All About ADHD
If it seems like everyone is getting diagnosed with ADHD, that’s because they are. According to data from the Center for Disease Control, about 10 percent of all children in the United States are diagnosed with ADHD, and an increasing population of adults are also being diagnosed with the disorder. ADHD has been studied for decades, and our understanding of the condition has improved significantly. Let’s take a look at what we know about ADHD…
ADHD is classified in the DSM-V (the book mental health professionals reference to determine the criteria for mental health disorders) as a “neurodevelopmental disorder,” meaning the disorder is caused by specific brain networks. The networks in the brain thought to be affiliated with ADHD we can call, “the attention center.” The attention center is made up of two distinct brain networks that traverse through multiple areas of the brain, but most of the action happens in the brain’s frontal cortex (the front part of your brain, behind your forehead and above your eyes).
The two networks of the attention center have distinct jobs. The first network is charged with allocating attention to stimuli that the brain finds useful, pertinent, fun or interesting. You can think of this as the “automatic attention” network of the attention center because it handles things we “automatically” want to pay attention to. Think of watching your favorite TV show or your favorite meal being placed in front of you- these are things we pay attention to “automatically,” or naturally. The other network of the attention center is responsible for allocating attention to things we find not useful, not pertinent, disinteresting, or boring. You can think of this as the “directed attention” network, as it requires us to direct our attention onto things. Imagine your attempts to pay attention in a class you find boring or trying to complete a mundane task. In the neurotypical brain, directed attention and automatic attention work in balance with one another, allowing that person to enjoy what they like, while also directing attention where and when it is needed.
In the ADHD brain, the attention center is set up such that the directed attention network is weaker or under-connected. Conversely, in the ADHD style attention center, the automatic attention network tends to be hyperconnected, or possible has very strong connections. When the attention center of the brain is set up with these two networks out of balance with each other, very particular behaviors will begin to come from this person.
Let’s imagine a 3rd grade student who is diagnosed with ADHD, and let’s suppose that this 3rd grader believes that math “is a waste of my time. Math is so boring and I’ll never need it.” But now imagine the child sitting in their math class. That student may be aware that the particular lesson of the day is important and may want to pay attention for the sake of their grades, but they inadvertently get distracted and end up missing most of the needed information from the lesson. This will occur because they had an under-connected network dedicating attention to what they found disinteresting.
But perhaps a few hours later that 3rd grader goes home. And let us also make the assumption that this child believes that Legos are the greatest invention of all time. This child will come home, get their Legos out, and hyperfocus on Legos until their parent forces them to come downstairs and eat dinner. Varying levels of focus are a common observation in ADHD behavior. It will feel like the ADHD brain is not capable of paying attention to disinteresting items for more than a few seconds, while it can pay attention to interesting items seemingly endlessly and at a high level. We see here the practical results of the unbalanced attention center being expressed as a child who has difficulty paying attention in class, but then hyper-focuses on preferred items.
Now imagine this child back in school the following day, once again getting bored in class. So they pick up their pencil start fidgeting with it, but they are still bored. Then they take their pencil, throw it across the room, and sprint through the room in an attempt to catch their pencil before it hits the ground. These behaviors are likely to be labeled hyperactive (running through the room) and impulsive (throwing the pencil). But here we can see that this child’s behavior has nothing to do with how much energy they have. It is once again the attention center that is responsible for what is happening.
To understand how the attention center creates impulsive and hyperactive behavior, you must first understand “default mode.” Default mode is something the brain does all the time whereby it defaults into using its most powerful networks to navigate the world. When default mode gets applied to the ADHD style attention center, it will default into seeking out behavior that person finds more interesting. Here, it is worth noticing that it is more interesting to fidget with a pencil rather than hold it like you are supposed to. It is more interesting for the 3rd grader to move around the room and make unique events happen in their environment, rather than remain still and follow rules. And so as this 3rd grader defaults into doing behaviors they can use the powerful automatic attention network to accomplish, we see hyperactive and impulsive behaviors follow.
So, what is ADHD? It is an imbalance in the attention center of the brain. Flowing forth from that imbalance are all the behaviors we know to affiliate with ADHD.
Some Clarification About The ADHD Brain’s Attention Center:
Note that claiming the directed attention network “allocates attention to boring things,” does a good job depicting the result of directed attention, but does not pinpoint what the directed attention network actually does. In fact, the directed attention network’s primary function is to inhibit things. A few examples…
1.) Our 3rd grader starts to pick on their little brother and their parent gets highly upset at our 3rd grader for antagonizing. The parent’s impetus is to yell at the 3rd grader, but they inhibit their anger response and take more appropriate action.
2.) Our 3rd grader comes home from school and desperately wants to play video games, but decides to inhibit their desire for video games and completes their homework instead.
3.) When our 3rd grader tries once again to pay attention in their math class, we see this time they are able to inhibit from looking at the squirrels out the window and direct attention to their teacher instead.
In all examples we see restraint occur, but in very different areas of functioning. In the adult, we see a good example of the directed attention network inhibiting emotional responses. The second example depicts our 3rd grader inhibiting behavior in the video game vs homework debate. The last example depicts how inhibition translates into “directed attention,” where we see our student inhibiting from distraction to put attention where it is needed, giving us the name “direct attention network.”
Related to the inhibition operated by the directed attention network is “executive functioning.” Executive functioning is a broad term meant to highlight “top down” functioning, or in other words, our brain’s ability to oversee what it is doing. From our ability to direct attention, direct effort, and simultaneously monitor ourselves, we get skills such as time management, prioritizing, organizing, adaptable thinking, task initiation, transitioning to new activities, and behavior and emotion regulation. Note that if the directed attention network is under-connected (as in ADHD), using executive functioning skills may prove difficult.
ADHD FAQ’s:
Does everyone have ADHD?
No, but it is very common for humans to have occasional difficulties with behavior commonly seen in ADHD. For instance, most people lose track of the remote control, experience inattention, mismanage their time, or become disorganized. ADHD is what happens when executive disfunction occurs at a level that warrants clinical diagnosis, rather than difficulties that occur within normal limits of human experience. You should consult your doctor and/or a mental health professional if you suspect the clinical presence of ADHD.
Will my child grow out of ADHD?
No. As noted above, ADHD is a set of brain networks set up in an imbalanced way. By comparison, we may look at the experience of someone who is left-handed. Left-handedness occurs when the brain orients itself in a particular way, similar to ADHD occurring due to specific brain networks setting up in specific balance. Just as it is highly unlikely for a lefty to grow up and become right-handed, it does not occur that people “grow out of” ADHD.
But something else to notice about left-handed people- especially when they are young, they may be faced with specific challenges. The scissors do not work well, they run out of elbow room at crowded dinner tables, or tying their shoes feels backwards from what everyone tries to show them. But eventually they grow up and learn how they need to hold the scissors, sit at the left end of the table for added elbow room, and get a feel for how they tie their shoes, and navigate their world without issue. Similarly, children with ADHD grow up and eventually understand, “oh, my brain works like this, so I’ll just handle this task like that.” Once a person understands how they need to approach things in their life, they tend to do just fine.