ADHD overview
Our ADHD resource section was created by Tucker Bayly in partial completion of his senior project at Moscow High School in 2023
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, characterized behaviorally by poor attention span, impulsivity, exceedingly high energy (hyperactivity), poor planning, disorganization, and numerous other related behaviors. ADHD is the most frequently diagnosed disorder of childhood. According to the CDC, around 10% of children are diagnosed with ADHD, 25% of whom will never receive treatment. With the average class size in the United States being 24 students, this means that there is an average of two students with ADHD in every public-school classroom. This is a very high number for a disorder that can create so much distress and academic struggle. Additionally, as rates of ADHD and other attentional issues rise, so do suicide rates in younger generations of boys, who appear to struggle with ADHD more frequently than girls. In correlation with this mental health epidemic, and as society continues to move indoors, recess and free play time have been reduced drastically both in and outside of schools. Play has been shown in numerous studies to be vital for neurological and social development and could be the key to reversing and preventing symptoms of ADHD and the struggles that come with it.
In order to understand treatment and management of ADHD as well as modern methods of diagnosis, it is important to first have an understanding of what is causing the disorder from a neurobiological standpoint. The current most widely accepted theory behind ADHD is what is called the Low Dopamine Hypothesis. This theory, originated from the fact that people with ADHD are far more likely to get addicted to stimulants (caffeine, nicotine, cocaine, methamphetamine, etc.) that increase the amount of dopamine and norepinephrine, as well as the fact that the drugs that are often effective in alleviating the behaviors of ADHD (Adderall, Ritalin, etc.) are also stimulants, and effect the brain in a similar way.
Dopamine, the neuromodulator that is most commonly associated with motivation and reward systems in the brain, can act both as an inhibitor as well as an enhancer for different networks in the brain, making it key for proper cognitive regulation. Having a low amount of dopamine in the brain firstly explains the behaviors of impulsivity and disorganization, as the brain wants the dopamine quickly leading to difficulty in long term planning or thinking through decisions, opting for the immediate benefit of doing something despite later consequences. This is also connected to the high rate of addiction and abuse of dopaminergic compounds in those with ADHD, as taking these stimulants allows them to feel “normal” during the high or while the compound is in the body, while ignoring the long-term side effects or risks of taking these things.
Secondly, as mentioned earlier, dopamine is essential for regulating brain networks and general cognitive function especially relating to attention and focus. The two networks in that system are the Task-Related Network, active as the name suggests when someone is focused on completing one task, and the Default-Mode Network, active when someone is in a state of enteroception, focusing on their own thoughts and feelings rather than stimuli from the outside world. In a neurotypical brain that is properly regulated these networks are anticorrelated, meaning they are not active at the same time as their functions interfere with one another. However, when there is a shortage of dopamine, as in brain of someone with ADHD, both networks can become active at the same time. This creates the symptoms of being spacey and distractible, as the person may have been trying to do something or even trying to relax and do nothing, but the anticorrelated network became active, causing them to be distracted with something else. Through the use of an Electroencephalogram (EEG) these brainwaves and networks can actually be measured, leading to more accurate diagnosis and preventing some issues that come with a strictly behavioral diagnoses.
The low dopamine hypothesis also explains hyperactivity and hyper-focus as a means for the brain to pursue more dopamine. From the perspective of affective neuroscience, play comes from a very primal part of the human brain and serves essentially to attempt to raise levels of dopamine through interacting with the environment, be it other people, or some other sort of activity. It becomes a sort of ultradian cycle, as dopamine levels rise through stimulation until reaching a threshold of inhibition, where one feels satisfied and is ready to be done, and begins to inhibit the behaviour it previously stimulated. Thus dopamine is stimulating to a certain point, and then, as dopamine levels elevate past a certain threshold point, it becomes inhibitory. Thus, many aspects of hyperactivity may actually be seen as hyper playfulness. Conceptualizing ADHD as a state of extended playfulness, with hyperactive children never reaching the natural chemical state of inhibition and maintaining the feeling of high-energy and playfulness long after their peers explains some difficulties with social interactions; as a neurotypical child may be in the mood to be calm or serious, a child with ADHD is unable to calm down.
This applies not only to play but also focusing on tasks and learning. The dopamine extends to what is often referred to as hyper-focus. When someone with ADHD finds something they are very interested in, that brings them a lot of dopamine, they experience the same effect but with whatever it is they’re focusing on. They are able to maintain focus on this one thing, again never reaching the threshold of inhibition, until they physically exhaust themselves or must move on due to other reasons. Learning to manage this double-edged sword is crucial for functioning with ADHD, and one of the best treatments for ADHD in early childhood has been shown to simply be more play.
