- Welcome to the Huberman lab podcast, where we discuss science
and science-based tools for everyday life. [upbeat music] I'm Andrew Huberman, and I'm a professor of
neurobiology and ophthalmology at Stanford school of medicine. Today, we are going to talk
all about attention deficit, hyperactivity disorder, or ADHD. We are also going to talk
about normal levels of focus. What are normal levels of
focus and how all of us, whether or not we have ADHD
or not can improve our ability to focus our ability to
rule out distraction. It turns out those are
two separate things, as well as remember information better. We are also going to talk about how we can learn to relax while focusing, which turns out to be a critical
component of learning new information and for coming
up with new creative ideas. So whether or not you have
ADHD or know someone who does, or if you're somebody who feels
that they do not have ADHD, but would simply like to
improve their ability to focus or to be more creative. This episode is definitely
for you as well. We are going to talk
about drug based tools that are out there. We are going to talk
about behavioral tools. We will talk about the role
of diet and supplementation, and we will talk about new emerging brain machine interface devices, things like transcranial
magnetic stimulation. If you don't know what
that is, don't worry, I will explain it to you. These are non-invasive methods
for rewiring your brain in order to make focusing
more natural for you and to teach you how to
increase your depth of focus. Now, just a quick reminder that any time we discuss
a psychiatric disorder, it's important that we remember that all of us have the
temptation to self-diagnose or to diagnose others. So, as I list off some of
the symptomology of ADHD, some of that symptomology
might resonate with you. You might think, oh, maybe I have ADHD or you might decide that someone you know, definitely has ADHD. However, it is very important
that you don't self-diagnose or diagnose somebody else the clear and real diagnosis of ADHD really should be carried out
by a psychiatrist, a physician, or a very well-trained
clinical psychologist. There are clear criteria
for what constitutes full-blown ADHD. However, many of us have
constellations of symptoms that make us somewhat
like somebody with ADHD and if you're struggling
with focus nowadays, as a lot of people are because of stress, because of smartphone use, which turns out can induce adult ADHD. We'll talk about that. We'll then pay attention
to the symptomology. You may actually require
professional treatment you might not, equally important is to remember that some of the terms that we cover, like impulse control and
attention and concentration are somewhat subjective and
they can change over time. Sometimes we have a better
level of attention than others. Maybe it depends on how we slept or other events going on in our life where something that
we're entirely unaware of. The important thing to remember is that we can all improve
our attentional capacity. We can all rewire the circuits
that make heightened levels of focus, more accessible to us. We can do that through multiple
types of interventions, and we are going to cover all
those interventions today. Before we march into the material, I'd like to remind that
this podcast is separate from my teaching and
research roles at Stanford. It is however, part of
my desire and effort to bring zero cost to consumer
information about science and science related tools
to the general public. And keeping with that theme, I'd like to thank the
sponsors of today's podcast. Our first sponsor is Roka. Roka makes eyeglasses and sunglasses that are of the utmost quality. I've spent a lifetime
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mattress and two free pillows. So let's talk about ADHD, Attention Deficit Hyperactivity Disorder. Let's also talk about focus and attention and everybody's ability
to focus and attend not just people with ADHD. We are also going to talk about tools that would allow anyone, whether or not they have ADHD or not to enhance their level of
concentration and focus. Now, ADHD used to be called
ADD Attention Deficit Disorder. We have record of ADD in
the medical literature dating back to as early as 1904. Now there's nothing special about 1904. That's just the first
time that it showed up in the standard medical literature. We have to believe that ADD, which we now call ADHD existed before 1904 and probably long before 1904, why? Well, because it has a
strong genetic component. If you have a close
relative that has ADHD, there's a much higher probability
that you will have ADHD and that probability goes
up depending on how closely related to that person you happen to be. So for instance, if you're an identical twin
and your twin has ADHD, there's a very high concordance as we say, a very high probability
that you will have ADHD up to 75% chance. If you have a fraternal twin with ADHD, that number goes down a
bit in the 50 to 60% range and so on. If you have a parent with ADHD, that number ranges anywhere
from 10 to 25% likelihood, that you will have ADHD
if you have two parents and so on and so on, okay? So there's a genetic component that genetic component it turns out, relates directly to how
specific neural circuits in the brain wire up, the chemicals they use and the
way they use those chemicals, a topic that we are going
to discuss in depth today. Now, if you have a close
relative with ADHD, that does not mean that
you are faded to have ADHD and if you happen to have ADHD, there are ways to overcome those symptoms of lack of attention,
impulsivity and so on. Another important point about ADHD is that it has nothing
to do with intelligence, whether or not we're
talking about intelligence measured by a standard IQ test a rather controversial issue
as many of you probably know, there are lots of forms of intelligence that a standard IQ test
just wouldn't pick up emotional intelligence,
musical intelligence, spatial intelligence, all
sorts of intelligences. None of them are related to ADHD. Being very high functioning
doesn't make you more likely to have ADHD and being ADHD doesn't necessarily mean
that you have a low IQ. So there are people with
ADHD who have low IQs people with ADHD with high IQ, people with ADHD with high
emotional IQ or with low IQ in the emotional scale,
it's all over the place. The important point is that
your ability to attend and focus does not relate to how smart
you are or your IQ of any type, not just a standard IQ. The renaming of the ADD to ADHD took place in the mid to late 1980s when the psychiatric community and the psychological community started taking better
notice of the fact that so-called hyperactive kids
also had attentional issues. This might seem obvious, but there's been extensive
and ongoing revision of the criteria for designating
a psychiatric disorder and this is still an
ongoing process even today. So in the mid eighties, we started hearing about ADHD and then gradually that term
ADD has been dropped away. However, just the renaming of ADD to ADHD has led to much better
diagnosis and detection of ADHD. So right now the current
estimates are that about one in 10 children
and probably more have ADHD. The current estimates are
anywhere from 10%, one in 10 to as high as 12%. Now, fortunately about half of those will resolve with proper treatment, but the other half typically don't. The other thing that we
are seeing a lot nowadays is increased levels of ADHD in adults and there's some question
as to whether or not those adults had ADHD that went undetected during their childhood or whether or not ADHD is now cropping up in adulthood due to the way that we are
interacting with the world in particular smart phone use, the combination of email,
text, real-world interactions, multiple apps and streams
of media and social media all coming in at once
trying to manage life. All of the things that are going on are creating a kind of cloud
of poles on our attention and so there is this
question to whether or not we are creating ADHD in
adults that never had ADHD prior to being an adult. So let's talk about attention and first let's just define
what we mean by attention out there in the scientific literature and in discussions about ADHD, we will hear things
like attention and focus and concentration and impulse control for sake of today's discussion, attention, focus, and concentration are essentially the same thing, okay? We could split hairs and
the scientific literature does split hairs about these. But if we want to understand the biology and we want to have a straightforward conversation about ADHD, if I say attention or focus, I'm basically referring to the same thing, unless I specify otherwise, okay? So people with ADHD have
trouble holding their attention. What is attention? Well, attention is perception. It's how we are perceiving
the sensory world. So just a little bit of neurobiology 101, we are sensing things all the time. There's information coming
into our nervous system all the time. For instance, right now
you're hearing sound waves. You are seeing things, you are sensing things against your skin, but you're only paying
attention to some of those and the ones that you're
paying attention to are your perceptions. So if you hear my voice,
you are perceiving my voice. You are not paying attention
to your other senses at the moment, okay? You might even be outside in a breeze and until I said that, you might not be perceiving that breeze, but your body was sensing it all along. So attention and focus are
more or less the same thing, but impulse control is something
separate because impulse control requires pushing out
or putting the blinders on to sensory events in our environment. It means lack of perception, impulse control is about
limiting our perception. People with ADHD have poor attention and they have high levels of impulsivity they're easily distractable. But the way that shows
up is very surprising. You might think that people with ADHD just simply can't attend anything. They really can't focus, even if they really want to,
but that's simply not the case. People with ADHD yes,
they are distractable. Yes, they are impulsive. Yes, they are easily annoyed by things happening in the room. They sometimes have a high
level of emotionality as well. Not always, but often however people with ADHD
can have a hyper focus and incredible ability to focus on things that they really enjoy or and are intrigued by. Now, this is a very important point because typically we think
of somebody with ADHD as being really wild and hyperactive, or having no ability whatsoever
to sit still and attend and while that phenotype as we call it that contour of behavior
and cognition can exist, many people, if not all people with ADHD, if you give them something
they really love, like if the child loves video games or if a child loves to draw, or if an adult loves a
particular type of movie or a person very much, they
will obtain laser-focus without any effort. So that tells us that people with ADHD have the capacity to attend, but they can't engage that attention for things that they don't
really, really want to do and as we all know much of life, whether or not you're a child or an adult involves doing a lot of things
that we don't want to do, much of our schooling
involves doing things that we would prefer not to do and sort of forcing ourselves
to do it, to attend, even though we are not super interested in what we are attending to. There are a couple other things that people with ADHD display quite often. One is challenges with time perception. Now time perception is
a fascinating aspect of how our brain works and later we're going to
talk about time perception and how you can actually get
better at time perception. It's very likely that right
now you are doing things that get in the way of
optimal time perception and I will tell you how
to adjust your ability to measure time with your brain. People with ADHD often run late. They often procrastinate, but what's interesting and surprising is that if they are given a deadline, they actually can perceive time very well and they often can focus very well if the consequences of
not completing a task or not attending are severe enough. It's a little bit like the
way that people with ADHD can really focus if they like something. Well, if they're scared
enough about the consequences of not attending, oftentimes not always, but oftentimes they can attend. If they're not really
concerned about a deadline or a consequence, well, then they tend to lose track of time and they tend to underestimate
how long things will take. Now many people do that,
not just people with ADHD, but people with ADHD have challenges, understanding how to line up
the activities of their day in order to meet particular deadlines even if it's just a simple thing, like finishing one set
of tasks before lunch, oftentimes they will remember
that lunch starts at noon, but somehow they aren't able
to fill the intervening time in a way that's productive and they can obsess about the upcoming deadline for instance, we will talk about how to remedy this. In addition, their spatial organization
skills are often subpar, not always, but often you will
find that somebody with ADHD uses what's called the pile system in order to organize things, they will take many belongings and this could be in the
kitchen or in their bedroom or in their office or in any space and they will start piling things up according to a categorization system that makes sense to them and only them. It doesn't really have
any logical framework. Now, many people use the pile system and if you use the pile system, that doesn't mean that you have ADHD in fact, if you're unpacking a house or you've moved recently, or you've received a lot
of presence recently, the pile system makes perfect
sense to organize your space. But people with ADHD
tend to organize things according to the pile system all the time and that pile system
doesn't work for them. Okay, so that's the key distinction that they use a filing system,
and it's not really files, they're piling things up in a
way that makes sense to them, but then it doesn't work for
them in terms of what tasks they actually need to perform. They can't find things or if anyone moves one thing
then it's very disruptive to their overall plan
because their overall plan doesn't really work in the first place. So that's a common
phenotype as we call it. A phenotype by the way, is just an expression of a
particular set of underlying genetic or psychological components, okay? So we say the phenotype. So a phenotype can brown
hair and green eyes, like for me, a phenotype could also be that somebody uses the
piling system, okay? The other thing that people
with ADHD have real trouble with is so-called working memory. Now you might think that people with ADHD would have really poor memories, but in fact, that's not the case. People with ADHD often
can have a terrific memory for past events, they can remember upcoming
events quite well. Their memory is clearly working. However, one aspect of
memory in particular that we call working
memory is often disrupted. Working memory is the ability to keep specific information online, to recycle it in your
brain over and over again, so that you can use it in
the immediate or short term. A good example of this
would be you meet somebody, they tell you their name, they give you their phone number verbally, and you have to walk back to your phone and enter it into your phone. People without ADHD might have
to put some effort into it, it might feel like a bit of a struggle, but typically they will be able
to recite that phone number in their mind over and over,
and then put into their phone. People with ADHD, tend to lose the ability
or lack the ability to remember things that they
just need to keep online for anywhere from 10 seconds
to a minute or two, okay? So a string of numbers like 6,
4, 3, 7, 8, 1 for most people would be pretty easy. 6, 4, 3, 7, 8, 1, 6, 4, 3, 7, 8, 1, you could probably remember
that a minute from now without writing it down. But if you add one more number
to that 6, 4, 3, 7, 8, 1, 3, it gets tougher, okay? So there's a reason why
phone numbers typically have seven digits in them, of
course, there's an area code, but remembering information
