The ADHD Brain

Secrets of Your ADHD Brain

Most people are neurologically equipped to determine what’s important and get motivated to do it, even when it doesn’t interest them. Then there are the rest of us, who have attention deficit — ADHD or ADD — and the brain that goes along with it.

Drawing of the brain of someone with ADHD and anxiety
left and right brain functions concept, analytical vs creativity

Attention deficit/hyperactivity disorder is a confusing, contradictory, inconsistent, and frustrating condition. It is overwhelming to people who live with it every day. The diagnostic criteria that have been used for the last 40 years leave many people wondering whether they have the condition or not. Diagnosticians have long lists of symptoms to sort through and check off. The Diagnostic and Statistical Manual of Mental Disorders has 18 criteria, and other symptom lists cite as many as 100 traits.

Practitioners, including myself, have been trying to establish a simpler, clearer way to understand the impairments of ADHD. We have been looking for the “bright and shining line” that defines the condition, explains the source of impairments, and gives direction as to what to do about it.

My work for the last decade suggests that we have been missing something important about the fundamental nature of the ADHD brain. I went back to the experts on the condition — the hundreds of people and their families I worked with who were diagnosed with it — to confirm my hypothesis. My goal was to look for the feature that everyone with ADHD has, and that neurotypical people don’t have.

I found it. It is the ADHD nervous system, a unique and special creation that regulates attention and emotions in different ways than the nervous system in those without the condition.

The ADHD Zone

Almost every one of my patients and their families want to drop the term Attention Deficit Hyperactivity Disorder, because it describes the opposite of what they experience every moment of their lives. It is hard to call something a disorder when it imparts many positives. ADHD is not a damaged or defective nervous system. It is a nervous system that works well using its own set of rules.

[Take This Test: Could You Have ADHD?]

Despite ADHD’s association with learning disabilities, most people with an ADHD nervous system have significantly higher-than-average IQs. They also use that higher IQ in different ways than neurotypical people. By the time most people with the condition reach high school, they are able to tackle problems that stump everyone else, and can jump to solutions that no one else saw.

The vast majority of adults with an ADHD nervous system are not overtly hyperactive. They are hyperactive internally.

Those with the condition don’t have a shortage of attention. They pay too much attention to everything. Most people with unmedicated ADHD have four or five things going on in their minds at once. The hallmark of the ADHD nervous system is not attention deficit, but inconsistent attention.

Everyone with ADHD knows that they can “get in the zone” at least four or five times a day. When they are in the zone, they have no impairments, and the executive function deficits they may have had before entering the zone disappear. People with ADHD know that they are bright and clever, but they are never sure whether their abilities will show up when they need them. The fact that symptoms and impairments come and go throughout the day is the defining trait of ADHD. It makes the condition mystifying and frustrating.

[Get This Free Download: What Every Thorough ADHD Diagnosis Includes]

People with ADHD primarily get in the zone by being interested in, or intrigued by, what they are doing. I call it an interest-based nervous system. Judgmental friends and family see this as being unreliable or self-serving. When friends say, “You can do the things you like,” they are describing the essence of the ADHD nervous system.

ADHD individuals also get in the zone when they are challenged or thrown into a competitive environment. Sometimes a new or novel task attracts their attention. Novelty is short-lived, though, and everything gets old after a while.

Most people with an ADHD nervous system can engage in tasks and access their abilities when the task is urgent — a do-or-die deadline, for instance. This is why procrastination is an almost universal impairment in people with ADHD. They want to get their work done, but they can’t get started until the task becomes interesting, challenging, or urgent.

How the Rest of the World Functions

The 90 percent of non-ADHD people in the world are referred to as “neurotypical.” It is not that they are “normal” or better. Their neurology is accepted and endorsed by the world. For people with a neurotypical nervous system, being interested in the task, or challenged, or finding the task novel or urgent is helpful, but it is not a prerequisite for doing it.

Neurotypical people use three different factors to decide what to do, how to get started on it, and to stick with it until it is completed:

1. the concept of importance (they think they should get it done).

2. the concept of secondary importance — they are motivated by the fact that their parents, teacher, boss, or someone they respect thinks the task is important to tackle and to complete.

