What is Attention Deficit Hyperactivity Disorder (ADHD)?
ADHD
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental conditions. Children with ADHD can struggle to pay attention, manage their emotions and control impulses. They may find it hard to make friends, resist temptation or think through the consequences of risky behavior. Many children don’t simply outgrow ADHD, and many adults continue to face real challenges from it.
How Common Is ADHD?
According to the Centers for Disease Control and Prevention, about 7.1 million children in the United States, or 11.4%, have been diagnosed with ADHD (1). Boys are more likely to be diagnosed than girls (2).
Most children with ADHD have at least one other mental, behavioral or developmental condition, such as behavior or conduct problems, anxiety, depression, autism spectrum disorder or Tourette syndrome (1).
What Are the Symptoms of ADHD?
People with ADHD often show excessive movement, frequent interrupting or talking out of turn, and daydreaming that gets in the way. Forgetfulness and careless mistakes are common. Children with ADHD may have trouble avoiding unnecessary risks, resisting temptation, making friends, taking turns and getting along with others (3).
What Causes ADHD?
The exact cause of ADHD isn’t fully understood, but genetics appear to play a major role. ADHD can look different from person to person. Some people are mainly hyperactive and impulsive, some are mainly inattentive, and some have a combination. Other factors linked to ADHD include brain injuries, premature birth, and alcohol or tobacco use during pregnancy (2).
ADHD is considered a neurodevelopmental disorder, meaning it involves differences in how important brain regions and circuits develop. Many people don’t simply outgrow it, which is why accurate diagnosis and early support matter.
How Does ADHD Affect Life Over Time?
ADHD often continues into adulthood. Adults with ADHD may continue to struggle with planning, organization, working memory and attention. ADHD is also linked to higher rates of anxiety, depression, low self-esteem, academic difficulties and substance use, and it can affect work, relationships and family life (4).
How Is ADHD Diagnosed?
ADHD is diagnosed by a qualified healthcare provider, usually with the help of questionnaires and rating scales. Signs of inattention can include missing details, trouble organizing tasks, being easily distracted and not seeming to listen. Signs of hyperactivity and impulsivity can include trouble doing quiet activities, constant fidgeting, talking excessively and moving around when expected to sit still. Several symptoms must be present before age 12, show up in more than one setting, such as home and school, and interfere with school, work or social life (3).
What Happens in the Brain With ADHD?
ADHD has traditionally been viewed as a problem with the brain chemicals norepinephrine and dopamine. These chemicals help nerve cells communicate in important brain pathways. But they are used throughout the nervous system, including in pathways not affected by ADHD, so research increasingly views ADHD as a difference in how several brain regions work and work together. These include the following areas.
The frontal and prefrontal cortex. These areas handle executive functions like reasoning, planning and self-control. Differences here can contribute to inattention, disorganization and impulsivity.
The limbic system. These structures deep in the brain help regulate emotions. Differences here can contribute to emotional outbursts, a short fuse, meltdowns and agitation.
The basal ganglia. These circuits receive input from across the brain and help regulate communication between brain regions. They act like the brain’s gas and brake pedals, helping start and stop thoughts, emotions and movements. Differences here can contribute to impulsivity, trouble with emotional control, and problems with attention and focus.
The reticular activating system. This is the brain’s main arousal system, located at the top of the brainstem. It helps activate the frontal lobes and other brain regions. Differences here can contribute to inattention, fatigue, poor concentration and sleep problems.
How Is ADHD Usually Treated?
ADHD is most often treated with medication and behavioral approaches. Stimulant medications, such as Ritalin, Adderall and Concerta, affect norepinephrine and dopamine and are among the most studied treatments for ADHD. They help many people. Because these brain chemicals are used throughout the nervous system, the medications can also cause side effects, such as sleep problems, decreased appetite, slowed growth, tics, headaches, stomachaches and irritability as the medication wears off (5). Your child’s prescriber can help weigh these benefits and side effects.
How the NeuroRescue Program Can Help
Our care is designed to work alongside your or your child’s pediatrician, prescriber, therapists and school team, never in place of them. Please don’t change any medication without talking with the prescriber.
Eye movements and attention. Many of the brain regions involved in ADHD also control certain types of eye movements, and research has found a number of eye movement differences in children with ADHD (6). The most studied are saccades, quick jumps of the eyes to a target, and anti-saccades, in which a person must look away from a new target instead of toward it. Both rely on frontal lobe areas that also help hold back unwanted responses. Because anti-saccades require holding back an automatic urge, they draw on the same kind of self-control involved in managing impulsive behavior.
One study found that children with ADHD took much longer to start certain saccades than children without ADHD, and suggested that measuring saccades may be a useful way to assess ADHD-related differences (7). Studies have also found that children with ADHD have more difficulty with anti-saccades (8). We use targeted eye movement exercises, including anti-saccades, with the goal of strengthening the brain’s attention and self-control systems.
Visual fixation, the ability to keep the eyes steady on a target, is also often affected in ADHD. Steady gaze is linked to steady posture, and research shows that the brain circuits involved in visual and attentional focus are also involved in planning whole-body movements (9).
Motor planning. The frontal cortex and basal ganglia also help plan and carry out movement, and motor planning difficulties have been found in children with ADHD. One study reported improvements in attention and on cognitive tests after a 12-week motor training program (10).
Primitive reflexes. Babies are born with automatic movement patterns called primitive reflexes, which help the brain develop and normally fade during the first years of life. Some studies have found retained primitive reflexes in children with ADHD, which may affect motor learning and behavior (11). Some research suggests that exercises to help these reflexes fade may be helpful in a range of neurodevelopmental conditions (12, 13). When an exam shows retained reflexes, your child’s program may include these exercises.
Rhythm and timing. Research has found differences in connections between the frontal lobes, cerebellum and basal ganglia in several neurodevelopmental conditions, including ADHD (14), and impaired motor timing appears to be part of this (15). We use a computerized system called the Interactive Metronome to train motor timing, which has been studied for improving attention and focus (16, 17).
Balance and vestibular rehabilitation. Some studies have found differences in balance and inner ear function in people with ADHD, using tests such as the video head impulse test and vestibular evoked myogenic potentials (18, 19). Vestibular rehabilitation has been studied for improving balance, as well as attention and focus, in people with ADHD (20). When testing shows a need, your program may include these exercises.
Cognitive training. We use computerized cognitive training, including working memory exercises, to build attention and focus. An early randomized controlled trial found that computerized working memory training improved working memory in children with ADHD and reduced parent-reported inattention (21). Later research has been mixed on how much these gains carry over into everyday life, so we use cognitive training as one part of a broader program.
Transcranial magnetic stimulation for adults. TMS uses a magnetic coil placed against the head to deliver gentle magnetic pulses to targeted areas of the brain. It has been studied for improving attention, focus and behavioral control in ADHD (22). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner and is offered only to patients 18 and older. Because ADHD often continues into adulthood, it may be an option for adults.
Every NeuroRescue Program is different, with therapies chosen based on testing and each person’s specific situation. No two brains are alike, and no two programs are either.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We then measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions.
Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function and endurance in the systems that need support. Our testing also helps us decide when to push and when to let you rest.
Our goal is to help you or your child build attention, self-control and coordination, and to feel more confident at home, at school, at work and with others.
Your Next Step
Living with ADHD can be challenging, but there is hope for improving focus, self-control and daily function. To find out if the NeuroRescue Program is right for you or your child, contact one of our patient care coordinators to schedule a Discovery Day.
It’s never too late to take the next step.
References
