He maps brains of children and teens with ADHD
Nicholas Fogleman combines brain imaging with clinical care to understand those with attention-deficit/hyperactivity disorder.
Although Nicholas Fogleman has no personal connection to attention-deficit/hyperactivity disorder, he reflects on how deeply ADHD impacted many of the students he taught in a sixth grade science class as part of Teach for America.
“It’s the most common childhood condition,” he explains. “I felt I could help the most people by studying it.”
Today, as a faculty member in the UNC School of Medicine, Fogleman serves as a co-investigator on the BrainMap study, which examines how adolescent brains develop and focuses on the differences between youth with and without ADHD. He also directs the UNC ADHD Program, offering evaluations, therapy, medication management and parent training to families.
His research centers on emotion regulation — the ability to understand, manage and respond to emotions in healthy ways. The prefrontal cortex is the brain’s control center for this regulation, along with planning, organizing, focusing and impulse control. For children with ADHD, this part of the brain often develops more slowly, leading to a delayed development of these critical life skills.
“Children with ADHD who struggle to regulate their emotions face the greatest risk for challenges at home, in school, with friendships, future employment and beyond,” he said. “If we can help children with emotion regulation, it can make a big difference in their quality of life.”
Charting the brain
Fogleman collaborates with Jessica Cohen, a leading expert in the field, as a co-investigator of the BrainMAP study. Using neuroimaging, they examine how the brains of pre-teen children with and without ADHD develop during adolescence.
“Brain growth is not linear; you get these rapid periods of growth and plateaus,” Fogleman explains. “Adolescence is a time of rapid development.”
The study began in 2020 and follows more than 150 children age 10 to 12, who receive brain scans every 18 months.
The BrainMAP team tracks how the brain changes over time, focusing on structural changes (the brain’s framework) and functional changes (the brain’s wiring). Their goal? To uncover developmental processes and create interventions tailored to individual patients.
Building better care
Fogleman’s commitment to improving the lives of those with ADHD extends beyond the lab. In 2022, he helped develop the UNC ADHD program to address critical gaps.
The program began by providing evaluations to children referred internally from UNC Health, then expanded to other offerings. Soon, pediatricians requested help with complex medication management, leading Fogleman to partner with Dr. Joseph Whitfield, a child and adolescent psychiatrist specializing in ADHD treatment.
“We know that different children respond differently to medication,” Fogleman said. “Having Dr. Whitfield on staff has expanded our services and been a huge benefit to children and their families.”
Later he added a virtual behavioral parent training program, offering help with effective behavior management and motivation techniques to homework systems and school-based supports.
“We meet parents where they are,” Fogleman says. “We understand that parenting children with ADHD can be stressful at times, and we aim to help parents practice supportive strategies and establish a positive relationship with their child.”
Fogleman’s experience underscores what research shows: When parents complete behavioral parent training before starting their child on medication, those children often need lower doses and experience a higher quality of life.
“The growth of the ADHD Program reflects the needs of our community, and I’m grateful for the support from UNC to develop these resources,” he says. “I look forward to continuing to work with our amazing faculty and students to support people across North Carolina.”