3. the concept of rewards for doing a task and consequences/punishments for not doing it.

A person with an ADHD nervous system has never been able to use the idea of importance or rewards to start and do a task. They know what’s important, they like rewards, and they don’t like punishment. But for them, the things that motivate the rest of the world are merely nags.

The inability to use importance and rewards to get motivated has a lifelong impact on the lives of individuals with ADHD:

How can those with an ADHD diagnosis choose between multiple options if they can’t use the concepts of importance and financial rewards to motivate them?

How can they make major decisions if the concepts of importance and rewards are neither helpful in making a decision nor a motivation to do what they choose?

This understanding explains why none of the cognitive and behavioral therapies used to manage ADHD symptoms have a lasting benefit. Researchers view ADHD as stemming from a defective or deficit-based nervous system. I see ADHD stemming from a nervous system that works perfectly well by its own set of rules. Unfortunately, it does not work by any of the rules or techniques taught and encouraged in a neurotypical world. That’s why:

People with ADHD do not fit in the standard school system, which is built on repeating what someone else thinks is important and relevant.

People with ADHD do not flourish in the standard job that pays people to work on what someone else (namely, the boss) thinks is important.

People with ADHD are disorganized, because just about every organizational system out there is built on two things — prioritization and time management — that individuals with ADHD do not do well.

People with ADHD have a hard time choosing between alternatives, because everything has the same lack of importance. To them, all of the alternatives look the same.

People with an ADHD nervous system know that, if they get engaged with a task, they can do it. Far from being damaged goods, people with an ADHD nervous system are bright and clever. The main problem is that they were given a neurotypical owner’s manual at birth. It works for everyone else, not for them.

Don’t Turn Individuals with ADHD into Neurotypicals

The implications of this new understanding are vast. The first thing to do is for coaches, doctors, and professionals to stop trying to turn people with ADHD into neurotypical people. The goal should be to intervene as early as possible, before the individual has been frustrated and demoralized by struggling in a neurotypical world, where the deck is stacked against him. A therapeutic approach that has a chance of working, when nothing else has, should have two pieces:

Level the neurologic playing field with medication, so that the ADHD individual has the attention span, impulse control, and ability to be calm on the inside. For most people, this requires two different medications. Stimulants improve day-to-day performance for a person with ADHD, helping him get things done. They are not effective at calming the internal hyperarousal that many with ADHD have. For those symptoms, the majority of people will benefit by adding one of the alpha agonist medications (clonidine/Kapvay or guanfacine/Intuniv) to the stimulant.

ADHD medication, though, is not enough. A person can take the right medication at the right dose, but nothing will change if he still approaches tasks with neurotypical strategies.

The second piece of ADHD symptom management is to have an individual create his own ADHD owner’s manual. The generic owner’s manuals that have been written have been disappointing for people with the condition. Like everyone else, those with ADHD grow and mature over time. What interests and challenges someone at seven years old will not interest and challenge him at 27.

Write Your Own Rules

The ADHD owner’s manual has to be based on current successes. How do you get in the zone now? Under what circumstances do you succeed and thrive in your current life? Rather than focus on where you fall short, you need to identify how you get into the zone and function at remarkable levels.

I usually suggest that my patients carry around a notepad or a tape recorder for a month to write down or explain how they get in the zone.

Is it because they are intrigued? If so, what, specifically, in the task or situation intrigues them?

Is it because they feel competitive? If so, what in the “opponent” or situation brings up the competitive juices?

At the end of the month, most people have compiled 50 or 60 different techniques that they know work for them. When called on to perform and become engaged, they now understand how their nervous system works and which techniques are helpful.

I have seen these strategies work for many individuals with ADHD, because they stepped back and figured out the triggers they need to pull. This approach does not try to change people with an ADHD nervous system into neurotypical people (as if that were possible), but gives lifelong help because it builds on their strengths.

[Read This Next: 6 Things You Didn’t Know About the ADHD Brain]

William Dodson, M.D., is a member of ADDitude’s ADHD Medical Review Panel.

