How the Brain Works and Recognising the Symptoms

As a counselling tutor, counsellor, and coach with ADHD, I have both a professional and personal understanding of the complexities of Attention Deficit Hyperactivity Disorder (ADHD). It is often misunderstood, dismissed as a lack of discipline, or reduced to a stereotype of hyperactive children who struggle to sit still. In reality, ADHD is a neurodevelopmental condition with profound effects on attention, emotional regulation, impulse control, and executive functioning. This blog explores the science behind ADHD, its core symptoms, and how differences in brain structure and function contribute to the lived experience of those with the condition.

What is ADHD?

ADHD is a neurodevelopmental disorder that affects both children and adults. It is characterised by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily life and functioning. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorises ADHD into three main presentations:

  1. Predominantly Inattentive Presentation – Individuals struggle with sustaining attention, organisation, and follow-through on tasks but may not display significant hyperactivity.
  2. Predominantly Hyperactive-Impulsive Presentation – Individuals exhibit high levels of physical activity, restlessness, impulsivity, and difficulty with self-regulation.
  3. Combined Presentation – A mix of both inattentive and hyperactive-impulsive symptoms.

ADHD is not simply a behavioural issue or a lack of effort. It is a condition rooted in neurological differences that impact how the brain processes information and regulates behaviour.

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How is the ADHD Brain Different?

Scientific research using neuroimaging techniques, such as MRI and fMRI, has revealed distinct differences in the brains of individuals with ADHD compared to neurotypical individuals. These differences affect key areas of the brain responsible for attention, impulse control, emotional regulation, and executive functioning.

1. Differences in Brain Structure

  • Prefrontal Cortex: The prefrontal cortex, which governs executive functions such as planning, impulse control, emotional regulation, and working memory, is often smaller or develops more slowly in individuals with ADHD (Shaw et al., 2007). This contributes to difficulties in organisation, decision-making, and self-regulation.
  • Basal Ganglia: This area of the brain, involved in movement regulation and reward processing, shows structural differences in ADHD brains. Abnormalities in the basal ganglia contribute to difficulties in self-control and impulse regulation (Valera et al., 2007).
  • Corpus Callosum: The corpus callosum, which facilitates communication between the two hemispheres of the brain, has been found to be thinner in individuals with ADHD, potentially leading to problems with coordination and cognitive processing (Hynd et al., 1991).

2. Differences in Brain Function

  • Dopamine and Noradrenaline Dysregulation: ADHD is strongly associated with imbalances in dopamine and noradrenaline, neurotransmitters responsible for motivation, reward processing, and focus (Volkow et al., 2009). A deficiency in dopamine can lead to seeking stimulation through movement, novelty, or risk-taking behaviour.
  • Delayed Brain Maturation: Longitudinal studies have shown that the brains of individuals with ADHD develop more slowly, particularly in areas responsible for executive functioning. However, these differences often diminish in adulthood, which may explain why some individuals experience a reduction in symptoms as they get older (Shaw et al., 2012).
  • Overactivity in the Default Mode Network (DMN): The DMN, which is active when the brain is at rest and not focused on tasks, tends to be more active in individuals with ADHD, leading to difficulties in sustaining attention and remaining engaged in tasks (Sonuga-Barke & Castellanos, 2007).

Core Symptoms of ADHD

The symptoms of ADHD vary widely between individuals and across different life stages. However, they are generally grouped into three main areas: inattention, hyperactivity, and impulsivity.

1. Inattention

Individuals with ADHD often struggle with:

  • Difficulty sustaining attention on tasks or conversations
  • Being easily distracted by external stimuli or internal thoughts
  • Forgetfulness in daily activities (e.g., missing appointments, misplacing items)
  • Struggling to follow through on instructions or complete tasks
  • Difficulty with organisation and time management
  • Avoiding or procrastinating on tasks that require sustained effort

This can make academic and workplace settings particularly challenging, as individuals may appear careless or disengaged when, in reality, they are struggling with attentional control.

2. Hyperactivity

Hyperactivity symptoms are more commonly observed in children but can persist into adulthood in different ways. These include:

  • Constant fidgeting, tapping, or moving when expected to remain still
  • Difficulty engaging in activities quietly
  • Feeling restless or driven by an internal sense of urgency
  • Talking excessively or interrupting conversations

In adults, hyperactivity often manifests as inner restlessness, an inability to relax, or engaging in multiple activities at once.

3. Impulsivity

Impulsivity in ADHD can lead to:

  • Difficulty waiting one’s turn in conversations or activities
  • Blurting out answers or interrupting others
  • Making hasty decisions without considering consequences
  • Struggling with delayed gratification
  • Emotional impulsivity, leading to intense reactions or mood swings

Impulsivity can create difficulties in relationships, work environments, and financial decision-making, as individuals may act on impulse without fully processing the consequences.

How ADHD Affects Daily Life

ADHD impacts multiple areas of life, often leading to challenges that others may misinterpret as carelessness or a lack of discipline.

1. Academic and Workplace Challenges

  • Difficulties with time management and meeting deadlines
  • Procrastination, followed by intense bursts of productivity under pressure
  • Struggles with maintaining attention in meetings or lectures
  • Forgetting important information, leading to mistakes or misunderstandings

2. Emotional Regulation and Mental Health

ADHD is often accompanied by difficulties in emotional regulation, leading to:

  • Intense emotional responses and mood swings
  • Rejection sensitivity dysphoria (RSD), a severe reaction to perceived criticism or rejection
  • Increased risk of anxiety and depression due to chronic frustration and self-doubt

3. Relationships and Social Interaction

  • Interrupting conversations or struggling to listen attentively
  • Forgetting commitments or appearing unreliable
  • Difficulty managing emotions in conflicts

Conclusion

ADHD is a complex and multifaceted condition that extends beyond childhood and affects various aspects of life. It is not a matter of laziness, poor discipline, or a lack of intelligence but a neurobiological difference that requires understanding and appropriate support.

By recognising the neurological underpinnings of ADHD and understanding its symptoms, we can move beyond outdated misconceptions and provide individuals with the tools they need to thrive. As a counselling tutor and coach with ADHD, I have seen firsthand how compassionate, evidence-based support can make a profound difference in the lives of those with the condition. Whether through coaching, therapy, medication, or lifestyle strategies, individuals with ADHD can harness their strengths and navigate challenges effectively.

If you suspect that you or someone you know has ADHD, seeking a professional assessment is a crucial first step. With the right support and understanding, ADHD can be managed in a way that allows individuals to reach their full potential.


References

  • Shaw, P., et al. (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. PNAS.
  • Valera, E.M., et al. (2007). Meta-analysis of structural imaging findings in attention-deficit/hyperactivity disorder. Biological Psychiatry.
  • Volkow, N.D., et al. (2009). Evaluating dopamine reward pathway in ADHD. JAMA.
  • Sonuga-Barke, E.J.S., & Castellanos, F.X. (2007). Spontaneous attentional fluctuations in ADHD: Contributions from the default mode network. Biological Psychiatry.
  • Shaw, P., et al. (2012). Neurodevelopmental trajectories of the human cerebral cortex in childhood and adolescence. JAMA Psychiatry.

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