Neurobiologic Differences in Children With AD/HD

ADD/ADHD occurs in approximately 11 percent of all children, according to the CDC.  If  you are someone who is blessed to have a child or teenager who has challenges with attention and executive function, there are few things you might want to keep in mind.  Children with ADD/ADHD are NOT alike, and ADD/ADHD is considered, at this point, a complex neurobiological disorder by the medical community .  We say this because of these main medical findings:

Children with ADD/ADHD seem to have reduced cerebral blood flow to some parts in the front of the brain.  These areas typically control attention, impulsivity, sensitivity to rewards and punishments, emotions, and memory.

There is underactivity of specific neurotransmitters in the brain, specifically dopamine and norephinephrine.    This has been shown on PET scans.  There have been several genes linked to ADD/ADHD – two were dopamine receptor genes, along with a dopamine transporter gene.  Remember, dopamine plays a major role in regulating attention, concentration, movement, behavior, response to punishment and reward, learning, working memory, analysis of a task, problem solving, and long-term memory.

Some sections of the brain are smaller in children and teenagers with ADD/ADHD.  This review looks at the specific areas of the brain with volume reduction.

There is a lag in structural brain maturation of children with ADD/ADHD.  ADHD children may more match children 1-3 years younger, with the largest lags in structural maturation seen in older children in one study.

So, if you are parenting or teaching children who have attentional and executive function challenges, understanding these neurobiologic differences many assist you in developing a more cohesive strategy for helping your child.

The other thing to remember is that ADD/ADHD often occurs with other things,  including learning disabilities, Tourette’s Syndrome, anxiety, depression, bipolar disorder, substance abuse, oppositional defiant disorder, conduct disorder, and executive functioning difficulties.  Sleep disturbances are also extremely common, along with challenges in transitions and changes in routine.  There are often multiple challenges to be addressed together in order to lead to success for the child or teen in school and in life.

Many blessings,

11 thoughts on “Neurobiologic Differences in Children With AD/HD

  1. Hi Carrie,
    Thanks for the post. I don’t have children with an ADD/ADHD diagnosis, however I am very interested to hear your thoughts on what this might mean for homeschoolers following the Waldorf curriculum which is very prescriptive in terms of what should be taught at specific ages. I am particularly noting in your post that children can have a 1-3 year delay, and I wonder if this would suggest delaying the start of academic work or moving at a slower pace perhaps?
    As much as I love Waldorf, I don’t think it really addresses individual differences between children by insisting – for example – that fractions must come in 4th grade or perspective drawing in 7th (etc. etc.) for all children of that age. Of course, as homeschoolers we get to decide for ourselves when to bring subjects for our individual children but still there is an implication (sometimes spoken, sometimes unspoken) that we are doing it wrong if we don’t follow the curriculum exactly as per Steiner’s indications.
    I am very interested in gender differences and, having a child with asynchronous development, sometimes feel that the curriculum is not a great fit for us. We make changes here and that feels like the right thing to do. I would love to hear what others who homeschool have to say about this.

    • I think by necessity the academic work is taken slower – perhaps that means a different trajectory with writing, for example; less main lesson books; if drawing is super difficult than less; if math is behind I think fractions of course can still be introduced in a very concrete way but perhaps not expanded on in an abstract way until middle school years….I think the main thing is yes, always, look at the child in front of you, know the curriculum and I do think for the most part the curriculum stands but often teachers (in schools and at home) don’t modify the academic part enough and get frustrated, and know realistically where the academic adjustments will need to come. There is a real art to that and a real bravery. I often think of Camphill and such where the idea is that the material is for that soul level of development, whether the academic piece comes in at all or in small pieces. I often think of the children I had in my practice; there was one very sweet little guy who worked a year to be able to make an “X” so he could sign his name. This little boy could not have done hardly any artistic or academic piece of a Waldorf School curriculum, but the timeline of the curriculum would have nourished his soul, visual things to look at he would have loved. And sometimes those are the pieces we have. These are the sorts of experiences I bring in when I write this blog. I am really about development at its core. I do have many Waldorf homeschoolers and teachers and parents here, but I really want this to be about all children. How do we nourish all the beautiful children of the world, who often deserve so much more than they are getting? Sorry for my random musings this Sunday morning..the world is on my brain today. Much love to you; I am not sure if that really answered your original question since I started rambling…

  2. The 1-3 year delay in brain maturation really isn’t so much about academic ability as it is about behavior and maturity. My daughter with adhd who is almost 10 *acts* like a 6 or 7-year-old. It has more to do with impulsiveness, emotional reactivity, etc. than it does with ability to gain knowledge. She is struggling academically in some areas such as reading, but it is more because of learning disabilities like dyslexia, which often accompany adhd. In other areas, she is not struggling, for example, math.

