Unpacking ADHD: Part 3 - The Brain's Inner Workings

This vivid and intricate brain illustration represents the diverse and multifaceted nature of ADHD, emphasizing the complex interactions between various brain regions.

Key Brain Regions Affected by ADHD

Let's take a closer look at the specific brain areas that are consistently involved in ADHD:

• The Prefrontal Cortex (PFC): This is the brain's command center, located right behind your forehead. It's vital for all those "executive functions" we talked about—like paying attention, controlling impulses, making wise decisions, and planning your day. In people with ADHD, this area often shows reduced volume and a slower path to maturity (National Center for Biotechnology Information, 2020; Kolar & Cortese, 2019; Wang et al., 2023).

• The Anterior Cingulate Gyrus (ACC) and Dorsolateral Prefrontal Cortex (DLFPC): These are specific parts of the PFC that are crucial for staying on task and controlling your thoughts. They tend to be smaller in individuals with ADHD, which can explain difficulties with goal-directed behavior (National Center for Biotechnology Information, 2020).

• The Basal Ganglia: These deep brain structures are involved in movement, but also in how we process rewards and make decisions. They can be smaller and affected differently in ADHD (Kolar & Cortese, 2019; Wang et al., 2023).

• The Nucleus Accumbens (NAc): A key player in the brain's reward system, this area helps us feel motivated and recognize what's important. Studies have found it to have lower volume in unmedicated children with significant ADHD symptoms (National Center for Biotechnology Information, 2020; Wu et al., 2024).

• The Insula: Especially the right insula, this region helps us notice important things around us and understand our internal body signals. It shows lower thickness in unmedicated children with ADHD (Wu et al., 2024).

• The Cerebellum: Often associated with balance and coordination, the cerebellum can also be affected in ADHD, potentially linking to the motor difficulties some individuals experience (Kolar & Cortese, 2019; Wang et al., 2023).

• The Corpus Callosum (CC): This is a thick band of nerve fibers that connects the two halves of your brain, allowing them to communicate. In ADHD, there can be reductions in the white matter (the "wiring") and smaller areas in the CC, suggesting altered communication pathways (Kolar & Cortese, 2019; Wang et al., 2023).

  
  

It's important to remember that these brain regions don't work in isolation. They're all part of intricate, interconnected networks. For example, the "frontostriatal network" (which includes parts of the frontal lobe and basal ganglia) is considered a major player in ADHD (Kolar & Cortese, 2019; Wang et al., 2023). Science tells us that ADHD isn't just about isolated structural problems in individual brain parts. Instead, the core issue seems to be how inefficiently or unusually these larger neural networks function and connect. The classic symptoms of ADHD—trouble focusing, impulsivity, and hyperactivity—are thought to stem from the disrupted communication and coordination within these interconnected brain areas that handle executive control, attention, and how we process rewards. This "network-centric" view is a much more sophisticated way of looking at ADHD than simply pointing to one "broken" part of the brain, and it's guiding exciting new research into how the brain truly works.

Next, in Part 4, we'll explore how stimulant medications might actually help reshape these brain pathways in children.

HC Telepsych NP

References

American Psychiatric Association. (2025, February 10). ADHD in adults: New research highlights trends and challenges. https://www.psychiatry.org/news-room/apa-blogs/adhd-in-adults-new-research-highlights

Cortese, S., & Castellanos, F. X. (2019). The neurobiology of ADHD: Still an enigma? Frontiers in Human Neuroscience, 13. https://doi.org/10.3389/fnhum.2019.00042

Cortese, S., Solmi, M., & Fusar-Poli, P. (2021). Neuroimaging of attention-deficit/hyperactivity disorder: A narrative review of recent findings. Current Opinion in Psychiatry, 34(2), 108–114. https://doi.org/10.1097/YCO.0000000000000674

Dutta, C. N., Christov-Moore, L., Ombao, H., & Douglas, P. K. (2022). Neuroprotection in late life attention-deficit/hyperactivity disorder: A review of pharmacotherapy and phenotype across the lifespan. Frontiers in Human Neuroscience, 16. https://doi.org/10.3389/fnhum.2022.938501

Kolar, A., & Cortese, S. (2019). The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): What every clinician should know. Current Psychiatry Reports, 21(10), 96. https://doi.org/10.1007/s11920-019-1088-7

National Center for Biotechnology Information. (2020). Attention-Deficit Hyperactivity

Disorder. In StatPearls. StatPearls Publishing.

Neuroimaging and ADHD: fMRI, PET, DTI findings, and methodological limitations. (2013). Journal of Attention Disorders, 17(6), 455–469. https://pubmed.ncbi.nlm.nih.gov/23682662/

Visser, J., van der Meer, S., van der Heijden, P. T., & de Jong, J. T. (2024). Unmet needs and priorities for stigma reduction in ADHD: A qualitative study with young adults, parents, teachers, and mental health care professionals. BMC Psychiatry, 24(1), 847. https://doi.org/10.1186/s12888-024-05459-y

Wang, S. Y. A., Manza, P., Tomasi, D., Volkow, N. D., Wang, G. J., & Zhang, Y. (2023). Shared and distinct neurobehavioral phenotypes of child obesity and ADHD. Translational Psychiatry, 13(1), 74. https://doi.org/10.1038/s41398-023-02359-x

Wu, F., Zhang, W., Ji, W., Zhang, Y., Jiang, F., Li, G., Hu, Y., Wei, X., Wang, H., Wang, S. Y. A., Manza, P., Tomasi, D., Volkow, N. D., Gao, X., Wang, G. J., & Zhang, Y. (2024). Stimulant medications in children with ADHD normalize the structure of brain regions associated with attention and reward. Neuropsychopharmacology.