Need to know: ADHD and the brain

Your child has received an ADHD diagnosis, and you are currently trying to understand what behaviours are developmentally appropriate and what can be attributed to their ADHD neurology. It is common for family, friends, and even partners to question the validity of the diagnosis and make comments like “he’s just a boy being a boy” or “she’ll grow out of it.” In some cases, they may even question your parenting skills.

Being surrounded by these conflicting messages can lead you to question what ADHD truly is. For many parents, the process of acceptance only comes when they genuinely understand how their child’s ADHD brain functions. They begin to see the impact of their child’s neurobiology on their cognitive, behavioural, and motivational functioning, where they previously attributed laziness, rudeness, defiance, or lack of care.

How does ADHD affect the brain?

ADHD affects the brain in three main ways:

1. Structure – Research using MRI scans to examine the brain structure of children with and without ADHD has confirmed structural differences. Kids with ADHD have smaller brain regions, particularly the amygdala, responsible for emotional control, self-control, and prioritising actions. Memory and learning areas are also smaller in size. These structural differences tend to diminish as children age, but ADHD symptoms can persist into adulthood.
   
   
2. Function – ADHD impacts multiple brain networks and the cognitive, motivational, and emotional processes they control. In addition to imbalances in network function, researchers have also identified an imbalance in connectivity between these networks. Two important neurotransmitters, dopamine and norepinephrine, play significant roles in ADHD. Dopamine helps regulate attention, motivation, and reward, while norepinephrine is involved in maintaining focus and regulating alertness.
   
   
3. Development – Studies have shown that brain maturation occurs more slowly in children with ADHD. These differences affect executive functioning, with children with ADHD performing 1-3 years behind their neurotypical peers in tasks related to executive functioning.

Although researchers have identified several differences in ADHD brains, there is still uncertainty about how these differences interact to influence ADHD symptoms.

Why is executive functioning important?

Executive functioning is a vital component for achieving success in every aspect of life. The neurobiology of the ADHD brain has an impact on executive functioning, which is fundamentally related to how your child learns, manages relationships, and meets your expectations. 

Executive dysfunction can present in many different ways. For example, you might see:

Lack of motivation, laziness, addiction to gaming/food, avoiding chores, being easily bored, or engaging in risky behaviour

Motivation and reward play crucial roles in the ADHD brain. Children with ADHD often struggle with maintaining focus and completing tasks that may seem mundane or uninteresting to them. One reason behind this is the brain’s non-typical reward system. Neurotransmitters like dopamine, responsible for feelings of motivation and reward, are not as effectively regulated in the ADHD brain. As a result, tasks that don’t offer immediate gratification or seem less stimulating may be challenging for your child to engage with.

Difficulty following instructions, making decisions, or struggling with learning in a classroom environment

Processing speed refers to how quickly the brain can take in, understand, and respond to information. Children with ADHD may exhibit slower processing speed compared to their peers. This means that they may need more time to process instructions, complete tasks, or make decisions. It’s important to provide your child with ample time and patience, allowing them the space they need to fully understand and respond. Rushing or pressuring them may lead to frustration and hinder their ability to perform at their best.

Not following instructions, forgetting important things, being disorganised, or frequently interrupting

Working memory is like a mental workspace that helps us hold and manipulate information in our minds. It’s crucial for tasks that require multitasking, problem-solving, and following multi-step instructions. Children with ADHD often struggle with working memory, which can make it difficult for them to remember and follow through on instructions, keep track of time, or stay organised. 

Easily becoming frustrated, quick to anger, or getting overexcited

Children with ADHD may experience heightened emotional sensitivity. Not only do they tend to experience feelings more strongly than their peers, they have more difficulty modulating those emotions appropriately. 

Brain training: ADHD Management strategies

Co-regulate to teach self-regulation: A child learns to regulate their emotions and behaviour through the supportive guidance and interaction with an emotionally stable parent. When your child is feeling heightened you can help them return to a relaxed state by providing a safe environment, modelling calmness and effective coping strategies, and using verbal and non-verbal cues to guide your child’s emotional regulation. When your child is feeling regulated don’t forget to ask your child to reflect on their emotions, triggers and what strategies they can use to help them manage intense feelings. 

Establish routines and structure: Creating predictable routines and providing structure can assist children with ADHD in managing their time, tasks, and responsibilities. Establish a consistent daily schedule for activities such as homework, meals, and bedtime. Use visual cues, calendars, music, or checklists to reinforce the routine and help your child stay on track.

Break tasks into manageable steps: Help your child break down complex tasks into smaller, more manageable steps. Provide clear instructions and support them in organising their thoughts and actions. Breaking tasks down can make them less overwhelming and increase the chances of successful completion.

Use visual aids and reminders: Visual aids such as charts, diagrams, or color-coded systems can enhance organisation and planning skills for children with executive dysfunction. Visual reminders can include sticky notes, timers, or visual schedules to keep track of time, deadlines, and upcoming events.

Provide clear and concise instructions: When giving instructions or conveying information, use simple, concise language and make sure your child understands what is expected of them. Breaking down instructions into shorter, explicit statements can help them focus and follow through more effectively.

Teach and practise organisational skills: Help your child develop organisational skills by teaching them strategies like using planners, folders, or digital tools for keeping track of assignments and materials. Encourage regular clean-up of their physical and digital spaces. In the early years, your child will rely on you to do or at least help with tasks, but it won’t be forever.

Make time for lots of breaks: For tasks that require sustained focus, break them into shorter time increments with planned breaks in between. Children with ADHD tire more easily and need more downtime than their peers. For example, set a timer for 15-20 minutes of focused work followed by a 5-minute break. 

Provide positive reinforcement: Praise, encouragement, and occasional rewards are important to boost your child’s efforts. Positive reinforcement can motivate them and increase their engagement in tasks that require executive functioning skills. You can tailor your rewards to your child’s interests and can include privileges, small treats, or special activities.

Collaborate with teachers: Maintain open communication with your child’s teachers and seek their support in implementing strategies that promote executive functioning skills at school. Teachers can also offer visual aids, break down tasks into smaller, more manageable steps, and use repetition and reminders to support your child’s working memory challenges.