The ADHD Brain

Everything You Never Knew About the ADHD Brain

Imagine hundreds of cars approaching an intersection that has no traffic light or stop sign. This is what happens to the ADHD brain every day where the prefrontal cortex (the intersection) is unable to properly regulate your various thoughts and feelings (the various cars approaching the intersection). Learn more about the “Intersection Model” for ADHD.

explaining the ADHD brain

Misinformation about attention deficit disorder (ADHD or ADD) abounds among the patients at my busy practice. Many think medication alone will control their symptoms. Others believe that ADHD will not affect their lives once they have graduated from college. And almost none fully understand the way the ADHD brain works to produce the symptoms they experience. To help, I have developed the Intersection Model — a framework that can be used throughout an individual’s life to make sense of behaviors, impulses, and emotions, and to create strategies to manage them.

ADHD and the Prefrontal Cortex

At the center of the intersection model is the prefrontal cortex (PFC). It is responsible for thinking, thought analysis, and regulating behavior. This includes mediating conflicting thoughts, making choices between right and wrong, and predicting the probable outcomes of actions or events. This vital region of the brain regulates short-term and long-term decision-making. In addition, the PFC helps to focus thoughts, enabling people to pay attention, learn, and concentrate on goals.

In my model, the PFC is the intersection through which attention, behavior, judgment, and emotional responses run (I call them cars or messages). A person with ADHD will likely react to whatever is in his focus at that moment — in other words, the faster car or stronger message. For people with ADHD, the PFC is unregulated; there are no traffic lights or stop signs controlling which message (car) gets through first. You could be the smartest, most motivated student ever, but if the teacher says “This species of dog…” and your thought switches to “I wonder what my dog is doing right now?” you get distracted.

ADHD and Fickle Focus

This unregulated intersection may explain why your attention wanders. Say you’re in the kitchen cleaning up and find something that belongs upstairs. You take it toward the stairs, but get distracted by the unfolded laundry you see in the living room as you walk by. You may think, “I forgot to do that,” and jump to folding laundry, forgetting that you were heading upstairs (not to mention cleaning up the kitchen).

People with ADHD get distracted because whatever is in their focus in the moment cuts off other, weaker messages. This can happen in mid-conversation, when a word triggers a thought that leads a person to another subject entirely.

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ADHD and Time Management

Judgment runs through the PFC, as well. When you say, “That’ll take me five minutes to finish,” that’s a judgment call. “I’ll be there in a half hour” is a judgment call, too. We can’t see time or feel it. Understanding time, conceptualizing time, isn’t as strong a message in the ADHD brain as the emotion behind a looming deadline or an unfinished task.

A person with ADHD might freak out about a deadline, saying, “Don’t talk to me, I have all these things to do and no time to do them!” Or the person says to himself, “This task is going to take forever,” and then uses that as a reason to procrastinate. If the person would just get started, the task would take maybe 10 minutes. In this case, the fastest car in the intersection is the emotion behind the judgment of how long it will take to meet the deadline.

ADHD and Emotional Regulation

Emotions run through the intersection of the PFC, bringing quick mood changes. “I won the lottery 10 minutes ago. Isn’t that great? But now my sink is overflowing. OMG, why does this always happen to me?” Impulsive anger (or sadness, or excitement, or worry) seems to come from nowhere, when actually the emotion is a quick reaction to an event that just occurred (in this case, the sink debacle). That is what is dominating the person’s focus at that moment.

In the ADHD brain, whichever emotion is in focus at the moment becomes the faster car. This is why those with ADHD express emotions more intensely than may be justified for a given situation. In females with ADHD, this emotionality is often misdiagnosed as a mood disorder.

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ADHD and Behavior/Impulsivity

Adults with ADHD self-medicate or spend too much money on unnecessary items, looking for quick gratification instead of bigger, more sustaining rewards. They may cling to a strategy even after it’s proven ineffective, and rush through tasks, making errors in haste. This mindset leads to negative feedback from the world around them, interpersonal difficulties, and job or school troubles. Such inflexibility and impulsivity have a cumulative demoralizing and isolating effect.

In response, the individual with ADHD develops a mindset that focuses on the negatives, which exacerbates the situation. When we say, “Nothing is getting better, so it’s pointless to try” or “They’re not going to like me anyway, so why try to be friends?” it can lead us to stop trying because we perceive the situation as something that will only end in failure.