    Now, I will grant that her distractibility and inability to tolerate any sort of “boredom”, which are both part of her adhd, do affect her academically simply because she sometimes can’t tolerate a lot of repetition and practice when developing skills. She recently had to take the CAT online standardized test, required by our state law. I sat near her during the testing, and it was very revealing. How she performed on the test was less about what she knew or could do than about whether her brain was in the mood to be on task at any given moment. During the reading comprehension portion of the test, there was one section where she did very poorly simply because she got bored and refused to read the second paragraph of the included selection and therefore couldn’t properly answer some of the questions about what she read. (We had already broken up the test, which was untimed, into multiple sections, stretched it out over several weeks, and she had already had a long break that particular day, so it wasn’t test burnout, it was adhd–she had been working for probably around 10 minutes.)

    In our Waldorf homeschool setting, our day stretches out very long, not because we have an overload of work to accomplish, but because of her frequent need for breaks and redirection. Main lesson could be done in an hour if we could go from one activity to the next smoothly and immediately, but that is rare. She lives in the moment, so if she suddenly feels like doing something–anything–different than what we are supposed to be working on at the moment, it is extremely hard to reason with her about how if we get x,y,z done, she can do what she wants later. She simply does not think that way.

    She can draw and paint quite nicely, but often doesn’t have the focus to keep at a long drawing, so the drawing will go very well until about halfway through, when she gets bored and stops caring, after which point there is little chance of getting her to refocus and finish nicely. So I do alter drawing assignments, knowing that she won’t be able to handle something lengthy or too involved. Painting is similar, and if any little thing goes wrong, forget it, she can’t deal with it. Her immediate reaction is to mess up the entire painting, even though we have had many conversations about how if you stop, take a deep breath, and look to mom for help, there is almost always a way to “fix” a mistake in the painting. But she is so impulsive she simply reacts. Reading is progressing very slowly partly because she has some learning disabilities that make it difficult, but also partly because it is hard to make progress when you can’t focus for more than about 10 or 15 minutes at a time on a reading lesson. And at certain times of the day, when she is tired or getting burned out, she can’t focus even that long. I look at math lesson suggestions, such as many of Marsha Johnson’s block ideas that I use frequently, and they will suggest doing 10-15 problems per lesson as practice. Forget it! We’re lucky to make it through 4 or 5 max, and sometimes 1 or 2 is it. And my daughter likes math! But at such a pace, it takes much longer to build up skills.

    • Hi Lisa! Nice to see you here! The lag spoken of above was in studies a simple physical maturation of structures of the brain – not really referring to academic or behavioral lags. However, as you have pointed out and I tried to point out above, ADD/ADHD often has co-morbidities and so learning challenges can be the result of the actual symptoms of ADD/ADHD, deficits in executive functioning, a specific learning disability or a co-existing conditions such as depression, anxiety. It has been estimated 25 to 50 percent of students with ADD/ADHD also have a learning disability and one study found up to 65 percent of students with ADD/ADHD had trouble especially with written expression. I think where the lag has most been documented in studies is due to executive functioning deficits – researcher Russell Barkley has found that teenagers with ADD/ADHD may have a 30 percent delay in age-appropriate skills – ie, poor organizational skill, weak self help abilities, poor personal hygiene skills, delayed motor skills, less independence, problems keeping friends –
      As far as attention span, normal teens have a strong working time of about 10-20 minutes before they tune out. So, they might be sitting in class but tuned out. I think the harder part with children with ADD/ADHD is they wander and get restless and move so we KNOW we have lost them. I think as children with ADD/ADHD grow up,( I don’t the age of your daughter, Lisa, but more toward the teen years) we can hold firm in 10 minute blocks at least, give a three to four minute break of movement like Brain Gym or tossing a bean bag, etc and go back to work to try to decrease lag time. I think sometimes the bigger issue is that everything has to be of interest, or they are lost. I have had adults with ADD/ADHD tell me over and over again (and these were successful people like chiropractors, eye doctors, electricians, etc) that once they figured out what they wanted to do and how to get there, they were more motivated and they worked harder than they ever did without any kind of goal in sight.
      Just food for thought. You absolutely know your daughter your best and you are doing a great job! I don’t think mothers teaching children with these challenges at home often hear that enough because it can be such a tough day to day road.

