This presentation explored the underlying biology of attention, impulsivity and the social/psychological factors impacting treatment. Pharmacotherapy, social and psychological interventions are discussed. The ADHD brain is highly conserved across multiple contexts and present in countries around the world. The ADHD brain has important gifts for human ecologic context adding to insight, creativity and innovation. Supporting people with an ADHD brain to develop skills, self-care and means to channel their abilities can allow many of the struggles of ADHD to manifest as gifts.

1. ADHD: Biopsychosocial Approaches to
Treatment Development and Interventions
Brain – Biology - Self

2. In this class we will cover…
• Experience of ADHD (Childhood,
Adulthood)
• Neurobiology of ADHD (Childhood,
Adulthood)
• Diagnosis and Assessment of ADHD
(Childhood, Adulthood)
• Treatments and Interventions
(Childhood, Adulthood)

3. ADHD and Evolution…
ADHD is found in all societies around the globe when assessed. What is it about the ADHD
mind that is vital for humanity? What does ADHD do?

4. Signal to Noise Ratio
What is important? We don’t just see with our eyes. We see with our brains. We don’t just
hear with our ears. We hear with our brains.

5. Signal to Noise Ratio
What is important? We don’t just see with our eyes. We see with our brains. We don’t just
hear with our ears. We hear with our brains.

6. Signal to Noise Ratio
What is important? We don’t just see with our eyes. We see with our brains. We don’t just
hear with our ears. We hear with our brains.

7. Signal to Noise Ratio
What is important? We don’t just see with our eyes. We see with our brains. We don’t just
hear with our ears. We hear with our brains.

8. Signal to Noise Ratio
What is important? We don’t just see with our eyes. We see with our brains. We don’t just
hear with our ears. We hear with our brains.

9. Signal to Noise Ratio
What is important? We don’t just see with our eyes. We see with our brains. We don’t just
hear with our ears. We hear with our brains.

14. Joint Attention Grows in
Parent Child Interactions
Parent Monitors Child’s
State and Adjusts Their
Actions to Increase
Child Attention
Modulating Oxytocin,
Dopamine and
Norepinephrine

15. ADHD Impacts Seen in Transitions
Kindergarten (Play, Sitting
Directions)
Grade School (Sitting, Joint Attention
Following Directions)
Middle School
(Homework, Multiple
tasks, Memorization)
High school (Balancing
Tasks, More independent
thought, Peer influences
The complex aspects of ADHD begin to appear at times
when new challenges and stressful tasks are required.

16. Explore how ADHD can impact
experience of development…

17. Attention is Not One Thing…
• For attention to work well it functions like a
conductor of an orchestra – Levine
• Mental Energy: Controlling the intensity of focus.
The gas peddle of alertness.
• Processing Controls: Filtering the extraneous
inputs a.k.a reducing noise, enhancing signal
(Norepinephrine).
• Production Controls: Adjusting and monitoring the
output.
• Planning and Organizing: Memory, Time, Spacing,
Sequencing and executive functions.

18. Impulsivity is Not One Thing…
– Aspects of Impulsivity
– Discounting of long-term reward
– Premature responding
– Motor inhibition
– Possible Neurobiological Substrates
– Waiting Impulsivity: Medial prefrontal cortex and nucleus
accumbens mediates ‘waiting’ impulsivity, including
premature responding with dopaminergic, serotoninergic,
and noradrenergic modulatory influences.
– Inhibitory Controls: Dorsal striatum and associated
circuitry including the inferior frontal cortex mediates
inhibitory control and is modulated by dopaminergic and
noradrenergic systems.

19. Neurobiology
ADHD Underlying neurobiological systems

20. Neurobiology of ADHD
• Major Biological Neurobiological
Aspects of ADHD can help us
understand the biological drivers of
ADHD treatment.
• Understanding These Four Factors
– Brain Structures and Systems
– Neurotransmitter Pathways
– Neurotransmitter Receptors
– Functional States

24. Brain Structures and ADHD
• Dopamine Pathways:
– Disruptions are found in the Mesolimbic/Mesocortical
– Disruptions are found in the Nigrastraital Pathways.
• Brain Structures Involved in ADHD
– Frontal cortex: Planning organizing and executive functions
– Parietal cortexes: Sensory and motor integration
– Basal ganglia: Movement (fine motor), emotional set-point,
pleasure and drive learning.
– Cerebellum: Integrated modulation of movement and
overlearned tasks.
– Hippocampus: Long-term memory storage and retrieval of
context related factors.
– Corpus callosum: Cross communication in the brain between
structures.

26. Default Mode Network ADHD
• https://youtu.be/rp1IleFD4D0

27. Hypofrontality
Frontal lobes we found to be
under active in high effort
cognitive tasks.

35. Neurobiology ADHD
• ADHD showed developmental delay in cortical
thickness
• Medication, Brain Change, Symptom Improvement
– Normalization of volumes in different brain regions
such as the parietal cortex and the hippocampus
parallel clinical improvement of symptoms
– Progressive volume loss of cerebellar regions and
hippocampus were associated with persistent
symptoms
• Connectivity: Decreased connectivity in ADHD found
in fronto-striato-parieto-cerebellar network.
– Connectivity normalized in all areas except one
– The parietocerebrellar functional circuit.

36. Assessment &
Diagnosis
ADHD Assessment and Diagnosis

42. ADHD Screeners Free
• Vanderbilt (Teacher, Parent & Other Adult)
https://www.brightfutures.org/mentalhealth/pdf/professi
onals/bridges/adhd.pdf
• Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom
Checklist.
https://add.org/wp-content/uploads/2015/03/adhd-
questionnaire-ASRS111.pdf
• Barkley’s Adult Quick Check
http://naceonline.com/AdultADHDtoolkit/assessmenttool
s/quickscreen.pdf
• Solid E-List of Different Scales (Can Complete Online)
http://adhd-institute.com/ratings-scale/

43. ADHD
Treatments and
Interventions

46. ADHD – Medication Basics
• Psychostimulants are the first line treatment and have the
best effects profile.
• Ritalin and other psychostimulants function as a NDRI.
Leading to an average increase of 3-4 times of dopamine
and norepinephrine in the striatum and prefrontal cortex.
• Psychostimulants can have impacts on growth, sleep,
seizures and increased risk of mania. Monitor these risks.
• Short Vs Long Acting: Long-acting medications are
available and choosing short acting vs long acting can be
typically done based on need for focus time and ability to
take a second dose.
• Non-Stimulant Medications: Have lower risk of addiction,
growth impacts and are effective in management of ADHD.
However, their effect sizes are smaller.