🧠 ADHD & How Anyone Can Improve Their Focus | Huberman Lab Podcast
Notes for the Huberman Lab Podcast #37.
ADHD stands for Attention Deficit Hyperactivity Disorder.
ADHD was first mentioned in scientific literature around 1904 and it was known back then as ADD. The renaming to ADHD happened in the 80's when the medical community started noticing that hyperactive kids also had attentional issues.
The neurons within the brain communicate through a complex network of pathways and every time we think or feel or do something, a pathway is activated. When we learn or experience something new, our brain creates a new pathway.
It is very important not to self diagnose. Diagnosis should only be done by an expert physician therapist or a clinical psychologist.
Some of us have symptoms that are somewhat like someone with ADHD but that doesn't necessarily mean that we do have ADHD itself.
Note: ADHD has nothing to do with intelligence. The two aspects of human existence are unrelated and any combination of the two can exist.
It's important to note that all of us can improve our attentional capacity.
We can all rewire the circuits that make heightened levels of focus more accessible to us.
ADHD has a strong genetic component.
If you have a relative that has it, there's a much higher probability that you will have ADHD.
That probability goes up the more closely related you are to that person:
- Identical twin has ADHD? There's a 75% chance you'll have it
- Fraternal twin → 50-60%
- Parent → 10-25%
~1/10 Children have it
The current estimates are that at least 1 in 10 children have ADHD. About half of those will resolve with proper treatment but the other half won't, which leads to ADHD continuing on into adulthood.
Adults can develop it without previously having it
There's some evidence that adults can also develop ADHD without previously having it in childhood, in particular due to myriad of attention grabbing things bombarding us all the time in the modern world.
This is in particular things like smart phones, and apps and social media, are creating a cloud of pulls on our attention.
Challenges with attention and impulsivity
Note: Attention / focus / concentration, for the sake of this discussion, are essentially the same thing.
People with ADHD have trouble holding their attention and have high levels of impulsivity.
Attention is perception i.e. focus on a particular sensation.
We're sensing many things across all of our sensing at once but we're not perceiving all of them. For instance, we might be outside in a breeze without paying attention to it. We could be sitting in a chair without noticing the pressure of the chair on our body. Etc.
Impulse control means lack of perception. It's about limiting our perception.
People with ADHD are easily distractable, have high levels of impulsivity and often high levels of emotionality and get quickly annoyed by things.
On the flip side, they have the ability to hyper focus on things they enjoy and are intrigued by. They can obtain lazer focus on things they love without any effort.
💡 People with ADHD have the capacity to attend, but they can't engage their attention for things that they really don't want to do.
Challenges with time perception and motivation
People with ADHD often run late and they often procrastinate because they can't perceive how long things will take.
However, if they're given a deadline, they can actually perceive time very well.
They can also focus very well if the consequences of not attending are severe enough.
If they're scared enough of the consequences of not attending, often times they can attend.
If they're not really concerned about consequences or of they don't have a deadline, then they tend to lose track of time and tend to underestimate how long things will take.
People with ADHD struggle with how to line up the activities of their day in order to meet particular deadlines.
Challenges with spatial organization
People with ADHD have subpar spatial organization skills. Often you will find that someone with ADHD uses the pile system to organize things - which means organizing things into categorical piles that make sense to them and only them (it doesn't really have any logical framework).
They find it hard to avoid using this system even though it doesn't really work for them, in the sense that it doesn't help them with any task that they need to perform. They can't find things, or if anyone moves one thing it's very disruptive to their overall plan because their overall plan doesn't really work in the first place.
Challenges with working memory
People with ADHD often can have terrific memories for past events, upcoming events, etc.
However, they do struggle with one aspect of memory called the working memory.
It's the ability to keep specific information easily accessible for immediate, short-term access.
People with ADHD lack the ability to remember things that just need to keep online.
Hyper focus is fueled by Dopamine
From a neuro-biological perspective, attention is signed by Dopamine.
Dopamine is a reward-feel good neuromodulator that stimulates action. It is a precursor to Epinephrine (adrenaline) which actually puts us into action.
As a neuro-modulator, activates certain circuits in our brain more than others. It tends to contract our visual world and it makes us pay attention to things that are outside (exteroception).
It also puts us in the state of motivation and wanting things outside the confines of our skin.
Neural Circuits in ADHD
Default Mode Network is the set of neural circuits that's active when we're sitting around and not doing anything, when our brain is essentially on auto-pilot.
These areas normally interact in a synchronized manner. However, for people with ADHD or people that haven't slept well, these brain areas aren't as well synchronized.
Task-Related Networks is the set of neural circuits that are trying to make us goal oriented.
Anytime you're restricting your behavior these networks are very active.
In a person without ADHD, the Default Mode Network and the Task-Related Networks are anti-correlated (think of them reacting like a seasaw, one is on while other is off).
In a person with ADHD, these two networks are more correlated, working together. When somebody gets better, via treatment or aging out of ADHD, these networks tend to become anti-correlated again.
Dopamine acts as a conductors to this anti-correlated beat of the Default Mode Network and the Task-Related Networks.
In people with ADHD, Dopamine doesn't do a great job at this. Why is that? Is it not at sufficiently high levels (i.e. not "loud" enough) or is it doing it all wrong (i.e. not conducting how it should)?
Dopamine is also involved in the way we perceive the world. It's release turns on areas of our brain that narrow our visual and audotory focus - it creates a tunnel of attentional focus.
The low Dopamine hypothesis of ADHD
It turns out that if Dopamine levels are too low in particular circuits in the brain, it leads to unnecessary firing of neurons in the brain that are unrelated to the task one is trying to do and unrelated to information one is trying to focus on.
💡 When Dopamine is low, certain neurons are firing when they shouldn't be.
