Summary of ADHD: The Brain-Behaviour Connection by Dr. Joel Nigg Ph.D.

Summary of The Brain-Behaviour Connection - Dr. Joel Nigg Ph.D.

So this post is to summarise some of the current thinking in neuroscience around ADHD as discussed by Dr. Joel Nigg, Ph.D. in a free webinar on ADDitude which aired on 28 June 2016. My intention is to make webinars like this one a bit more accessible to the everyday person who might get a little lost in all the scientific jargon. I studied A-Level Biology and Chemistry and then Applied Genetics and the University of Liverpool before transferring to a Business Management degree so I have a reasonable basic scientific understanding, but I struggle to follow some of the webinars, I can’t be the only one!

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Neuroscience Basics (How the brain works)

Very basically, the brain consists of different areas, each playing a different role in helping us to function. These areas are connected together by axons, like little wires, which are wrapped in something called white matter or myelin sheath, like insulation. This insulation helps to transmit messages from one part of the brain to the other without losing any information so any damage to this can prevent the brain from working properly.

Up until now there has been a lot of focus on the actual brain tissue, the grey matter, with a suggestion that there is a slight reduction in the amount of grey matter in ADHD brains but now there is a shift in focus to the white matter, the insulation around the wires connecting the areas of the brain.

The white matter develops over time as we grow from infant, to child, to adult but in ADHD brains there seems to be slower development of this layer, and it can be underdeveloped, or thinner, than in ‘neurotypical’ brains. This would therefore explain why the brain does not function as it should do.

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Signs of Inattentive ADHD – A Guide for Teachers, TAs and Other Professionals

Inattentive PI ADHD Classroom Identify List

Inattentive ADHD Can Be Overlooked in the classroom as it is Less VISIBLE than COMBINED or Hyperactive/ Impulsive ADHD

Around 5% of children are affected by ADHD, at a ratio of 2:1 girls to boys according to the DSM-5.1 Girls are more likely to present with Predominantly Inattentive ADHD (ADHD PI) whereby the child is not as likely to be a disruptive influence in the classroom as a child with Predominantly Hyperactive/Impulsive ADHD (ADHD PH/I), or classic ADHD, may be.

The signs of ADHD PI are much harder to spot because generally these children are trying to ‘fit in’ with their peers, not wishing to draw attention to themselves as they feel like they are not  achieving as well as they could do. I’ve heard children as young as 8 say that they don’t want to be ‘found out’ because people think they’re bright, but really they feel stupid because they keep making mistakes and feel like they need to try harder.

I wrote in my article about growing up with Inattentive ADHD that I felt invisible and in some ways that was what I was aiming for when I was younger, I didn’t want to stand out. I coasted through school managing to do fairly well but I could have achieved more if someone had been able to explain to me that my brain worked differently to my peers and that trying to be like them wasn’t going to solve all of my problems.

Medication could have helped with some of my symptoms, helping me to focus in lessons, and extra time in exams may have helped, but I think, more importantly, understanding why I couldn’t seem to do things like everyone else would have made a huge difference. I wasn’t just lazy or stupid, I was trying as hard as I could and every failure felt enormous, even if it was getting 9/10 on a maths test. Support from a teacher or another professional would have meant learning techniques and strategies to manage my time, organise my things and how to manage my emotions and build up my self-esteem.

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Symptoms Checklist for Diagnosis of ADHD

ADHD Symptoms Checklist - Diagnostic Criteria

What are the main ADHD Symptoms and How do they Diagnose ADHD?

To obtain an ADHD diagnosis you must speak to a health professional, the usual first step would be to speak to your GP. If there is enough evidence to seek a referral you will then be referred to a specialist or consultant who will be able to assess and diagnose ADHD. Unfortunately in the UK there is a real need for ADHD specialists and waiting list times can be in excess of 18 months after referral.

At your first appointment the specialist will ask you a series of questions about ADHD symptoms that you may have now, and that you may remember experiencing as a child. I actually took along my mum to the appointment so that she could answer questions about my childhood that I struggle to remember. You may also be asked to complete a number of questionnaires to aid the consultant in reaching a diagnosis.

In the case of a child referral to a Community Paediatrician is usually made rather than a specific ADHD specialist. This means shorter referral times and the Paediatrician will have a broad knowledge of a number of conditions which may exhibit similar symptoms to ADHD. It is usual for the school setting to be involved in diagnosis, the Paediatrician may carry out observations in the school setting and the school will be asked to fill out a questionnaire to assess the symptoms of the child. The same questionnaire will be given to the parents/carer to assess symptoms shown in the home setting and these will be compared.

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