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Updated on February 5, 2021

56 Comments & Reviews

  1. Thank you very much for trying hard to get to this positive view. I refused to label my son from infancy either as naughty or hyperactive or bad….I just stood my ground with family and friends and said he was a curious and active, and intelligent child. Today he is 9 and is in the school gifted program…..and yes I am facing all the challenges to keep him motivated to get organized and get things done….but he is NOT adhd….I will pray and cheer you on….and will read more closely​ on what you have to say. Thank you. Blessings!!!

    1. Dezdouz, out of curiosity, you seem to make an extreme point of making sure everyone knows your son is “NOT” adhd (quoted capitals)… any special reason? Just saying, I have adhd myself. (Inherited it from my Dad.) But it doesn’t make either of us bad people. “Different” maybe, but not bad.

      If some day you decide your son DOES have adhd, there’s no shame in it. Nothing wrong with labels either, as long as they are accurate.

      Just food for thought: by applying negative stigmas to a thing/person/condition, you further alienate the thing/person/condition from society. Kinda counter-productive, imho, but that’s just me… 🙂

      1. Hmmm…it does seem like that…that I don’t want my son labelled as ADHD. I didn’t realize that….

        Here on blogs like this and on adhd websites, its people like me, parents who care, adults with adhd searching for answers who visit these pages.

        The real world especially one that involves school is far less accommodating of ADHD kids. I am 100% sure, if my child started school with an ADHD tag, no one would look beyond his ADHD behavior…..I chose to highlight his intelligence and magnify his abilities, thus turning the teachers to those traits which has led to him testing in the top 2% superior gifted range.
        Similar case, different mum, I would tell her, her kid was very intelligent (so similar to my son)….she would always role her eyes and say he’s a handful, etc, etc … son and her’s would play together for hours….so I know what I am talking about….she took him and got him diagonsed as ADHD….and there he is being limited by his ADHD diagnosis in school.

        It was just the difference in two mothers’ perception of their kids.

        Websites and blogs are not the same as the real world.

        I truly believe it takes one person to believe in you to reach great heights, when one is a child that should ideally be a parent who believes in you.

        The world can be selfish at times, and once a tag, always the tag no matter how much you succeed above it.

        There are interesting articles on giftedness and excective functioning and how it can be misdiagnosed as ADHD…(leaving out the giftedness)

        I am empathetic towards little kids I meet who have been already diagnosed as ADHD, They could maybe have been instead ‘gifted with executive functioning not fully developed.’

        See why I am not happy with the ADHD tag, it limits a child…… especially if the parents can’t see beyond that tag….like my friend….she’s found an excuse for his behavior and forgotten about how Intelligent he can really be.

        She goes telling everyone he’s ADHD, I go round telling everyone my son’s gifted….for similar behaviors.
        The reaction/interaction of people is proof of what labels can do.

        Also, in those moments, when I am exasperated with his behavior, it helps a lot to remember just how Intelligent he is.

        50 years ago and still in some other places in the world, kids climb trees, jump walls, splash in muddy puddles, play and fight and play again with friends, and are not ADHD….they energies got used up outside.
        Now here in the US when they are enclosed indoors and they disturb their parents who are busy on WhatsApp or Twitter or Facebook, it eventually becomes diagnosed as ADHD, not everyone, but the rate at which kids are being diagnosed ADHD is alarming.

        In the really real world, ADHD does have a negative tag attached to it…….when instead it should be a way of understanding.

        There are just so many aspects to consider, so many counter arguments, I can’t even begin to elaborate. We would be going back and forth umpteen number of times.

        To sum it up, yes you are right, I don’t want my son labelled ADHD. I want him to be seen as Gifted and then I’ll work along with him and others who care to strengthen his executive functioning skills….and search for studies like this that give me a better insight into helping him out.

        This article about the ADHD brain was so very insightful.

        Thank you for your observations, I should be more mindful.