that strings out longer than seven numbers or a sentence or two that's challenging for most people, people with ADHD have severe challenges, even with much smaller
batches of information over even much smaller batches of time. Deficits in working memory are also something that we see in people who have frontotemporal dementia, so damage to the frontal lobes or age-related cognitive decline and so it will come as
no surprise that later when we discuss treatments, supplements, and other tools for ADHD, that many of those treatments, supplements and tools for
ADHD are similar to the ones that work for age-related
cognitive decline. Okay, so we've more or less established the kind of menu of items that
people with ADHD tend to have some have all of them. Some have just a subset of them. Their severity can range
from very intense to mild, but in general, it's challenges with attention and focus, challenges with impulse control,
they get annoyed easily. They have kind of an impulsivity, they can't stay on task. Time perception can be off, they use the piling system or a system that doesn't
work well for them in order to organize their
things in physical space and they have a hard time
with anything that's mundane that they're not really interested in. But again, I just want to
highlight that people with ADHD are able to obtain
heightened levels of focus, even hyper-focus for things
that are exciting to them and that they really want to engage in. So now you have the
contour of what ADHD is, and if you're somebody
who doesn't have ADHD, you should also be asking
yourself which aspects of ADHD are similar to things
I've experienced before. Because what we know
about the healthy brain is that there's also a
range of abilities to focus. Some people focus very well on any task. You give them a task, they can
just laser in on that task. Other people that have to kind
of fight an internal battle, they have to convince themselves that it's important or interesting. They have to kind of incentivize
themselves internally. Other people doesn't matter, they could be bored to
tears with the information, but they can do it just because they are, "Very disciplined people." We tend to admire those people but as you'll see a little bit later, it's not clear that that's the best way to run your attentional system. There might be something to this business of having heightened levels of attention for the things that you are most interested or excited by. So let's drill into this
issue of why people with ADHD actually can focus very intensely
on things that they enjoy and are curious about. Now, enjoyment and curiosity
are psychological terms, they're not even really
psychological terms. They're just the way that we
describe our human experience of liking things, wanting
to know more about them. But from a neuro-biological perspective, they have a very clear
identity and signature and that's dopamine. Dopamine is released from neurons, it's what we call a neuromodulator and as a neuromodulator
it changes the activity of the circuits in the brain, such that certain circuits
are more active than others and in particular, dopamine creates a
heightened state of focus. It tends to contract our visual world and it tends to make us
pay attention to things that are outside and beyond
the confines of our skin. That's what we call exteroception. Dopamine also tends to put
us in a state of motivation and wanting things outside
the confines of our skin. So whether or not we're pursuing something physical in our world, or whether or not we're
pursuing information in our outside world, dopamine is largely
responsible for our ability and our drive to do that. But dopamine as a
neuromodulator is also involved in changing the way that
we perceive the world. So, as I mentioned earlier you have all these senses coming in and you can only perceive some of them because you're only paying
attention to some of them. Dopamine when it's released in our brain tends to turn on areas of our brain that narrow our visual focus and our auditory focus, so it creates a cone
of auditory attention, that's very narrow, creates a tunnel of visual
attention that's very narrow. Whereas when we have less dopamine, we tend to view the entire world, we tend to see the whole
scene that we are in, we tend to hear everything all at once. So as I describe this, hopefully you're already
starting to see and understand how having dopamine
release can allow a person, whether or not they have ADHD or not to direct their attention
to particular things in their environment, all right? So now what we're doing is
we're moving away from attention as this kind of vague ambiguous term, and we're giving it a
neurochemical identity dopamine, and we are giving it a
neural circuit identity and just to put a little
bit of flavor and detail on which neurocircuits those are, I want to discuss two general
types of neurocircuits that dopamine tends to enhance. So let's talk neurocircuits and for those of you that
love hearing neuroscience, nomenclature, you're
going to eat this part up and for those of you that
don't like a lot of names of brain areas I invite you to tune out or just try and grab
the top contour of this. I will describe it in
pretty general terms, but I will give some detail
because I know there are some of you out there who
really want to dig deeper into what the exact structures
and connectivities are, okay? So there are two main
types of circuits that we need to think about
with respect to ADHD, attention and dopamine. The first one is called
the default mode network. The default mode network is
the network of brain areas in your brain and my brain
and in everybody's brain that is active when
we're not doing anything when we're just sitting
there idle at rest. Now it's very hard to
not think about anything, but when you're not engaged
in any type of specific task, so you're not driving, you're
not playing a video game, you're not trying to study,
you're not trying to listen, you're just sitting
there letting your brain kind of go wherever it wants to go. Your default mode network
underlies that state of mind. The other set of circuits that
we're going to think about and talk about with respect
to ADHD are the task networks, the networks of the brain
that make you goal oriented, or that are at least trying
to make you goal oriented and those are a completely
different set of brain areas. However, the default mode network and these tasks networks are
communicating with one another and they're doing that
in very interesting ways. So first I want to describe how these two sets of brain areas, the default mode network and the task networks
normally interact, okay? So little bit of naming here again feel free to ignore it if you don't want this level of detail, but the default mode network includes an area called the
dorsolateral prefrontal cortex, frontal cortex, no surprises in the front and you have a dorsal, the top and side lateral part
dorsolateral, prefrontal cortex. You got one on each side
of your brain, right? And then you have a brain area called the posterior cingulate cortex and then you have an area called
the lateral parietal lobe. Again, you don't need to
remember these names for, these are three brain areas that normally are synchronized in their activity. So when one of these areas is
active in a typical person, the other areas would be active as well. So it's a little bit
like a symphony or a band like a three-piece band
is like drums, guitar, and bass they're playing together, okay? That's how it is in a typical person and in a person with ADHD, or even a person who has subclinical ADHD or in any human being
who hasn't slept well, what you find is the default mode network is not synchronized. These brain areas are just
not playing well together. Now the task networks include
a different set of structures. It still involves the prefrontal cortex, but it's a different part of
the prefrontal cortex, okay? Tends to be the medial prefrontal cortex and there are some other brain areas that the medial prefrontal
cortex is communicating to all the time, mainly to suppress impulses. It's shutting down the desire to stand up or to scratch the side of
your cheek or your nose, if you're trying not to do that, anytime you're restricting your behavior, These task directed networks
are very active, okay? Now normally in a person without ADHD, the task networks and
the default mode networks are going in kind of Seesaw fashion, they are actually what
we call anti-correlated. So it's not just that
they are not correlated, they're actually opposing one another they are anti-correlated. In a person with ADHD, the default mode networks
and the tasks networks are actually more coordinated. That might come a surprising, I think that we all have this tendency to kind of jump to conclusion
and assume that somebody who doesn't have an easy time
paying attention or has ADHD, that their brain must
be completely incoherent that it's not working well and because everything's out of whack, but there's something interesting
about people with ADHD whereby the task networks
and the default mode networks are actually working together
in a way that's correlated and that is what's abnormal. So this would be like the
guitar bass and the drums playing together in a way where the bass isn't keeping the
backbeat and the drums, aren't keeping the backbeat
that they're playing together, they're all playing the
melodies and harmonies in a way that just doesn't sound right. That's what's going on in the
brain of somebody with ADHD and we can now confidently say based on brain imaging studies, that when somebody gets better, when they're treated for ADHD
or when they age out of ADHD, as sometimes it's the case
that the default mode networks and the task networks tend to become anti-correlated again, okay? So that's the underlying neurobiology, but you'll notice that I
didn't mention dopamine at all. What dopamine is doing in this context is dopamine is acting like a conductor. Dopamine is saying this
circuit should be active then that circuit should be active. It should be default mode network and then when the default
mode network is not active, then it should be the task network. So it's really acting as a
conductor saying, you go, now you go, now you go, now you go. And in ADHD, there's something about
the dopamine system that is not allowing it
to conduct these networks and make sure that they stay what, the engineers or physicists
or mathematicians would say out of phase to be anti-correlated, okay? Out of phase and anti correlate,
essentially the same thing, at least for purposes of this discussion. So that raises two questions, could it be that dopamine is
not at sufficiently high levels or could it be that dopamine
is just doing it all wrong? In other words, is there no conductor or is
the conductor playing with like little tiny toothpicks and so the instruments can't see what they're supposed to do. They can't get the instruction 'cause it's just not
loud enough, so to speak, or could it be that the
information is getting out, but the information that's
getting out is wrong, the conductor's there, but the conductor is in
very good at conducting. Now we can gain insight
into how the system works and fails and how to treat it by looking at some of the current and previous treatments for ADHD, as well as some of the recreational drugs that people with ADHD
tend to pursue and like now I'm certainly not a
proponent of people with ADHD taking drugs recreationally, that's not what this is about, but if you look at their
drug seeking behavior and you couple that drug seeking behavior to their desire to remedy
their attention deficit, you start gaining some
really interesting insight into how dopamine is
regulating these circuits in normal circumstances
and in people with ADHD. So what exactly is going on
with the dopamine system, in people with ADHD and what's going on
with the dopamine system in people that have
terrific levels of attention for any task? Well, in the year 2015, an
important paper came out. The first author is Spencer, and it came out in a journal
called Biological Psychiatry, and it formalized the so-called low dopamine hypothesis of ADHD. The idea that dopamine
was somehow involved or not at the appropriate
levels in people with ADHD had been around for a pretty long time, but a formal proposition of
the low dopamine hypothesis led to some really important
experiments and understanding of what goes wrong in ADHD. It turns out that if
dopamine levels are too low in particular circuits in the brain, that it leads to unnecessary
firing of neurons in the brain that are unrelated to the
task that one is trying to do and that is unrelated to the information that one is trying to focus on. So if you think back
before you've got this default mode network and
a task-related network, and they need to be in
this kind of concert of anti-correlation and an ADHD
they're firing together. Well, the problem seems to
be that when dopamine is low, certain neurons are firing
when they shouldn't be, this is like a band, right? We'll go back to our band,
that's a guitar bass in it, and the person playing the drums and it's as if one of those or
several of those instruments are playing notes when they
shouldn't be playing, right? The pauses and music are just as important as the actual playing of notes. When dopamine is too low neurons fire, more than they should in these networks that govern attention. This is the so-called
low dopamine hypothesis and if you start looking anecdotally at what people with ADHD
have done for decades, not just recently since
the low dopamine hypothesis has been proposed, but what they were doing in
the 1950s and then the 1940s and the 1960s. What you find is that they
tend to use recreational drugs, or they tend to indulge
in non drug stimulants. So things like drinking,
six cups of coffee or quadruple espressos, or when it was more prominent smoking a half a pack of cigarettes and drinking four cups of coffee a day or if the person had access to it using cocaine as a recreational drug or amphetamine as a recreational drug. All of those substances
that I just described in particular cocaine and amphetamine, but also coffee and cigarettes increase levels of
multiple neurotransmitters, but all have the quality
of increasing levels of dopamine in the
brain and in particular, in the regions of the brain
that regulate attention and these task related and
default mode networks okay? Now young children, fortunately don't have access
to those kinds of stimulants most of the time and those stimulants
all have high potential for abuse in adults. So we will talk about
the potential for abuse in a few minutes. But if you look at children, even very young children with ADHD, they show things like
preference for sugary foods, which also act as dopamine
inducing stimulants. Now, of course, once they
get access to soda pop and coffee and tea, they start to indulge in
those more than other people. For a long time, it was thought that children with ADHD consumed too many sugary
foods or drank too much soda or adults with ADHD would take recreational
drugs like methamphetamine or cocaine or would drink coffee to excess or smoke cigarettes to excess because they had poor levels of attention and because they couldn't
make good decisions, they were too impulsive and so forth and while that certainly
could be the case, knowing what we now know about dopamine, and the fact that having
enough dopamine is required in order to coordinate
these neural circuits that allow for focus and
quality decision-making an equally valid idea
is that these children and these adults are actually
trying to self-medicate by pursuing these compounds, right? Things like cocaine lead to
huge increases in dopamine. Well, what happens was
when somebody with ADHD takes that drug, it turns out they actually obtain heightened levels of focus, their ability to focus on things other than things they absolutely care intensely about goes up, likewise, children who consume anything that increases their levels of dopamine, if those children have ADHD,
they tend to be calmer, they tend to be able to focus more. Now, this is very different than children who do not have ADHD. When they consume too much sugar, they tend to become super hyperactive. When they consume any kind of stimulant, they tend to go wild and
