Teaching SEL

Social Emotional Learning Lessons for Teachers and Counselors

Understanding ADHD

Symptoms, Biology, and Management Strategies

ADHD, known as attention deficit hyperactivity disorder, is a neurodevelopmental condition that impairs the brain’s capacity to regulate attention, concentration, and impulse control. Individuals with ADHD frequently experience challenges in maintaining focus on tasks, finishing assignments, and managing their impulses. This disorder is typically diagnosed during childhood and can persist into adulthood, affecting various aspects of an individual’s life.

It’s important to note that ADHD is a complex and highly individualized condition, and symptoms can vary widely from person to person. The exact cause of ADHD is unknown, but it is thought to be caused by a combination of genetic and environmental factors. There is no single diagnostic test for ADHD. Doctors typically diagnose ADHD based on a child’s history, behavior, and performance on neuropsychological tests. Seeking professional evaluation and guidance from healthcare providers, psychologists, or psychiatrists is crucial for accurate diagnosis and effective management of ADHD.

Symptoms of ADHD

The symptoms of ADHD can vary from person to person, but some of the most common symptoms include:

  • Inattention: Difficulty staying focused on tasks, following instructions, and completing work
  • Hyperactivity: Excessive fidgeting, talking, and difficulty sitting still
  • Impulsivity: Acting without thinking, interrupting others, and having difficulty waiting their turn

ADHD is classified into three main types based on predominant symptoms:

  • Predominantly inattentive presentation: Individuals struggle with sustaining attention, organizing tasks, and often appear forgetful or easily distracted.
  • Predominantly hyperactive-impulsive presentation: Individuals exhibit excessive physical restlessness, impulsive behavior, and have difficulty waiting their turn.
  • Combined presentation: Individuals display symptoms of both inattentiveness and hyperactivity-impulsivity.

Key Brain Regions Involved in Focus:

The brain circuits involved in focus are complex and involve many different parts of the brain. However, some of the key brain regions involved in focus include:

  • The prefrontal cortex is a region of the brain that is involved in higher-order cognitive functions, such as attention, planning, and decision-making.
  • The basal ganglia are a group of nuclei located deep within the brain. They are involved in movement, learning, and attention.
  • The thalamus is a relay station that sends information from the senses to the cortex. It also plays a role in attention and arousal.
  • The amygdala is a small almond-shaped structure that is involved in emotion and fear. It can also play a role in attention by directing attention to threatening or emotionally salient stimuli.

Key Neurotransmitters:

Dopamine and norepinephrine are two neurotransmitters that play important roles in attention, focus, and impulse control. People with ADHD often have lower levels of these neurotransmitters in certain parts of the brain. This can lead to challenges with attention, focus, and impulse control.

  • Dopamine is a neurotransmitter that is involved in reward and motivation. It is also involved in the control of movement. People with ADHD often have lower levels of dopamine in the prefrontal cortex, a part of the brain that is involved in attention, planning, and decision-making. This can lead to problems with staying focused on tasks, completing work, and controlling impulses.
  • Norepinephrine is a neurotransmitter that is involved in arousal, attention, and learning. It is also involved in the control of stress and anxiety. People with ADHD often have lower levels of norepinephrine in the prefrontal cortex and the basal ganglia, two parts of the brain that are involved in attention, movement, and impulse control. This can lead to problems with staying focused on tasks, controlling impulses, and learning new information.

What are the Treatments for ADHD?

There are a number of different treatments available for ADHD, including:

