ADHD & How Anyone Can Improve Their Focus

ADHD and Focus

• ADHD used to be called ADD 
  • First appeared in medical literature in 1904
  • Strong genetic component 
    • Higher probability if a close relative has ADHD
    • Identical twin with ADHD: 75% chance
    • Fraternal twin with ADHD: 50–60% chance
    • Parent with ADHD: 10–25% chance
• ADHD is not related to intelligence 
  • No correlation with standard IQ tests or other forms of intelligence
  • People with ADHD can have high or low IQs, emotional intelligence, etc.

Improving Focus and Concentration

• Tools to enhance concentration and focus for everyone, not just those with ADHD
• Overcoming symptoms of ADHD through rewiring neural circuits and understanding brain chemicals
• Importance of not self-​​diagnosing or diagnosing others with ADHD 
  • Proper diagnosis should be done by a psychiatrist, physician, or well-​​trained clinical psychologist

ADHD Overview

• Half may resolve with proper treatment
• Increased levels of ADHD in adults

ADHD Characteristics

• Poor attention and focus
• High levels of impulsivity
• Easily distractible
• Can hyperfocus on things they enjoy or are intrigued by
• Challenges with time perception 
  • Often run late, procrastinate
  • Can focus well if consequences are severe enough
• Spatial organization skills often subpar 
  • Use “pile system” for organizing belongings
• Trouble with working memory 
  • Can have good memory for past events
  • Struggle to keep information online for short-​​term use

ADHD and Neurobiology

• ADHD shares some characteristics with age-​​related cognitive decline and frontotemporal dementia

• Treatments, supplements, and tools for ADHD may overlap with those for age-​​related cognitive decline
  ADHD and Focus

• People with ADHD can obtain heightened levels of focus, even hyper focus, for things that excite them

• Dopamine is responsible for focus, motivation, and perception 
  • Released from neurons as a neuromodulator
  • Creates a heightened state of focus and motivation
  • Narrows visual and auditory focus
• Two main types of neural circuits related to ADHD and dopamine: 
  • Default mode network: active when not engaged in specific tasks 
    • Includes dorsolateral prefrontal cortex, posterior cingulate cortex, and lateral parietal lobe
  • Task networks: goal-​​oriented networks 
    • Includes medial prefrontal cortex and other areas that suppress impulses
• In a typical person, default mode network and task networks are anticorrelated (opposing each other)
• In a person with ADHD, default mode network and task networks are more coordinated, which is abnormal
• Dopamine acts as a conductor, regulating the activity of these networks 
  • Low dopamine hypothesis of ADHD: suggests that dopamine levels may be insufficient or not functioning properly in people with ADHD

ADHD Treatments and Recreational Drugs

• Current and previous treatments for ADHD, as well as recreational drugs used by people with ADHD, can provide insight into how dopamine regulates neural circuits
• Not promoting recreational drug use, but examining drug-​​seeking behavior can help understand the desire to remedy attention deficits

• 2015 paper by Spencer in Biological Psychiatry formalized the low dopamine hypothesis of ADHD
  Dopamine and ADHD

• Low dopamine hypothesis in ADHD

  • Low dopamine levels lead to unnecessary firing of neurons
  • Disrupts the balance between task-​​related networks and default mode networks
• People with ADHD often self-​​medicate with stimulants 
  • Caffeine, nicotine, sugar, cocaine, amphetamines
  • Increases dopamine levels, leading to better focus and attention
• Children with ADHD 
  • Prefer sugary foods, which increase dopamine levels
  • Calmer and more focused when consuming stimulants

ADHD Medications

• Ritalin, Adderall, Modafinil 
  • Prescription stimulants used to treat ADHD and narcolepsy
  • Increase dopamine levels in the brain
• Ritalin (methylphenidate)
  • Similar to amphetamine
  • Time-​​release formulas
• Adderall (combination of amphetamine and dextroamphetamine) 
  • More commonly prescribed for ADHD
  • Shorter life in the bloodstream, allowing for better dosage control
• Modafinil
  • Also used to treat ADHD and narcolepsy

Understanding ADHD Medications

• Structurally and chemically similar to street drugs like cocaine and methamphetamine 
  • Increase dopamine, norepinephrine, and to a lesser extent, serotonin levels
• Appropriate dosages and medical supervision can lead to effective treatment for ADHD 
  • Many people achieve relief with these drugs, especially if started early in life

• Some people take these drugs without a clinical diagnosis of ADHD

  • Adderall is the most commonly used in this context
    Recreational Stimulant Use and ADHD

• 25%-35% of individuals aged 17–30 use Adderall without ADHD diagnosis

  • Second in incidence only to cannabis
  • Stimulant use is common in this age group
• Reasons for stimulant use: 
  • Increased focus and energy
  • Caffeine, nicotine, and other stimulants have long been used for this purpose
• ADHD medications like Adderall and Ritalin are amphetamines 
  • Surprisingly, they help children with ADHD focus and calm down