run around like crazy. Actually, I have an anecdote about this just to illustrate it. I have a friend, he has two children that
are now in their teens and twenties, but when they were little, one time, I brought them some
chocolate just as a gift, when I showed up at their
house and within 30 minutes, the kids were running around like crazy I mean they were pretty high energy kids, but they were going bonkers and that's actually when the
mother, my friend at the time, unfortunately, still now
looked at the chocolate, realized that it was chocolate
with espresso beans in it. It was like dark chocolate
with espresso beans so I was really at fault there, you don't want to give kids dark chocolate with espresso beans, but what you're really
seeing that hyperactivity that is dopamine, okay? It's the sugar combined with
the caffeine in this case, combined with a few other
compounds that exist in chocolate, that really increase
our levels of alertness and our tendency to want
to move around a lot, okay? So dopamine and low levels of dopamine apparently are what's
wrong in people with ADHD, that dopamine hypothesis is what led to the idea
that treating people, children and adults included
with dopaminergic compounds would somehow increase
their ability to focus and if you look at the major
drugs that were developed and now marketed by
pharmaceutical companies for the treatment of ADHD, those drugs have names like Ritalin. Nowadays, it's typically
things like Adderall, Modafinil and some of the other derivatives, they all serve to increase
levels of dopamine in particular dopamine in the networks that control task directed behavior, and that coordinate the
default mode network and these task-related networks. So many of you have
probably heard of Ritalin. Ritalin is a prescription
stimulant that is prescribed for ADHD as
well as for narcolepsy. Narcolepsy is a condition in which people tend to fall asleep during the day time, quite a lot, excessive daytime sleepiness, not due to lack of sleep at night, but also tend to fall asleep
when they get excited, if they're really emotionally
excited or about to eat or any other kind of activity that would normally get somebody
really aroused and alert people with narcolepsy
tend to fall asleep, or they tend to become
what's called cataplectic. They tend to just sort of
go limp in the muscles. So it's this invasion of
sleep into the daytime. It's dysregulated by emotion. You can imagine why a stimulant, something that would wake
you up, make you very alert, focused and motivated would be a good treatment for narcolepsy. Adderall also is used to treat
ADHD and to treat narcolepsy things like Modafinil also used to treat ADHD and narcolepsy. So you're sensing a theme here. So what are the differences
and similarities between these drugs and what can that tell us about ADHD? Well, Ritalin was one of
the first-generation drugs that was prescribed for ADHD
in order to deal head on with this dopamine hypothesis. This idea that in ADHD,
dopamine levels are too low. Nowadays, Adderall is the
more typically prescribed drug for ADHD that has to do with some of the so-called
pharmacokinetics, the rate at which those
drugs enter the system and how long they last in the system. So for instance, Ritalin was a drug that was packaged into various time-release formulas. Whereas initially Adderall was
only released in a form that had a very short life, So meaning that it wasn't
in the bloodstream very long and didn't affect the brain for very long and so the dosages could be
controlled in a more typical way without going into a lot
of tangential detail. As you all know, at
different times of day, you tend to be more or less alert. So a long sustained release drug while that might sound like
a really terrific thing. If that drug is having an effect of making you more alert and it's released across
very many hours of your day, there might be periods of your day when you feel too alert, periods of your day, when you feel just right
and periods of your day, when you wished that you were more alert. These are some of the
pharmacokinetics, kinetics, meaning movement of
the different compounds within the bloodstream
and brain that could, you could imagine in a very real way, would impact whether or not
someone would feel really good on one of these drugs or whether or not they would feel too anxious
or too sleepy and so on. Let's take a step back
for a second and just ask, what are these drugs? We know they increase dopamine, but what are they really? Well, Ritalin also called methylphenidate is very similar to amphetamine speed, or what's typically call speed in the street drug nomenclature. Adderall, which goes by
various other names, okay? So Adderall, Adderall XR, my
dialysis, things like that. Adderall is basically a combination of amphetamine and dextroamphetamine. Now some of you probably realize this, that Adderall is amphetamine, but I'm guessing that there a
good number of you out there, perhaps even parents and
kids that don't realize that these drugs like cocaine and
amphetamine methamphetamine, which are incredibly dangerous
and incredibly habit forming and have high potential for abuse. Well, the pharmaceutical versions of those are exactly what are used to treat ADHD and they're not exactly like
cocaine or methamphetamine, but they are structurally
and chemically very similar and their net effect in the brain and body is essentially the same, which is to increase dopamine primarily, but also to increase
levels of a neuromodulator called epinephrin or norepinephrine also called noradrenaline and adrenaline those names are the
same and to some extent to increase levels of serotonin
in the brain and blood, but not so much serotonin, that's just kind of a small
smidgen of effect, okay? So dopamine way up norepinephrine
and adrenaline way up. So that's motivation
drive, focus and energy and to some extent, a
little bit of serotonin, which is really more about
feeling calm and relaxed and you can imagine why that would be a good balancing effect for
dopamine and norepinephrine. So what I'm essentially
saying is that the drugs that are used to treat
ADHD are stimulants, and they look very much alike. In fact, nearly identical to some of the so-called street drugs, stimulants that we all
here are so terrible. However, I do want to emphasize that at the appropriate dosages and working with a quality psychiatrist or neurologist or family physician does have to be a board certified MD that prescribes these things, many people with ADHD
achieve excellent relief with these drugs, not all of
them, but many of them do, especially if these treatments
are started early in life. So now knowing what these drugs are, I want to raise the question
of why prescribe these drugs? I mean, everyone has to make
a decision for themselves or for their child as to whether or not they're going to take these things or not. I also want to acknowledge
that many people out there, many, many people out there
are taking these drugs, even though they have not
been clinically diagnosed with ADHD when I say these drugs, I'm specifically referring
to Ritalin and Adderall and Modafinil, but more
typically it's Adderall, okay? People using cocaine and amphetamine for recreational purposes, that's a completely different beast and it is indeed a beast and it's something that
I strongly discourage. However, I'm aware that up
to 25% of college students, and perhaps as many as
35% of all individuals between the ages of 17
and 30 are taking Adderall on a regular or semi-regular basis in order to work, in order to study and in order to function and
focus in their daily life. Even though they have not
been diagnosed with ADHD, there's a whole black market for this. They're getting it from
people with prescriptions. I'm not here to pass judgment. I just want to emphasize
how these drugs work. Some of the things that
they do to enhance cognition and focus that actually
serve the brain well in certain individuals and how
they can be very detrimental in other individuals. I sort of blew right past it. But the fact that in upwards
of 25% of young people are taking things like Adderall, despite not having a
clinical diagnosis of ADHD. Well, that's a ridiculously high number. A few years ago, it was estimated that
Adderall use and Ritalin use without diagnosis of ADHD
was second in incident only to cannabis, but actually now the
consumption of Adderall without prescription is higher than the consumption of
cannabis in that age group. So what that means is that
there's a lot of stimulant use in that age group and there are a lot of adults also using and abusing stimulants
in order to gain focus. Then we can have a whole
discussion about whether or not life is becoming more demanding, whether or not the need
for focus is excessive and that's why people are doing that. But frankly, it's an
interesting discussion, but it's not one that would
deliver us to any answers. Rather, I'd like to focus
on the ways that people now and people have always
been self-medicating to increase, focus, right? Caffeine, which I can indulge some, I don't think to
access has long been used as a stimulant to increase dopamine, increase norepinephrine, increased focus and energy
and in addition to that, it works through the so-called cyclic amp, phosphodiesterase pathway,
remember anytime you see, you hear an ASE, that's an enzyme. Phosphodiesterase is involved in the conversion of things like cyclic amp into energy for cells and so forth. Basically coffee gives you
energy it makes you feel good and it increases focus
because of the circuits that it engages in the brain. People have been taking caffeine and continue to take it caffeine for ages. People also used to smoke cigarettes, nicotine in order to gain focus. Nowadays, that's less common
because of the concerns, quite valid concerns about
lung cancer from smoking, but there's a lot of vaping out there. There are a lot of people
now consuming nicotine, which is the active
substance in cigarettes and in most nicotine vapes
that stimulates the brain to be more focused and more alert. So the idea of taking
stimulants of consuming things or smoking things in order
to increase alertness is not a new idea. It's just that in ADHD, it's surprising that these
things would work, right? I mean, if the problem is Attention Deficit Hyperactivity Disorder, what we're really talking about here, or children that are prescribed a drug that ought to be a stimulant, it ought to make them hyper hyperactive and rather than doing that, it actually somehow
serves to calm them a bit, or at least allow them to focus. Here's the reason, children have a brain that's a very plastic
meaning it can remodel itself and change in response to
experience very, very quickly compared to adults. Taking stimulants as a child, if you are a child diagnosed with ADHD allows that forebrain task
related network to come online, to be active at the appropriate times and because those children are young, it allows those children
to learn what focus is and to sort of follow or
enter that tunnel of focus. Now, by taking a drug, it's
creating focus artificially, it's not creating focus because
they're super interested in something it's chemically
inducing, a state of focus, and let's face it a lot
of childhood and school and becoming a functional adult is about learning how to focus even though you don't
want to do something. In fact, when I was in college, I had this little trick
that may or may not work for some of you, which is if I couldn't
focus on the material I was trying to learn, I would delude myself into thinking that it was the most
interesting thing in the world. I would just kind of lie
to myself and tell myself, okay, this, I won't mention the subjects, I absolutely love this. I would just, I would tell
myself that I loved it and I noticed that just that selective or deliberate engagement of
that desire to know circuit, whatever that is in my brain,
no doubt involves dopamine, allowed me to focus and
remember the information and somewhat surprisingly
or perhaps not surprisingly, I would often fall in
love with the information. I find that that was my favorite class. So it was what I wanted to learn the most. So that's one way you
can do it artificially, but kids with ADHD, they
can't do that, right? They're told to sit still and they end up getting up 11 times. They are told that they
can't speak out in class or that they have to remain
in their seats for 10 minutes and they just, despite their best effort, they simply cannot do it, they're highly distractable. So what are we to make
of this whole picture that we need more dopamine,
but these kids with ADHD, they're getting their
dopamine by way of a drug, which is for all the
world amphetamines, right? It's speed, that's really what it is. What are the long-term consequences, where the short-term consequences
and what should we make of people taking these drugs
without a clinical need? What are the consequences there? Well, in order to get to
some of those answers, I went to one of my colleagues, this is a colleague
that I've actually known for a very long time, I was
their teaching assistant when they were an undergraduate, they went on to get an
MD, a medical degree, as well as a PhD and become
a pediatric neurologist that specializes in the
treatment of epilepsy and ADHD in kids of all
ages, from age three to 21, that's the age range, pretty broad age range and has
extensive knowledge in this and what makes them particularly
interesting for sake of this discussion is that they
have a child, a young boy, who's now showing signs of ADHD and they are on the
threshold of trying to decide whether or not they
will prescribe Adderall or something similar. So we had a discussion about this and prior to learning that
their child may have ADHD. I asked the following questions. First of all, I asked, what do you think about
giving young kids amphetamine? And their answer was, on the
face of it, it seems crazy, but provided that the
lowest possible dose is used and that that dosage is
modulating as they grow older and develop those powers of attention, their observation was that
they've seen more kids benefit than not benefit from that. Now I'm certainly not saying
what people should do. You obviously have to go to a doctor because as I always say, I'm not a doctor, I don't prescribe anything, I'm a professor so I profess things and here I'm professing that
you talk to your doctor, if you're considering
giving Ritalin or Adderall or any type of stimulant
to your child, of course, what could be more important
than the health of your child. But it was a very
interesting answer because typically we hear yes,
medicator don't medicate. Rarely do we hear that the
medication should be adjusted across the lifespan and in
any particular kind of way. Now the fact that this person, this now friend of mine
and colleague of mine has so much expertise in
the way that the brain works and is considering putting
their child on such medication. I said, why wouldn't you wait until your kid reaches puberty? I mean, we know that in boys and in girls, there are increases in testosterone and estrogen during puberty, that dramatically change the
way that the body appears. But also that dramatically change the way that the brain functions
in particular we know this, that puberty triggers the
activation of so-called frontotemporal task related
executive functioning. That's just fancy science
speak for being able to focus, being able to direct your attention, being able to control your
impulses, look at a small child, or look at a puppy and then
look at an older child, or look at a dog, very different levels, patterns of spontaneous behavior. Young children move around a lot they're, I don't want to say shifty, cause that makes it sound like
they're up to something bad, which they might be, but they don't have to
be up to something bad, they fidget a lot. So to puppies, everything's a stimulus as
animals and humans get older, they learn how to control
their behavior and sit, still, listen and focus even
if they don't want to. So giving a drug that allows
a child to access that stillness early on it's
thought will allow them to maintain that ability as time goes on. But I decided to push
a little bit further, I said, well, why would you do it now as opposed to during
