Secrets of the ADHD Brain

ADDitude

Most people are neurologically equipped to determine what’s important and get motivated to do it, even when it doesn’t interest them. Then there are the rest of us, who have attention deficit.

 

Learn the secrets of the ADHD brain

ADHDers know that they are bright and clever, but they are never sure whether their abilities will show up when they need them.

ADHD is a confusing, contradictory, inconsistent, and frustrating condition. It is overwhelming to people who live with it every day. The diagnostic criteria that have been used for the last 40 years leave many people wondering whether they have the condition or not. Diagnosticians have long lists of symptoms to sort through and check off. The Diagnostic and Statistical Manual of Mental Disorders has 18 criteria, and other symptom lists cite as many as 100 traits.

Practitioners, including myself, have been trying to establish a simpler, clearer way to understand the impairments of ADHD. We have been looking for the “bright and shining line” that defines the condition, explains the source of impairments, and gives direction as to what to do about it.

My work for the last decade suggests that we have been missing something important about the fundamental nature of ADHD. I went back to the experts on the condition — the hundreds of people and their families I worked with who were diagnosed with it — to confirm my hypothesis. My goal was to look for the feature that everyone with ADHD has, and that neurotypical people don’t have.

I found it. It is the ADHD nervous system, a unique and special creation that regulates attention and emotions in different ways than the nervous system in those without the condition.

The ADHD Zone

Almost every one of my patients and their families want to drop the term Attention Deficit Hyperactivity Disorder, because it describes the opposite of what they experience every moment of their lives. It is hard to call something a disorder when it imparts many positives. ADHD is not a damaged or defective nervous system. It is a nervous system that works well using its own set of rules. Despite ADHD’s association with learning disabilities, most people with an ADHD nervous system have significantly higher-than-average IQs. They also use that higher IQ in different ways than neurotypical people. By the time most people with the condition reach high school, they are able to tackle problems that stump everyone else, and can jump to solutions that no one else saw.

The vast majority of adults with an ADHD nervous system are not overtly hyperactive. They are hyperactive internally.

Those with the condition don’t have a shortage of attention. They pay too much attention to everything. Most people with unmedicated ADHD have four or five things going on in their minds at once. The hallmark of the ADHD nervous system is not attention deficit, but inconsistent attention.

Everyone with ADHD knows that they can “get in the zone” at least four or five times a day. When they are in the zone, they have no impairments, and the executive function deficits they may have had before entering the zone disappear. ADHDers know that they are bright and clever, but they are never sure whether their abilities will show up when they need them. The fact that symptoms and impairments come and go throughout the day is the defining trait of ADHD. It makes the condition mystifying and frustrating.

People with ADHD primarily get in the zone by being interested in, or intrigued by, what they are doing. I call it an interest-based nervous system. Judgmental friends and family see this as being unreliable or self-serving. When friends say, “You can do the things you like,” they are describing the essence of the ADHD nervous system.

ADHD individuals also get in the zone when they are challenged or thrown into a competitive environment. Sometimes a new or novel task attracts their attention. Novelty is short-lived, though, and everything gets old after a while.

Most people with an ADHD nervous system can engage in tasks and access their abilities when the task is urgent — a do-or-die deadline, for instance. This is why procrastination is an almost universal impairment in people with ADHD. They want to get their work done, but they can’t get started until the task becomes interesting, challenging, or urgent.

How the Rest of the World Functions

The 90 percent of non-ADHD people in the world are referred to as “neurotypical.” It is not that they are “normal” or better. Their neurology is accepted and endorsed by the world. For people with a neurotypical nervous system, being interested in the task, or challenged, or finding the task novel or urgent is helpful, but it is not a prerequisite for doing it.

Neurotypical people use three different factors to decide what to do, how to get started on it, and to stick with it until it is completed:

1. the concept of importance (they think they should get it done).

2. the concept of secondary importance–they are motivated by the fact that their parents, teacher, boss, or someone they respect thinks the task is important to tackle and to complete.

3. the concept of rewards for doing a task and consequences/punishments for not doing it.

A person with an ADHD nervous system has never been able to use the idea of importance or rewards to start and do a task. They know what’s important, they like rewards, and they don’t like punishment. But for them, the things that motivate the rest of the world are merely nags.