ADHD Medication in Children

• Pediatric neurologist’s perspective: 
  • Medicating children with ADHD can be beneficial if the lowest possible dose is used and adjusted over time
  • Medication should be adjusted across the lifespan
• Puberty triggers activation of frontotemporal task-​​related executive functioning 
  • Ability to focus and control impulses improves with age
• Early treatment is key due to high neuroplasticity in childhood 
  • Ages 3–12 have the highest neuroplasticity
  • Early treatment can help develop appropriate levels of functioning and focus

Diet and ADHD

• Elimination diets, avoiding sugars, dairy, and gluten have been suggested to improve ADHD symptoms

• Studies and data are needed to determine the effectiveness of dietary changes in treating ADHD
  Role of Diet and Nutrition in ADHD

• Children with ADHD tend to pursue sugary foods to increase dopamine levels

• Study on the effects of diet on ADHD symptoms: 
  • 100 children, 50 in the elimination diet group, 50 in the control group
  • Crossover design, children served as their own control
  • Dramatic effects observed: enhanced focus, less impulsivity, better control of body movement
  • Elimination diet: oligoantigenic diet, removing foods children had mild allergies to
  • Criticisms of the study: skepticism about the overall structural design
• Anecdotal evidence from pediatric neurologist: 
  • Elimination of simple sugars has a dramatic and positive effect on ADHD symptoms
  • Oligoantigenic diets are controversial
  • Consensus: children with ADHD should avoid high sugar and simple sugar foods
  • Exploring existing allergies to foods might be beneficial
• Omega‑3 fatty acids and ADHD: 
  • Known benefits: antidepressant effects, mood elevation, cardiovascular protection, immune system support
  • Modest positive effects on focus and attention
  • Can help adults with ADHD function well on lower doses of medication or eliminate medication entirely in rare cases
  • Omega‑3 fatty acids play a supportive or modulatory role in ADHD treatment

Key Takeaways:

• Diet can have a significant role in reducing ADHD symptoms
• Children with ADHD should avoid high sugar and simple sugar foods
• Exploring existing food allergies might be beneficial

• Omega‑3 fatty acids can play a supportive role in ADHD treatment
  ADHD and Focus

• Distinction between modulation and mediation is important for understanding ADHD

• ADHD diet, Oligoantigenic diet, and supplements are often discussed as potential treatments

Neural Circuits and Chemistry of Focus

• People with ADHD can focus on things they care about but may experience more attentional blinks than others
• Attentional blinks: when focusing on one thing, you may miss other information
• Distractibility in ADHD could be due to over-​​focusing on certain elements and missing others

Open Monitoring and Panoramic Vision

• Open monitoring: a property that allows for better attention and recognition of multiple targets
• Panoramic vision: dilating your gaze to see a wider view, accessing open monitoring state
• Can be trained and practiced to improve focus

Reducing Attentional Blinks

• Studies show a simple practice of focusing on interoception (internal body sensations) for 15–17 minutes can significantly reduce attentional blinks

• This practice can improve focus in a near-​​permanent way without additional training
  Meditation and Attention

• Meditation can improve attention and focus in people of all ages

• 17-​​minute meditation sessions can rewire the brain for better attention
• Can offset age-​​related cognitive decline

Attentional Blinks and Time Perception

• Attentional blinks: moments when the mind shuts off and misses information
• Actual blinks can affect time perception 
  • Fast blinks: higher frame rate, time seems to pass slowly
  • Slow blinks: lower frame rate, time seems to pass quickly
• Dopamine levels affect time perception and attention 
  • Higher dopamine levels: overestimate time intervals, slow-​​motion mode
  • Lower dopamine levels: underestimate time intervals, disorganized in time

Improving Attention through Blink Control and Physical Activity

• Training to control blink frequency can improve attention and focus
• Physical activity before focusing tasks can help improve attention
• Fidget toys and repetitive physical activities can help children with ADHD focus better

• Adults can also benefit from physical activity to improve focus and attention
  ADHD and Reverberatory Activity

• ADHD individuals have a lot of reverberatory activity in their nervous system

  • Constant desire to move, difficulty sitting still and focusing
• Techniques to reduce shaking and improve focus: 
  • Tapping foot, bouncing knee, pacing while speaking, nodding head, gesticulating

Blinking and Focus

• Drugs like Ritalin, Adderall, and caffeine make us blink less, increasing focus
• Tiredness leads to more blinking, reducing focus
• Blinking regulates the amount of information going into the nervous system

Cannabis and Focus

• Chronic cannabis users have decreased spontaneous eye blink rates
• Cannabis increases dopamine and other neurochemicals, creating a state of calm and focus
• However, cannabis is known to deplete memory

