ADHD: Symptoms, Tests, Influencing Factors, and At-Home Management
Attention Deficit Hyperactive Disorder. I’m sure you’ve heard of it, especially if you live in America where, between 2003 and 2011, the number of children diagnosed with the condition aged 4 to 17 years increased by 42 percent. According to the Center for Disease Control and Prevention (CDC), it’s still on the rise.
But, while we may have all heard of the condition and even have a vivid idea of what it is (whether from personal experience or just witnessing it in friends or their children), the science behind the brain of someone with ADHD is incredibly complex. Research is inconclusive on many things, including causality and some treatments. But multiple studies are contributing to conclusions being reached.
In this post, we’ll look at some of those possible causes and conclusions to better understand what’s going on in the brain of someone with the condition. We’ll briefly look at the physical characteristics of the ADHD brain, genetic and environmental factors, and how to best manage it at home (of course, after talking to your healthcare provider about the best options).
But first, the symptoms…
ADHD has clearly defined symptoms, and in order to be diagnosed, an individual must meet at least 6 out of 9 symptoms from two categories (inattention and hyperactivity/impulsivity) as well as four additional conditions. To see a list of the requirements from the Diagnostic and Statistical Manual, fifth edition (DSM-5) needed to be diagnosed, go here.
Amen Clinics lists these as the symptoms associated with classic ADD/ADHD:
- Easily distracted
- Poor follow through
- Trouble listening when others talk to them
- Making careless mistakes/poor attention to detail
- Being fidgety
- Difficulty awaiting their turn
- Act as though driven by a motor
- Being noisy
- Talking excessively
- Interrupting others
If you think you or your child might have ADHD, there are online tests available to take that can provide a beginning point of conversation with your healthcare practitioner. You can find an adult test here, and a child test here.
The ADHD Brain
The brain of someone with ADHD has offered many variables compared to a control subject in tests. It has been observed that ADHD results in thinner brain tissue in the areas specifically associated with attention . It has also been observed that those with ADHD have less white matter, that area of the brain containing myelinated axons that form the basis of higher executive function skills, processing speed, and synchrony of brain function .
Dopamine dysregulation is a major effect on the brain of people with ADHD. This is why stimulant drugs are an effective treatment.
Additionally, it has been observed that aberrant myelination is present in those with ADHD . This is a crucial observation because it is indicative of a most fundamental process being delayed. George Bartzokis explains: “In the first four decades of life, myelination is essential for establishing increasingly sophisticated psychological functional capacities such as inhibitory control, social behavior, and higher executive functions” . Myelination is the process of axons in the brain being covered with a myelin sheath, which acts similarly to an electrical insulator. The more myelin sheath there is covering an axon node, the faster a message going down the axon can travel, thus creating smoother brain functions. If myelination is delayed, the brain’s ability to create these connections is also delayed.
So, what is the significance of these characteristics of the ADHD brain? It provides the understanding that ADHD is not only a symptom-based diagnosis but is also a physically observable condition. This allows a better comprehension of the condition and more enhanced treatment outcomes. Knowing what’s physically going on in the ADHD brain can lead to more accurate treatment.
But how does a brain become like this?