The inability to use importance and rewards to get motivated has a lifelong impact on ADHDers’ lives:

How can those diagnosed with the condition choose between multiple options if they can’t use the concepts of importance and financial rewards to motivate them?

How can they make major decisions if the concepts of importance and rewards are neither helpful in making a decision nor a motivation to do what they choose? This understanding explains why none of the cognitive and behavioral therapies used to manage ADHD symptoms have a lasting benefit. Researchers view ADHD as stemming from a defective or deficit-based nervous system. I see ADHD stemming from a nervous system that works perfectly well by its own set of rules. Unfortunately, it does not work by any of the rules or techniques taught and encouraged in a neurotypical world. That’s why:

ADDers do not fit in the standard school system, which is built on repeating what someone else thinks is important and relevant.

ADDers do not flourish in the standard job that pays people to work on what someone else (namely, the boss) thinks is important.

ADDers are disorganized, because just about every organizational system out there is built on two things — prioritization and time management — that ADDers do not do well.

ADDers have a hard time choosing between alternatives, because everything has the same lack of importance. To them, all of the alternatives look the same.

People with an ADHD nervous system know that, if they get engaged with a task, they can do it. Far from being damaged goods, people with an ADHD nervous system are bright and clever. The main problem is that they were given a neurotypical owner’s manual at birth. It works for everyone else, not for them.

Don’t Turn ADHDers into Neurotypicals

The implications of this new understanding are vast. The first thing to do is for coaches, doctors, and professionals to stop trying to turn ADHD people into neurotypical people. The goal should be to intervene as early as possible, before the ADHD individual has beenfrustrated and demoralized by struggling in a neurotypical world, where the deck is stacked against him. A therapeutic approach that has a chance of working, when nothing else has, should have two pieces:

Level the neurologic playing field with medication, so that the ADHD individual has the attention span, impulse control, and ability to be calm on the inside. For most people, this requires two different medications. Stimulants improve an ADHDer’s day-to-day performance, helping him get things done. They are not effective at calming the internal hyperarousal that many with ADHD have. For those symptoms, the majority of people will benefit by adding one of the alpha agonist medications (clonidine/Kapvay or guanfacine/Intuniv) to the stimulant.

Medication, though, is not enough. A person can take the right medication at the right dose, but nothing will change if he still approaches tasks with neurotypical strategies.

The second piece of ADHD symptom management is to have an individual create his own ADHD owner’s manual. The generic owner’s manuals that have been written have been disappointing for people with the condition. Like everyone else, those with ADHD grow and mature over time. What interests and challenges someone at seven years old will not interest and challenge him at 27.

Write Your Own Rules

The ADHD owner’s manual has to be based on current successes. How do you get in the zone now? Under what circumstances do you succeed and thrive in your current life? Rather than focus on where you fall short, you need to identify how you get into the zoneand function at remarkable levels.

I usually suggest that my patients carry around a notepad or a tape recorder for a month to write down or explain how they get in the zone.

Is it because they are intrigued? If so, what, specifically, in the task or situation intrigues them? Is it because they feel competitive? If so, what in the “opponent” or situation brings up the competitive juices?

At the end of the month, most people have compiled 50 or 60 different techniques that they know work for them. When called on to perform and become engaged, they now understand how their nervous system works and which techniques are helpful.

I have seen these strategies work for many ADDers, because they stepped back and figured out the triggers they need to pull. This approach does not try to change people with an ADHD nervous system into neurotypical people (as if that were possible), but gives lifelong help because it builds on their strengths.

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The Owner’s Manual for Driving Your Adolescent Brain by JoAnn Deak

Foreword Book Reviews

This owner’s manual lets teens kick the tires as they learn to drive their new-model brains.

The Owner’s Manual for Driving Your Adolescent Brain offers fun-filled, easy-to-understand information about how the brain works, grows, and develops to help young people successfully navigate through the challenging years from ages ten to twenty.

Adolescence is a highly dynamic developmental period, and the brain is the body’s most dynamic, and mysterious, organ. Psychologists JoAnn and Terrence Deak use ordinary concepts and language along with scientific terms to explain the various parts of the brain and how they interact with each other, using an analogy that many adolescents understand: the way a car works and the care it needs to operate at its best.