Typical common treatments for ADHD as stated before tend to be medication, primarily stimulants. These pharmaceuticals are generally very effective in treating and reducing ADHD behaviors, but recent studies including those that emphasize the value of play highlight the lesser known yet very serious side effects of these drugs when prescribed at a young age. Not only are children that started taking stimulants at a young age statistically shorter than their peers, but due to the changes in behavior they are often held back in other ways. Linking back to the ultradian cycle of play, it serves as a natural way to increase levels of dopamine until the brain has enough, then tapering off, the pharmaceuticals essentially highjack this system, raising dopamine levels without the need for any preceding behavior. Behaviorally this is effective for alleviating symptoms, but what this does in turn is discourage these children from engaging in play. This lack of play can be detrimental for a child’s social development, as learning to socialize with peers and learning lessons from play and activity that would naturally raise levels of dopamine is key for social as well as neurological development.
Tapping into these deeper cognitive functions as well as basic human biology is key in finding alternative treatments to ADHD, with the tradeoff of behavioral treatment taking more time and difficulty in consistency than simply taking a medication. In a broader study looking at the impact of diet on behavior and cognitive function, it was found that minor food allergies and limiting or cutting out consumption of foods that create small amounts of antibodies or inflammation can greatly improve cognitive and physical health. This is because the neurons can experience small amounts of inflammation from mild food allergies, inhibiting the ability to function at maximum efficiency. Taking a supplement such as fish oil that reduces inflammation has also been shown to create a similar effect in alleviating mild symptoms of neurological disorders as well as building a healthy nervous system all throughout the body. However, in the case of ADHD, diet has been shown to only be able to do so much as a treatment and the modification of other behaviors specifically relating to play and physical activity. A study done by Jaak Panksepp showed this definitively in rats, but the experiment is yet to be directly translated over to humans although its implications still apply and numerous studies of play support the translation into the human species. To simplify, Panksepp lesioned the brains of rats to simulate ADHD. He then separated them into experimental groups, with the control group being regular healthy rats. Allowing some groups to have free play time with other rats while others were isolated, he found that the rats allowed to play tested nearly identically to the control group, while the rats that were not allowed time to play still maintained symptoms of ADHD. Although that is a very simplified explanation of a very complex study, the implications of the importance of play in not only prevention but treatment of ADHD are demonstrated.
This basic understanding of ADHD is crucial for managing ADHD for parents, teachers, as well as those that have the disorder themselves. But more specific tricks for integrating these things into the classroom or into general life is a lot easier said than done, and it can be overwhelming trying to find a balance. In the subsections below, there is advice from experts with years of experience in dealing with ADHD, as well as more information about what can more specifically be done to integrate these things and actually apply the knowledge of the disorder into the classroom and everyday life.
Our ADHD resource section was created by Tucker Bayly in partial completion of his senior project at Moscow High School in 2023
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, characterized behaviorally by poor attention span, impulsivity, exceedingly high energy (hyperactivity), poor planning, disorganization, and numerous other related behaviors. ADHD is the most frequently diagnosed disorder of childhood. According to the CDC, around 10% of children are diagnosed with ADHD, 25% of whom will never receive treatment. With the average class size in the United States being 24 students, this means that there is an average of two students with ADHD in every public-school classroom. This is a very high number for a disorder that can create so much distress and academic struggle. Additionally, as rates of ADHD and other attentional issues rise, so do suicide rates in younger generations of boys, who appear to struggle with ADHD more frequently than girls. In correlation with this mental health epidemic, and as society continues to move indoors, recess and free play time have been reduced drastically both in and outside of schools. Play has been shown in numerous studies to be vital for neurological and social development and could be the key to reversing and preventing symptoms of ADHD and the struggles that come with it.
In order to understand treatment and management of ADHD as well as modern methods of diagnosis, it is important to first have an understanding of what is causing the disorder from a neurobiological standpoint. The current most widely accepted theory behind ADHD is what is called the Low Dopamine Hypothesis. This theory, originated from the fact that people with ADHD are far more likely to get addicted to stimulants (caffeine, nicotine, cocaine, methamphetamine, etc.) that increase the amount of dopamine and norepinephrine, as well as the fact that the drugs that are often effective in alleviating the behaviors of ADHD (Adderall, Ritalin, etc.) are also stimulants, and effect the brain in a similar way.
Dopamine, the neuromodulator that is most commonly associated with motivation and reward systems in the brain, can act both as an inhibitor as well as an enhancer for different networks in the brain, making it key for proper cognitive regulation. Having a low amount of dopamine in the brain firstly explains the behaviors of impulsivity and disorganization, as the brain wants the dopamine quickly leading to difficulty in long term planning or thinking through decisions, opting for the immediate benefit of doing something despite later consequences. This is also connected to the high rate of addiction and abuse of dopaminergic compounds in those with ADHD, as taking these stimulants allows them to feel “normal” during the high or while the compound is in the body, while ignoring the long-term side effects or risks of taking these things.