Interoceptive Awareness in ADHD

• Interoceptive awareness: one’s sense of their own internal state (heartbeat, breathing, etc.)
• Study found no difference in interoceptive awareness between ADHD and non-​​ADHD individuals
• ADHD individuals are aware of their internal state, but struggle with coordinating task-​​directed networks and default mode networks

ADHD Medications

• Classic drugs: methylphenidate (Ritalin), modafinil, Rmodafinil, Adderall 
  • Work by increasing levels of dopamine and norepinephrine
  • Dosages vary according to severity and age

• New and emerging non-​​prescription approaches focus on increasing dopamine, acetylcholine, and serotonin levels using supplement compounds

  • Showing promising efficacy in peer-​​reviewed studies
    Smart Drugs and Nootropics

• Drugs for ADHD treatment are sometimes referred to as smart drugs or nootropics

• Examples include Ritalin, Adderall, caffeine, methamphetamine, and cocaine
• The distinction between drugs of abuse and drugs of treatment is a fine and blurry line
• All carry side effects, such as addiction, sexual dysfunction, and cardiovascular problems

Drug Schedules for ADHD Treatment

• Researchers are exploring drug schedules for ADHD treatment
• Questions include whether to take Adderall every day or every other day, or only occasionally
• Combining drug treatment with behavioral exercises may be more effective
• The goal is to taper off drugs and use the trained circuits without chemical intervention

Omega‑3 Fatty Acids and ADHD

• Consumption of omega‑3 fatty acids can positively modulate attention and focus
• 300 milligrams of DHA per day is the threshold for attentional effects
• Phosphatidylserine (200 milligrams per day) can reduce ADHD symptoms in children when combined with omega‑3 fatty acids

Ginkgo Biloba and ADHD

• Ginkgo Biloba has minor effects in improving ADHD symptoms, but not as effective as Ritalin and Adderall
• Can cause headaches and has varying vasoconstrictive and vasodilating properties

Modafinil and Armodafinil

• Gaining popularity for ADHD and narcolepsy treatment, as well as for staying awake for long periods
• Modafinil is a weak dopamine reuptake inhibitor, leading to increased focus
• Also acts on the orexin system, which regulates sleepiness and hunger
• Armodafinil is a lower-​​cost, chemically slightly different version of Modafinil

• Both drugs can raise levels of attention and focus, but may have varying effects on individuals
  Hypersensitivity to Medication

• About 5% of people are hypersensitive to medication

  • Require far lower doses to experience the same effects

Acetylcholine

• Neurotransmitter involved in generating muscular contractions and movements
• Released from two sites in the brain: 
  • Pedunculopontine nucleus (PPN) — brain stem, acts like a sprinkler system
  • Nucleus basalis — basal forebrain, more like a fire hose to a specific location
• Collaborate to activate particular locations in the brain for focus

Alpha GPC

• Increases acetylcholine transmission
• Dosages up to 1200 mg/​​day shown to offset age-​​related cognitive decline
• Typical dosage for studying/​​enhancing learning: 300–600 mg

L‑Tyrosine

• Amino acid that acts as a precursor to dopamine
• Can improve focus, but dosage can be tricky
• Ranges from 100 mg to 1200 mg
• Approach with caution, especially for those with underlying psychiatric or mood disorders

PEA (Phenylethylamine)

• Stimulates dopamine levels
• Fine line between too little, enough, and too much
• Examine​.com is a good resource for information on PEA and L‑Tyrosine

Racetams

• New PEPT, for example, taps into the cholinergic system similarly to Alpha GPC
• Can lead to heightened cognitive capacity
• Legal status varies by country
• Emerging area of research, showing promise for cognitive decline and brain injuries

Transcranial Magnetic Stimulation (TMS)

• Non-​​invasive tool for treatment of neurological and psychiatric conditions
• Involves a coil placed over specific brain areas to send magnetic stimulation
• Can increase or decrease activity in specific brain regions
• Not a fine-​​grained tool, but has potential for various applications
  Transcranial Magnetic Stimulation (TMS)
• Stimulates motor cortex or any area of the brain with precision
• Can engage neural circuits, behaviors, and thought/​​emotional patterns
• Has far-​​reaching implications

TMS for ADHD

• Stimulates portions of the prefrontal cortex that engage task-​​directed, focused states
• Non-​​invasive, no drug involved
• Combined with focused learning tasks
• Clinical trials comparing TMS to drug treatments for ADHD

Smartphone Use and Attention

• Constant context switching on smartphones may lead to attention deficits
• Adolescents need to use smartphones for less than 60 minutes per day to avoid attentional issues
• Adults may need to limit smartphone use to 2 hours per day or less
• Smartphones may be eroding attentional capacities

Study on Smartphone Use and Inattention

• Explored smartphone use and attention difficulties in 7102 adolescents
• Found that using smartphones for more than 60 minutes per day led to significant attentional issues

Maintaining Focus

• Limiting smartphone use can help maintain focus
• Success in life is often proportional to the amount of focus brought to an activity
• Importance of rest and proper sleep