ADHD: Brain Pathway Differences

00:00 I have two more graphics for you to look at that illustrate the structural differences in the brain of a child with ADHD.

00:07 I just wanted to say, before we take a look at these, everything you're going to see here is smaller or less, and they seem like very negative things, which in one context they can be. But keep in mind that you want to encourage your clients that because of their ADHD, they can do some pretty spectacular things and see connections that other people without ADHD may not.

00:30 But for the sake of this discussion, we're focusing on the pathophysiology and the structural differences in the brains of children with ADHD.

00:38 So you see, we have reduced cerebral and cerebellar volumes.

00:42 We have smaller prefrontal cortex volumes.

00:45 You have cortical thinning and you have smaller posterior corpus callosum regions.

00:50 Okay. Like I said all kind of negative things.

00:53 And I've got one more negative thing to share for you.

00:57 But I want to encourage you pause and go back and look at these slides and these graphics again to make sure you have this information solid in your own brain.

01:06 The last one now we're looking at a coronal section of the brain on the left.

01:10 You see you have the caudate the putamen and the Globus pallidus.

01:14 Those are all parts of the striatum.

01:16 And on the right we're talking about the last structural difference we're going to discuss today is that there's a decreased gray matter in the posterior temporal and inferior parietal cortices.

01:27 As we wrap up the discussion on the pathophysiology of ADHD, this is one slide that puts a lot of key points together for you.

01:34 So this is going to help you as a study guide.

01:37 We're going to look at the pathways and then the associated impairments in ADHD.

01:41 And you've got this all in one neat package.

01:44 So you've got the three brains there.

01:46 Look at the first one on the left.

01:48 We're using that to represent the frontostriatal and the thalamic projections okay. You got us.

01:55 You see the image. All right.

01:56 So if there's difficulty in the FS pathways those are the symptoms that you're going to see I've listed them there for you.

02:04 Inattention impulsivity executive dysfunction.

02:06 They're going to have trouble in school.

02:09 Now when you look at the thalamus in the anterior thalamic radiation you're going to have trouble with inattention and impulsivity.

02:16 So that is where you're going to see the symptoms.

02:19 If it's the frontostriatal and the thalamic projections that are involved.

02:24 Now let's move over to the to the brain in the middle.

02:26 You notice the graphic that's overlaid on the brain is that deep red color? This represents the cerebellar tracks.

02:33 Now let's talk about the associated impairment in ADHD.

02:36 Now it's involving the cerebellum and the middle cerebellar peduncle.

02:40 Now this leads to inattention poor cognitive performance.

02:44 And you can have some pretty severe ADHD symptoms.

02:48 The third brain on the far right has a yellow graphic overlaid that represents the corticospinal tract.

02:55 Now, the associated impairment with a brain with ADHD is a little more complex than the other two we just talked about.

03:01 Now with the CST it can lead to inattention impulsivity.

03:05 Those all make sense, right? But you can also have age related improvement in the hyperactive and impulsive symptoms. So we wanted you to be aware of that.

03:14 In fact, there's good news.

03:16 Up to 30% of adults no longer need medication once they become adults.

03:21 But the last two are kind of more difficult.

03:24 There's the autistic traits and poor adaptive functioning.

03:29 So that wraps up our discussion on both the etiology and the pathophysiology of ADHD.