Secondly, as mentioned earlier, dopamine is essential for regulating brain networks and general cognitive function especially relating to attention and focus. The two networks in that system are the Task-Related Network, active as the name suggests when someone is focused on completing one task, and the Default-Mode Network, active when someone is in a state of enteroception, focusing on their own thoughts and feelings rather than stimuli from the outside world. In a neurotypical brain that is properly regulated these networks are anticorrelated, meaning they are not active at the same time as their functions interfere with one another. However, when there is a shortage of dopamine, as in brain of someone with ADHD, both networks can become active at the same time. This creates the symptoms of being spacey and distractible, as the person may have been trying to do something or even trying to relax and do nothing, but the anticorrelated network became active, causing them to be distracted with something else. Through the use of an Electroencephalogram (EEG) these brainwaves and networks can actually be measured, leading to more accurate diagnosis and preventing some issues that come with a strictly behavioral diagnoses.
The low dopamine hypothesis also explains hyperactivity and hyper-focus as a means for the brain to pursue more dopamine. From the perspective of affective neuroscience, play comes from a very primal part of the human brain and serves essentially to attempt to raise levels of dopamine through interacting with the environment, be it other people, or some other sort of activity. It becomes a sort of ultradian cycle, as dopamine levels rise through stimulation until reaching a threshold of inhibition, where one feels satisfied and is ready to be done, and begins to inhibit the behaviour it previously stimulated. Thus dopamine is stimulating to a certain point, and then, as dopamine levels elevate past a certain threshold point, it becomes inhibitory. Thus, many aspects of hyperactivity may actually be seen as hyper playfulness. Conceptualizing ADHD as a state of extended playfulness, with hyperactive children never reaching the natural chemical state of inhibition and maintaining the feeling of high-energy and playfulness long after their peers explains some difficulties with social interactions; as a neurotypical child may be in the mood to be calm or serious, a child with ADHD is unable to calm down.
This applies not only to play but also focusing on tasks and learning. The dopamine extends to what is often referred to as hyper-focus. When someone with ADHD finds something they are very interested in, that brings them a lot of dopamine, they experience the same effect but with whatever it is they’re focusing on. They are able to maintain focus on this one thing, again never reaching the threshold of inhibition, until they physically exhaust themselves or must move on due to other reasons. Learning to manage this double-edged sword is crucial for functioning with ADHD, and one of the best treatments for ADHD in early childhood has been shown to simply be more play.
Typical common treatments for ADHD as stated before tend to be medication, primarily stimulants. These pharmaceuticals are generally very effective in treating and reducing ADHD behaviors, but recent studies including those that emphasize the value of play highlight the lesser known yet very serious side effects of these drugs when prescribed at a young age. Not only are children that started taking stimulants at a young age statistically shorter than their peers, but due to the changes in behavior they are often held back in other ways. Linking back to the ultradian cycle of play, it serves as a natural way to increase levels of dopamine until the brain has enough, then tapering off, the pharmaceuticals essentially highjack this system, raising dopamine levels without the need for any preceding behavior. Behaviorally this is effective for alleviating symptoms, but what this does in turn is discourage these children from engaging in play. This lack of play can be detrimental for a child’s social development, as learning to socialize with peers and learning lessons from play and activity that would naturally raise levels of dopamine is key for social as well as neurological development.
Tapping into these deeper cognitive functions as well as basic human biology is key in finding alternative treatments to ADHD, with the tradeoff of behavioral treatment taking more time and difficulty in consistency than simply taking a medication. In a broader study looking at the impact of diet on behavior and cognitive function, it was found that minor food allergies and limiting or cutting out consumption of foods that create small amounts of antibodies or inflammation can greatly improve cognitive and physical health. This is because the neurons can experience small amounts of inflammation from mild food allergies, inhibiting the ability to function at maximum efficiency. Taking a supplement such as fish oil that reduces inflammation has also been shown to create a similar effect in alleviating mild symptoms of neurological disorders as well as building a healthy nervous system all throughout the body. However, in the case of ADHD, diet has been shown to only be able to do so much as a treatment and the modification of other behaviors specifically relating to play and physical activity. A study done by Jaak Panksepp showed this definitively in rats, but the experiment is yet to be directly translated over to humans although its implications still apply and numerous studies of play support the translation into the human species. To simplify, Panksepp lesioned the brains of rats to simulate ADHD. He then separated them into experimental groups, with the control group being regular healthy rats. Allowing some groups to have free play time with other rats while others were isolated, he found that the rats allowed to play tested nearly identically to the control group, while the rats that were not allowed time to play still maintained symptoms of ADHD. Although that is a very simplified explanation of a very complex study, the implications of the importance of play in not only prevention but treatment of ADHD are demonstrated.
This basic understanding of ADHD is crucial for managing ADHD for parents, teachers, as well as those that have the disorder themselves. But more specific tricks for integrating these things into the classroom or into general life is a lot easier said than done, and it can be overwhelming trying to find a balance. In the subsections below, there is advice from experts with years of experience in dealing with ADHD, as well as more information about what can more specifically be done to integrate these things and actually apply the knowledge of the disorder into the classroom and everyday life.