  • Medication:
    • Stimulant medications
      • Stimulant medications for ADHD work by increasing the levels of dopamine and norepinephrine in the brain, which are important for attention and focus, specifically in the prefrontal cortex. Optimal levels of these neurochemicals help improve executive functioning, including planning, organization, and execution.
      • Ritalin and Focalin are short-acting formulations of methylphenidate, a common stimulant medication. They typically last around 3-4 hours and start taking effect within 30-45 minutes. Methylphenidate can be crushed and mixed with foods for children who have difficulty swallowing pills. There are also liquid and chewable tablet forms available.
      • Amphetamine medications, such as Adderall, Evekeo, Zenzedi, and Dexedrine, are also short-acting and have similar effects to methylphenidate. They take effect within 30-45 minutes and last around 3-4 hours. Amphetamines are slightly more potent than methylphenidate and tend to have a slightly longer duration of action.
      • As with methylphenidate, some preparations of amphetamines have been created to release the medication over a greater period of time, extending the duration of the effect of the medication. This is of great benefit when trying to provide a response that lasts through a school day (typically 6-8 hours).  Some of these compounds take effect as quickly as the short-acting forms of these medications.
      • It’s important to find the right balance of medication for each individual, as too much stimulation can lead to increased side effects and potential worsening of ADHD symptoms. Different individuals may respond differently to various formulations, so if one medication doesn’t work well, it’s worth considering alternatives.
    • Non-stimulant medications
      • Nonstimulant medications for ADHD fall into two categories: norepinephrine modulators and alpha agonists. Both types have been approved by the FDA for treating children with ADHD.
      • The most commonly used nonstimulant medication is Atomoxetine (Strattera), which is a norepinephrine modulator. It works by increasing the levels of norepinephrine in the brain, improving signaling between nerves and different brain areas. Atomoxetine has been found to reduce ADHD symptoms in children who don’t respond to stimulant medication or can’t tolerate the side effects.
        • Atomoxetine takes up to six weeks to reach its maximum effectiveness and works continuously, unlike stimulant medications. It has been shown to be helpful for all subtypes of ADHD and can also reduce anxiety or tics in children with ADHD.
      • Viloxazine (Qelbree) is a new medication approved by the FDA in 2021 for the treatment of ADHD in children aged 6 to 17. It is also a norepinephrine reuptake inhibitor like Atomoxetine but hasn’t been directly compared to stimulants or Atomoxetine in terms of effectiveness.
      • Clonidine (Catapres, Kapvay) and Guanfacine (Tenex, Intuniv) are alpha agonists, initially developed to lower high blood pressure in adults. They stimulate specific receptors in the brain, triggering the release of norepinephrine. These medications have been shown to improve concentration, reduce hyperactivity, impulsivity, and can also help with tics, aggression, and sleep problems.
    • Behavioral therapy: Behavioral therapy can help people with ADHD learn how to manage their symptoms and improve their behavior. Behavioral therapy techniques include:
    • Parent training: Parents learn how to set clear expectations, provide positive reinforcement, and manage their child’s behavior.
    • Individual therapy: Children learn how to manage their emotions, improve their self-esteem, and develop coping skills.
    • Group therapy: Children learn how to interact with others and develop social skills.
    • Combination therapy: Some people with ADHD may benefit from a combination of medication and behavioral therapy.
    • Lifestyle changes: Making lifestyle changes, such as getting enough sleep, eating a healthy diet, and exercising regularly, can also help to improve symptoms of ADHD.

How to Improve Focus:

There are a number of things that can interfere with focus, including:

  • Stress: Stress can make it difficult to focus by increasing the activity of the amygdala, which can make us more easily distracted.
  • Lack of sleep: When we are sleep-deprived, our brains are less able to focus.
  • Medical conditions: Some medical conditions, such as ADHD, can make it difficult to focus.
  • Substance misuse: Substance misuse can interfere with focus by disrupting the brain’s natural ability to regulate attention.

There are also several things that people can do to improve their focus, including:

  • Get enough sleep. Getting enough sleep is essential for optimal brain function, including focus. Aim for 7-8 hours of sleep per night.
  • Exercise regularly. Exercise has been shown to improve focus and concentration. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
  • Eat a healthy diet. A healthy diet provides the nutrients that the brain needs to function properly. Make sure to eat plenty of fruits, vegetables, and whole grains.
  • Manage stress. Stress can interfere with focus, so it is important to find healthy ways to manage stress. This could include relaxation techniques, such as deep breathing or meditation, or spending time doing activities that you enjoy.
  • Take breaks. Taking breaks throughout the day can help to improve focus and prevent fatigue. Get up and move around every 20-30 minutes, or take a few minutes to relax and clear your head.
  • Avoid distractions. When you are trying to focus, it is important to avoid distractions such as television, social media, and cell phones. Find a quiet place to work where you will not be interrupted.
  • Reward yourself. When you are able to focus and complete a task, reward yourself with something that you enjoy. This will help to reinforce the behavior of focusing.

Content for this post was compiled from Child Mind Institute and the Huberman Lab podcast.