        1. You are absolutely correct If the child is gifted. Not all are. My son sufferred with that label throughout school until we were advised out of the blue that his accomplishment level of the baisics was 5 or more years behind his peers. They advised us that he would be transferred to a group of “his peers” in a dead end program in the fall when he was 12. We objected voiciferously ( the last time I did that the school division settled after incurring 250,000 in legal fees, 100, 000 in senior executive overtime and ancillary expenses and the cost to political friends of 750,000 for construction.
          . He was allowed to remain with his peers and would be evaluated at ethe end of the next school year.
          I have discovered at the age of 70 that i am ADHD But fortunately I was gifted. In a way that overcame the typical expelled from school on my 16th birthday solution of that time. I was able to turn savant like skills in math and an IQ in the top 1% into a consulting career. I succeeded beyond any of my goals and was able to earn a mid six figure income consulting and retire comfortablya at age 60. Despite 3 settlements with exxes after age 50. (Untreated ADHD?)
          We enrolled him in Sylvan learning center and re enrolled him 3 times . The result was that he graduated with his peers froma high school with skills and working habits that provide him an excellent job in the aviation business. It was indeed hard work but primarily his. He is a successful world traveller and extremely hard working and caring individual.
          My grandon is also ADHD and gifted and my daughter and her husband worked extremely hard to avoid the “label” in school. Succsessfully.
          One size or solution IMHO doesnt work for all.

          A friend and fellow chorister has a young preschool son who shows many similar behaviors in our church. I have suggested to him that his son appears to have the “Edison” gene. It is what i say to other parents when they mention their childs ADHD to me.

          1. Sorry for all the mispells. This Ipad and my shaky fingers are thinking about a divorce..

        2. It always makes me a bit emotional when I read what good parents say about their gifted/adhd children, because I’m the typical example of a child that wasn’t diagnosed nor helped in any way and fell into depression, anxiety, addictions, etc… and it feels like such a waste because I know I could’ve done great things if only someone had talked about me like you talk about those children and tried to help me that way.

          Those children are lucky to have you as parents/grandparents. 🙂

          1. I would like you to know that you are not alone. I am the same way. I daydream at times what that would have felt like and how my life may have been with that positive upbringing instead of what I felt like was the insignificant child.

        3. I was one of those kids who was not diagnosed until adulthood. I remember spending most of my time in high school grounded because I was not making the grades my parents wanted out of me. They were afraid of the ADHD label. The school I went to for elementary school had me evaluated by a councilor, because they saw I was struggling, and out of that my parents were encouraged to have a psychiatrist evaluate me because I was showing signs of ADHD. They did not, and they continued to use the neurotypical rule book on me. They just saw the times I got in the zone, and that I was gifted. When I was 21, I was finally able to get diagnosed. I ended up developing anxiety from the delay, though I will say after 4 years of treating the ADHD, my anxiety is almost gone, just with ADHD meds. With this “label” I have been able to get the help that I need to get through college, and get the grades my parents always knew I could. Sometimes labels can be helpful, it just depends on when they are placed and how much you fight to show people the good in the ADHD, so they see past the label.

      2. I agree with your comment. My gifted daughter was just diagnosed with ADHD- inattentive type at 19, right after I was at age 54. I can’t read enough about this as I finally was diagnosed after years of other labels for depression, anxiety etc. My father passed never knowing he had it.

      3. I agree with your comment. My gifted daughter was just diagnosed with ADHD- inattentive type at 19, right after I was at age 54. I can’t read enough about this diagnosis after years of other labels for depression, anxiety etc. My father passed never knowing he had it.

    2. I think that it is wonderful that he has a parent who is taking an active interest in his welfare and creating a supportive environment.

      My circumstances: son aged nine diagnosed with ADHD two years ago.

      His dad (me) diagnosed one year ago! I wish my parents had know when I was a child. I went under the radar because I was conscientious – I wanted to do the “right thing” – and bright (in the top couple of percentage points). I went to a boarding school for the last 3 years of secondary school which in hindsight was a blessing. At university, all that structure fell away. Nevertheless I managed to clock up 3 bachelors degrees and a master of laws degree. I have variously been a lawyer an investment banker, partner in a large consulting firm (note the variety…).

