impact of default mode network but also has been shown to assist with ADHD because it thickens your prefrontal cortex, a part of your brain that's involved in focus, planning, and impulse control. Additionally it also raises your brain's level of the neurotransmitter dopamine, which is in short supply in ADHD brains typically. How can you improve the frontal-striatal-cerebellar function? When considering the responsibilities of the frontal-striatal-cerebellar pathway discussed above (motor, cognitive, and behavioral functions as well as motor timing and reward processing)- one of the best tools to create neuroplasticity in this system is the Interactive Metronome. Our lives revolve around timing- everything from reading, writing, sleeping, speaking and walking to more sophisticated movements like sports activities and playing an instrument. Synchronizing the body’s “internal clock” or “internal timing” helps the functional brain networks communicate more efficiently allowing all systems to be working at peak levels and the cognitive processes are free to allocate its resources to higher executive functions such as memory, processing speed and attention. Research studies have found the association between impairment in mental timing in individuals with ADHD. This is why many individuals with ADHD struggle with time management- completing tasks and projects prior to deadlines. How can I improve my ADHD symptoms without medication? For those who are looking for more than medication to help improve the symptoms of ADHD and find the root cause of the problem, an evaluation at CFNC is the next step for you! We will evaluate to understand which brain regions are involved and customize a treatment plan specifically for you or your loved one to create neuroplasticity and retrain your brain!

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