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- 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
working on the visual system
and I can tell you that
there are many features
built into our visual system
that allows us to see things clearly,
whether or not we are in shade
or bright sunlight, et cetera.
A lot of sunglasses have the problem
that you have to constantly take them off
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Roka, sunglasses have solved this problem.
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One thing I like so much
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A lot of performance glasses,
they look kind of ridiculous, frankly,
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they have a lot of different styles,
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The company was founded by
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If you'd like to try Roca,
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Today's episode is also
brought to us by Belcampo.
Belcampo is a regenerative
farm in Northern California
that raises organic grass fed
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I tend to eat meat about once a day.
So typically I'll fast
until about noon or one
and then my lunch consists
of a small piece of steak
or chicken and some salad
and then I tend to eat my
carbohydrates in the evening
before I go to sleep.
Sometimes and especially
lately I'm eating my protein
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because I'm playing around
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For me, it's extremely important
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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.
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