puberty or after puberty? And their answer was very specific and I think very important,
what they said was look, neuroplasticity is greatest in childhood and tapers off after about age 25, but neuroplasticity from
age three until age 12 or 13 is exceedingly high and they're right, when you sit back and you look at the
literature on neuroplasticity, you'd say childhood plasticity
and young adult plasticity is much greater than adult plasticity, but that early childhood
plasticity is far and away the period in which you
can reshape the brain at an accelerated rate. So this lines up really well
with the clinical literature. Not surprisingly, there are clinician that
early treatment is key. If you have the opportunity to
work with a quality physician and treat these things early, these drugs can allow
these frontal circuits, these task-related circuits
to achieve their appropriate levels of functioning and for
kids to learn how to focus in a variety of different contexts. Now, is that the only thing
that they should be doing? Of course not. So the next question I asked was what should we make of all
this diet related stuff, right? I've heard before that the
so-called elimination diet or ingesting no sugars
or no dairy or no gluten, that all of these things
have been purported to improve symptoms of ADHD and
people and parents with ADHD go to fanatic lanes to try
and find the exact foods that are causing problems
and the exact foods that the kids can eat in order to try and get their brain wired up right, and correctly, and to avoid lifelong ADHD and their answer was really interesting. But before I tell you their answer, I want to tell you the
studies and the data related to this question
of whether or not food and the constellation
of foods that one avoids and will eat has anything to
do with our levels of attention and in particular, whether or not that can be
used as a leverage point to treat ADHD. So you can imagine the
challenges of exploring the role of diet and nutrition in any study, but especially in a study on ADHD, why? Well, because as I mentioned
before, children with ADHD, and it turns out adults with ADHD tend to pursue sugary
foods or any types of food that increase their levels of dopamine. They are naturally drawn to those foods, whether or not they realize it or not, presumably as a way to try and treat their lack of focus and impulsivity. So in this study that I'm
about to share with you, there was no drug treatment,
it was just a study, manipulating diet and
involved 100 children, 50 in the so-called
elimination diet group, the special diet where
certain foods were eliminated and 50 in the so-called control group. However, being a well-designed
randomized controlled trial, this study also included a crossover, meaning where the kids would
serve as their own control or control group at a
certain portion of the study. So there'll be in one group where they eliminated certain foods and then after a period
of time in the study, they would swap to the other group. This is a powerful way to design a study for reasons that you can imagine, because you start to
eliminate changes and effects due to individual differences. In any case, 100 children
total 50 in each group at any one period in time and the effects that they
observed were extremely dramatic. In the world of statistics and
analysis of scientific data, we talk about P-values,
probability values. What's the likelihood that something could happen according to chance and typically the cutoff would be something like P less than 0.05, that's less than 0.05 chance essentially, of the effect being due to chance. However, in this study, every single one of the
effects is P less than 0.0001, very, very infant decimally small probability that the effect
observed could be due to chance. So what were these effects? These effects were
enhanced ability to focus, less impulsivity, even less tendency to move
when trying to sit still. So everything from mental focus to the ability to control
their bodies improved when they were in the
elimination diet group, what was eliminated? Well, the elimination diet
in this particular study was a so-called oligoantigenic diet. It was a diet in which each
kid took a test to determine which foods they had antibodies for, meaning that they were mildly allergic to. Now in this study, it was very important that the kids not be
extremely allergic to any food because as I mentioned before, they actually served as a
control at one point in the study where they were eating all sorts of foods, including foods that
had mild allergies to. So basically what the study
said was that eliminating foods to which children have allergies can dramatically improve
their symptoms of ADHD. And this study, not surprisingly because it was published in such a high quality
journal Lancet, et cetera, large number of subjects
set the world on fire. People were extremely
excited about these results because here in the absence
of any drug treatment, there was a significant improvement in ADHD symptoms observed
and then came the criticisms. So many papers were published
after this specifically dealing with re-analysis of these data and I want to be fair in saying that the data in the paper look good, but there are criticisms of the overall structural
design of the study. I don't want to go into
all the details exactly 'cause it gets really nuanced
about some of the statistics and the way that one
examines these types of data, but there was skepticism and in science, skepticism is healthy, especially when making decisions about whether or not to treat or feed children one food or another, or give
them one drug or another. Now I want to return to
the story of my friend, who is a pediatric
neurologist and treats ADHD and has a child who is on the precipice of perhaps starting to take drugs
for the treatment of ADHD. I asked the simple question,
do you see an effect of diet? Meaning when parents control
the diet of their children, does it make a positive or
negative or no difference in terms of the way that
the kids respond to ADHD, drugs like Ritalin and
Adderall or whether or not it can help them avoid treating
with those drugs entirely? And her response was very
straightforward, she said, elimination of simple sugars has a dramatic and positive effect. She's observed that over
and over and over again in many dozens, if not
hundreds of patients, okay? Now that's not a peer reviewed study, that's a statement that I'm
conveying to you anecdotally, but it's a highly, highly informed one. I said, what about
these elimination diets? She said, and I found other
sources to support this, that these oligoantigenic
diets are controversial. There are many people who really believe in identifying all the things
that you're allergic to and making sure that you and especially your
kids avoid those foods. However, there's another camp
that's starting to emerge in the peer reviewed
scientific literature, showing that when kids are
not exposed to certain foods in particular nuts and
things of that sort, they develop allergies to those foods and then when exposed to them later, they cause real problems. So there's a whole galaxy of
discussion and controversy and outright fighting about allergies and kids and whether or
not the oligoantigenic diet is the appropriate one. However, out of the four
neurologists and psychiatrists that I spoke to about ADHD
in preparation for this, every single one said children with ADHD, as much as possible, should be encouraged to avoid high sugar and simple sugar foods of most kinds and if they can find particular foods that exacerbate their symptoms, obviously eliminating
those foods is beneficial and the foods that
exacerbate their symptoms change over time. So I don't like giving
a complicated answer, but I also don't like
giving an incomplete answer. What this tells me is that children, especially young children who have ADHD should probably not eat much sugar in particular simple sugars. In addition to that, exploring whether or not
they have existing allergies to foods, they already
consume might be a good idea. At least that's what this paper, the Pelsser et. al Lancet
paper seems to speak to and I should mention that that
paper was published in 2011. Since then there have been many
dozens of studies exploring the same thing, as well as
meta analysis of all those data and it does appear that 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 are able to not take medication at all, or eventually wean
themselves off medication as young adults and as adults. One interesting question
is whether or not adults should modify their diet in order to increase their levels of focus, if they're already having
normal levels of focus, but we'd like more or would like to reduce existing adult ADHD,
that's an interesting, and even more controversial topic, it brings us right into the
realm of what are called omega-3 fatty acids. I've talked many times
on this podcast about the known benefits of omega-3
fatty acids in particular, getting a one gram 1000 milligrams or more even as much as 2000
milligrams each day of the so-called EPA component
of omega-3 fatty acids known to have antidepressant effects, mood elevating effects, known to have important effects protecting the cardiovascular system. I think it's now clear that
the immune system also benefits that omega-3 fatty acids that
include a gram or more of EPA that are very beneficial typically that's done through fish oil, liquid fish oil is going to
be the most cost efficient, but they're capsule forms for those of you that don't like fish oil, you can ingest this through other means you can get it from certain
algaes or krill, et cetera. You have to make it compatible
with your particular diet, whether or not you're vegan or vegetarian or omnivore, et cetera. Omega-3s have shown, been shown to have all these
positive health benefits. Do they have positive effects
on focus and attention? And the answer is you can find studies that support that statement and
the effects are significant, but the effects are modest. You can also find studies
that show no effect, however much like with
omega-3s and antidepressants, whereby ingestion of omega-3
fatty acids of a gram or more of EPA per day allows
people with major depression to get away with taking lower doses of antidepressant medication. It does seem that ingestion of
omega-3 fatty acids in adults that include EPA is of
1000 milligrams or more can allow adults with ADHD or mild attention deficit issues to function well on
lower doses of medication and in rare cases to
eliminate medication entirely. So what this says is once again, that the omega-3 fatty
acids are beneficial, will they cure or eliminate ADHD? I think it's safe to say, no, they are playing a supportive or what we call a modulatory role. Just like good sleep, plays a supportive and modulatory role for essentially everything,
your immune system, your ability to think your
ability to regulate your emotion, it's modulating that process. This component of modulation is extremely important to highlight and I think I want to spend
a moment on it because this is especially important
in the context of ADHD and all the information that's out there. There are biological
processes that are mediated by particular compounds like dopamine. So for instance, the
ability to feel motivated, to attend to focus is mediated
by the circuits in the brain that release dopamine. However, attention is also
modulating by how rested you are. If you want to eliminate your
ability to think well at all, just stay up for two nights
and don't sleep at all right? If you do that, you will have modulating
the circuits in your brain that respond to various things and you will be highly distractible. You'll be highly emotional. You will feel like garbage, but that doesn't mean that sleep mediates, focus and attention. It modulates it indirectly. Likewise, I think these
omega-3 fatty acids in particular the EPA is which
are so beneficial for mood and apparently also for attention, they directly mediate attention and mood, what they do is they
modulate those circuits, they make dopamine more available. They make whatever dopamine is available, more likely to bind to
the various receptors that are present on neurons and so forth and I think this is very
important because likewise diet in any discussion about nutrition has to include this
framework of is the diet, the elimination diet, or whether or not it's some
other diet or esoteric diet, ketogenic diet, is it modulating
or mediating a process? And most likely in the context of ADHD, it's modulating that process. So if the ADHD is mild or
if it's caught early enough, or if it's in conjunction
with pharmacology with a prescription treatment, well, then it might help
guide the child or adult to a better place of being able to focus. But it's not going to be the
switch that flips everything. Now that does not mean that
consuming the wrong foods, sugary foods or foods that
you happen to be allergic to is a good idea it will
still be detrimental. So I hope that conceptual framework helps because if you go online, if you're somebody with ADHD or not your going to be
bombarded with the ADHD diet, the oligoantigenic diet,
the elimination this, this supplement that EPA and I think it's very important
to understand whether or not you're talking about
something mediating a process or modulating a process. Now drugs like Ritalin,
drugs like Adderall, they are tapping into the circuitries and the neurochemistries that
mediate attention and focus. They are not the only
alternatives or the only choices rather for treatment of these circuits and enhancement of the circuits for focus. I'm going to talk about other alternatives and some behavioral alternatives that are not very well known, but are very, very
effective in a few minutes. But I really want to make
this clear distinction between modulation and mediation, because it's vital for anyone
that's trying to modulate or mediate anything
within their own brain. If any of you are interested
in this oligoantigenic diet, as it relates to ADHD, and you want to explore
a more recent study besides that classic 2011 Lancet study, that's rather controversial. There's a paper that was
published in frontiers in psychiatry just last year, 2020. The title of the paper is, "Oligoantigenic diet
improves children's ADHD rating scale scores reliably
in added video rating." The added video rating is
just that they're using an additional measure
of focus and attention. Again, that's Frontiers
in psychiatry, 2020, I'll put a link to it in the caption, and that's a more recent
study for you to peruse. So we've talked about the
neural circuits of focus and the chemistry of focus, but we haven't talked yet
about what would make us better at focusing and what
focusing better really is. So let's take a step back and think about how we focus and how
to get better at focus and I'm going to share with
you a tool for which there are terrific research data that will allow you in a single session to enhance your ability to
focus in theory forever. What am I about to read you
is from an excellent book that I recommend, if any of you are
interested in neuroscience and things like meditation
and default mode networks and things of that sort, the book is called, "Altered Traits." Science reveals how
meditation changes your mind, brain and body and no,
I'm not going to try and convince you to meditate. I'm going to share with you
a small passage in the book that relates some research
data related to focus that are very important. If you want to meditate,
that's your choice. That's a separate matter. This is a book by Daniel
Goleman and Richard Davidson and I should just mention that Goleman is a well-known author has written books on emotional
intelligence and so forth. Richard Davidson is also a PhD. He's a professor of
psychology and psychiatry, and he's at a University
of Wisconsin Madison, he's done terrific work on brain states and modulation of brain
states and so forth. What we're about to talk about is when attention works and
when attention falters and what we are specifically
going to talk about are what are called attentional blinks, not actual eye blinks. We're going to talk about
that in a few minutes, but we're going to talk