The faster car metaphor plays into being chronically late. If you are on your way out the door to go to work, and say, “I have 15 minutes left, I can just do this one thing,” you make yourself late to work. If you didn’t have ADHD, you would stop and think, “Oh, I have 15 minutes, but that’s not enough time to do this thing, or I’ll be late to work like last time.” If you have ADHD, the stronger message isn’t that you were late for work last time, but the desire to play a video game for a couple of minutes or phone a friend about going out on the weekend right now. And you are late for work — again. You keep doing the same things over and over because past experiences are being cut off by what is in your focus at the moment.

Why People with ADHD Feel So Anxious

As ADHD expert William Dodson, M.D., writes: “The vast majority of adults with an ADHD nervous system are not overtly hyperactive. They are hyperactive internally. Most people with unmedicated ADHD have four or five things going on in their minds at once.”

The current thought regarding individuals with undiagnosed/untreated ADHD is that they tend to overcompensate for their difficulties with an anxiety-like response, such as racing thoughts, sleep difficulties, nervousness, and excessive worry. This overcompensation might look like this: You start heading to work and think, “Did the garage door actually close? I don’t remember seeing it close. What if I kicked something, which tripped the sensor and the garage door is open? A thief is going to see that there aren’t any cars in the garage and that no one is home. He’s going to come in and take all my stuff. And when he leaves, he’s going to let the cats out. I’m never going to see them again. I love them and I can’t live without them. I have to go back and check. But I’ll be late for work. What am I going to tell my boss?”

As I’ve said, people with ADHD often forget things that aren’t in their focus, so these anxious thoughts are an attempt to keep these items (cars) in the intersection, so that the person doesn’t forget about them. Holding many things in your mind creates a lot of tension, a traffic jam of sorts. Whenever too many things — thoughts or emotions — try to pass through the intersection at the same time, you’re apt to feel anxiously overwhelmed and shut down. For instance, when trying to clean a cluttered room, with many items demanding your attention and none of them sticking out as more important than the other, you don’t know what to do first, so you don’t do anything.

It’s frustrating when you go to the store for paper towels — and come back with everything but paper towels. Buying paper towels is the fastest car when you enter the store, but when you see the delicious looking pasta salad or the shiny red apples, they become the faster cars and overtake the paper towels — unless you’ve written down “buy paper towels” on a to-do list and read it.

ADHD and Regulating Emotion, Maintaining Motivation and Performance

Everybody likes to do things that are important and interesting, and that they’re good at. We don’t like things that are boring, frustrating, and not important. The problem is that those definitions change.

Let’s say school is important to you. You spend all your time in the library studying, on your way to a 4.0. You have one more exam left, but you studied, so you should be fine. The test, and the motivation to do well, is the fastest car in the intersection. Right before you walk into the exam room, however, you get into a fight with your best friend — and you get a C on the exam. You studied and you tried your hardest, but the fight was the stronger message during the test.

“You could do this yesterday, so why can’t you do it today?” The individual with ADHD hears this a lot during his lifetime.

ADHD, Mood Disorders, and Low Self-Esteem

In addition to having variable moods, individuals with ADHD tend to have difficulty staying happy or satisfied. If you keep reacting to everyday bad experiences (remember the overflowing sink?) and don’t realize that those things are daily stressors — you’ve handled things like this before, you will have to handle things like this again — it will be hard to feel happy. In the ADHD brain, negative messages cut off positive messages. We don’t think, “Well, I have my health” and pull that thought out during stressful times. Some with ADHD go from one negative experience to another, and are never satisfied with their performance.

Every person’s ADHD affects him or her differently, but symptoms and behaviors can be explained through the Intersection Model. You can use this understanding of your ADHD brain to your advantage. You can find ways to erect a few stop signs or traffic lights, to make positive messages stronger and keep them in your focus longer, and improve your overall functioning and sense of self.

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“Are You Criticizing Me, Again?”

The intersection model affects our relationship with partners. Here’s an example from my life:

Every Tuesday night, I come home and ask my husband if the garbage is ready, because it gets collected on Wednesday morning. Every Tuesday night, he gets defensive: “I did this and that, and this…what do you expect?” For him, the stronger message is “I am being criticized again.” Those with ADHD are more likely to hear criticism when their partner merely asks a question.

Think of how many negative messages a child with ADHD receives throughout his life: 20,000 more criticisms by sixth grade than his non-ADHD counterparts. My husband was diagnosed with ADHD in grade school, so he’s always heard, “You can do this, why can’t you do that?” “Sit down,” “Be quiet.” His nickname in high school was Slacker.