Curatolo, D’Agati, and Moavero point out: “There are multiple genetic and environmental risk factors with small individual effect that act in concert to create a spectrum of neurobiological liability” 
Genetic factors are believed to be a prominent cause of ADHD. It has been observed that children with ADHD have a genetic predisposition to the condition, though not all children who have this genetic predisposition end up acquiring it. This is because multiple other variables play on that genetic predisposition, and it is thought to be these variables acting together upon genetics that cause ADHD. According to the National Institute of Health, ADHD is likely among those with a close relative who also has it. Franke et al. observe that “family studies have shown that ADHD shows familial clustering both within and across generations” 
Environmental factors make up a solid web of influences on the brain that lead to ADHD. They include pre-, peri-, and postnatal factors (including maternal drug and alcohol exposure, low birthweight and complications, and malnutrition), heavy metal exposure, nutritional factors, and lifestyle and psychosocial factors [3, 5]. Things like essential fatty acids have been seen to reduce the symptoms of ADHD . The Western Diet (or Standard American Diet [SAD]) has also been observed to cause more of a likelihood of ADHD. Froehlich et al. report that an Australian study “found an increased likelihood of an ADHD diagnosis in children who consumed more fat, refined sugars, and sodium and less fiber, folate, and omega-3 fatty acids. Study strengths included adjustment for many prospectively collected prenatal and concurrent covariates, while weaknesses included case identification by parent report of a prior ADHD diagnosis” 
All of the above information is meant to provide a foundational understanding of practical ways to help manage ADHD at home, whether for adults or children. Following is a list of research-based ways to do that:
- Diet: As mentioned above, omega-3 fatty acids can reduce the symptoms of ADHD , and having a diet high in proteins and low in carbohydrates has also caused a reduction in symptoms. Some elimination diets have also been successful . Foods that are high in omega-3’s include salmon, sardines, chia seeds, flax seeds, walnuts, and soybeans. Try to make trying new foods a fun experience for your child, and find creative ways to add them to their diet. Add chia and flax seeds, and even walnuts, to any smoothie. Go here for easy ways to make protein a big part of breakfast.
- Meditation: Meditation has been found to increase the white matter in the brain. As discussed above, white matter in individuals with ADHD is lower in tests than those of controls. White matter is the area of the brain where myelination takes place. Meditating can drastically increase the myelination, leading to better focus and control of emotions and thoughts, as well as faster processing speed [8,9]. Here is a list of different types of meditations and how to perform them. Take a look and choose according to what seems best for you or your child. You can also visit headspace.com and sign up for free guided meditations (they have an app!). Meditation and relaxation may be very difficult at first for kids. Take it slow and walk them through. If they like massage, try gentle massage while they ease into deep breathing and meditation.
- Exercise: Multiple tests have observed that physical exercise leads to increased myelination, dopamine and neurotransmitters in the brain . It has also been seen to decrease learned helplessness, something that those with ADHD often deal with . Don’t rush into exercises with your child. Rather, make it a slow and fun process. Do it with them, and be open to starting out just with walks and jumping jacks.
- Using a reward system: Using a reward system at home can help increase dopamine in the brain . Those with ADHD generally respond better to praise and rewards than to negative feedback (negative feedback can contribute to learned helplessness). To see different ways to implement a reward system go here. Keep in mind that every child is different. Some will need small rewards given every 15 minutes (like a snack or a walk outside), while others might be able to perform tasks for an hour before needing a reward to revamp motivation.
- Limiting screen time: While screen time doesn’t cause ADHD, it can certainly exacerbate symptoms . Victoria L. Dunckley, M.D., discusses the consequences of screen time on the brain, including gray matter atrophy, comprised white matter, impaired cognitive functioning, and impaired dopamine function . To see the American Academy of Pediatrics guidelines for screen time, go here. If this is a major point of contention for your child, try using the reward system idea to motivate them to do other things rather than screen time. For example, “I’ll reward you with __ if you do 30 minutes of (art, reading, playing outside, etc.) rather than screen time.” However, screen time can also be used as to reward other things, like finishing homework or chores, though the screen time rewarded should be limited and used at the appropriate time (not right before bed). For example, “If you do your homework for 30 minutes straight while I help you, you can get 15 minutes of screen time this weekend. For every 30 minutes of homework (or chores) that you do this week, you can add 15 minutes of screen time to this weekend, but only to a 2-hour maximum.” Of course, tailor this to your’s and your child’s needs and specific situation.
For additional ways to manage ADHD at home, visit this article from everydayhealth.com.
ADHD is a highly complex neurobehavioral disorder affecting many children and adults. Focus on new research and studies is continually being fostered. I hope this post was helpful for you in understanding the many factors and variables that play a part in ADHD.