about attentional blinks. I'm paraphrasing here because Goleman and Davidson wrote
about this so beautifully. I'd rather paraphrase from
them than try and just make up a new way to say it that is less interesting or less good, but I want to credit them. Attentional blinks are
really easy to understand, if you think about a where's Waldo task, you know this task where's Waldo where, there are a bunch of people and objects and things in a picture and somewhere in there is Waldo with the striped hat and the
glasses and go skinny dude, and you have to find Waldo and so it's a visual search and it's visual search for an object that has distinct features, but is embedded in this
ocean of other things that could easily be confused as Waldo. So you tend to look, look, look, look, look, look, look, look, look, and then you find Waldo. Kids can do this they enjoy doing this. Adults may or may not enjoy it, but they can do it too. They find Waldo, when you find Waldo or when you search for a target in some other visual
search task at that moment, your nervous system
celebrates a little bit and it celebrates through
the release of neurochemicals that make you feel good,
you found it and you pause. Now, the pause is interesting
because when you pause, what we know from many experiments is that in that moment of pause
and mild celebration, however, mild you are not
able to see another Waldo sitting right next to it. So what this means is in
attending to something in searching and in
identifying a visual target your attention blinked
it shut off for a second and there's a more formal
and more laboratory type way that we look at this. The more typical way to
do this is to give someone a string of letters or a string of numbers and beforehand you tell them
be on the lookout for the letters R and Z, okay? You're just going to watch
this string of numbers go by and there will be a letter R in there, and there will be a letter Z in there and try and spot them both and what you find is when you present that string of numbers,
and then they see the R, they see the R they
register it consciously and they tend to miss the Z, just like in the Waldo type example. Now, of course the numbers
are going by pretty quickly, but they can spot the R. They could also spot the Z, if you told them
beforehand, just spot the Z and the numbers are moving
through at the same rate in both conditions. So what that means is that in every case, you are capable of seeing the R or the Z it's when you try and see
both that seeing the first one prevents you from seeing the second one, it's what we call an attentional blink. We do this all the time and people with ADHD
tend to have many more attentional blinks than people that don't and this is true for
children and for adults. This is an important point. So important that I want
to emphasize it twice in case you attentionally blinked. If you see something
that you're looking for, or you're very interested in something, you are definitely
missing other information in part because you're
over focusing on something and this leads to a very
interesting hypothesis about what might go wrong in ADHD, where we've always thought
that they cannot focus and yet we know they can focus on things they care very much about, well, maybe just maybe they are experiencing
more attentional blinks than people who do not have ADHD and indeed, there are data
now to support the possibility that that's actually what's happening and that should be exciting
to anyone that has ADHD. It should also be exciting
to anyone that cares about increasing their focus and
their ability to attend. What this is saying is
that these circuits, that underlie focus in
our ability to attend and our ability to eliminate distraction, they aren't just failing to focus. That's just a semantic way
of describing the outcome. They are over focusing on certain things and thereby missing other things. And so our distractability
or the distractability of somebody with ADHD could exist because they are over focusing on certain elements and there are there for missing other elements that they
should be attending to. So what they really need is this property that we call open monitoring. Now open monitoring is something that's described in the
book that I just referred to and that typically is
associated with people who have done a lot of meditation, so called Vipassana meditation, or have spent a lot of
time learning how to do what's called open gaze visual analysis and open gaze thinking. But there's a simpler version of this that allows us to bypass all that. First of all, your visual system has
two modes of processing. It can be highly focused,
a soda straw view. So looking for the R in
this string of numbers in the example that I just gave, or if you're very excited about something you're in that soda
straw view of the world, and you're missing other things, okay, that's high levels of attention. However, there's also a
property of your visual system that allows you to dilate your gaze, to be in so-called panoramic vision. Panoramic vision is something
you can do right now, no matter where you are,
and I can do it right now, you won't know that I'm doing it, but even though I'm still
looking directly at you, I'm consciously dilating my
gaze so that I can see the ceiling, the floor and
the walls all around me. That panoramic vision
is actually mediated by a separate stream or
set of neural circuits going from the eye into the brain and it's a stream or set of circuits that isn't just wide angle view. It also is better at
processing things in time. Its frame rate is higher. So you've seen slow motion video, and you've seen standard video, slow motion video gives
you that slow motion look, because it's a higher frame rate. You're thin slicing time, okay? You can use panoramic
vision to access the state that we call open monitoring. When people do that, they are able to attend to and recognize multiple targets within
this string of numbers. They can see the R and they can see the Z and they can see additional things. So this is something
that can be trained up and people can practice whether or not they have ADHD or not. What involves is learning how to dilate your gaze consciously, that's actually quite
easy for most people, whether or not you wear corrective lenses or contacts or not you can consciously go into open gaze and then you can contract
your field of view as well. There have also been studies done where people were taught to
think in a particular way for a very short period of time, and that forever changed
their ability to limit or reduce the number of
these attentional blinks. There are now published
accounts in the literature of a simple practice done
for about 15 minutes, where subjects were asked to
just sit quietly eyes closed and do what is sort of akin to meditation, but to not direct their mind into any particular state or place, but simply to think about their breathing and to focus on their
so-called interoception, focus on how their body feels, their mind drifted to bring it back, okay? So it's basically meditation
for about 15 minutes. That might not seem like a
significant or unusual practice or that it would have any impact at all. But remarkably, just doing
that once for 17 minutes, significantly reduced the
number of attentional blinks that people would carry out. In other words, their focus got better in a near permanent way without
any additional training. There's something about that
practice of reducing the amount of visual information coming in and learning to pay attention
to one's internal state, what we call interoception
that allow them an awareness, such that when they needed
to look for visual targets, when they need to focus on
multiple things in sequence, they didn't experience the same number of attentional blinks and I should mention not
incidentally as people age and their working memory gets worse and their ability to focus gets worse, the number of attentional blinks that they carry out goes up, and there are now studies
exploring whether or not the simple meditation like
practice of 15 to 20 minutes or so of sitting and just quietly resting and paying attention to one's breathing and internal state can
also offset some of that age-related what is
called cognitive decline. So what these data tell me is that regardless of whether
or not you're a child or you're an adult, whether or not you have ADHD or not, whether or not you're experiencing age-related cognitive decline, or you would simply like to avoid age-related cognitive decline, a simple practice of taking 17 minutes sitting and paying attention
to your internal state, just interocepting,
registering your breathing, registering the contact of your skin with whatever surface you're on, can forever rewire your brain
to be able to attend better and possibly even offset some of that age related
attentional drift. Now, I don't expect anyone to
start meditating regularly. I don't expect anyone to do
anything they don't want to do, but I think most of us could handle one meditation's session
of 17 minutes or so and so if ever there was a
tool that stood to rewire our attentional circuitry
in a powerful way. This seems to be it and in addition, the ability
to engage in panoramic vision, to dilate our gaze, the so-called open monitoring
that allows the brain to function in a way that it can detect more
information faster, that's a powerful tool as well and the beauty of that tool is
that it works the first time and it works every time. Now, how exactly it works
is a little bit unclear. Is it for instance, orchestrating this synchrony or asynchrony between the default mode network and the task related
networks we don't know. Those studies have not
yet been carried out. Nonetheless, the effects are significant, they are long lasting
and they appear to exist after just one session of this quiet 17 minute interoception, which to me makes it seem like a very worthwhile thing
to do for everybody. So we just talked about
attentional blinks, which are essentially blinks of thinking it's your mind shutting off for a moment and missing information. Now let's talk about actual blinks, the sort that you do with your eyelids. Now, this might come
across as somewhat obvious, but you can do fast, what
are called spontaneous blinks and they're always coordinated
between the two eyes or you can do long blinks like when you go to sleep at night, you do one very long blink,
and I'm not being facetious. When you go to sleep at night, you are shutting your eyelids and you are limiting the
amount of information coming in and your perception of
time starts to drift as you go into sleep. Your perception of time
changes from very fast, at one moment to very slow
meaning the frame rate at which you are analyzing
information dreaming, et cetera, is variable when you were in sleep, sometimes it's very fast. Meaning you experienced
things in slow motion. Sometimes it's very fast. In waking to your experience of time can sometimes be very fast
sometimes be very slow. Typically the more alert you
are, the higher the frame rate, your thin slicing your experience. You've probably had this happen. If you're ever very stressed and you're waiting for
something or somebody, it seems like it takes forever because your frame rate is higher you're analyzing time more finely. Conversely, if you are very
relaxed or even sleepy, you wake up and you have to think of all the things you have to do. It will seem like the world
is going by very, very fast and that you are moving very slow. Time is going at the same rate, but your perception of
time is what's changed. Believe it or not. Your perception of time is
also changed on a rapid basis. Moment to moment basis
by how often you blink. This is a well-established literature in the world of neuroscience
that unlike the literature and claims about blinking and sociopathy, which have no basis, the science of blinking as
it relates to time perception has some very good data to support it. I want to just emphasize
one study in particular, which is quite appropriately titled, "Time dilates after spontaneous blinking." This is a paper that was
published in current biology. The first author is
Terhune, T-E-R-H-U-N-E. It's a wonderful paper. They examine the relationship
between fluctuations in timing and blinking and to
make a long story short what they found is that
right after blinks, we reset our perception of time, okay? So blinks in that sense
are a little bit like the curtain coming down on a scene between scenes in a play or takes in a movie, and
they clap the clap thing, they started take in our,
what do they say, action and then at the end they do the
thing and they click it down and they say, it's a take that's one take when you blink it's a take, okay? Now what's interesting and will immediately make
sense to you as to why this is important is
that the rate of blinking is controlled by dopamine. So what this means is that dopamine is controlling attention. Blinks relate to attention and focus, and therefore the dopamine
and blinking system is one way that you constantly modulate and update your perception of time and fortunately, it's also
one that you can control. So the basic takeaway of
this study was that blinking controls time perception, but also that levels of dopamine can alter your sense of
time and stay with me here, and that blinking and dopamine
are inextricably linked. They are working together
to control your attention. When dopamine levels go up, people tend to overestimate
how long something lasted, why? Because they are
processing time more finely it's slow motion mode. When dopamine levels are lower, they tend to underestimate time intervals. Let's remember back to the
very beginning of the episode, what's going on in people with ADHD, they are not good at managing their time, they tend to run late,
or they are disorganized. They are not just disorganized in space, meaning in that physical
space, around them, they're disorganized in time. Their dopamine is low,
we know that as well and so they are
underestimating time intervals and so it makes perfect sense
that they would be late. It makes perfect sense that
they would lose track of time or the ability to focus. This is really exciting
because what it means is that children with ADHD, adults, with ADHD or people with normal levels of focus that want to improve
their ability to focus can do so through a training that involves learning how often to blink and when, and how to keep their visual
focus on a given target and it turns out this study
has actually been done. There's a study again,
I'll link to the study, entitled "Improvement of attention in elementary school students through fixation focused
training activity." I won't go through all the details, but what they found was a short period of focusing on a visual target, allowed the school
children to greatly enhance their ability to focus on
other types of information and a significant component
of the effect was due to the way that they were
controlling the shutters on their eyes, their eyelids,
and controlling their blinks. So what they did in this
study is they had these kids focus their visual attention on some object that was relatively close, like their hand for a minute or so, which actually takes some
effort if you try and do that, they were allowed to blink. However, it's known from other work that if people can consciously
override the desire to blink, at least to the point where
they feel like they have to, or else their eyes were dry out, that actually can increase
attention even further and they had conditions where
they would look at a point further across the room and
even further across the room. It only took a few minutes
each day to do this 30 seconds in one
condition, or maybe a minute and then at another station of looking a little bit further out and a little bit further out, however, there was an important
feature of this study that is definitely worth mentioning, which is before they did this visual focus, task or training, they did a series of physical
movements with the kids so that the kids could sort
of eliminate or move out some of their desire to move and would thereby enhance
their ability to sit still. Now it's long been known
that kids need a recess, they need time to run around
and play and roll around, do whatever it is that they do in order to be able to sit still at all. Adults probably need this too, frankly, but kids need it more because
