Improper regulation of neurotransmitters in ADHD – Coursera ADHD – Week 5

This week’s class gave us a more detailed look at the neurochemistry of ADHD. Much of it focused on monoamines, catecholamine synthesis, chemical structures, and neurobiology of the brain. I’ll attempt to distill the information down to what I, as a parent, find most helpful.

The neurotransmitters dopamine and norepinephrine are deficient or dysregulated in ADHD. On the molecular genetic level, research shows that the genes most likely linked to ADHD also affect dopamine and norepinephrine.

The entire mechanism of motivation and attention is complex and involves multiple brain areas and neurochemicals. Although it was not covered in detail, the transmitter serotonin is also thought to modulate brain function and affect the symptoms of ADHD. Because the system is so complex, researchers feel that the issue with ADHD might be more a dysregulation of the neurotransmitter system where the release of chemicals is out of sync than a systematic deficiency of dopamine or norepinephrine. That being said, most ADHD drugs work by increasing their production and/or slowing their re-uptake to extend their effect.

One of the lecture slides was a great venn diagram showing serotonin, norepinephrine, and dopamine functionality. The diagram here, from the World of Caffeine website, is a more complex version of the one used in class. It shows how the three monoamines balance to create optimal attention, motivation, mood, and cognitive function.

World of Caffeine also has a nice summary of how caffeine affects the neurotransmitters. Caffeine is frequently the ADHD stimulant medication of choice for adults with ADHD symptoms.

Outside of the formal lecture, responses to the office hours questions were also posted this week. Amid general course and detailed brain anatomy information, were a few answers about kids and ADHD that stood out:

  • ADHD diagnoses decrease with age due most likely to several factors including the disorder naturally improving with age in some individuals.
  • The current definition of ADHD and system of diagnosis will not over identify children if clinicians are careful in their assessments and look for other explanations for problems with impulse control and attention regulation other than ADHD. However, too often our healthcare system doesn’t allow adequate time for evaluations. This can also lead to missed diagnosis.
  • Exercise and diet cannot prevent the onset of ADHD but they can help improve the symptoms. Dr. Rostain recommends the book Spark by Dr. John J. Ratey for anyone interesting in learning more about using exercise to improve ADHD.
  • ADHD is linked to poor sleep. It is possible the same brain difficulties that lead to ADHD symptoms also interfere with sleep regulation.
  • Although autism and ADHD  are entirely different entities, the same genes are involved.
  • Psychosocial stress increases ADHD risk and insufficient sleep diminishes focusing and productivity for everyone.
  • Brain training can build focus, attention, and cognitive processing but there is limited data on which programs are most effective because the field is very new.
  • There is no correlation between ADHD and IQ other than as a group, children with ADHD have a slightly lower average IQ of 95 rather than the 100 of the general population. This little fact, to me, says that if a child who is highly or exceptionally gifted has symptoms that look like ADHD, extra care should be taken in trying to determine what is actually going on. It might be ADHD but it might just as easily be normal behavior for a stressed, high-energy, gifted child.

In a few of the office hours answers students were referred to Judith Warner’s recent article on ADHD in Time. The gist of the article seems is that ADHD is a true medical condition and if we get too worried about over diagnosis we run the risk of having insurance companies or congress deny effective treatment options to vulnerable kids. She states that it is a developmental disorder not a symptom of social pathology.

Yes, ADHD is a real problem and is classified as a developmental disorder. Yet, carefully treating kids negative affected by it does not preclude an in-depth discussion on modern childhood. It is a disorder triggered or amplified by certain environmental conditions. This makes it all the more important to closely examine what has happened to childhood over the last 20 years to see how we may have turned on the ADHD genes.

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