I can change my tone of voice, jump up and down, remind him that we have this fight every single week, but it doesn’t matter. He’s still defensive. I ask him: “Do you think I’m criticizing you for not taking out the garbage?”

“Yeah.”

“Nope! I’m just wondering if it’s done, because, if not, I’ll go do it myself.”

“Oh…OK! How was your day?”

My husband and I have lived together for 13 years, and this happens once a week. Because if I don’t ask that second question, we’re not talking about the same thing. I’m wondering if the garbage is ready to be collected, and he thinks he is hearing the same childhood criticisms again; he thinks he is having something he didn’t do pointed out to him again. In his brain, that is one of those fast cars likely to cut off any other car with a different interpretation of the situation.

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  1. I’m a little concerned by the “ADHD and Working Memory Challenges” section being about, erm, memory issues. “Working memory” is another term for “executive function” and therefore covers ALL symptoms of ADHD and not just the memory ones!

    1. Hi SMG! Thank you for reading and commenting! Working memory actually refers to the capacity to hold relevant information in your mind, and changing it in some way, in order to problem solve; while executive functions are a group of actions/behaviors that allow someone to maintain focus and be organized enough to reach their goal. Working memory is an executive function, but not the only one. Executive function is like the conductor in an orchestra, while working memory would be like a cello, one of the pieces that contribute to the overall music. The conductor synchronizes all these pieces and keeps tempo so the music comes together. Hopefully that clears things up a little!

  2. Understanding WHY I’m being defensive helps. I know I’m doing it, I’ve often wondered what in the world could have happened to me to make me turn so quickly over what seems to be nothing?! My relationship has suffered from this, looking at myself through this mirror by reading this magazine is helpful. I’m grateful, thank you

  3. Great article. I like the model as it seems to describe my experiences well. Being prone to criticism is one that is particularly relevant as it played a big part in the breakup of my marriage.

    I would like to add a different perspective on your Tuesday night argument. It’s not clear from what you’ve written but I would like to ask what your first interaction is when you get home. In my case it was what has been done, needs doing etc. The important thing on my ex wife’s brain was what needs doing and thus that was always the first point of communication. Mine was we haven’t seen each other all day and the first thing you talk about is the chores.

    Having had time to ruminate a lot on my “over” sensitivity I understand that it has an effect on those around me. Maybe as well though, the bin being put out is not as important initially as making each other feel wanted.

    Very much a balancing act from both sides. Things that need doing appear to be the ADHD person’s curse and by proxy those they live with. I think however though that the ‘need’ is relative. I know my ex wife and I see things differently now

    Thanks again for an insightful article.

    1. I don’t see your expectations as being unreasonable or necessarily ADHD related. I’m the one with ADHD, and I would not do this to my husband, unless it was something that needed to be done right away. And, I would be irritated if when I got home from the office, the first thing my husband did was tell me what needed to be done. I think that says more about the marriage/relationship than your ADHD.

      1. “I think that says more about the marriage/relationship than your ADHD.”
        I do not agree with this statement entirely. I think that the question is perhaps a result of having dealt with the ADHDer not getting things done. In that respect, I feel that it is a byproduct of the ADHD. Just my opinion.

        1. Yes FireSprite. The pattern of behaviour and responses I think initially set off by my inability to consistently do what I had agreed to do. Couple that with complete lack of u derstanding or even an inkling that ADHD was involved it is easy to see how our conditioned expectations led us down the route we travelled.

          My current partner has a daughter who may well be ADHD/ASD so has more of an understanding and expectations of me built on already having dealt with such. Also though, I have a far greater understanding of how my differences can be experienced by those around me. For me it comes down to all of us trying to live with empathy and compassion for ourselves and others but this is not our typical cultural or social construct. It is also clear to me now how our parents operated often becomes the way we operate and this can be difficult to change unless there is a big stimulus (divorce, loss of job, bankruptcy) and some form of understanding – articles and other resources like this.

      2. Hi AnneHW, to some extent I agree with you. Part of the issue was the fact that I struggled with doing the things I had agreed to do which over time led to a pattern of behaviour on both our parts. I think the point William Dodson asks about a lot is the emotional sensitivity and how I might have perceived ongoing criticism may have been affected. Also though isn’t that part of the complexity of ADHD, the fact that so many of our behaviours are experienced by others as well. Thanks for reading and commenting.

