Why having ADHD isn’t just a simple matter of “just trying harder”

20 July

The Myth of Willpower

One common misconception about ADHD is that those who have it simply lack willpower or aren't trying hard enough. This overlooks the neurological differences between neurotypical people and people with ADHD, that make tasks that require sustained attention A LOT more challenging for people with ADHD.

The Neurological Explanation for ADHD

Research has shown that ADHD is associated with differences in brain structure and function. Individuals with ADHD often have lower levels of dopamine, a neurotransmitter that plays a key role in attention and reward pathways. According to a study published in the Journal of Child Psychology and Psychiatry, there is evidence of reduced dopamine activity in the brains of people with ADHD, which can contribute to difficulties in sustaining attention and regulating behavior (Volkow et al., 2009).

Additionally, a review article in The Lancet Psychiatry highlighted that people with ADHD have reduced volume in certain brain regions, such as the prefrontal cortex, which is critical for executive functions like planning, decision-making, and impulse control (Hoogman et al., 2017). These neurological differences aren’t actually a matter of willpower but rather reflect the unique brain chemistry and structure of individuals with ADHD - that is, even if a person with ADHD wants to do something and is willing themself to “just do it”, they sometimes physically cannot, which means there’s a lot more energy expended by that person trying desperately to do something that they don’t have the brain chemistry to do.

I like to use the analogy of someone who is shortsighted and can’t see in the distance, and someone else telling them to try harder to see. The person who is shortsighted will tire themselves out squinting and trying harder to see, but because they lack the correct physiology in their eyes to be able to see clearly, they can’t physically do anything to help themselves see any better. But… what they can do is use additional supports (like glasses or contacts) to be able to see like the average person can…

Using this analogy, in the same way that people who are shortsighted don’t have the correct physiology for light to be refracted correctly onto their retina to see clearly, people with ADHD don’t have the correct amount of dopamine to be able to carry out executive functions.

So what does having the right amount of dopamine really mean?

Research indicates that dopamine plays a crucial role in executive functioning, which includes skills such as planning, decision-making, and impulse control. A study published in Neuroscience & Biobehavioral Reviews by Cools and D'Esposito (2011) found that dopamine levels in the prefrontal cortex are directly linked to cognitive control and executive functions. The study suggests that optimal dopamine levels are essential for maintaining cognitive flexibility and goal-directed behavior.

In addition, research published in Frontiers in Human Neuroscience by Diamond (2013) reviewed multiple studies and concluded that dopamine is integral to various aspects of executive functioning. The review highlighted that dopamine influences the ability to focus, switch between tasks, and inhibit inappropriate responses, all of which are key components of executive function.

Therefore, a certain amount of dopamine is required in the brain in order to complete executive functioning tasks such as the ability to focus, switch tasks, prioritise, manage time, organise, manage emotions, manage impulses and initiate tasks. It also requires a balanced amount of dopamine. But studies have shown that people with ADHD have less dopamine and less balanced amounts of dopamine, which mean people with ADHD can find any of these tasks much more difficult, and likely debilitating, because they do not have the required amount of dopamine that will enable them to do these tasks day in and day out, and to do them on demand. The struggle to do tasks without the required fuel (dopamine) can take a huge mental and physical toll (just ask any ADHD-er who has forgotten to take their medication)

So what can be done about it?

It follows that if the level of dopamine available to people with ADHD can be increased, or balanced out, this would help manage the struggle significantly. One way to achieve this is through the use of ADHD medication (in consultation with your medical practitioner) which increases dopamine availability in the brain. However, medication can only last so long and does wear off throughout the day (there are slow acting and fast release versions), and they may not work for everyone. Some people don’t take to medication, or prefer not to take it.

So what else can be done?

This is where experts recommend either combining non-pharmaceutical interventions, like coaching with medication, to improve the management of ADHD symptoms, or to use non-pharmaceutical strategies as a stand alone.

According to the study by Safren et.al.(2005) published in the Journal of Attention Disorders, people who received both coaching and medication reported better overall functioning, improved organisation, time management and goal achievement, compared to those who only received medication.

In the same way that people who are shortsighted can use glasses to support them to see, people with ADHD can use strategies like medication, or coaching to support them with their executive functioning.

So if you’re interested in finding out how coaching can help you or a loved one manage ADHD symptoms better, book a complimentary 45 minute session with me below.

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References

Cools, R., & D'Esposito, M. (2011). Inverted-U–shaped dopamine actions on human working memory and cognitive control. Neuroscience & Biobehavioral Reviews, 35(4), 581-591.
Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135-168.
Hoogman, M., Bralten, J., Hibar, D. P., Mennes, M., Zwiers, M. P., Schweren, L. S., ... & Franke, B. (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry, 4(4), 310-319.
Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., & Otto, M. W. (2005). Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: A randomized controlled trial. Journal of the American Medical Association, 304(8), 875-880.
Volkow, N. D., Wang, G. J., Newcorn, J. H., Kollins, S. H., Wigal, T. L., Telang, F., ... & Swanson, J. M. (2009). Brain dopamine transporter levels in treatment and drug naive adults with ADHD. Journal of Child Psychology and Psychiatry, 50(8), 870-878.