- Philip Shaw, Michele Gornick, Jason Lerch, Anjene Addington, Jeffrey Seal, Deanna Greenstein, Wendy Sharp, Alan Evans, Jay N. Giedd, F. Xavier Castellanos, Judith L. Rapoport. Polymorphisms of the Dopamine D4 Receptor, Clinical Outcome, and Cortical Structure in Attention-Deficit/Hyperactivity Disorder. Arch Gen Psychiatry. 2007;64(8):921–931. doi:10.1001/archpsyc.64.8.921
- BARTZOKIS, G. (2005). BRAIN MYELINATION IN PREVALENT NEUROPSYCHIATRIC DEVELOPMENTAL DISORDERS: PRIMARY AND COMORBID ADDICTION. Adolescent Psychiatry, 29, 55–96
- Curatolo, P., D’Agati, E., & Moavero, R. (2010). The neurobiological basis of ADHD. Italian Journal of Pediatrics, 36, 79. http://doi.org/10.1186/1824-7288-36-79
- Franke, B., Faraone, S. V., Asherson, P., Buitelaar, J., Bau, C. H. D., Ramos-Quiroga, J. A., … Reif, A. (2012). The genetics of attention deficit/hyperactivity disorder in adults, a review. Molecular Psychiatry, 17(10), 960–987. http://doi.org/10.1038/mp.2011.138
- Froehlich, T. E., Anixt, J. S., Loe, I. M., Chirdkiatgumchai, V., Kuan, L., & Gilman, R. C. (2011). Update on Environmental Risk Factors for Attention-Deficit/Hyperactivity Disorder. Current Psychiatry Reports, 13(5), 333–344. http://doi.org/10.1007/s11920-011-0221-3
- RAZ, R. and GABIS, L. (2009), Essential fatty acids and attention-deficit–hyperactivity disorder: a systematic review. Developmental Medicine & Child Neurology, 51: 580–592. doi:10.1111/j.1469-8749.2009.03351.x
- Nigg, J. T., & Holton, K. (2014). Restriction and Elimination Diets in ADHD Treatment. Child and Adolescent Psychiatric Clinics of North America, 23(4), 937–953. http://doi.org/10.1016/j.chc.2014.05.010
- Lieff, Jon. (2012, June 25). Meditation and Brain Changes: Recent Research and New Applications [Blog post]. Retrieved from http://jonlieffmd.com/blog/meditation-and-brain-changes-recent-research-and-new-applications
- Fernandez, Alvaro. (2008, June 4). Study: Meditation Against ADHD [Blog post]. Retrieved from https://www.huffingtonpost.com/alvaro-fernandez/study-meditation-against_b_103534.html
- Berwid, O. G., & Halperin, J. M. (2012). Emerging Support for a Role of Exercise in Attention-Deficit/Hyperactivity Disorder Intervention Planning. Current Psychiatry Reports, 14(5), 543–551. http://doi.org/10.1007/s11920-012-0297-4
- Additude Editors. (2008, December). Exercise and the ADHD Brain: The Neuroscience of Movement. Retrieved from https://www.additudemag.com/exercise-and-the-adhd-brain/
- Warner, Jennifer. (2009, September 8). ADHD Tied to Brain’s Reward Pathway. Retrieved from https://www.webmd.com/add-adhd/news/20090908/adhd-tied-to-brains-reward-pathway
- Dewey, Caitlin. (2015, March 25). Is the Internet Giving Us All ADHD. Retrieved from https://www.washingtonpost.com/news/the-intersect/wp/2015/03/25/is-the-internet-giving-us-all-adhd/?utm_term=.2e9c7009aba7
- Dunckley, Victoria L. (2014, February 27). Gray Matter: Too Much Screen Time Damages the Brain. Retrieved from https://www.psychologytoday.com/blog/mental-wealth/201402/gray-matters-too-much-screen-time-damages-the-brain