the circuits in the brain that control reflexive
movements and as we say, kind of rhythmic undulating
behavior and things like that, that's an active suppression and kids have less of
that circuitry built up until they hit about age 15 or 16. So they had the kids move around a bit and then do this focus training. That brings me to another treatment that's actively used nowadays
in schools for kids with ADHD, but also is starting
to be used by many kids and by parents in order to
keep their kids focusing and not going crazy in the car
or not acting out in general and that's the prevalence of
these so-called fidgeter toys or things that kids can do actively and repetitively in order to move out some of their underlying
reverberatory activity in their nervous system. So what you will find is
that some kids with ADHD are now given a rubber band on their desk, literally a rubber band
that's attached to their desk and they're able to pull on it, even snap it against the desk, if I had done that when I was a kid, I think my teachers were
throw me out of class, but I think it's great
that they're allowing them to do this now as a way of moving some of their physical energy out or engage their physical energy, rather, as opposed to trying to sit statue still all the time and attend and it turns out that does
enhance these children's ability to focus mentally when they
have some physical activity to attend to and it turns out
it also can work for adults. I'll share with you I related anecdote because it illustrates
the underlying mechanism. I've had the great privilege
of being able to do a number of surgeries, brain surgeries
during my career. So one thing you find when
you do brain surgeries, is that the brain's pretty small regardless of the species
that you're working on and you're in there
and you're trying to do something very specific
and the more you try and hold your hands really steady, the more they want to shake, all right? So it's not natural for any of our limbs to sit perfectly still, depending on how much coffee you had, how well rested you are and your sort of baseline
level of autonomic arousal. Some of you may find that
you can hold out your hand, absolutely rock solid, others
will shake a little bit more. It doesn't mean you're if you're shaking, doesn't mean you're calm if you're still. What it relates to is the amount of what we
call premotor activity, the number of commands to move that are being sent through the system and that's what I mean
by reverberatory activity and it does seem that kids
with ADHD and adults with ADHD have a lot of reverberatory activity in their nervous system and so that's that constant desire to move it's hard for them to sit still and therefore it's hard
for them to attend, to harness their attention. When you do a surgery and you find that your hands are shaking, what you learn from your mentors, which I did and what works extremely well, whether or not you're
doing a surgery or not, is that you simply tap your foot or you bounce your knee a little bit, which you might think would
make your hand shake even more, but provided that it's subtle. What it does is it actually
shuttle some of the activity from those premotor circuits
to elsewhere in the body and then you're able to sit
much more still with your hand, you're able to perform the
surgery with much more precision. You are able to write with
much better handwriting and for those of you who
engage in public speaking, if you ever too nervous, that's why pacing while
you public speak helps if you're nervous, that's why bouncing your
knee behind the podium works as well. That's why nodding your head
and gesticulating can help. It's not a matter of, "Moving energy out of the body." That doesn't actually happen, what it is you're engaging
those premotor circuits that are sending through commands. It's like trying to stuff, a bunch of stuff through a funnel, and it creates this tension, so you're giving it an outlet
for the neural circuitry to be able to move something so that you can keep other
components of your body and your mental attention engaged and locked onto something
what we call focus. One thing related to this
whole business of blinking and focus and training yourself to focus and not blinking, et cetera,
is that most all of the drugs, Ritalin, Adderall, and recreational drugs that increase dopamine, even coffee and tea and
other forms of caffeine, they tend to make us blink less and when we get tired,
we tend to blink more. Now this is sort of a duh, right? But being wide-eyed
with excitement or fear or with your eyes, barely
being able to keep them open, now it should make perfect
sense that these shutters on the front of your eyes, they aren't just there for winking and they aren't just there
for cosmetic purposes. They are there to regulate
the amount of information going into your nervous system and they're there to regulate how long you are bringing information
into your nervous system and in what bins, how widely or finely you are binning time is
set by how often you blink and how widely or specifically you are grabbing attention
from the visual world is set by whether or not you're
viewing things very specifically like a cross area through a
soda straw view like this, or whether or not you
were in this panoramic sort of whole environment mode, this kind of fisheye lens
or wide angle lens mode and in fairness to the
pharmacology and the circuitry, while dopamine and heightened
levels of alertness and excitement tend to make
us blink less and attend more. There's actually a study that's looked at the other neurochemical systems and drugs and how those relate to blinking and so this will all be obvious
by the title of the paper I'm about to share with you. This is a paper entitled, "Decreased spontaneous eyeblink rates in chronic cannabis users, evidence for stride or cannabinoid,
dopamine interactions." Okay, I'm not going to go
into all the details here, but one thing that is
somewhat surprising is that many people with ADHD
use or abuse cannabis, you might think, well,
why would they do that? Because I thought that
a increase in dopamine is actually what's going to lead to heightened levels of attention and that's what these
people in children crave. Well, it turns out that cannabis also increases dopamine
transmission in the brain, but because of the other chemicals, it increases namely serotonin and some components of the
cannabinoid and opioid system, it creates that kind of
alert, but mellow feel and again, here I'm not
a proponent of this, I personally am not a
THC or cannabis user. It's just not my thing and obviously it's illegal some places and so you have to
determine that for yourself it does have medical purposes
in some places it is legal, but THC increases dopamine
and increases neurochemicals that can also create a state of calm. So it's that sort of middle ground and this paper has a
beautiful demonstration whereby not just while
people are using cannabis, but depending on how
long they've been using cannabis across their lifespan, the rates of eye blinking change. So if you look at the number of years that people have been using
cannabis on a regular basis, either daily or up to excuse
me, weekly, or up to daily, what you find is that for people that have not been using cannabis at all, or have only been using
it for about two years, their rates of eye blinks are much higher than people who've been using
it chronically for 10 years. In other words, people who may be using cannabis for 10 years, don't blink very often at all. Now cannabis has well known
effects in depleting memory, but it does seem to engage the focus and blinking system in a
way that increases focus. So basically what I'm saying is marijuana seems to
increase people's focus, but then they can't remember
what they were focusing on. Something I'd like to discuss
just briefly is the so-called interoceptive awareness that's
present in people with ADHD, both children and adults. Interoceptive awareness is one sense of one's own internal state heartbeat, breathing contact of skin with
a given surface, et cetera. For a long time, there
was this hypothesis, this idea that people with ADHD, were just not in touch with how they felt that somehow they weren't registering all the stuff that was
going on inside them changes in heart rate and so forth and so they were behaving in a way that was dysregulated
or appear dysregulated, and that if they could
just learn to attend to their internal state better, that somehow they would
function better in the world. Now, before we described a process, literally a 17 minute
interoceptive exercise that does seem to lead to improvements in one's ability to focus
for a longer period of time. However, it's very unlikely
that that was due to increasing interoceptive awareness per se. It probably wasn't because
people gain a much heightened or improved ability to understand what's going on internally. In fact, you can imagine
how that might actually prevent one's ability to
pay attention to things in the outside world. So while there is benefit
to just sitting there and being in stillness, as they say, or focusing on one's
breathing and internal state for sake of then accessing information in the external world, a really nice study called
interoceptive awareness and attention deficit
hyperactivity disorder explored whether or not
interoceptive awareness was different in people with
ADHD or did not have ADHD and the findings were essentially
that there's no difference that people with ADHD,
children, and adults, they are aware of what's
going on inside them just as much as anyone else's and the typical measure
of interoceptive awareness is one's ability to count
their own heartbeats. This is actually challenging
for some individuals and very easy for other individuals, regardless of their attentional capacity. Some people just can
really feel their heartbeat without taking their
pulse other people cannot and these studies are pretty
straightforward to do. You ask people to sit there
and to count their heartbeats, and then you are
monitoring their heartbeats and you get to gauge
how accurate they are. So it's important to understand
that people with ADHD are in touch with how they feel. It's really a question of whether or not they can take the demands
that are placed upon them and enter a cognitive
state of mental state that allows them to access the information they need to access in other words, whether
or not they can focus, but it is absolutely wrong to think that the child that's getting
up 11 times during a short six minute interaction at the table, or whether or not a child who somehow has to venture off every moment or a coworker of yours who's an adult who's constantly fidgeting or moving things around that
somehow they are unaware that they are oblivious, they're not oblivious to how they feel. Chances are they're very
challenged in the situations that they're in and they're doing
everything they can to try and regulate their attention. So I think it's an
important study to highlight because it really
underscores the fact that something else is going on and that something else
has everything to do with this ability to coordinate these tasks directed networks, and to coordinate that in the proper way with that default mode network and that is a process as you now know, that's regulated exquisitely
by certain neurochemicals and in particular the
neurochemicals, dopamine, norepinephrine and serotonin, and a fourth one I'd like
to throw into the mix, which is acetylcholine, which is very vital for cognitive focus. So now I want to switch
back to talking about some of the drugs that are typically used to access those systems,
prescription drugs and I want to talk about
some of the new and emerging non-prescription approaches to increasing the levels of dopamine, acetylcholine and serotonin in the brain using various supplement type compounds, because several of them are showing really remarkable efficacy in excellent peer reviewed studies. So before moving to some of
the newer atypical compounds and things sold over the counter, I'd like to just briefly
return to the classic drugs that are used to treat ADHD. These are the ones I mentioned earlier, methylphenidate also called Ritalin, Modafinil or armodafinil is
another one and Adderall, again, all of these work by increasing levels of
dopamine and norepinephrine. Typically they're taken
orally in pill form, or sometimes in capsule form the dosages that are appropriate vary, according to severity of the condition for a given person and
the age of the person. This is a complicated
landscape for each individual. They have to figure out the pharmacology that's best for them. Some individuals are even layering long or time to release Ritalin
with Adderall in smaller doses, it can get quite complex or it
can be quite straightforward if you are really
interested in these drugs and how they work and you'd like to get a glance
at a table of all the results from all the studies of
which there are now hundreds, there's an excellent review
about these drugs and their use and their comparison to
similarly structured drugs in particular MDMA and
cocaine and amphetamine, meaning Street Amphetamine to really illustrate the similarities of action and some of
the problems associated with long-term use. I don't expect you to
read this article in full I'm here so that you don't
have to go read these articles, but in case you want a ton of information, the paper is Esposito et al
Frontiers and bio-sciences, it's an excellent, excellent review of the entire literature. It is quite long. I can put a link to that
study in our caption, and it essentially
describes all the studies that have been done, peer
reviewed and published, and it refers to these
drugs in an interesting way. It doesn't just refer these
drugs as for treatment of ADHD. It actually refers to them
using language that ordinarily I'm not very fond of,
but I'll agree to here, which is so-called smart
drugs or nootropics. It also covers caffeine, which
again as I mentioned earlier, increases dopamine norepinephrine and to some extent serotonin, but what I like about this
review so much is that in putting, these drugs of abuse, methamphetamine, and cocaine,
right alongside these drugs, like Ritalin and Adderall
and also caffeine, we start to realize that
the distinction between drugs of abuse and the distinction
between drugs of treatment is actually a very fine and
sometimes even a blurry line and in thinking about whether
or not one wants to use these prescription, I want
to emphasize prescription, not drugs of abuse, but prescription drugs for treatment of one's
own attentional capacity. I think it is important to understand the extent to which they all carry more or less the same side effects. The one exception being
caffeine caffeine side effects can be anxiety if you ingest
too much of it, insomnia, if you drink it too late in the day, but typically it will not
cause the major side effects of the other drugs, such as high propensity
for addiction and abuse. Amphetamines of any
kind as well as cocaine can cause sexual side effects because they're vasoconstrictors. So, men have trouble achieving erection, there can often be the intense
desire or libido for sex, but an inability to actually perform. So that's an issue with
any kind of stimulant. So these drugs are not
without their consequences. In addition, and here I'd lump
caffeine back into the mix. In addition, they almost all
carry cardiac effects, right? They increase heart rate, but they also have effects on
constriction of blood vessels and arteries and veins
and so forth in ways that can create cardiovascular problems. Now, caffeine is a bit
of a complicated one. I talked about this on a podcast long ago, but I'll just remind you that it turns out that if you are caffeine
adapted, in other words, if you are used to drinking caffeine then the ingestion of caffeine, most often will cause vasodilation
who actually allow more blood flow through. However, if you are not caffeine adapted, it will cause vasoconstriction due to an increased stress response. So if you're familiar with caffeine, caffeine can actually
have a little bit more of a relaxation response although if you drink enough of it, it will make you amped up. These other drugs, almost
