Posted by: counselorcarmella | August 24, 2011

ADD and The Brain


Contrary to what logic would dictate, the brain of the person with AD/HD is actually less active than the normal brain. There is an insufficient amount of the neurotransmitter dopamine in the brain of the adult with AD/HD. This is a chemical that carries the electrical impulses between nerve cells. It  also seems that the dopamine uptake system is sluggish.  For that reason, the AD/HD brain actually needs more stimulation.


And that is why stimulants (Vyvanse, Adoral, Concerta, Ritalin) have been the treatment of choice for years. When the brain is under stimulated, it seeks out  external sources of stimulation. It starts paying attention to anything and everything in the person’s environment to try and stay alert.  Stimulants regulate the brain internally by increasing dopamine levels and strengthening dopamine signals. This way, the stimulation the brain  needs is   provided internally rather than externally.


ADD is also related to  levels of activity in the pre frontal cortex. People with  ADD have decreased activity in their pre frontal cortex when they are trying to concentrate.  The PFC functions normally when they  aren’t  trying to  focus on  a task, whereas   in people without  ADD, activity in the PFC increases when focussing. Dr. Daniel Amen  describes what the PFC does this way: Overall, the pfc is the part of the brain that watches, supervises, guides, directs, and focuses your behavior. It contains “executive functions”: time management, judgment, impulse control, planning, organization, and critical thinking. Our ability as a species to think, plan ahead, use time wisely, and communicate with others is heavily influenced by this part of the brain. The pfc is responsible for behaviors that are necessary for you to act appropriately, focus on goals, maintain social responsibility, and be effective.” Problems in the pfc lead to the organization of daily life spiraling into chaos while internal supervision goes awry. People with pfc problems exhibit problems with impulse control, doing things they later regret. They also experience impaired attention span, distractibility, procrastination, poor judgment, and difficulty expressing themselves.


Living with AD/HD is like watching television with a channel surfer. A few seconds of one station, then a few minutes of another, followed by a few seconds of several stations . . . The problem is not that the person with AD/HD can’t attend to things, but that the person with AD/HD attends to everything! If the current task stops being interesting–if it does not reward the person’s attention any longer–then the mind flits off to something else. What kind of rewards? Entertainment, excitement, interest, novelty.


Concentration difficulties also escalate with boredom and fatigue. If a person with AD/HD is working on a familiar task, there is an increased tendency to daydream. Or if a person with AD/HD has been focusing on some task for a period of time, he or she may “use up” the supply of concentration and may have difficulty with the next project or task. There can also be problems with activation. With AD/HD, it’s hard getting started on a task as well as sustaining energy and staying with a task. The goal in treating ADD is not to prevent these mental excursions but to bring them more under voluntary control.


We expect a certain amount of impulsive behavior from teenagers because their PFC is still in the process of developing anyway, but  adults are supposed to be able to think through their behaviors.  With  those experiencing hyperactive/impulsive ADD, this is a real challenge.   These folks often experience foot in mouth disease, make on the spot purchases, or   end relationships or walk out on jobs based on how they feel in the moment. Some of them are adrenalin junkies, driving too fast,  sky diving,   or even  creating conflict  for purposes of  stimulation.


Neuroimaging studies provide valuable information about the anatomic and functional differences in the brains of persons with ADHD, yet neuroimaging remains a research tool rather than a clinical one.



  1. Content here is VERY well done! I will be linking here from ADD Overview 101 on my ADD-info blogsite ADDandSoMuchMore (dot com)

    ADD Overview 101 is the first in a series on ADD Basics, and your post will be a great counter-balance to the slightly more “tech-talkie” front end to this particular series.

    I especially LOVE the following:
    The goal in treating ADD is not to prevent . . . mental excursions but to bring them more under voluntary control. QUOTABLE! (and I may actually quote you) Let me know if you’re interested in some mutual guest blogging.
    mgh (Madelyn Griffith-Haynie, SCAC, MCC – blogging at ADDandSoMuchMore and ADDerWorld – dot com!)

  2. […] The ADD Brain: a very readable post about the above in PLAIN language […]

  3. […] ADD and The Brain ( […]

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