      My son’s ADHD is more pronounced. Stimulation medication, however, works wonders. He is also very bright. However he still sufferes from disorganisation and a lack of self control (esp in the morning). It has helped us being able to inform his school/teachers about his ADHD because most of them have received some training about it. They look out for him and communicate with us about his progress. In some cases it is just to ensure we know what is happening at school because he often forgets or forgets to tell us. Or to put it in the terms of the article, his mind is full dealing with other equally important things! Sometimes this disorganisation can be cause for us to have a good laugh, sometimes a cry. His personality is also relevant. He is an “innovator” and a “driver”. His mind generates an idea (promoted by something he has read, seen on TV or learned from another person) and then he acts. Today, a Sunday, it was making a flute from a carrot using an electric drill and a knife. There was limited consultation, planning etc. He seeks forgiveness not permission. Anyway, he had a great time and felt a sense of achievement about what he had created.

      So does a diagnosis matter? Yes it does because it can lead to suitable treatment, understanding and a more supportive environment IF those who are entrusted with the diagnosis are able to respond appropriately. The challenge in my view is identifying those who can and need to be be entrusted with the diagnosis and concealing it from those who might respond to it ignorantly or with malice. The problem is not with the label but the labellers.

  2. Thank you for this article. It would be helpful if it included examples of what some people put on their list of how they get into the zone – just to provide an idea. Thank you.

  3. Thank you for this article, especially how clearly you’ve spelled out our inability to use “importance and rewards to get motivated.” I’m still not sure it will convince other people who consider this a moral concern, but it helps me.

    I have one issue and that is with this sentence: “People with ADHD have a hard time choosing between alternatives, because everything has the same lack of importance.” For me everything has exactly the same importance, not lack of it. Isn’t that the more common ADHD experience? Having everything be shiny and worthy and equally important? Before I was diagnosed I would go grocery shopping by looking at EVERY item in the store and deciding whether I wanted it, because they all deserved a chance! Now I use an app and a list but I still feel sorry for all the important things I’m not choosing. lol.

  4. I just created an account because I found this article very good. It explains some of the things i usually have a hard time explaining to people around me in such a clear way, so thank you so much and I can’t wait to read more articles on this website if they are of the same quality.

    I needed that positivity right now, because although I have found helpful solutions this year (just got diagnosed at 29), I’ve come to the conclusion they’re just not enough yet. I still have a hard time fighting procrastination and I keep failing in the realization of my projects, and then depression inevitably comes back.

    I would also like to know more about the tricks people found because I’m gonna try to write them down as you advise, but I have the feeling the list will be short…

    1. As is mentioned by you Make List make a new list. Now that i am retired i post a list of tomorrows events on the Bathroom Mirror. With times. And yes iam interested in all of them. I use the standard iphone,ipad clock and calendar for alarms a day before and an hour before. Before retirement my assistant became responsible for my calendar and made sure ileft on time and was prepared for all meetings.

  5. My son was not diagnosed with ADHD until he was 18. He was always highly intelligent and different. He excelled at school (straight A’s and 1’s) and left to take his place at Cambridge university just after his eighteenth birthday. Unfortunately he did not cope well and was sent home six weeks later, whereupon we had a specialist diagnose his ADHD. It was a further 3 years before Cambridge would accept him back but he then went on to graduate 3 years later with a 1st in Social Anthropology. He does struggle, I became his mum/PA when he returned home but he was lucky to then work for a company that saw his uniqueness as a gift. He was there for a year and was very successful. I just said goodbye to him today as he set off to begin his Masters at the University of Chicago. He is a brilliant, unique and wonderful young man. Socially responsible and I believe his condition is attributable to his many gifts. He also suffers from anxiety and depression and takes medication for all three but he is stable and coping with life. I wholeheartedly support the work you’re doing to provide greater understanding of this condition, which is in no way straightforward or the same for everyone.

  6. Thank you so much for this article. I am 29 years old and have been misdiagnosed a number of times, and treated with for anxiety, depression, even mania. Mostly from primary care specialist who weren’t using the right tools to ask me (who doesn’t know the right things to say) the right questions.

    I am now seeing a psychiatrist, who has been able to sort through the clutter, and thinks that the main cause is indeed adhd. This article felt like home, and shines light on every thing I am going through, and have been through.

    Thank you!

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