always lead to vasoconstriction, increased heart rate dilation
of the pupils, less blinking, heightened levels of attention, which looks very much like stress and at its extremes looks very much like the effects of street drugs, like cocaine and amphetamine. Because of the large amounts of dopamine that released in the brain. People tend to crave
that state over and over and yet with each subsequent use are able to get less and less of that euphoric feeling or that really, really focused feeling. So one thing that's being
explored quite extensively now in the treatment of
ADHD are drug schedules. Whether or not people should
take Adderall every day or every other day, whether or not they should take it only every once in a while, whether or not young children
can take it just a few times and engage in behavioral
training of the sort that I talked about before,
where they're doing, maybe it's a 17 minute
meditation type exercise, but more likely it would be the movement followed by the visual focusing, cause that's only done for
20 or 30 or 60 seconds. Why would you do that? Well in a chemically enhanced state, your brain is more plastic. The circuits are able to
modify and learn better. That's the optimal time to engage in focus in a very deliberate way. So just taking a drug and expecting focus to just work at any point and being able to turn
focus on and off at will, that's an unrealistic expectation, right? More likely the best use of
things like Adderall, Modafinil, armodafinil and Ritalin is going to be to combine those treatments
with behavioral exercises that actively engage the very circuits that you're trying to train up and enhance and then perhaps I want
to highlight perhaps tapering off those drugs so that then one can use those circuits without any need for
chemical intervention. So despite any controversy
that might be out there, I think it's fair to say that the consumption of omega-3 fatty acids can positively modulate the systems for attention and focus. So then the question becomes how much EPA, how much DHA does that differ for, what's helpful for depression, et cetera and actually it does differ in reviewing the studies for this it appears that a threshold
level of 300 milligrams of DHA turns out to be an
important inflection point. So typically fish oils or
other sources of omega-3s will have DHA and EPA and typically it's the EPA that's harder to get at sufficient levels, meaning you have to take
quite a lot of fish oil in order to get above that 1000 milligram or 2000 milligram
threshold to improve mood and other functions. But for sake of attention, there are 10 studies that
have explored this in detail and while the EPA component is important, the most convincing studies
point to the fact that getting above 300 milligrams per day
of DHA is really where you start to see the attentional effects. Now, fortunately, if you're
getting sufficient EPA for sake of mood and other
biological functions, almost without question, you're getting 300
milligrams or more of DHA. So that usually checks that box just fine. What's interesting is that
there's another compound phosphatidylserine that has
been explored for its capacity to improve the symptoms of ADHD. Again, I don't think
this is any direct way, but rather in a modulatory way, but it appears that phosphatidylserine taken for two months for
200 milligrams per day, was able to reduce the
symptoms of ADHD in children. It has not been looked
at in adults yet as, at least as far as I know, but that this effect was greatly enhanced by the consumption of omega-3 fatty acids. So now we're starting to
see synergistic effects of omega-3 fatty acids
and phosphatidylserine again that was 200 milligrams per day. This is something that sold over the counter in capsule
form, at least in the U.S. there were two studies, both were double-blind studies. I carried out for anywhere
from one to six months on both boys and girls and it
really was boys and girls, not men and women. This was kids age one
to six or seven to 12, and it was a fairly
large number of subjects. So 147 subjects in one
case in 36 in the other, the takeaway is that getting
sufficient levels of EPA and particularly there's 300
milligram threshold of DHA, plus, if you are interested
in it and it's right for you, 200 milligrams of phosphatidylserine can be an important augment for improving the symptoms of ADHD. You'll also find literature out there and many claims about
so-called Ginkgo Biloba, which has been shown to have minor effects in improving the symptoms of ADHD, not nearly as effective
as Ritalin and Adderall. Ginkgo Biloba is not
appropriate for many people. I am one such person, I don't have ADHD, but when I'd taken Gingko,
even at very low doses, I get absolutely splitting headaches. Some people do not
experience those headaches, but it's known to have very
potent vasoconstrictive and vasodilating properties
that vary depending on when you took the compound. So for those of you that
are exploring Ginkgo Biloba, and you will see a lot of
claims about Ginkgo Biloba for attention in ADHD
definitely take the vasodilation vasoconstriction headache
issue into consideration. So I'd like to talk
about the drug Modafinil and the closely related drug armodafinil that's AR Modafinil. Because Modafinil and armodafinil are gaining popularity out there, both for treatment of ADHD and narcolepsy, but also for communities of people that are trying to stay
awake long periods of time. So it's actively used in the
military by first responders, it's gaining popularity
on college campuses and people are using it more
and more as an alternative to Adderall and Ritalin and
excessive amounts of coffee. It does increase focus
and to a dramatic extent, Modafinil typically was very expensive, I don't know if it's still this expensive, but when one has a prescription for it, it could still cost as
much as eight or $900 even $1000 a month. Armodafinil is a far
less expensive version, that's chemically slightly
different than Modafinil. Regardless of price people are taking
Modafinil and armodafinil. Want to emphasize that
unlike Ritalin and Adderall, Modafinil and armodafinil
are weak dopamine re-uptake inhibitors, and that's how they lead
to increases in dopamine. So, whereas Ritalin and
Adderall, amphetamine, and cocaine lead to big
increases in dopamine also through re-uptake
mechanisms and so forth Modafinil is a weaker
dopamine re-uptake stimulator and so what that means is that it leaves more dopamine around to
be active at the synopsis, the gaps between neurons, however, it also activates other systems. It acts on the orexin system, which is actually a peptide
that we talked about in the episode on hunger, because it regulates hunger and appetite, and it regulates sleepiness
and feelings of sleepiness. In fact, the, excuse me, orexin also called hypocretin system, the orexin hypocretin system is what's disrupted in narcolepsy. That was the important
discovery of my colleagues, Emmanuel Mignot and Seiji Nishino at Stanford some years ago, they identified the
biological basis of narcolepsy and it's a disruption in the
so orexin hypocretin system and Modafinil is one of the primary treatments for narcolepsy. It also has these other
effects on the dopamine system and on the norepinephrine system, even though it doesn't lead
to quite as intense levels of dopamine and arousal and focus, it does have the property of
raising levels of attention and focus, and that's
why people are using it. So it's a somewhat
milder form of Adderall. Armodafinil for some people
works as well as Modafinil and as I mentioned before, it's much lower cost for
other people it doesn't. I have an experience, meaning I do have an experience that I'll share with you with armodafinil. A few years ago, I was suffering from
jet lag, really terribly and I was traveling overseas. I went to a meeting to give a talk, I took half of the prescribed
dose of armodafinil. It was prescribed to me. I took that half dose
and I gave my lecture and then I stayed around
to answer questions and then four hours later, a friend of mine came up to me and said, you've been talking for
four and a half hours, and they're only a few people still here. Luckily there were still a
few people be a lot weirder, if the room was completely empty, 'cause it wasn't being recorded. So I have firsthand knowledge of the sorts of cognitive
effects that it can create. I personally would not
want to be in that state for sake of studying or learning or for doing this podcast, for instance and I can honestly say that today, all I've adjusted is some coffee and some Yerba latte tea and some water. I'm not on any of the compounds
that I've described during the course of today's episode. You might ask why I took
half the recommended dose of armodafinil and the reason
is that I'm somebody who's fairly hypersensitive to
medication of any kind, what you find if you
look in the literature, is that about 5% of people are hyper hyper sensitive to medication. They require far lower
doses of any medication than other people in order to
experience the same effects. I'm somebody that I think has, or modest a hyper if that
sort of oxymoronic statement, but a modest hypersensitivity
to medication. So I've almost always been able to get by, on taking less of whatever
was prescribed for me and feel just fine or in this case to feel
like it was still too much, it turned out that the right
dose of armodafinil for me was zero milligrams. Now you may notice that I haven't talked much about acetylcholine. Acetylcholine is a neurotransmitter that at the neuron to muscle connections, the so called neuromuscular junctions is involved in generating
muscular contractions of all kinds for all movements. Acetylcholine is also released
from two sites in the brain. So a little bit of
nomenclature here again, feel free to ignore the nomenclature, but there is a collection of
neurons in your brain stem that send projections forward, kind of like a sprinkler system that's very diffuse to
release acetylcholine and those neurons reside
in an area or a structure that's called the
pedunculopontine nucleus, the PPN and then there's a separate
collection of neurons in the basal forebrain called unimaginatively nucleus
basalis the nucleus at the base and they also hose the
brain with acetylcholine, but in a much more specific way. So one is sort of like a sprinkler system and the other one is more like a fire hose to a particular location and those two sources of acetylcholine, collaborate to activate
particular locations in the brain, and really bring about a
tremendous degree of focus to whatever is happening at
those particular synapses. So it could be a focus
on visual information or auditory information, if you're listening closely
to what I'm saying right now, and you just heard closely step out from the rest of my sentence, no doubt there was acetylcholine released at the sites in your brain where the neurons that
represent your recognition of the word closely occurred, okay? So now you have an example
and you have an understanding and hopefully a picture in your mind of how all this is working, not surprisingly then drugs
that increase cholinergic or acetycholine transmission will increase focus and cognition. One such compound is so-called alpha GPC, which is a form of choline
and increases acetycholine transmission dosages as high
as 1200 milligrams per day, which has a very high dosage spread out, typically it's 300 or
400 milligrams spread out throughout the day have
been shown to offset some of the effects of
age-related cognitive decline, improved cognitive functioning people that don't have
age-related cognitive decline that's a very high dose. Typically when people are
using alpha-GPC to study or to enhance learning of any kind, they will take somewhere
between 300 and 600 milligrams that's more typical. Again, you have to check with your doctor, you have to decide if the safety margins are appropriate for you obviously you'll want to check that out, but alpha-GPC is effective in creating more focused by way of
this cholinergic system, It stimulates acetylcholine release from both of those locations, the PPN in the back of the
brain and nucleus basalis in the front of the brain. There are two other over
the counter compounds that are in active use out
there for treatment of ADHD and in use for simply
trying to improve focus and the first one is L-Tyrosine it's an amino acid that
acts as a precursor to the neuromodulator dopamine and now knowing everything you know about dopamine, attention and
the circuits involved, it should come as no surprise as to why people are exploring the use
of L-tyrosine for that purpose. L-tyrosine does lead to
increases in dopamine. They are fairly long lived
and L-tyrosine can improve one's ability to focus, however, the dosaging can be
very tricky to dial in. Sometimes it makes
people feel too euphoric or too jittery or too
alert that they are then unable to focus well. So the dosage ranges are huge, you see evidence for 100 milligrams all the way up to 1200 milligrams. It's something that really should be approached with caution, especially for people that have any kind of underlying psychiatric
or mood disorder, because dysregulation of
the dopamine system is central to many of the mood
disorders such as depression, but also especially
mania bipolar disorder, schizophrenia, things of that sort. So it's something that
really should be approached with caution, nonetheless,
in exploring what's out there and even some studies online that were done in either animal
studies or human studies, it's clear that L-tyrosine
is being explored for that purpose as is PEA and Phenethylamine, which is a essentially PEA,
but some related compounds. So there's a whole class of dopaminergic or dopamine stimulating supplements that people are using to try and get their dopamine
levels up and again, it's kind of a fine line
between too little enough and too much. If you want to get the literature on those two compounds
there, I will refer you to this great website at
examine.com just as it sounds and you can put in L-tyrosine or PEA, and you can get the details on that. But I highly recommend also
going to their section on ADHD to see how those particular
comment OENs relate specifically to ADHD and cognitive focus. And last but not least in terms of these different compounds, I do want to mention the Racetams. These are somewhat esoteric and probably most of you
haven't heard about them, but some of you probably
know a lot about them and they are becoming more popular. They go by names like New
pepped and things of that sort. The Racetams. are illegal
in certain countries. They are gray market in other countries, and they are sold over the
counter in this country, in the U.S. so they have
different margins for safety you definitely need to
consult your doctor, especially if you have ADHD, but new pepped has been shown when taken, at 10 milligrams, twice
daily can be more effective than some of the other Racetams. What is Noopept? Noopept taps
into the cholinergic system, the acetylcholine system in
ways, very similar to alpha-GPC, but seems to have a slightly
higher affinity for some of the receptors involved and can
lead to those heightened states of cognitive capacity and there are these
studies one in particular, comparative studies of new pepped, Racetams in the treatment of patients with mild cognitive disorders and brain diseases of
vascular and traumatic origin. That's a mouthful. What this study basically points to is the fact that people who
are experiencing some degree of inability to focus
due to prior concussion or some vascular event, a
stroke or a schemey of any kind, because neurons need blood, when the blood supply
is cut off to neurons, or when there's a bleed in the brain. Subsequent to that, often there are challenges in maintaining focus. This is very common for
people who have done sports, where there's a lot of
running into each other with your head like rugby
football, hockey, and so forth, but also people who have
experienced head blows or often overlooked is the fact that most traumatic head injury
is not actually from sports, even football it's from
things like construction work from high-impact work of that kind. So there does seem to be some efficacy of new Pepped and Racetams.
