ADHD Explained

ADHD is a neurodevelopmental condition characterised by inattention, hyperactivity, and impulsivity. There are three subtypes of ADHD: Hyperactive, Inattentive and Combined. According to MRI scans taken in 2017  by Gehricke JG et al, the brains of children with ADHD showed smaller brain volumes with the size of specific brain structures reduced. By adulthood, the ADHD brain has mostly normalised in size but not in function. The ‘ADHD brain’ is literally wired differently with complex micro and macrostructures showing smaller amounts of white and grey matter contributing to poor executive function, emotion regulation and attention. Anxiety and depression can be comorbid with ADHD as can Obsessive Compulsive Disorder and Oppositional Defiant Disorder. People with ADHD often experience learning difficulties. The following explains more about the role of specific brain structures and regions and how they differ in ADHD.

• Grey and white matter house nerve bodies and axons respectively, signalling across a synapse (a gap between the two). In ADHD there is a delay in signalling, contributing to slower processing.

• The Prefrontal Cortex regulates behaviour, emotions and attention. People with ADHD tend towards hyperactivity, inattention and poor decision making do to alterations in circuitry and weaker activation of the Prefrontal Cortex.

• The Basal Ganglia responsible for motor learning, also helps regulate behaviour, emotions, and the ability to plan, focus, and multi-task; all of which are dysregulated with ADHD due to inward deformations in the Basal Ganglia resulting in dopamine dysregulation.

• The Default Mode Network (DMN) is active when we are at rest enabling daydreaming. In an ADHD brain, the DMN has difficulty switching off. Where normally it would relay messages to the Prefrontal Cortex to switch tasks, in ADHD the process is slower and therefore we can get stuck daydreaming or in mental wandering.

• The Limbic System is a set of brain structures including the hippocampus, hypothalamus, amygdala:

  • The hippocampus is responsible for memory formation and spatial navigation; your ability to know where you are, where you want to go and how you plan to get there. People with ADHD suffer from poor working memory and a poor sense of direction.

• The hypothalamus controls the autonomic nervous system and hormone release. People with ADHD can be stuck in sympathetic dominance (fight-flight mode) as the stress hormones cortisol and norepinephrine are dysregulated. They therefore have difficulty managing stress as the Hypothalamic-Pituitary-Adrenal (HPA) axis, responsible for the stress response is dysfunctional. Cortisol is also related to our circadian rhythm which is dysregulated in ADHD causing difficulty getting to sleep and waking up.

• The amygdala is the brain’s emotional alarm system. In ADHD it suffers altered connectivity with the prefrontal cortex, the result of which is an overactive amygdala which explains the difficulty in emotional regulation, rejection sensitivity dysphoria and impulsivity.

• The thalamus relays sensory signals to the cortex. It can be reduced in volume in people with ADHD causing inattention and difficulty switching tasks, hence our ability to occasionally hyper-focus but comorbid with emotional dysregulation; if you try to drag someone away from a task on which they are hyper focused, they can have an emotional outburst.

It is suggested that as well as genetic mutations caused by certain syndromes, environmental factors like chronic stress during brain development could contribute to underdeveloped brains. Today, more and more research is being done into how Yoga and mindfulness techniques can regulate the autonomic nervous system, support the HPA axis and positively affect specific brain structures and regions. It can be a practical adjunct in the treatment of ADHD.

If you suspect you have ADHD, speaking to other people with the condition can help. There are a number of interesting and validating podcasts I recommend, including ADHD Chatter Podcast on YouTube or Spotify and https://www.adhdwomenswellbeing.co.uk/adhd-podcast

If you want a diagnosis, consult your GP. You can either go on a very long waiting list, or go down the Right to Choose path which can speed things up. Alternatively, you could arrange a private assessment in your area.

The following article may be helpful: https://magazine.medlineplus.gov/article/adhd-across-the-lifespan-what-it-looks-like-in-adults

Why not read A Day in the Life of a Woman with ADHD.