    • Also, Lisa, I was going to ask if you had ever done any treatment….medications or biofeedback therapy and if those things made a difference.

    • Thank you for your responses Carrie. The main point I was trying to make was in response to Cathy’s question about whether the 1-3 year lag in brain development meant that we should start academic work later or take it slower. I haven’t found a need to delay academic work any later than it is already “delayed” in Waldorf education. Some (but not all) work may need to progress more slowly, but that is not necessarily because of adhd itself. It can just as likely be because of the accompanying learning disabilities that many, but not all, people with adhd have. My daughter works more slowly in reading, but not in math. Even despite some of the challenges I mentioned with getting her to practice some math skills, we are pretty much on target with a typical Waldorf curriculum. Even though reading and writing are huge struggles, she is extremely intelligent, has an amazing memory, and soaks up knowledge and information like a sponge.

      In answer to your other question, I have held off any type of medicating but am close to rethinking that choice. She has been in cognitive-behavioral therapy for over a year, and while the therapist has never pushed medication, she has mentioned that children on medication make more progress in therapy. I am hoping to take my daughter to an integrative pediatrician this summer and see if we can start working with diet, supplements, or whatever else might be needed. It doesn’t seem fair to her that we are trying to get her to work so much against her brain without doing something to support that brain in its efforts.

    • Yes, Lisa, I agree. And most of the adults I have spoken to who have ADD/ADHD (our eye doctor, our equine chiropractor at the barn, successful adults) have said really for them it was needing things that interested them and also A LOT of repetition. Our eye doctor was saying specifically he had to get to the point where things just came so fast he didn’t have to think about it, that it was automatic. That takes a lot of repetition. I think the good things about children with ADD/ADHD is that often they can come up with the big picture and ways to really simplify things. Most of the children and teens I know with ADD/ADHD alone don’t seem to get too tied up in the minute and that can be a real advantage in simplifying technical subjects.
      I agree that in Waldorf I think we are on track, but the work may need to go more slowly. I think whether or not this is attributed to ADD/ADHD or the four things I laid out in my earlier reply varies in each and every child. All of the children seem so so different. Some really struggle with working memory, or math or drawing and painting whereas your daughter does not.
      One book you might enjoy, in which the author states some ideas about the treatment choices you are thinking of is Dendy’s “Teaching Teens With ADD/ADHD & Executive Functioning Deficits”. In it she talks about how she was 100 percent against medications, and then how with the NIMH/MTA study where medications were found to be absolutely one of the most effective interventions for treating a majority of children with attention deficit disorders. If you can get this book on Interlibrary loan or something, that starts on page 235. The medications, from what I understand, can be a real trial and error and also many times the dosages prescribed are way too low. I think an integrative ped would be wonderful. There is also quite a bit out there about supplements and other things so I hope to get some of that into a post later this week.

  3. Thank you, Carrie. Yes I think you have answered my question. And that’s right – it is absolutely an art to be really present for each child and adjust constantly to meet where they are right now, this day, and tomorrow may be different again. Like a dance between the two of you. But very hard sometimes when I inevitably get it wrong.

  4. Lisa, do you think that the 2 hour main lesson format is something which just doesn’t work well for children with ADD/ADHD? Given what you have written, it sounds like the Charlotte Mason style of very short lessons would suit your daughter. I don’t know much about Charlotte Mason education at all, but it just popped into my head when reading your comment. For me, this is a very interesting topic: how do we adapt Waldorf education to meet the needs of individual children and the home setting?

    • I do a main lesson every day with 1.5 hours or so of material planned, it just stretches out over 3-4 hours because she needs so many breaks. In a way I guess she is getting multiple short lessons–but they are all about the same topic, where with Charlotte Mason they would probably be about different topics.

  5. Pingback: Teaching Children With ADD/ADHD | The Parenting Passageway

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