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Can ADHD brain become normal?


Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity and impulsivity that begins in childhood and can persist into adulthood. ADHD is estimated to affect around 5% of children and 2.5% of adults worldwide. While ADHD has historically been viewed as a childhood disorder, it is now known that symptoms frequently continue into adulthood in the majority of cases.

The exact causes of ADHD are not fully understood, but research suggests that genetics, environmental factors and brain abnormalities may play a role. Studies using brain imaging techniques have revealed differences in brain structure and function between people with ADHD compared to those without the disorder. These brain differences are thought to underlie the difficulties with impulse control, attention and hyperactivity in people with ADHD.

Currently, there is no cure for ADHD but various treatments can help manage symptoms. Treatments include medications, therapy, education, training and lifestyle changes. With appropriate treatment and support, people with ADHD can thrive and live fulfilling lives. However, a question that often arises is whether the brains of people with ADHD can ever become ‘normal’. In other words, can the underlying brain differences in ADHD be reversed to resemble the brains of those without the disorder?

Do the brains of people with ADHD differ from neurotypical brains?

Over the past few decades, an extensive body of research using structural and functional brain imaging techniques has revealed differences in the brains of people with ADHD compared to those without the disorder.

Some of the main brain differences that have been found include:

Brain volume

– Overall brain volume is 3-4% smaller in people with ADHD.

– The frontal lobes, cerebellum and basal ganglia tend to be smaller. These areas are involved in inhibition, motivation and cognitive control.

Brain activity

– Reduced brain activity in prefrontal regions involved in attention, planning and motivation.

– Abnormalities in reward pathways, including reduced activation of the ventral striatum during reward anticipation. This is linked to impulsivity and motivation deficits.

– Increased slow wave activity indicating immature brain development.

Dopamine signaling

– Elevated dopamine transporter levels resulting in increased reuptake of dopamine from the synapses. This leads to reduced dopamine signaling, which is implicated in ADHD symptoms.

Brain connectivity

– Weaker connections between brain networks involved in executive function, attention and motivation.

– Underconnectivity between the prefrontal cortex and subcortical structures.

Brain maturation

– A delay of up to 3 years in cortical maturation, most prominent in prefrontal regions.

Overall, neuroimaging research indicates adults with ADHD have persistent differences in brain structure, activity, connectivity and maturation compared to their non-ADHD peers. These differences are believed to generate the symptoms of ADHD.

Can the ADHD brain become normal with treatment?

Given the documented brain abnormalities in ADHD, an important question is whether treatment can normalize the ADHD brain to resemble neurotypical brains without the disorder.

Unfortunately, at the present time, there is no clear evidence that existing ADHD treatments permanently ‘normalize’ the brain. However, treatments can lead to improvement in brain function and structure. Additionally, maturation continues well into adulthood, thus some brain differences may attenuate over time.

Here is what we know so far about the effects of treatments on the ADHD brain:

Medication effects on the ADHD brain

– Stimulants like methylphenidate and amphetamines are the most common medications for ADHD. These drugs increase levels of dopamine and noradrenaline in the brain, which improves signaling in brain networks involved in motivation, focus and cognitive control.

– Studies show stimulant medications normalize and improve connectivity between the prefrontal cortex, striatum, cerebellum and other areas while on medication. This correlates with symptomatic improvement.

– However, most studies find brain networks revert to their abnormal connectivity patterns after medication is withdrawn. Changes do not seem to persist.

– Chronic stimulant treatment may modestly improve developmental delay and normalize brain maturational trajectories over 1-2 years. However, maturation remains delayed compared to non-ADHD peers.

– So in summary, medications provide a temporary ‘fix’ to brain abnormalities but do not appear to lead to permanent normalization once discontinued.

Non-medication treatments and the ADHD brain

Non-medication treatments for ADHD include:

– Behavioral interventions like cognitive behavioral therapy (CBT), teaching skills to improve focus, organization, impulse control.

