The ADHD Mind: Diagnosis and Treatment Information for Adults

A doctor talks about ADHD symptoms, causes, misconceptions and treatments associated with a diagnosis.

Inside the ADD Mind, Part 3

The problem of the "unaware" husband is not that he fails to think enough about what he is doing. The problem is that the cognitive mechanisms that should help him stay on task, without constantly and consciously weighing alternatives, are not working effectively.

The brain's signaling system

Some might take my orchestra metaphor literally and assume that there is a special consciousness in the brain that coordinates other cognitive functions. One might picture a little man, a central executive somewhere behind one's forehead, exercising conscious control over cognition like a miniature Wizard of Oz. Thus, if there is a problem with the orchestra's playing, one might attempt to "speak" to the conductor, requesting - or demanding - needed improvements in performance.

Indeed, this presumed "conductor," or controlling consciousness, is often the target of encouragement, pleas, and demands by parents, teachers, and others as they attempt to help those who suffer from ADD. "You just need to make yourself focus and pay attention to your schoolwork the way you focus on those video games!" they say. "You've got to wake up and put the same effort into your studies that you put into playing hockey!"

Alternatively, they may impose punishments on people with ADD or shame them for their failure to "make themselves" do consistently what they ought to do. These critics seem to assume that the person with ADD needs only to speak emphatically to the "conductor" of his own mental operations to get the desired results.

In reality, there is no conscious conductor within the human brain. There are networks of neurons that prioritize and integrate all of our cognitive functions. If these networks are impaired, as they are in ADD, then that individual is likely to be impaired in the management of a wide range of cognitive functions, regardless of how much he or she may wish otherwise.

How medication helps

There is now considerable evidence that executive functions of the brain impaired in ADD depend primarily, though not exclusively, on two particular neurotransmitter chemicals: dopamine and norepinephrine.

The most persuasive evidence for the importance of these two transmitter chemicals in ADD impairments comes from medication treatment studies. Over 200 well-controlled studies have demonstrated the effectiveness of stimulant medications in alleviating symptoms of ADD. These medications work effectively to alleviate ADD symptoms for 70 to 80 percent of those diagnosed with this disorder.

The primary action of medications used for ADD is to facilitate release and to inhibit reuptake of dopamine and norepinephrine at neural synapses of crucially important executive functions. Improvement produced by stimulants generally can be seen within 30 to 60 minutes after an effective dose is administered. When the medication has worn off, ADD symptoms generally reappear at their former level.

Stimulants do not cure ADD; they only alleviate symptoms while each dose of medication is active. In this sense, taking stimulants is not like taking doses of an antibiotic to wipe out an infection. It is more like wearing eyeglasses that correct one's vision while the glasses are being worn.

Given the often-dramatic alleviation of symptoms experienced by people with ADD when they take stimulant medications, it is very difficult to sustain the notion that ADD impairments amount to a lack of willpower.

Much more remains to be learned about how the brain's complicated neural networks operate to sustain the broad range of functions encompassed in "attention." Yet it is clear that impairments of executive functions, those brain processes that organize and activate what we generally think of as attention, are not the result of insufficient willpower. Neural-chemical impairments of the brain's executive functions cause some individuals who are good at paying attention to specific activities that interest them to have chronic impairment in focusing for many other tasks, despite their wish and intention to do otherwise.

This article is from Attention Deficit Disorder: The Unfocused Mind in Children and Adults by Thomas E. Brown, Ph.D., and published by Yale University Press. Reproduced by permission. For more information, or to purchase a copy of this title, please visit

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TAGS: Talking About ADD, ADHD Symptoms, Hyperfocus and ADHD

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