References:

Vogt BA. Cingulate impairments in ADHD: Comorbidities, connections, and treatment. Handb Clin Neurol. 2019;166:297-314. doi: 10.1016/B978-0-444-64196-0.00016-9. PMID: 31731917.

Gehricke JG, Kruggel F, Thampipop T, Alejo SD, Tatos E, Fallon J, Muftuler LT. The brain anatomy of attention-deficit/hyperactivity disorder in young adults - a magnetic resonance imaging study. PLoS One. 2017 Apr 13;12(4):e0175433. doi: 10.1371/journal.pone.0175433. PMID: 28406942; PMCID: PMC5391018.

Gonzalez NA, Sakhamuri N, Athiyaman S, Randhi B, Gutlapalli SD, Pu J, Zaidi MF, Patel M, Atluri LM, Arcia Franchini AP. A Systematic Review of Yoga and Meditation for Attention-Deficit/Hyperactivity Disorder in Children. Cureus. 2023 Mar 14;15(3):e36143. doi: 10.7759/cureus.36143. PMID: 37065343; PMCID: PMC10101238.

Winke Francx, Alberto Llera, Maarten Mennes, Marcel P. Zwiers, Stephen V. Faraone, Jaap Oosterlaan, Dirk Heslenfeld, Pieter J. Hoekstra, Catharina A. Hartman, Barbara Franke, Jan K. Buitelaar, Christian F. Beckmann,

Arnsten AF. The Emerging Neurobiology of Attention Deficit Hyperactivity Disorder: The Key Role of the Prefrontal Association Cortex. J Pediatr. 2009 May 1;154(5):I-S43. doi: 10.1016/j.jpeds.2009.01.018. PMID: 20596295; PMCID: PMC2894421.Integrated analysis of gray and white matter alterations in attention-deficit/hyperactivity disorder, https://doi.org/10.1016/j.nicl.2016.03.005.

Sobel LJ, Bansal R, Maia TV, Sanchez J, Mazzone L, Durkin K, Liu J, Hao X, Ivanov I, Miller A, Greenhill LL, Peterson BS. Basal ganglia surface morphology and the effects of stimulant medications in youth with attention deficit hyperactivity disorder. Am J Psychiatry. 2010 Aug;167(8):977-86. doi: 10.1176/appi.ajp.2010.09091259. Epub 2010 Jul 1. PMID: 20595414; PMCID: PMC4254769.

Luu B and Fabiano N (2025) ADHD as a circadian rhythm disorder: evidence and implications for chronotherapy. Front. Psychiatry 16:1697900. doi: 10.3389/fpsyt.2025.1697900

Onnink AM, Zwiers MP, Hoogman M, Mostert JC, Dammers J, Kan CC, Vasquez AA, Schene AH, Buitelaar J, Franke B. Deviant white matter structure in adults with attention-deficit/hyperactivity disorder points to aberrant myelination and affects neuropsychological performance. Prog Neuropsychopharmacol Biol Psychiatry. 2015 Dec 3;63:14-22. doi: 10.1016/j.pnpbp.2015.04.008. Epub 2015 May 5. PMID: 25956761; PMCID: PMC4515357.

Stevens MC, Haney-Caron E. Comparison of brain volume abnormalities between ADHD and conduct disorder in adolescence. J Psychiatry Neurosci. 2012 Nov;37(6):389-98. doi: 10.1503/jpn.110148. PMID: 22663946; PMCID: PMC3493096.

(https://www.sciencedirect.com/science/article/pii/S2213158216300468)https://www.davidsongifted.org/gifted-blog/understanding-diagnosing-and-coping-with-slow-processing-speed/

https://chadd.org/attention-article/managing-inattentive-adhd-with-psychosocial-treatments/

https://chadd.org/attention-article/mindfulness-meditation-and-yoga-as-treatments-for-adhd/

https://my.clevelandclinic.org/health/body/limbic-system

Stress - Begin Where You Are.

