Despite the many differences among children and adults with ADHD, there is one similarity shared by virtually all of them. Although they have considerable chronic difficulty in getting organized and getting started on many tasks, focusing their attention, sustaining their efforts, and utilizing their short-term working memory, all of those diagnosed with ADHD tend to have at least a few specific activities or tasks for which they have no difficulty in exercising these very same functions in a normal or an extraordinary way.
The inconsistency in motivation and performance is the most puzzling aspect of ADHD. It seems like the child or adult with the disorder who can show strong motivation and focus very well for some tasks should be able to do the same for most other tasks that they recognize as important. It appears as if this is a simple problem of lacking “willpower.” If you can do it for this, why can’t you do the same for that and that, which are even more important? However, ADHD is not a matter of willpower. It is a problem with the dynamics of the chemistry of the brain.
The most basic factor contributing to the ability of persons with ADHD to focus very well and efficiently utilize their executive functions on some tasks, while being chronically unable to focus adequately on most other tasks, is a problem of neural transmission. For many years, it has been recognized that individuals with ADHD tend to chronically have insufficient release and reloading of the neurotransmitter dopamine at synaptic junctions of neurons in the networks that manage executive functions.
Many studies have demonstrated that treatment with stimulant medications improves the efficiency of neural communication. However, this increased release and slowed reloading is not under voluntary control. It occurs only for those tasks in which the individual with ADHD has a strong interest. The heightened interest may be because that activity has brought pleasure or other rewards to the person in the past. Or interest may be intensified because the person fears that something he or she anticipates as being unpleasant is likely to occur very quickly if he or she does not attend to the task immediately. Whether because of anticipated pleasure or fear, the heightened interest generates increased release of dopamine instantly, and sustains it for as long as the intensified interest persists.
The second factor that influences the ability to pay attention to some tasks but not to others is the relative weakness in working memory that is characteristic of many persons with ADHD. Working memory is essential for keeping in mind relative priorities of our various interests at any given time.
Social psychological research has shown that individuals with larger working memory capacity are generally better able to deal with emotions, pleasant and unpleasant, without getting excessively caught up in them. Those with ADHD tend to have less “bandwidth” in their working memory functions, and are likely to have more difficulty than others in quickly linking together various memories relevant to doing or not doing a task. They are less likely to take into account the bigger picture of which the present moment is a part (see “Stuck in Emotion,” below). They operate more like someone watching a basketball game through a telescope, unable to take into account the rest of the action on the court, the threats and/or opportunities that are not included in the small circle of focus provided by their telescope.
Excerpted from Outside the Box: Rethinking ADD/ADHD in Children and Adults, by THOMAS E. BROWN, Ph.D. Copyright 2017. American Psychiatric Association Publishing.
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