Question: Hi Dr. Barkley, thanks for doing this.  
  
  
  What is your elevator pitch for what is going on in the brain due to ADHD?
  
  &amp;#x200B;
  
  Do you have any tips for someone figuring out which medication regimen works?
Answer: In my opinion, ADHD arises from problems with brain maldevelopment especially in the prefrontal executive networks that can arise either from genetic factors (different gene variants and mutations for building and regulating such networks) or from acquired disruptions to the development of these networks and regions.  While certain brain regions and gray matter or somewhat smaller during development, this may not be so much the case by adulthood.  Nonetheless, we continue to see evidence of reduced connectivity of some regions with others that are part of these executive networks, of excess connectivity with non-executive regions, and especially with more variable functioning in these connections or networks that give rise to the ADHD symptoms and related executive function (EF) networks.  So in short its a problem with connectivity and functioning of networks critical for self-regulation and EF, such a inhibition, self-awareness, time management, working memory, emotional self-regulation and motivation, and planning and problem solving.  It helps to understand what is happening in ADHD by over simplifying brain activity as being where knowledge is acquired (back part of the brain) and where that knowledge is activated and applied in daily performance (frontal executive brain).  ADHD partially disconnects the typical interaction of these brain regions, in a sense.  So ADHD is far more a problem of doing what you know, not knowing what to do.  Its a performance problem, not a knowledge problem.  Adults with ADHD are not ignorant, but they struggle to apply all of what they know in key situations where such knowledge should have guided their actions and decision making, and it didn't.
content: Q: Hi Dr. Barkley, thanks for doing this.  
  
  
  What is your elevator pitch for what is going on in the brain due to ADHD?
  
  &amp;#x200B;
  
  Do you have any tips for someone figuring out which medication regimen works?
   Ans: In my opinion, ADHD arises from problems with brain maldevelopment especially in the prefrontal executive networks that can arise either from genetic factors (different gene variants and mutations for building and regulating such networks) or from acquired disruptions to the development of these networks and regions.  While certain brain regions and gray matter or somewhat smaller during development, this may not be so much the case by adulthood.  Nonetheless, we continue to see evidence of reduced connectivity of some regions with others that are part of these executive networks, of excess connectivity with non-executive regions, and especially with more variable functioning in these connections or networks that give rise to the ADHD symptoms and related executive function (EF) networks.  So in short its a problem with connectivity and functioning of networks critical for self-regulation and EF, such a inhibition, self-awareness, time management, working memory, emotional self-regulation and motivation, and planning and problem solving.  It helps to understand what is happening in ADHD by over simplifying brain activity as being where knowledge is acquired (back part of the brain) and where that knowledge is activated and applied in daily performance (frontal executive brain).  ADHD partially disconnects the typical interaction of these brain regions, in a sense.  So ADHD is far more a problem of doing what you know, not knowing what to do.  Its a performance problem, not a knowledge problem.  Adults with ADHD are not ignorant, but they struggle to apply all of what they know in key situations where such knowledge should have guided their actions and decision making, and it didn't.