It only has to take one event to trigger a complete change in your breathing habit. You might always have breathed in your belly (although you were probably not aware of this), then one day you were traumatised by a major stressor. This could be anything that put you into an immediate stress response, from a traumatic event to being yelled at. How your body responds is what is important here.

Commonly with the stress response, your breath shifts from belly to chest. You want to pull air into your lungs so that oxygen can be sent to your heart rapidly, enabling you to fight or flee from the threat. In a healthy system, once the threat is over, the stress response is switched off and breathing returns to the belly.

In modern society where we are constantly under threat on a psychological and physiological basis, the stress response can be triggered again and again in a single day. So what happens? The breath gets stuck in your chest and whether you feel stressed or not, your body thinks you are and keeps you in the stress response.

With so much threat around us, how do we know that we are stuck in the stress response? There are too many signs to list, but here are some things to look out for:

• Being easily startled.

• Constant doing - restlessness.

• Eyes darting around.

• Constant chatter.

• Rushing.

• Low pain tolerance.

• Consistent tension in the back of the skull, jaw, neck or shoulders.

• Feeling regularly overwhelmed.

• Sensory overload - sensitivity to light and sound in particular.

• Over-thinking and spending too much time in the head.

• Consistent chest breathing and pulling of the breath.

• Mouth breathing.

• Difficulty with concentration and focus.

• Listlessness, exhaustion or fatigue.

Sound familiar? Whatever you do, DON’T carry on as you are! Stress is not your friend. The stress hormones that are constantly rampaging around your body can do serious damage to your health. Now is the time to implement self care.

If you find that your mind is busy, busy, busy, you might need to begin with movement. A simple routine like the cat sequence I frequently teach can be a good place to begin. Don’t worry about the breathing but do notice the contact your body has with the floor.

If you are overwhelmed, begin at your feet. Notice them, feel them on the ground and if that is difficult, massage them so that you really feel the sensations in your feet. Squeezing the arms and legs can be useful if you feel disconnected from yourself.

If you can cope with stillness, concentrate on your breath. Sound is the easiest way of making the shift from chest breathing to belly breathing. It doesn’t matter what it is but you could try, sss, fff, ahh, brr. Sound that can loosen a tense jaw is brilliant!

Practice breathing through your nose as often as possible. It took a single event to alter your breath; it is possible to change it back within 24 hours. It just takes practice. Mouth breathing or shallow breathing reduces the amount of Carbon Dioxide (CO2) you take in. CO2 is necessary for vaso-dilation (dilating your blood vessels) which allows for oxygen uptake. Without this, blood vessels constrict which means the flow of blood is slowed leading to potential complications. Red blood cells hang on to oxygen when CO2 is low, therefore the body’s cells are not receiving enough oxygen to thrive.

If after reading this you start to panic, STOP! This is life and you are not alone. Stuff gets in the way of self care. But now you understand the importance of taking time for yourself and addressing the issue, begin where you are.

If you need support on your journey, do get in touch.

Finding Space in a Frantic World - Part 2

Following on from last month’s post when you were invited to practice the 3 step breathing space as a way of ‘checking in’ to your sense of self, we are going to continue by looking at further areas where self awareness can make a big difference to our sense of space.

Posture. When life gets on top of you, physical tension builds up in the body. Most commonly, the shoulders protract in an effort to protect your heart; your emotional centre.

Over time, the more protracted you get, the more the body has to compensate in order to be able to look straight ahead. You are likely to develop tension in your neck that may cause headaches. I often see a permanent crease in the neck after years of compensation. Alternatively, the head is pushed forwards and the curves of the spine become exaggerated. These physical changes result in a decrease in lung capacity as you are literally restricting their ability to expand. The breath becomes shallow, often in the chest, which sends a message to the autonomic nervous system (ANS) that you are stressed. The pattern of lacking mental, emotional and now physical space perpetuates. Shoulder protraction may begin with poor posture which still sends a message of stress and even depression to the brain and body, culminating in actually feeling that way even if you were not before.