Freya Harrison’s lively, colorful illustrations add a touch of whimsy that greatly enhances the text, and fun science facts keep the reader enjoyably engaged. For example, did you know that if the cell body of a single neuron in your spinal cord that is about one hundred microns in diameter (about the size of a pinhead) were the size of a baseball, its axon would be nearly 2,416 feet long? That’s “eight times as tall as the Statue of Liberty, twice as tall as the Eiffel Tower, and almost as high as the tallest skyscraper on Earth.”

The Deaks also tackle some of the more troublesome aspects of adolescence, including the strong, and sometimes misguided, drive for independence and the emotional turbulence that characterize this time of life. Understanding that the brain’s different structures develop and mature at different rates, with the cerebral cortex (which participates in complex decision-making) not fully developed until adulthood, can help teens appreciate why they may need guidance from mature adults when it comes to making important decisions.

Learning that regular exercise supercharges the brain might lead even the most sedentary teen to frequent the gym or take up a sport. And understanding that, until the prefrontal cortex is fully mature, young people will have the tendency to act impulsively or engage in risky behaviors may help to protect them from making and acting upon some bad decisions; they may even find it easier to ask the advice of a trusted adult before their immature brain leads them astray. While geared to adolescents, parents and other adults who work with youth may find much to appreciate and enjoy in this manual on the care of their charges’ “grey matter.”

JoAnn Deak is an educator and preventive psychologist. Terrence Deak is a professor of Psychology and Behavioral Neuroscience at Binghamton University in upstate New York, where he runs an active neuroscience laboratory.

The authors make it clear that, no matter which types of life decisions adolescents must face, the choice always remains in their own hands. This respectful acknowledgment, together with the admission that making good decisions isn’t always easy, can help young people understand, and accept, both their limitations and their power.

Kristine Morris
January 28, 2014

Brain, Interrupted

Brain, Interrupted, The New York Times

By Bob Sullivan and Hugh Thompson | New York Times – Tue, May 7, 2013

  • Yahoo! Finance/Getty Images –

Technology has given us many gifts, among them dozens of new ways to grab our attention. It’s hard to talk to a friend without your phone buzzing at least once. Odds are high you will check your Twitter feed or Facebook wall while reading this article. Just try to type a memo at work without having an e-mail pop up that ruins your train of thought.

But what constitutes distraction? Does the mere possibility that a phone call or e-mail will soon arrive drain your brain power? And does distraction matter — do interruptions make us dumber? Quite a bit, according to new research by Carnegie Mellon University’s Human-Computer Interaction Lab.

There’s a lot of debate among brain researchers about the impact of gadgets on our brains. Most discussion has focused on the deleterious effect of multitasking. Early results show what most of us know implicitly: if you do two things at once, both efforts suffer.

In fact, multitasking is a misnomer. In most situations, the person juggling e-mail, text messaging, Facebook and a meeting is really doing something called “rapid toggling between tasks,” and is engaged in constant context switching.

As economics students know, switching involves costs. But how much? When a consumer switches banks, or a company switches suppliers, it’s relatively easy to count the added expense of the hassle of change. When your brain is switching tasks, the cost is harder to quantify.

There have been a few efforts to do so: Gloria Mark of the University of California, Irvine, foundthat a typical office worker gets only 11 minutes between each interruption, while it takes an average of 25 minutes to return to the original task after an interruption. But there has been scant research on the quality of work done during these periods of rapid toggling.

We decided to investigate further, and asked Alessandro Acquisti, a professor of information technology, and the psychologist Eyal Peer at Carnegie Mellon to design an experiment to measure the brain power lost when someone is interrupted.

To simulate the pull of an expected cellphone call or e-mail, we had subjects sit in a lab and perform a standard cognitive skill test. In the experiment, 136 subjects were asked to read a short passage and answer questions about it. There were three groups of subjects; one merely completed the test. The other two were told they “might be contacted for further instructions” at any moment via instant message.

During an initial test, the second and third groups were interrupted twice. Then a second test was administered, but this time, only the second group was interrupted. The third group awaited an interruption that never came. Let’s call the three groups Control, Interrupted and On High Alert.

