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ADHD isn't simply about failing to pay attention - it's a fundamental challenge in self-regulation. Imagine trying to drive a car with faulty brakes. You know exactly where you need to go, but controlling your journey becomes nearly impossible. This is daily life for the 13 million American adults with ADHD. Their brains struggle with self-regulation - the ability to control behavior with an eye toward the future. Brain imaging reveals developmental differences in regions responsible for self-control, particularly in the prefrontal cortex. The condition is highly heritable, with twin studies showing 70-80% concordance rates in identical twins. What's crucial to understand is that ADHD creates a "knowing-doing gap." Adults with ADHD typically know what they should do but struggle to implement that knowledge when needed. They aren't lazy or unmotivated - they're fighting against neurological differences that make self-regulation extraordinarily difficult. This explains why a talented professional might consistently miss deadlines despite understanding their importance, or why someone might maintain a perpetually cluttered workspace despite numerous organization attempts.