Focus, Dopamine & The Brain:
The ADHD Guide
It’s not a willpower deficit. It’s an Executive Function disorder. We treat children (Ages 6+) and adults who are tired of "trying harder" without results.
Medically Reviewed by David Glenn, PMHNP-BC
Real Psychiatric Services • Columbus, OH
"If you just bought a planner, you'd be fine." "Why can't you just sit still?" "You're so smart, but you don't apply yourself."
If you have ADHD, these are phrases you've heard your entire life. At Real Psychiatric Services, we know that Attention Deficit Hyperactivity Disorder (ADHD) is not a behavioral problem caused by bad parenting or laziness. It is a complex neurodevelopmental condition that affects the brain's ability to regulate attention, emotion, and impulse.
The "Dopamine Deficit": Why Your Brain Works Differently
To treat ADHD effectively, we first have to respect the biology behind it. The ADHD brain is wired differently, specifically regarding a neurotransmitter called Dopamine.
The Reward Pathway
In a neurotypical brain, completing a small task (like folding laundry) releases a small hit of dopamine—a "reward" that keeps you going. In an ADHD brain, that reward is missing or delayed. This makes mundane tasks feel physically painful or impossible to start.
The Prefrontal Cortex
This is the "CEO" of the brain, responsible for planning, organizing, and impulse control. In ADHD, this area is slightly smaller or less active, leading to "Executive Dysfunction"—the inability to organize thoughts and actions.
Beyond "Hyperactivity": The Hidden Symptoms
While the stereotype of ADHD is a young boy running around a classroom, the reality is much more nuanced, especially in adults and women. We screen for the symptoms that fly under the radar:
1. Executive Dysfunction
- ADHD Paralysis: Sitting on the couch for hours, screaming at yourself internally to get up and do the thing, but being physically unable to move.
- Time Blindness: A chronic inability to sense the passage of time. "I'll just do this for 5 minutes" turns into 4 hours, or you consistently underestimate how long a commute takes.
- Task Initiation Deficit: The "Wall of Awful." Simple tasks feel like climbing a mountain because your brain cannot find the "start" button.
2. Emotional Dysregulation (RSD)
"Rejection Sensitive Dysphoria (RSD) is the sudden, intense emotional pain triggered by perceived rejection or criticism. It is unique to ADHD."
- Feeling physically crushed by mild feedback at work.
- People-pleasing to avoid the possibility of someone being mad at you.
- Sudden bursts of anger or tears that seem disproportionate to the situation.
3. The "Dopamine Chase"
- Hyper-fixating on a new hobby for two weeks, buying all the gear, and then never touching it again.
- Impulsive spending or eating to get a quick dopamine hit.
- Doom-scrolling on social media because it provides a constant stream of novel information.
A Lifespan Approach: From Grade School to the Office
Pediatric Care (Ages 6+)
For children, untreated ADHD isn't just about grades—it's about self-esteem. Kids who are constantly corrected ("Sit down," "Focus," "Stop that") internalize the message that they are "bad."
We work with parents and schools to create a treatment plan that supports learning without turning children into "zombies." Our goal is to preserve their creativity and spark while giving them the brakes to stop when they need to.
Adult ADHD
Many of our patients are high-functioning adults who "masked" their symptoms for years. They got through college on adrenaline and all-nighters, but now, the demands of a career and family have caused the structure to collapse.
Getting diagnosed as an adult can be a grieving process ("Why didn't I know sooner?") but also a massive relief. Finally, there is an explanation.
Medication Management: "Pills Don't Teach Skills"
But they do turn on the engine so you can drive the car. At Real Psychiatric Services, we use a tailored, safe approach to medication.
Stimulants (First-Line)
Examples: Adderall, Vyvanse, Concerta, Ritalin.
How they work: These increase the availability of dopamine and norepinephrine in the prefrontal cortex. They are fast-acting (working within 30-60 minutes) and are effective for 70-80% of patients.
The "Paradoxical Effect": In an ADHD brain, stimulants often have a calming effect. They reduce the internal noise, allowing you to focus on one thing at a time.
Non-Stimulants
Examples: Strattera, Qelbree, Intuniv.
How they work: Ideal for patients who cannot tolerate stimulants, have heart conditions, or have a history of substance use. These medications build up in the system over time (like an antidepressant) to provide 24/7 symptom coverage, not just during the work day.
Columbus & Telehealth Access
Navigating ADHD care regulations can be confusing. As a practice located in Columbus (Clintonville/Worthington area), we adhere to all Ohio Board of Nursing and Federal regulations regarding controlled substances.
While many visits can be conducted via our secure Telehealth platform, federal law may occasionally require an in-person visit for certain prescriptions. Our central location at 4770 Indianola Ave makes this convenient for patients across Franklin County, from OSU students to professionals in the Short North.
Patient FAQ
Will medication change my personality?
No. When dosed correctly, medication should make you feel more like yourself, not less. You should still have your humor, creativity, and spark—just with the ability to actually finish the projects you start. If you feel "zombie-like," the dose is too high, and we will adjust it immediately.
Do I need a formal neuropsychological testing report?
Not always. While full neuropsych testing is valuable, our psychiatric nurse practitioners are qualified to diagnose ADHD through comprehensive clinical interviews and standardized assessment scales (like the ASRS or Vanderbilts) during your intake.