So what can you do about it? When sitting, raise your hips slightly higher than your knees. This allows the hip flexor muscles (at the top of your thighs) to switch off and enables your pelvis to sit in ‘neutral’ so that the natural curves of your spine are supported by gravity. It helps to support the lumbar curve so that this part of your back can rest and you can maintain length throughout your spine without creating tension. Any deviation to this and you have to compensate as you can see in the first two images above.

Whatever table or desk you are sitting at, it is important to make sure that your chair is at the correct height so that you don’t have to hunch your shoulders to use your keyboard or write or even eat. Make sure your computer monitor is at eye level. It might be a good idea to purchase a separate keyboard if you use a lap top for hours every day. The worst thing of all for posture, is to sit side on to your desk. Do what you can to be able to face your monitor squarely. If you regularly have to turn, turn your whole body not just your neck or spine, otherwise you risk developing a scoliosis by only ever rotating in one direction. Sitting with the legs crossed will in time create an imbalance in your pelvis which will carry on up the spine, so uncross your legs and sit with your heels under your knees instead.

Try this exercise daily to maintain mobility in the shoulders and relieve tightness across the chest.

Emotions You are probably aware that negative thoughts such as worry and doubt cause the sensation of anxiety in the body; butterflies in the tummy or the literal feeling of adrenaline surging through you. Negative thinking therefore, causes stress. The brain and nervous system only understand stress as threat and will essentially do what is natural to support you in escaping the threat. You will be forced to take shallow breaths into the chest in preparation to run or fight. So in order to relax the nervous system we need to move the breathing into the belly so informing the brain that you are in fact in a state of rest. Thoughts are not facts. So write positive affirmations and post them around you! ‘I am confident’. ‘Overcoming challenges builds strength’. Or as I saw on the final of The Great British Bake Off; ‘I have won’ (the great British bake off). Making affirmations in the present tense, as if they have already happened, helps us to think more positively.

Breath Lying on your back with your knees bent, or sitting upright with your lumbar spine supported, breathe into your belly as if you were inflating a balloon both upwards and width-ways. This may feel alien to begin with, especially if you are used to chest breathing. You may have to imagine your rib cage expanding first and then bring the breath down to the belly.

With practice this action will inform your ANS that you are relaxed. If you are familiar with Ujjayi breathing, this pranayama will slow your breath down and help you to relax more. You should aim to breathe out for twice as long as you breathe in. Initially however, you may need to keep the ratio equal and gradually lengthen the out breath. This is particularly important if you are depressed and/or suffer from lethargy, as lengthening the out breath makes us more relaxed and as a result, for some at least, a little sleepy.

I like to start my day with this breathing practice while still lying in bed. It is also a helpful practice to lull you to sleep and to give you mental space at the end of your working day.

Do you ever get home with the feeling that the last thing you are ready for is your family pouncing on you and demanding your attention? One of the biggest gifts you can give your family is time to yourself first. After all, I’m sure they would rather enjoy your company when you are relaxed and jovial, than when grouchy and snappy! Let it be known that before you spend time with them, you need 5 minutes to lie down somewhere quiet and focus on your breathing.

In addition to the breathing practice, you can use the out breaths to visualise your back, neck and shoulder muscles relaxing; melting like butter into the ground beneath you. Stay for as long as you need to so that you relieve some of the tension of the day.

If this sounds like your life, you might find the Stress Busting Yoga on the first Sunday of each month a helpful lesson to take. During the two hours from 10.00 - 12.00, we practice some strong asana to rid the body of stress hormones and include some restorative poses, deep breathing and relaxation or meditation to help you feel restored.