ADHD Roadmap - "What is ADHD?" Pt2.

Hey folks, welcome back to my series on managing adult ADHD. I'm Evan, your resident mental health and addiction therapist, and for our first video I decided, well, it's probably most important to talk about what ADHD is, breaking down the disorder, and how it affects us. Despite how common ADHD is, I find so many people just don't fully understand what the disorder is, how it impacts them, and therefore if you don't know the basis of the problem or the symptoms, then How are you going to solve it?

How are you going to find interventions that are proven to clinically benefit you? Let's go ahead and start from the beginning because clinicians started identifying this symptom cluster of ADHD symptoms being written about as early as the 19th century. Now it was included in the DSM volume 2 in 1968 and it was known as hyperkinetic reaction of childhood. Though our concept of ADHD has evolved over the years, still this cluster of symptoms has been recognized as a disorder that greatly impacts the lives of those who have it.

Now, it does not come without controversy because the thing with ADHD is many people can relate with the symptoms, so therefore they think it's just a normal part of existence. However, people who suffer, it's very different. It affects them on such a deep level, and the research shows that it's connected with so many adverse outcomes and some positive ones, which we'll go over as well. Now, what's most important is what ADHD is and how it impacts our brain and therefore behavior. So one of the key features of ADHD is how it affects the area of our brain known as the prefrontal cortex.

And this is the newest evolved part of our brain. It's what makes us uniquely human because it allows us to do higher thinking, mathematics, art, thinking far ahead. This idea, this conception of ourself, it's responsible for so many things. Essentially, it's the adult part of our brain. It's the last part of our brain to fully develop until become adults. So this part of our brain, the adult part of our brain, one of the most key important features in how it relates to ADHD is our ability to self-regulate both our thinking and our behaviors.

One of the metaphors I like to use to describe the phenomenon of the ADHD brain is that of a stoplight because in the more typical brain we have the red, the yellow, and the green that functions pretty predictably. Now the green is what tells us to do things. It tells us to go. It's the motivation we need to get things done or to do things that are pro survival. In that typical brain we have the yellow light which says okay we need to slow down on this and the red light that says we need to stop this activity and start doing another one that we need to do.

However things are a little bit different in the ADHD brain. Now in the ADHD brain it looks quite different. The traffic light operates in more of a randomized way. It just doesn't go green, yellow, red, green, yellow, red in a predictable fashion, it's kind of all over the place. So in the ADHD brain, we have these periods of motivation, right? So the green light comes on and maybe the green light does not stay on long enough. So I need to do this activity and I get distracted or it becomes overwhelming or I get bored with it and then I quickly switch to red.

Maybe I can skip the yellow light and I go right to red and I stop and then maybe I stay in the red light way too long, right? And I never go back to the green light to do the thing that I need needed to do. However, it could work in the same way whereas I'm in the green light and I don't get to that red light. That green light is telling me to go, go, go and maybe I do an activity and get locked in for hours and hours and hours and then I neglect the other activity. I don't go to yellow, then red and then back to the other activity.

And this creates a lot of dysfunction in the lives of someone with ADHD because we're kind of all over the place. So what are the underlying mechanisms that makes this traffic light a little faulty? Now, One of the key neurotransmitters, brain chemicals associated with ADHD is our favorite, dopamine. And now this is typically seen as the pleasure center, right, in the world of addiction where I work. We talk a lot about dopamine because it's a reward chemical. Anything we do pro-survival makes us feel good.

For example, if I eat when I'm very hungry, drink when I'm thirsty, sex, anything pleasurable, dopamine is guiding me, telling me what I need to do to survive. Dopamine, as we're starting to gain more of an understanding of what it is, also associated with motivation to do things and anticipation of reward. I get the dopamine when I know that reward is coming. So folks with ADHD have a lack of dopamine to the best of our understanding right now. Things can change in research, but a lack of dopamine in certain parts of our brain like the prefrontal cortex that tells us, that motivates us to do those things we need to do even if they're not very fun, right?

So in the ADHD brain, we lack that motivation to often do things we need to do to have that green light turn on. And in a later talk way more detail about dopamine, why it's important, and how we can use dopamine to our advantage. As one prominent researcher, Russell Barkley, once put it, having ADHD is like knowing exactly what you need to do, however, not feeling like you have the ability to follow through and do it. Now, this comes back to motivation, to that red light, yellow light, and green light.

ADHD folks seek novelty, things that are new, things that release dopamine, and that includes things like substance abuse. Because as we talked about, substance use is highly associated with dopamine. So there's all these things that could get us in trouble. When we seek novelty, we don't have a routine. We can't keep our feet on the ground and focus on what we need to do. So this combination of things leads to a lot of problems, to a lot of corollaries with poor outcomes in health, mental health, and anything else you could really think of.

As you may know, ADHD is broken down into three separate subcategories, and the first is predominantly inattentive, struggling with focus of attention. The second is predominantly hyperactive, trouble self-regulating, the body. That's a way that I look at it as well. The third is a combined type, so having a mix of both. So when you look at the symptoms of ADHD, it is broken down into those two broad categories of symptoms. And one reason people think it's maybe not the best way of looking at it is because it's the same underlying mechanism why people struggle with inattention, which is regulation of the mind and regulation of the body with hyperactive.

Because what you often see with children, the ones who are diagnosed pretty early, it's because they're extremely hyperactive and they're causing a lot of trouble at home or in the classroom. But as they get older, that often calms down and it becomes more predominantly inattentive. And for folks like me, who was not really a hyperactive kid. That's why I didn't get diagnosed until much later. I was much more inattentive, but I just found ways to get by. A common question is, well, I think I may have these symptoms.

I could relate with them. Perhaps I have ADHD. What do I do next? Now the most important thing is to get an assessment from a professional. For A neurodevelopmental disorder like autism or ADHD, it's important that you see a psychologist or a psychiatrist. Those are the main ones who could diagnose it. But I want to dig in a little bit deeper into how ADHD is diagnosed and how you could go about doing that. So be sure to tune into the next video to check that out.