People with ADHD self-medicate with stimulants
People with ADHD tend to use recreational drugs that are stimulants:
- smoking cigarettes
All of those stimulants increase levels of Dopamine in the brain, in particular in the areas of the brain that regulate attention and these Task-Related and Default Mode networks.
Children with ADHD show preference for sugary foods, which also act like Dopamine-inducing stimulants.
When people with ADHD take these stimulants they get heightened levels of focus - their ability to focus on things other than things they absolutely care intensely about goes up.
💡 People with ADHD get calmer and increase their ability to focus under the influence of stimulants.
Conversely, people without ADHD tend to get hyperactive on stimulants. Hyperactivity is a consequence of high levels of dopamine.
All drugs for the treatment of ADHD are focused on increasing levels of Dopamine, in particular in the areas of the brain that control Task-Related behavior and that coordinate Task-Related networks with the Default Mode Network. Examples are:
- Ritalin (methylphenidate)
All of these stimulants prescribed for ADHD are also used to treat narcolepsy. Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep.
Ritalin was the first drug to deal with this dopamine hypothesis, which typically has a long release cycle throughout the day and thus can lead to more unbalanced sense of alertness throughout the day. Nowadays, Adderall is more commonly prescribed as it's release schedule into your system is shorter and easier to control with different dosage regimes.
This difference comes down to the pharmacokinetics of the two drugs.
- Ritalin is very similar to amphetamine.
- Adderall is a combination of amphetamine and dextroamphetamine.
The net effect of street drugs like meth and speed and even cocaine is the same as the drugs used to treat ADHD, which is to increase Dopamine as well as Epinephrine.
⇒ Motivation, Drive, Focus and Energy!
💡 At appropriate dosages, many people with ADHD achieve excellent relief with all of these stimulants
(especially if these treatments are started early in life).
⚠️Non-Prescribed Adderall, Caffeine, Nicotine
Potentially as many as 35% of all individuals between 17-30 are taking Adderall at a regular or semi-regular basis in order to work, study and in order to function and focus in their daily life even though they were not diagnosed with ADHD.
25% of students are taking Adderall frequently and that they take it more than they consume marijuana.
The idea of taking stimulants for improving focus is not a new idea.
Caffeine has been used for ages to increase Dopamine, Epinephrine and generally increase focus and energy.
Nicotine, historically in the form of smoking and more recently in pill form or through vaping, has been used for the same purpose as well.
Taking stimulants as a child allows the forebrain Task-Related Network to activate at the appropriate times and, since children are young and have brains that are very plastic, it allows them to learn what focus is and to follow that tunnel of focus.
Note that this focus is artificial, it is not generated due to interest in something, it's chemically inducing a state of focus.
💡 Main driver of focus is how interesting something is.
A trick to improve focus for something non-interesting is to manually convince yourself otherwise.
Tell yourself that this boring thing is phenomenally interesting and your brain might just believe you.
When/How To Medicate: A Highly Informed (Anecdotal) Case Study
Even though medicating children with amphetamine seems crazy, provided that the dosage is minimal and modulated with their progress and growth as their focus improves over time, more kids benefit than not benefit from that.
We know that puberty triggers the ability to focus and control impulses. Young children fidget a lot, they find it hard to stay in one spot, everything is stimulating. Same is typically true for animals. Once humans and animals grow older they learn to focus, to sit and listen, even if they don't want to.
Giving a drug like amphetamine to a child to access that stillness early on would allow them to maintain that ability as time goes on. But why do it now as opposed to after puberty?
Neuroplasticity from age 3 to puberty around age 12 or 13 is exceedingly high. This is why early treatment at that age is most effective as children learn how to focus and shape their brain accordingly.
💡 Early treatment of ADHD is key because Neuroplasticity is the highest at a very young age (pre puberty).
Elimination Diets can be helpful
Elimination Diets (such as no sugar, or no carbs, or no diet) have been reported to reduce symptoms of ADHD. People (many times parents trying to help their child) spend a lot of time and energy in finding this perfect diet.
There was an important study with 100 children, 50 in an elimination diet group and 50 in a the control group (children were also strategically swapped between groups to account for any individual differences) and the effects were extremely dramatic. In the study the observed effects were enhanced ability to focus, less impulsivity, even less tendency to move when trying to seat still for kids that were in the Elimination Diet group at a given time. The elimination diet in this particular study was an oligoantigenic diet.
💡 Eliminating allergenic food items from individual diets can dramatically improve symptoms of ADHD.
Note that the data in the paper looks good but the structural design of the study does deserve some scrutiny. Oligoantigenic diets are controversial. For instance, some studies have shown that when children are not exposed to certain foods such nuts, they tend to actually develop allergies to them. Then when exposed to them later, they expose real problems.
As far as elimination diets go, most scientists and experts tend to agree that sugar are bad and their elimination is significantly beneficial to ADHD symptoms.
💡 Elimination of high sugar and simple sugar from the diet has shown a dramatic effect in reducing ADHD symptoms.
Also, if there happen to be certain foods that you notice exacerbate your ADHD symptoms, obviously, eliminating those foods is beneficial. Note that the food that does this changes over time.
💡 Children, especially young children, with ADHD should avoid sugar, especially simple sugars.
In addition to that, eliminating food that they already consume and happen to be mildly allergic to, might be a good idea.
Diet can have a highly significant role in eliminating or at least reducing the symptoms of ADHD. So much so that some of the children end up not needing medication at all or eventually win themselves of medication as young adults and adults.
It does seem that ingestion of omega-3 fatty acids in adults that include EPA of 1g or more can allow adults with ADHD to function well on lower doses of medication and in rare cases to eliminate medication entirely.
💡 Omega-3 fatty acids with EPA of 1g or more are beneficial for ADHD! Can be taken daily.