We expected the Interrupted group to make some mistakes, but the results were truly dismal, especially for those who think of themselves as multitaskers: during this first test, both interrupted groups answered correctly 20 percent less often than members of the control group.

In other words, the distraction of an interruption, combined with the brain drain of preparing for that interruption, made our test takers 20 percent dumber. That’s enough to turn a B-minus student (80 percent) into a failure (62 percent).

But in Part 2 of the experiment, the results were not as bleak. This time, part of the group was told they would be interrupted again, but they were actually left alone to focus on the questions.

Again, the Interrupted group underperformed the control group, but this time they closed the gap significantly, to a respectable 14 percent. Dr. Peer said this suggested that people who experience an interruption, and expect another, can learn to improve how they deal with it.

But among the On High Alert group, there was a twist. Those who were warned of an interruption that never came improved by a whopping 43 percent, and even outperformed the control test takers who were left alone. This unexpected, counterintuitive finding requires further research, but Dr. Peer thinks there’s a simple explanation: participants learned from their experience, and their brains adapted.

Somehow, it seems, they marshaled extra brain power to steel themselves against interruption, or perhaps the potential for interruptions served as a kind of deadline that helped them focus even better.

Clifford Nass, a Stanford sociologist who conducted some of the first tests on multitasking, has said that those who can’t resist the lure of doing two things at once are “suckers for irrelevancy.” There is some evidence that we’re not just suckers for that new text message, or addicted to it; it’s actually robbing us of brain power, too. Tweet about this at your own risk.

What the Carnegie Mellon study shows, however, is that it is possible to train yourself for distractions, even if you don’t know when they’ll hit.

Bob Sullivan, a journalist at NBC News, and Hugh Thompson, a computer scientist and entrepreneur, are the authors of “The Plateau Effect: Getting From Stuck to Success.”

Bilingual Brains – Smarter and Faster

Psychology Today

Published on November 22, 2012 by Dr. Judy Willis, M.D., M.Ed. in Radical Teaching

By Judy Willis, M.D., M.Ed.

A Gift Parents Can Give Children that Money Can’t Buy

Recent studies of children who grow up in bilingual settings reveal advantages over single language children, including both increased attentive focus and cognition. The findings correlate with prefrontal cortex brain activity networks, which direct the highest levels of thinking and awareness.

 

Compared to monolinguals, the studied bilingual children, who had had five to ten years of bilingual exposure, averaged higher scores in cognitive performance on tests and had greater attention focus, distraction resistance, decision-making, judgment and responsiveness to feedback. The correlated neuroimaging (fMRI scans) of these children revealed greater activity in the prefrontal cortex networks directing these and other executive functions. (Bialystok, 2009; Kaushanskaya & Marian, 2007).

 

This increased executive function activation in the brains of children in bilingual settings extends beyond the translation of language intake and output. The powerful implications of the new research are about brainpower enhanced by growing up bilingual.

The Brain’s CEO is a Late Bloomer

 

The networks that appear more active in the brains of bilingual children are part of the brain’s CEO networks, called executive functions. These are a constellation of cognitive abilities that support goal-oriented behavior including directing attentive focus, prioritizing, planning, self-monitoring, inhibitory control, judgment, working memory (maintenance and manipulation of information), and analysis.

 

It is not during the first months or even years of life that the brain undergoes its greatest changes with regard to cognition. These neural networks of executive functions are the last regions of the brain to “mature” as recognized by the pruning of unused circuits and the myelination of the most active networks that as they become stronger and more efficient.

Executive functions such as selective attentive focus and the ability to block out distraction are typically minimally developed in childhood. These functions gradually become stronger throughout the years of prefrontal cortex maturation into the mid twenties. It is with regard to these executive functions that research about the “bilingual brain” is particularly exciting.

What is Happening in the Brains in Bilingual Settings?

 

This aspect of bilingual research has focused on bilingual upbringing with one language spoken at home that is not the same as the dominant language of the country. The interpretations of researchers, such as Ellen Bialystok who compared responses of 6-year olds from bilingual and monolingual homes, suggest the bilingual brain is highly engaged in the cognitive challenge of evaluating between the two competing language systems. This requires executive function attention selecting and focusing on the language being used while intentionally inhibiting the activity of the competing language system.

