The ADHD Brain

3 Areas of Research Advancing Our Understanding of ADHD

“In the three decades since John Ratey and I wrote Driven to Distraction, new findings in neuroscience related to brain plasticity and fMRIs have advanced our understanding of ADHD and led to a major improvement in the care we give.”

Forty-two years ago, when I started treating what we now call ADHD, I’d heard different versions of these words: “Sorry, Doc, but I just don’t believe in this ADD stuff. It’s a phony disorder created by the drug companies so they can sell more drugs.” “My son doesn’t have ADD or XYZ. He needs what boys have always needed: structure, authority, and discipline. If he buckles down, he’ll get straight As. It’s up to his mother and me to see to it that he does.”

Dr. John Ratey and I knew there was more to this condition than what appeared in the textbooks or the Diagnostic and Statistical Manual of Mental Disorders (DSM). We started comparing notes on our patients, whom we listened to and learned from. They were especially helpful in teaching us about the positive tendencies often embedded in ADHD — attributes missing from the textbooks. Increasingly, we saw that the more we identified the talents and passions embedded in our patients’ ADHD, the better they did. This got us excited. We were breaking new ground. We were reframing the perceptions of ADHD, giving hope, and laying new foundations for success.

Writing Driven to Distraction

As the years went by, we developed our strength-based model of ADHD, which posits that there is as much good stuff (creativity, originality, curiosity, an entrepreneurial spirit, spunk, and persistence) as there is bad. In 1994, we gathered our notes and stories and put it all into a book called Driven to Distraction. (#CommissionsEarned)

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The public, for the most part, had never heard of the condition, or they dismissed it as a lame excuse used to duck responsibility and hard work. After the book came out, I was on a talk show where the host actually asked me, “What can you do for ADD that a stiff shot of whiskey couldn’t do better?”

Brain Plasticity Research

We’ve come a long way since the mid-1990s. Millions of people have read Driven to Distraction, and almost everyone has heard of ADHD today. They may not understand ADHD in its full, variegated complexity, but they at least know it is a real condition supported by vast research and rooted in hard science.

One of the most compelling new findings in neuroscience is this: The brain can change. In medical jargon, it’s called brain plasticity. Once thought to be fixed after a certain age, the brain is capable of growing, changing, and learning new things throughout our lives.

John and I have been especially captivated by three separate lines of research tied to brain plasticity, each of which has led to a major improvement in the care we give.

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  • Functional magnetic resonance imaging (fMRI). The fMRI has delineated two important networks, or connectomes, in the brain: The task positive network (TPN), which lights up when we’re creatively engaged, and the default mode network (DMN), which activates when the task is over, and we’re staring off into space. John and I used the DMN to explain why people with ADHD are prone to mind-wandering, which can lead to negative thinking and morbid brooding. We help our patients find ways to redirect their attention away from the DMN and activate the TPN by engaging in something positive and stimulating.
  • The lifesaving power of human connection. The social sciences have produced a mother lode of evidence on the vital power of connection. We call it the other vitamin C; if you don’t get enough connection, you can wither and die. This is why U.S. Surgeon General Vivek Murthy has called loneliness a public health crisis. People with ADHD are particularly prone to feeling isolated, so we work hard to help our patients learn how to make sustaining connections.
  • Brain research. We’ve recently discovered that ADHD action resides in neural pathways between the cerebellum and the front of the brain. The cerebellum controls balance. If you stimulate the cerebellum by doing balance exercises, you may see major improvements in the symptoms of ADHD and dyslexia. Balance has become a therapeutic intervention, as have programs of non-invasive mild electrical stimulation using AC current, such as the Fisher Wallace Stimulator, and other devices.

With these advances in understanding the ADHD brain, I’m no longer being asked if a shot of whiskey could surpass the treatment I can offer.

Driven to Distraction & Brain Plasticity: Next Steps

Edward Hallowell, M.D., and John Ratey, M.D., co-wrote a series of books on ADHD.

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