    2. Hi Michael! Thank you for reading and commenting! No, it wasn’t clear whether or not this was my first question or not, so I’m sorry for the confusion. My question would come after the ‘hey how was your day’ discussions, and not the first thing when i walk in the door. I understand how that would be perceived as criticism and taken as if the chores were more important than connecting with your significant other. I was using this as an example of defensiveness, and didn’t really flush out the context for space reasons! But you’re right and thank you for asking for clarification!

      1. Thank you. Something I have come across since is a value system and way of communicating known as Non Violent Communication or Compassionate Communication developed by Marshall Rosenberg which I believe would help all but particularly people where ADHD is concerned.It looks at understanding the fundamental needs underlying our feelings and emotions and how our emotional communication often obscures the need that wasn’t met.

        An example maybe when a loved one returns late without you having known where they have been. An emotional response of anger is often given but this hides the need of knowing the other person was safe.

        Michael Ferguson explores this in greater detail in the chapter Navigating Emotions in his book the The Drummer and the Great Mountain, a Guidebook to Transforming Adult ADD/ADHD

  4. Love the intersection analogy! I’ll definitely pass the article along to my wife and others struggling with ADD. I’d add another thought to the mix about interpreting questions from others as criticisms. For me, I often read criticism into the same type of questions from my wife, co-workers, family members, etc. What makes this even more destructive is that I typically just internalize the negative feeling I receive because I either feel bad or guilty for forgetting the task (garbage bin) in the first place, or I’m desperate NOT to have a confrontation about it that just ends up reinforcing that I’m somehow “broken” and need to have allowances made for. This constant internalizing tends to show up as passive/aggressive behavior and/or comments from me. My wife and I are getting better at recognizing this pattern and intercepting it early with a “time out, let’s talk” conversation. I can’t stress enough how medication only tackles a part of the ADD issue! Counseling with a ADD specialist and behavior modification (lists, daily communication, and humor) is just as, if not more important. Thanks for the article!

    1. Thank you for reading and commenting! I’m so glad it was helpful! I’m also happy you’ve found ways to cope more effectively and have a supportive spouse to help! Best of luck to you for continuing on this positive path!

    2. I absolutely agree! Unfortunately, many medical plans don’t cover life coaches, etc.
      I have to admit though, that a “time out, let’s talk about it” scenario would be a horrible idea for me personally. It would become another negative to avoid. The ‘let’s talk’ part would seem like the endless conversations throughout my life that pretty much resulted in me feeling even worse about myself, hence, making me feel even more defensive. Another lecture, another time to just sit and discuss my shortcomings, overlooking any positives about myself. Wow. Just the thought of it makes me defensive, apparently. Lol. It can be interesting which words can trigger those emotions differently for each individual, depending upon their experiences and current mindset.

  5. Great article and great analogy. I would like a follow up article with some practical ways to put up those stop signs at the intersection or hire a traffic cop who does not make the intersection worse! In Israel we have a lot of roundabouts (traffic circles) . Wow. That might actually metaphorically be very helpful within the analogy! If we (or our loved ones, students, etc..) can be helped to use this to see all the cars on the traffic circle but each must wait its turn so that everyone can wind up moving ahead! Love to see you develop on the theme practically.

  6. I’m probably more self critical than anything else. I was having a bad day recently, and feeling frustrated with all the things I kept forgetting. I know I commented out loud on how stupid I was. My husband finally said, “you are way too hard on yourself.” Usually I’m not, but at the time nothing seemed right. I’m not sure what triggers this, but it happens every now and then.

  7. “Let’s say school is important to you. You spend all your time in the library studying, on your way to a 4.0.”

    This is the only part I disaggree with this brilliant article. If you spend so much task on a task or objective, it can’t be because it is important to you. That is not how ADD-brains work. Pursuing an objective in a consistent way is possible if the tasks involved are interesting. ADD people are not able to motivate themselves because something or its consequences are important. Rather, what matters is how interesting the tasks are.

    1. Thank you for your comment RV! ADHD’ers can do anything they find interesting meant that the person in this example found school interesting – maybe not motivated by grades or what neurotypicals are motivated by, but for their own reasons. That’s what i meant by this portion – that this particular ADHD’er found school interesting and important enough to hyperfocus on it in order to get a 4.0. The portion that got cut due to space issues included ‘focused on school to the point of excluding everything else, like friends, social activities, and other responsibilities in order to maintain the GPA’. So i agree with you, and apologize that wasn’t clear! Thank you for your insight!

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