and things like it. It's an emerging area and
as I mentioned in the U.S. these things are sold over the counter. Again, you have to figure
out if it's right for you, but they are beginning
to show some promise, and I'm intrigued by
them because of the way that they tap into the cholinergic system, which is both directly involved in focus, and the ability to focus, but is also important for things related to age-related cognitive decline. So a decline in cholinergic
transmission or acetylcholine as we call it in the
brain is one of the things associated with cognitive decline and it does seem that increasing
cholinergic transmission can offset some of that cognitive decline and perhaps even more so in conditions such as vascular damage or
concussion to the brain. If you're interested in
atypical treatments for ADHD compounds or improve
focus and related themes, and you like reading about this stuff, there's an excellent review article that I can refer you to it's by Ahn et al, AHN it was published in 2016 so it's a little bit behind the times, although it's surprisingly
comprehensive given that, which lines up all the various
drugs that I've discussed, Racetams., and Adderall and Ritalin, and various forms of dopaminergic agents and cholinergic agents
spells out whether or not they are sold over the
counter by prescription, and really lines them
up in all their effects, their drawbacks, et cetera. I'll refer you to that study. It's available in its full
length form online for free it's Hen et al the journal
is neuro plasticity, neural plasticity, 2016 should be very easy to find
if you put those keywords in, and while it is a review, it is a very comprehensive review and if you're really into this stuff, and you also want to
learn a thing or two about how these things interact
with neurofeedback, et cetera, there's some information in there as well. I know I've already covered
a lot of information, but there is one more
category of technology for the treatment of ADHD
and for enhancement of focus in anyone that I would like to emphasize and that's transcranial
magnetic stimulation. Transcranial magnetic
stimulation also called TMS is achieving increasing
popularity nowadays for the treatment of all
sorts of neurologic conditions and psychiatric conditions. It is a non-invasive tool, it involves taking a coil
it's a device with a coil that's placed over particular
locations in the brain, and then sends magnetic
stimulation into the brain and it can actually pass through the skull without having to drill through the skull and nowadays can be used to both lower the amount of activity or increase the amount of activity in specific brain areas. It's spatial, precision is not remarkable. That doesn't mean it's not of use, but it is not a super
fine green tool, okay? It's not a canon, but
it's also not a needle. It is somewhere in between. It can direct the activity
of particular brain regions at particular depths and as I mentioned, it can increase or decrease that activity. So for instance, I've had a TMS coil placed on my head, not for therapeutic purposes, even it was, I wouldn't tell you, but rather just for, well, I'm a neuroscientist and I worked in a lab with
one for entertainment, exploratory purposes, please
don't do this at home. It was placed over my motor cortex, which generates voluntary action and it was a coil that at that time could only inhibit neurons and so what I was doing
as I was moving objects around on a table, just like I am now, it was actually a pencil, not a pen and I was tapping the pencil and then the TMS coil was turned
on and for the life of me, I could not move that pencil, okay? Because it was inhibiting
my upper motor neurons in the portion of my cortex that controls voluntary activity. As soon as the coil was turned off, I could return to
tapping the pencil again, nowadays it's possible
to stimulate motor cortex or any area of the brain
with some degree of precision that could create the impulse to move without actually making
the decision to move. So you can literally engage
certain neural circuits and therefore behaviors
and certain thought and emotional patterns by way of transcranial
magnetic stimulation. This has far reaching
and vast implications, as you can probably imagine in discussing ADHD with a
colleague that uses TMS, what they are doing is they
are taking the TMS coil to children and adults that have ADHD, and they're using it to
stimulate the portions of the prefrontal cortex
that we talked about earlier that engage task directed focused states. So rather than using a drug that generally increases dopamine, and some of the other chemicals involved there you using directed TMS
stimulation of the circuits and fortunately, I was
quite relieved to hear this, they are combining that with
a focused learning task. So they're literally
teaching the brain to learn in a noninvasive way, no drug at all and right now there are
experiments clinical trials going on, comparing TMS of this sort to the drug treatments of the
sort that we described earlier that engaged these circuits through pharmacologic mechanisms. So very exciting times for TMS, very exciting times for
pharmacology related to ADHD and for enhancing focus in general and when I say very exciting times, I mean, no drug is perfect, but the constellation of
drugs that's out there is getting much larger, but because they tap
into different aspects of their circuitry, I do think that we are well on our way to identifying the ideal
combinations of drug treatments, technological treatments, and behavioral paradigms
for increasing focus in both children and adults with ADHD. And as a final final point, I also want to mention
something about technologies that are making it harder
for all of us to focus, regardless of whether or not we have pre-existing ADHD or not. You can probably guess
where this is going. Everybody nowadays seems
to have a smartphone. I'm sure there are a few
individuals out there that don't have a smartphone. Nonetheless, most people have them. Most kids want one, as
soon as they can get them and they are small, they
grab our attention entirely. But within that small box of attention, there are millions of attentional windows scrolling by, right? So just because it's one
device that we look at does not mean that we are focused, we are focused on our phone, but because of the way, in which context switches
up so fast within the phone, it's thought that the
brain is struggling now to leave that rapid
turnover of context, right? Many, many shows, many,
many Instagram pages, many, many Twitter feeds
many, many websites. Basically the whole world, at least in virtual format is available within that small box. Unlike any other technology humans have ever dealt with before, even though there are trillions infinite number of bits of information in the actual physical world, your attentional window, that aperture of constriction and dilating that visual window is the way in which you cope with all that overwhelming information typically. Well within the phone, your visual aperture
is set to a given width it's about this big, typically the phone seem
to be getting bigger, but nonetheless, it's about that big and within there, your attentional window is
grabbing it near infinite number of bits of
information, colors, movies. If a picture is worth 1000 words, a movie is worth a billion pictures, the brain loves visual motion and so the question is, does that sort of interaction
on a regular basis lead to deficits in the types of attention that we need in order to perform well in work, in school,
relationships, et cetera and the short answer is
yes, it does appear so we are inducing a sort of ADHD and while the studies on this
are ongoing because prominent use of smartphones really
took off right around 2010 and we're only in 2021
longstanding studies take time, which is essentially to say the
same thing as long standing. There are some studies
and one in particular that I'd like to highlight one was actually carried
out pretty early in 2014. This is a study that
explored smartphone use at the time they called
it mobile phone use, but smartphone use and inattention, difficulties in attending
in 7,102 adolescents that's a huge study, a population based cross-sectional study and you will be probably
surprised and somewhat dismayed to hear that in order
to avoid this decrease in attentional capacity, adolescents needed to use their smartphone for less than 60 minutes per day, in order to stay focused and
centered on their other tasks. Otherwise they started to really run into significant issues. So 60 minutes is not much, I've a feeling that most young people are using their phone more
than 60 minutes per day, I know I am. I think for adults, the number's probably higher
meaning if you're an adult, I'm going to just extrapolate
from what I read in this study. It seems that probably two
hours a day on the phone would be the upper limit beyond which you would probably experience pretty severe attentional deficits. I'm a big fan of Cal Newport
who wrote the book "Deep work." He's also written an excellent book, "A world without Email." I've never met him, but I'm
a huge admirer of his work and I will paraphrase
something that he said far more eloquently than I ever could, which is that the brain does
not do well with constant context switching, meaning it can do it, but it diminishes our
capacity to do meaningful work of any other kind. And so Cal, as I understand is very he's our computer science professor at Georgetown, by the way, is very structured and very disciplined in his avoidance of cell phone use. I think we're all striving to do that. I'm not here to tell you what to do, but I think whether or
not you have ADHD or not, if you're an adolescent
limiting your smartphone use to 60 minutes per day or less and if you are an adult to
two hours per day or less is going to be among the
very best ways to maintain, just to maintain your ability to focus at whatever level you can
now and as I always say, most of the things that we get recognized for in life success in
life, in every endeavor, whether or not it's school
relationships, sport, creative works of any kind
are always proportional to the amount of focus that
we can bring that activity. It is important to rest of
course, to get proper sleep. But I stand behind that statement and I leave you with that
study about attention and cell phones and how cell
phones are indeed eroding our attentional capacities. So I realized I covered a
lot of information about ADHD and the biology of focus and
how to get better at focusing. We talked about the behavioral and psychological phenotypes of ADHD. We talked about the
underlying neural circuitry. We also talked about the neurochemistry and we talked about the
various prescription drug treatments that are
aimed at that neurochemistry and aimed at increasing focus in children and adults with ADHD. We also talked about over
the counter compounds, the role of particular types
of diets and elimination diets and we talked about interactions
between these various features in dictating outcomes for ADHD and enhancing focus in general, we also talked a little bit
about emerging neurotechnologies and how certain technologies
like the smartphone are no doubt hindering
our ability to focus and put us at greater risk of
developing ADHD at all ages. I do acknowledge the irony
and somewhat the contradiction of doing a two hour plus episode on ADHD If indeed, people who are watching this have challenges with attention, I want to emphasize that this podcast, like all of our podcast episodes are timestamped for a specific reason. They are designed to be digested in whatever batch one chooses, right? You don't have to watch or
listen to the entire thing all at once however, if you've gotten to this
point in the podcast, I want to thank you. I do hope that you've learned
a lot about this condition. I hope you've also learned a lot about your own capacity to focus and things that you can
do to enhance your focus. We even talked about
a tool that takes just one 17 minute session to
enhance your ability to focus thereafter, presumably forever. If you're enjoying this podcast
and you're learning from it, please subscribe to our YouTube channel that really helps us. In addition, in the
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we talked a lot about supplement based compounds. If you're interested in supplements and you want to see the
supplements that I personally take, you can go to Thorn that's
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supplements that Thorn makes, supplements aren't for everybody, you by no means have to take supplements. But if you are going to take supplements, it's important that you take supplements from a source that's reputable and which the ingredients
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My notes:
• Attention is perception.
• ADHD = poor impulse control.
• ADHD can have hyper focus on something they really enjoy.
• Challenges with time perception. often run late. Procrastinate. But if they are given a deadline, they can usually follow it very well. Especially with the consequences of missing it.
• Spatial organization is not good. pile system. tend to organizations using pile systems all the time and it doesn’t work for them.
• Trouble with working memory. ability to keep specific memory online so you can use it currently. Ex: someone gives you phone number and you have to remember it before you put it in your phone.
• Dopamine creates a heightened state of focus. puts us in a state of motivation and wanting something in our outside world.
• How we perceive the world. Dopamine when’s it’s released narrows our focus. Less dopamine, we tend to view the entire world.
• DOPAMINE enhances two neural circuits. Default mode network - active when we’re not doing anything.
• Other set of circuits is the task networks. Make you goal oriented.
• These two networks communicate. Even though they are very different.
• In a normal person, both are active at once.
• In Normal people default mode network is not synchronized.
• In ADHD these circuits are actually playing together but not correctly.
• dopamine acts as the conductor between these two circuits. When default mode is not active, it’s telling the task network to activate.
• In ADHD dopamine does not allow to conduct these networks… to be anti correlated. You don’t want both on at same time.
• Is there not enough dopamine? Or is the conductor just wrong.
• If dopamine levels are too low, it leads to unnecessary firing of neurons that are unrelated to the task at hand.
• This is like a band as if one or more of those instruments are playing notes when they shouldn’t be. When dopamine is too low, neurons are firing to much. This is the low dopamine hypothesis.
• ADHD patients tend to indulge in behaviors like drinking 6 cups of coffee, smoking half a pack of cigarettes, using cocaine, amphetamine. Increase levels of dopamine in brain, in particular, in parts of brain that regulate attention.
• Children with adhd will be calmed and focused by dopamine inducing elements like sugar and chocolate. Not from the sugar or actual nutrients, but by the dopamine that is released. Normal kids will go crazy and be bouncing off the walls.
• Ritalin, amphetamine, and modafinil all increase dopamine in task oriented circuits.
• Nearly identical to street drug stimulants.
• In one study, an elimination diet of eliminating allergy foods decreased adhd symptoms.
• Some experts believe to avoid simple sugars and foods that make symptoms worse.
• Attention is modulated by how well rested you are.
• Book recommendation: Altered Traits
• People with ADHD have more attentional blinks
• Attentional Blink (AB, or 'blink') is the phenomenon that the second of two targets cannot be detected or identified when it appears close in time to the first.
• So it isn't so much that ADHD can't focus, they are just focused on the wrong thing.
• What ADHD people need is "open monitoring." Associated people who meditate alot.
• We have two modes of focus. "Soda straw" focus. Tunnel vison. Tuning out other simuli.
• We also have panoramic vision. Dilating gaze to see the whole picture.
• 17 minutes of meditation achieves this.
• The rate of blinking is controlled by dopamine. Dopamine is controlling attention. Blinks relate to attention and focus. Therefore, the dopamine and blinking system is one way you constantly modulate perception of time. When blinking levels go up, people tend to overestimate how long something lasted. Because they are processing time more finally.
• When dopamine levels are lower, we tend to underestimate time intervals.
• This means people with ADHD can improve focus by using a training that involved learning how often to blink and when and how to keep their visual focus on a target.
• Focusing on a visual target helped school children focus on other visual targets after the fact.
He already did one episode before on focus and it was an absolute banger! Most people in this community would love it I think: https://www.youtube.com/watch?v=LG53Vxum0as
he's of the opinion that modafinil is unhealthy as its an 'indirect dopamine receptor agonist'. thoughts?
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As someone with ADHD I'd like to clarify a few things. He phrased being able to focus on things if we *really* cared or something like that. This makes it seem like we don't care about things, but a better way to phrase it is that we cannot force ourselves or fake caring. If I'm preoccupied with something that I care about, I'm going to have a really hard time focusing because 1. I am thinking about what I'm excited to think about and 2. Because if I stop thinking about it, I'll forget what mental progress I was making.
I'm just imagining someone as a parent yelling at their kid about how if they really cared then they would have ______
There were a few other things that I feel like he didn't get just right, but that was the main one. Other than that, I'd say that he really honed in on dopamine, but norepinephrine is also really important. He also kind of, but only barely explained that there are different dopamine receptors. So low dopamine is only part of the problem if you also have a low amount of receptors.
I love this series. Depression one was brilliant. Stuff on testosterone makes me wanna get on TRT haha. Im ADHD- PI, will listen the fuck out of this, thanks
I am a little bit bumped out that he didn't even mention NRI's like Atomoxetine (Strattera) for the treatment of ADHD symptoms.
I believe it is quite interesting and that it is also a "safer" and useful alternative.
This was a great session. I also wanted to share this book by Dr. Gabor Mate - which is really helpful in understanding the various dimensions of ADHD. https://drgabormate.com/book/scattered-minds/