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By Sophia C.
Affecting one in twenty children worldwide, attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder characterized by symptoms of hyperactivity, impulsivity, and inattention. Recently, breakthroughs in ADHD research have furthered psychologists’ understanding of the disorder.
ADHD’s nature as a neurodevelopmental disorder calls for treatment options that alter the patient’s biological and neurological functioning, assuming that neurological abnormalities cause the behavior deficits of ADHD. Consequently, the main course of treatment for ADHD is psychotropic drugs, specifically stimulants. However, as research fails to identify biofactors unique and specific to those with ADHD, no definitive and objective medical tests can confirm the existence of ADHD in patients. Diagnosed solely off of observations of behavioral symptoms, psychological research fails to provide biological criteria to distinguish ADHD brains from neurotypical brains.
Understanding these shortcomings in ADHD research, psychologists focused extensively on the neurological and biological research of ADHD, discovering a connection between ADHD and cerebellar cognitive affective syndrome (CCAS), also known as Schmahmann’s syndrome.
In the late twentieth century, neurologist Jeremy Schmahmann discovered cerebellar cognitive affective syndrome (CCAS), a cognitive condition resulting from damage to the cerebellum from trauma, stroke, genetics, or other brain insults. Also known as the “little brain,” the cerebellum regulates one’s balance, motor coordination, and vestibular equilibrium. According to clinical psychologists, Edward Hallowell and John Ratey, symptoms of CCAS are caused by physical damage to the cerebellum, which explains why patients with CCAS struggle with maintaining balance and coordination: their physical equilibrium is disrupted. However, a damaged cerebellum also disrupts one’s emotional equilibrium. When the cerebellum is damaged, the speed, capacity, and consistency of one’s emotional and cognitive processes are affected as well. This leads to cognitive symptoms such as impaired executive functioning and affective regulation, hyperactivity, distractibility, and anxiety. Surprisingly, these symptoms almost exactly mirror those of ADHD (Hallowell and Ratey). Intrigued by the correlation between CCAS and ADHD, psychologists further studied the cerebral function in ADHD patients, and as expected, numerous pieces of evidence reveal structural and functional cerebral deficits in ADHD patients.
In a study led by Maurizio Cundari, who specializes in neurocognitive and ADHD research, brain imaging techniques were used to study the brain activity of ADHD patients while performing executive function tasks. Results showed that cerebral volumes in ADHD patients were four percent smaller than healthy controls. Images also revealed that patients had thinner, less myelinated, and less organized fibers in the cerebellum, limiting optimal performance and functioning of the region.
To further investigate these findings, Cundari and colleagues ran attention and reaction tests with results showing ADHD patients yielding substandard performances as opposed to those of the control group, along with slower processing speeds, higher distractibility, and problems with selective attention (Cundari et al.). The symptoms and effects of a damaged cerebellum and CCAS drew a striking parallel with those of ADHD. Thus, it is educational to infer that cerebral abnormalities play a significant role in producing ADHD. However, these findings are still considered clinically insignificant, meaning that these differences are not major enough to be a distinguishing diagnostic criterion.
Although no significant brain differences have been found in patients with ADHD, evaluating the relationship between CCAS and ADHD invites psychologists to gain a fuller understanding of the etiology of ADHD while expanding neurological research for the disorder.
Mental illnesses are a product of nature and nurture; that is, a byproduct of both genetics and the environment. Brain abnormalities underlie and accompany mental illnesses, and while specific brain abnormalities are not part of the diagnostic criteria for ADHD, identifying differences between ADHD and neurotypical brains can inspire sustainable treatment options. Although a widely known disorder, the real nature of ADHD is extremely misunderstood, and many facets of this complex disorder remain unsolved. However, the boundlessness of ADHD research compels psychologists to tread the unknown. The future is bright for ADHD, and with the leadership of mindful pioneers, the study of ADHD will undoubtedly continue to grow and benefit society.
References
Cundari, Maurizio, et al. “Neurocognitive and Cerebellar Function in ADHD, Autism and Spinocerebellar Ataxia.” Frontiers in Systems Neuroscience, vol. 17, 21 Jun. 2023, doi.org/10.3389/fnsys.2023.1168666.
Hallowell, Edward M., and John J. Ratey. ADHD 2.0 New Science and Essential Strategies for Thriving with Distraction- from Childhood Through Adulthood. Ballantine Books, 2021.
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