– Neurofeedback – training to enhance brain wave patterns associated with attention/calmness.

– Cognitive training – computer tasks targeting attention, memory and reasoning.

– Physical exercise has been shown to improve attention, cognitive control and ADHD symptoms.

– Diet/nutrition may play a role, with benefits seen from restricting sugar, optimizing fatty acids and micronutrients.

– Unproven treatments like EEG biofeedback, restrictive diets or brain stimulation have little evidence so far.

Studies investigating the brain effects of non-medication ADHD treatments show:

– CBT may improve functioning of the prefrontal cortex and dorsal attention network. Benefits are larger when combined with medication treatment.

– Neurofeedback can normalize brain waves patterns during training but changes do not seem to persist once treatment stops.

– Cognitive training can improve functioning in trained brain networks but effects are often limited to the specific skills acquired. Transfer to broader functioning is limited.

– Exercise has beneficial effects on brain volume, activity, dopamine, BDNF and vascularization. But regular exercise is required for continued benefits.

– Diet changes may improve dopamine signaling and inflammation but more research is needed on brain effects.

In summary, non-medication treatments like CBT, neurofeedback and exercise can lead to temporary improvements in brain function for those with ADHD. However, permanent normalization of the underlying brain differences has not been demonstrated.

Intensive interventions

A few small studies have looked at the impacts of intensive ADHD interventions on the brain. These involve training multiple domains like working memory, impulse control and planning over extended time periods.

For example, one study had adolescents with ADHD undergo an intensive 8 week ‘cognitive remediation’ intervention. Scans before and after revealed increased activation in frontal, temporal and cerebellar regions linked to improved cognitive performance.

Similarly, an intensive 6 week summer treatment program for ADHD children found gains in attention and impulse control were tied to changes in basal ganglia, prefrontal and parietal cortex function.

While these limited studies are encouraging, they have yet to demonstrate full normalization of ADHD brain differences. Plus gains were at least partially lost in follow up, suggesting continued intervention is likely required to sustain benefits.

Can maturation normalize the ADHD brain?

The brain continues to mature well into the 20s and even early 30s. Areas like the prefrontal cortex governing executive functions are among the last to develop. Given ADHD involves a maturational delay, especially in prefrontal regions, an important question is whether development and maturation alone is enough to eventually normalize ADHD brain differences.

Research looking at brain maturation and ADHD symptoms over time shows:

– ADHD teens and adults continue to ‘catch up’ in cortical maturation over time, narrowing the developmental gap.

– By early 30s, cortical thickness approaches normal levels but often remains slightly thinner in frontal, temporal and parietal areas.

– Symptoms tend to improve with maturation but around two thirds retain residual symptoms as adults. Hyperactivity declines while inattention often persists to some degree.

Conclusion

In summary, substantial scientific evidence demonstrates that the brains of people with ADHD differ from neurotypical brains in structure, function, connectivity and maturation. These differences are thought to underlie the symptoms of inattention, hyperactivity and impulsivity in ADHD.

Treatments like medication, behavioral interventions and exercise can provide temporary improvement in ADHD brain differences and functioning. But currently available treatments do not appear to fully and permanently ‘normalize’ the ADHD brain.

Maturation continues into adulthood and likely contributes to symptom improvement over time. But studies suggest brain differences from non-ADHD peers often persist, at least to some degree, even once maturation has completed.

The reasons ADHD brain differences endure despite treatments and maturation are unclear. Observed brain abnormalities suggest fundamental differences in wiring and architecture. Additionally, ADHD involves multiple genes which interact in complex ways to shape neurodevelopment.

Overall, while we have learned much about the ADHD brain in recent decades, additional research is still needed to determine if permanent normalization is possible. Intensive behavioral interventions targeted at improving brain function and architecture may hold promise. Ultimately, progress in understanding ADHD genetics and neurobiology will help guide development of treatments that can meaningfully and persistently improve the lives of those living with ADHD.