The ADHD Brain - What’s Really Going On?
If you’ve ever been told to just try harder — this isn’t about effort. It’s about wiring.
That difference shows up in how we process time, regulate emotion, manage energy, and find motivation — not because we’re lazy or undisciplined, but because the brain itself is wired differently.
Neuroimaging studies have shown structural differences in the brains of people with ADHD, particularly in the prefrontal cortex — the area responsible for executive functions like attention regulation, planning, and impulse control (Hoogman et al., 2017). It’s not about damage or deficiency. It’s about how our brains are built to respond to novelty, stimulation, and unpredictability.
One of the most researched biological factors in ADHD is dopamine. This neurotransmitter helps regulate the brain’s reward and motivation system — and in ADHD, dopamine transmission can be lower or more inconsistent (Faraone & Larsson, 2019). That’s why we often struggle with effort-based tasks unless there’s a clear sense of urgency, interest, or consequence. It’s not a lack of willpower — it’s a different threshold for what activates the brain’s attention system.
Sleep is another often-overlooked part of the ADHD picture. While traditional lab-based studies such as polysomnography often find no structural sleep differences in adults with ADHD, wearable and actigraphy research paints a different story. Smaller but growing studies show that people with ADHD tend to experience longer sleep onset, lower efficiency, and — crucially — greater night-to-night variability in when and how well they sleep (Boonstra et al., 2007; Denyer et al., 2025). It’s not necessarily less sleep — it’s more unpredictable sleep. And that inconsistency alone can contribute to fatigue, mood swings, and cognitive overload.
For many people, stimulant medication can help. These medications work by increasing dopamine and norepinephrine levels in the brain, improving focus, attention, and emotional regulation. They are among the most effective psychiatric medications available (Catalá-López et al., 2017). But they’re not a cure. Medication doesn’t teach executive function or self-trust. It doesn’t erase years of confusion or shame. And for some, it doesn’t work at all — or only works partially.
That’s why the best outcomes for ADHD come from a combination of support: medication, psychological therapy, environmental adjustments, coaching, and compassion. Treating ADHD as purely a medical issue misses the complex ways it interacts with our emotions, identities, and environments.
For decades, people with ADHD have been told to “just try harder.” But this isn’t a matter of effort. It’s a matter of wiring — and what happens when that wiring goes unseen, unsupported, or misunderstood.
Understanding how the ADHD brain works isn’t about making excuses.
It’s about making sense of our lives — and giving ourselves the tools, care, and context we’ve always deserved.
If this helped you reframe something you’ve carried for years, you’re not alone.
I’d love to hear how you’ve come to understand your ADHD differently — feel free to reply or leave a comment.
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Boonstra, A. M., Kooij, J. J. S., Oosterlaan, J., Sergeant, J. A., Buitelaar, J. K., & van Someren, E. J. W. (2007). Hyperactive night and day? Actigraphy studies in adult ADHD: A baseline comparison and the effect of methylphenidate. Sleep, 30(4), 433–442. https://doi.org/10.1093/sleep/30.4.433
Catalá-López, F., Hutton, B., Núñez-Beltrán, A., Page, M. J., Ridao, M., Macías Saint-Gerons, D., Catalá, M. Á., Tabarés-Seisdedos, R., & Moher, D. (2017). The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PLOS ONE, 12(7), e0180355. https://doi.org/10.1371/journal.pone.0180355
Denyer, H., Carr, E., Deng, Q., Asherson, P., Bilbow, A., Folarin, A., Groom, M. J., Hollis, C., Sankesara, H., Dobson, R. J. B., & Kuntsi, J. (2025). A 10‑week remote monitoring study of sleep features and their variability in individuals with and without ADHD. BMC Psychiatry, 25, Article 294. https://doi.org/10.1186/s12888-025-06729-z
Faraone, S. V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry, 24(4), 562–575. https://doi.org/10.1038/s41380-018-0070-0
Hoogman, M., Bralten, J., Hibar, D. P., Mennes, M., Zwiers, M. P., Schweren, L. S. J., … & Franke, B. (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: A cross-sectional mega-analysis. The Lancet Psychiatry, 4(4), 310–319. https://doi.org/10.1016/S2215-0366(17)30049-4
