While Nicholas Fogleman’s focus on attention-deficit/hyperactivity disorder (ADHD) is timely, his path to the field was far from direct.

After interning at a pediatrician’s office as a high school student, teaching sixth grade science as part of Teach for America after college, and completing a training program at the National Institutes of Health (NIH), where he explored different types of research and discovered neuroimaging, Fogleman knew three things: He liked working with kids, he enjoyed psychology and neuroscience, and he wanted to help people.

These realizations led him to enroll in graduate school at the University of Louisville, where he earned a PhD in clinical psychology and studied ADHD, a brain condition that affects attention, activity level, and impulse control.

Although Fogleman has no personal connection to ADHD, he reflects on how deeply it impacted many of the students he taught, students who would have benefited from tailored interventions and other resources.

“It’s the most common childhood condition,” he explains. “I felt I could help the most people by studying it.”

Exploring emotion in ADHD

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.

Challenges with attention and impulse control can lead to clashes with parents, teachers and peers, often escalating into patterns of defiance, hostility, and negativity. A child who struggles to complete daily tasks, like getting ready for school or doing homework, may receive repeated criticism, which can lead to anxiety and depression.

“These are actually behavioral expressions of difficulties with emotion regulation,” Fogleman points out. “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. If we can help children with emotion regulation, it can make a big difference in their quality of life.”

Charting the brain

Fogleman’s interest in neuroimaging began at the NIH, where he witnessed rapid advancements in brain imaging technology. Neuroimaging allows researchers to visualize the brain’s structure and function, offering insights into anatomy and activity in real time.

In graduate school, Fogleman focused on ADHD in the clinic and neuroimaging techniques in the lab. He expanded this expertise after joining Carolina in 2019 as a postdoctoral fellow under Jessica Cohen, a leading expert in the field. When his fellowship ended, Cohen supported his transition to a faculty role that integrates both clinical and brain imaging skills.

Today, Fogleman continues to collaborate with Cohen 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 — a critical stage that has received far less attention than early childhood or college years.  

“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 aged 10 to 12, who receive brain scans every 18 months.

The BrainMAP team tracks how the brain changes over time, focusing on two distinct types of development. Structural changes reflect the brain’s physical growth and maturation, like watching a building’s framework rise from the ground. Functional changes, on the other hand, reveal how different brain regions communicate, much like the electrical wiring threaded through that framework. Some circuits are fully connected, while others remain incomplete, influencing how power flows through the structure.

Their goal? To uncover developmental processes and create interventions tailored to individual patients.

Building better care

While Fogleman’s research sheds light on adolescent brain development, his commitment to improving the lives of those with ADHD extends beyond the lab.

When COVID-19 upended the world, many community needs went unmet, including support for individuals with ADHD. Driven by these challenges, Fogleman joined the UNC Department of Psychiatry in 2022 to help develop an ADHD program that would address critical gaps.

The program began by providing evaluations to children referred internally from UNC Health. As word spread, families began asking about therapy services, prompting Fogleman to expand offerings. Soon, pediatricians requested help with complex medication management, leading Fogleman to partner with Joseph Whitfield, a child and adolescent psychiatrist specializing in ADHD treatment.

“There are different ways we think about managing ADHD symptoms,” Fogleman says. “One of them is medication. We know that different children respond differently to medication. Having Dr. Whitfield on staff has expanded our services and been a huge benefit to children and their families.”

Even with these additions, demand for the program continued to grow. Fogleman wondered: How can we serve more people efficiently while maintaining quality care?

The answer was a virtual behavioral parent training program. Over eight online sessions, providers teach parents strategies for supporting their children — from 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.

Over the past three years, Fogleman has grown the UNC ADHD Program by training and partnering with graduate and medical students, postdoctoral scholars, and providers from various fields — a response to rising demand for ADHD care. Next, he aims to expand school-based services and begin serving adults in 2026.

“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.”