Workings of the ADHD Brain
ADHD brains have issues with the neurotransmitter norepinephrine, which is linked with dopamine. The best way to explain dopamine is to see it as the chemical in the brain that makes the person feel good quickly; one of the instant release, feel-good, chemicals.
Below is a graph that shows levels of dopamine in an ADHD and non-ADHD brain. Dopamine levels go up and down slightly throughout the day in non-ADHD brains. They may have spikes but not as many as an ADHD brain. An ADHD brain’s dopamine, however, sits at zero as a baseline. The brain is aware this is not correct and needs to be closer to the middle, so it finds something to stimulate itself, however, because the system is broken, it finds random things stimulating and can only release too much dopamine.
Someone with ADHD may, therefore, suddenly find daydreaming or fidgeting stimulating. (Hyperactive and inattentive ADHD subtypes are the same underlying issue, it just presents differently.) This may not be a problem if the brain is very stimulated for only a bit, then goes back to zero, but the system is broken, so the person may find daydreaming or fidgeting stimulating for a few hours, days, or even weeks, and they cannot do anything other than daydream or fidget. Understandably this can become a serious issue, as it means everything gets ignored unless it is that one stimulating thing. The person may find small things like showering or going to appointments infuriating because having zero dopamine can begin to feel like a deficit and not only unmotivating but painful. Brains don’t choose to do things that are painful. So, the brain begins to ignore those things without the individual’s awareness.
The CEO: Or absence of.
A good metaphor to explain the struggle is that of a business without a CEO. A CEO’s role is to take the information into the business and distribute tasks, workload, money, etc. to the correct place. An ADHD brain doesn't have a CEO, so things are all over the place and get missed. Suddenly, a worker in accounting might realise stuff isn't happening and steps up. They take on the CEO role, but they only know about accounting, so they ensure the finances are run but things like the IT jobs don't get done and all of the computers break. The IT manager gets sick of it and fires the accountant to take over but then the company goes broke.
Sometimes an ADHD brain may have no one running the show and everything is all over the place. At other times the accountant is running the place and budgeting is perfect, but appointments are being forgotten and self-care isn’t happening.
The role of therapy is to begin to create lifestyle and daily routine changes based on the goal of having each department head working together without the need for a CEO. Learning how to do this is difficult and very different to how those without ADHD work, but it is definitely possible.