 

When bilingual brains evaluate language, control and storage networks of both their languages are active and available. This ongoing processing, that seems instantaneous, is not reflexive or unconscious. It requires deliberate focus of attention on specific input and withholding of focus from simultaneous distracting input to analyze the language being used. Their brains need to evaluate and determine not only the meaning of words, but also which patterns of sentence structure and grammar apply and recognize nuances of pronunciation unique to the language of focus.

 

Bialystok describes this massive activity as exercising the executive functions early in bilinguals at work to decipher these multiple codes within each language. These control networks make choices, such as which memory storage circuits are the language-correct ones to activate from which to select the correct word, syntax, and pronunciation. The choices are demanding of a CEO that can simultaneously direct where ongoing new input is sent for successful evaluation and activate the correct language storage banks to use for response. These executive functions simultaneously coordinate the evaluation of the content of the messages and direct the response to that information.

Implications for Brighter Starts

 

One of the most significant implications of the bilingual research is the recognition that even very young children’s executive functions appear responsive to exercise which strengthens them for future use. An example from the research is these children’s higher scores on cognitive testing.

 

This incoming research supports encouraging parents to retain use of their native language in the home, but too often, social pressures and mistaken beliefs often limit children benefiting from the bilingual brain booster.

 

One problem is parents concern that exposure to one language is less confusing for children. When I taught fifth grade in a school where most of the students’ primary language was Spanish, I recall recently immigrated parents of my students telling me that although they were just learning English, they tried to only speak English at home with their children. They felt that would help their children learn English more successfully and believed that exposure to two languages would be confusing and make the transition to their new schools more difficult.

 

Another issue limiting the bilingual experiences was children’s desire to fit in. As my students’ English fluency improved, they would sometimes be asked by their parents to translate from English to Spanish during school conferences or meetings. When they did so, such as during “Back to School Night”, many were clearly embarrassed that their parents didn’t speak English and even tried to avoid having classmates hear them speak Spanish to their parents. When I would ask them about their reluctance, some would tell me that it made their parents seem “ignorant” when they did not speak English. My urging of parents to sustain the bilingual experience by speaking Spanish with their children in the home was thus resisted as children began to develop this bias against their native language.

 

The mistaken parental beliefs about confusing the brain with two languages and the response to their children’s negative responses to their native language cause these children to miss out on a unique and powerful opportunity to strengthen their highest cognitive brain potentials. One intervention educators and others in the community can do to avoid loss of the bilingual boost is to explain to new immigrants about the research and the strong impact they can have on their children’s academic success by retaining their native language in the home.

 

The other intervention is to lay to rest the mistaken assumption that the brain has limitations that are overwhelmed with duel language exposure. The more we learn about neuroplasticity, the more it appears the reverse is true. Experiences with new domains of challenge in general seem to strengthen the brain’s executive functions and cognition. This is evident on neuroimaging as well as in performance on the cognitive testing, reading comprehension, and success learning subsequent new languages. New challenges that include the use of judgment, analysis, deduction, translation, prioritizing, attention focusing, inhibitory control, delayed gratification, and pursuit of long-term goals are associated with increasing the number, strength, and efficiency of the executive function networks.

 

Just like our muscles become stronger with physical workouts, the developing brains of children in bilingual environments appear to build strength, speed, and efficiency in their executive function networks. This is the “neurons that fire together, wire together” phenomenon that in response to the electrical activations of messages traveling through them when used, executive function networks develop stronger connections – dendrites, synapses, and myelinated axons.

For now, it appears that when families have another language that can be spoken in the home where children are being raised it could be an opportunity to both enrich their language skills and also provide a cognitive boost for their highest brain networks of executive functions.

The implications of the bilingual research raise considerations of what other early exposures before and during school years can be designed to promote these executive function activations in all children. What are the implications regarding introducing second languages to young children from monolingual homes? Perhaps grandparents, nannies, friendships with families who speak another language could spend time with the children, or parents could participate in parent-child language classes suitable for youngsters such as learning and singing songs with movements in another language.

 

Does the bilingual benefit on cognition also work on older children and adults who learn second languages to the point of fluency? I’ll address some of these questions in my next blog, including the relationship of executive function activation and building new networks of learning with reduction in the manifestations of cognitive degenerative diseases such as Alzheimer’s disease.