Welcome to the huberman Lab podcast, where we discuss science and science based tools for everyday life. 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 a
PhD, or not can
improve our ability to focus.
Our ability to rule out. Distraction 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 symptomatology of ADHD, some of that symptomology might resonate with you. You might think. Oh, maybe I.
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 a full-blown ADHD.
However, many of us have constellations.
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 will talk about that.
Well, 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 depends on how we slept or other events going on in our life or 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
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
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So let's talk about ADHD
attention deficit, hyperactivity disorder.
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.
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 percent range and so on, if you have a parent with ADHD
that number ranges anywhere from 10 to 25 percent 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 closed,
Relative with ADHD, that does not mean that you are fated
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 rather controversial issue. As many of you probably know they're lots of forms of intelligence that a standard IQ test just
And 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. You have low IQs people, with ADHD, with high
IQs, 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.
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
an ongoing process even today.
So in the mid 80s, we started hearing about ADHD. And then
gradually that term, a TD 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 intend
to as high as 12 percent. 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 smartphone,
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 pulls
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.
Richard and 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.
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 are only paying attention to some of those
And the ones that you're paying attention to our 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 are easily distractible.
But the way that shows up is very surprising. You might think that people with ADHD
just simply can't attend to 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.
Distractible. Yes. They are impulsive.
Yes. They are easily
annoyed.
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. Orange 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 it's an adult loves a particular type of movie, where 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
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, 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 often times. Not always but often times, they can attend. If they're not really concerned.
Learned 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 often times. They will remember that lunch starts
at noon.
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 in, this could be in the kitchen or in their bedroom, or in the
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.
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 that 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.
Ian of a particular set of underlying genetic or psychological components. Okay. So we see the phenotype. So if you want I can be 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
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 would be able to recite that phone number in their mind over and
over and then put it 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, 643 781
for most people would be pretty easy. Six,
four three, seven, eight one.
Six were 3781. You could probably remember that a minute from now, without writing it
down. But if you add one more number to that 643, 78130 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
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 is 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.
And have decline.
Okay, so we've
More or less established. That 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 its challenges with attention and focus challenges with impulse control. They get annoyed easily have kind of an Impulse civet e. 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. He give them a task. They can just laser in on that task
other people that have to fight an
internal battle. They have to convince themselves that it's important or interesting. They have to incentivize themselves. Internally other
people.
Doesn't matter if they could be bored to tears with the information, but they can do it just because they
are quote unquote. 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 there, just the way that we describe our human experience of liking things wanting to know more about them, but from a neurobiological 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. It's what we call, Xterra
reception.
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. It 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.
Tea and just to put a little bit of flavor and detail on which neurocircuits. Those are? I want to
discuss two, general
types of neural circuits that dopamine tends to enhance.
So let's talk neural circuits. 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.
Some of you out there who really want to dig deeper into what the exact structures and connectivity is our. 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 or just sitting there idle at
rest. Now, it's very hard to not think about anything.
Thing,
but when you're not engaged in any type of
specific tasks, 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 were 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, or 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 task 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
A network includes an area called the dorsal lateral. Prefrontal cortex
frontal cortex. No surprises in the front and you have a dorsal, the top
and side lateral part. Dorsal lateral, 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,
And 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 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, any time, you're restricting, your behavior. These tasks
directed networks are very active. Okay?
Now normally in a person without ADHD,
the task networks and the default mode networks are going and kind of seesaw fashion. They are actually what we call anti-correlated. So it's not just that they are not correlated. They are actually opposing one another. They are anti-correlated
in a person with ADHD
the default mode networks and the task 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 that's not working. Well, and because everything is 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.
Way where
the base is in, keeping the BackBeat and the drums aren't keeping the back beat 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 is the case that the default mode networks and the task networks tend to
Come 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,
is this circuit should be active than 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.
Item. That is not allowing
it to conduct these networks and make sure that they stay what you know, the engineers are physicists or mathematicians would say out of phase 2B anti-correlated okay, out of phase and anti-correlated 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 the dopamine is just doing it all wrong. In
other words. Is there no conductor or is the conductor?
With a little tiny toothpicks and so the instruments can't see what they're supposed to do. They can't get the instruction because 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 is there? But the conductor is in very good at conducting.
Now we can gain insight
into how this 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.
Rugs 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 getting some really interesting insight into how dopamine is regulating these circuits in normal circumstances, and in people with ADHD, so,
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 level.
As in people with ADHD have been around for a 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 or bass in it and 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.
Stimulant so things like drinking 6 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 is a recreational drug. All of those substances that I just described and particular cocaine and amphetamine but also coffee and cigarettes
increased 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 tasks 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 adult. 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 consume
too many sugary Foods or drank too much soda or
adults. With ADHD would
take recreational drugs like methamphetamine or cocaine or
Wood, drinked 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
And 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
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 hyper
active when they consume any kind of stimulant they tend to go
wild and run around like crazy. Actually 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, we 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 realize that it was chocolate with
espresso beans in it was like dark chocolate 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 combine.
Bind 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
and 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
The 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 tasks 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 which people tend to fall asleep during the daytime 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
Hurt 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 or 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.
HD 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.
Kinetics 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 to 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.
I 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 adderal Adderall XR, my my - my diocese.
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 are 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.
Those are
exactly what are used to treat ADHD. Now, 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 epinephrine or norepinephrine also called noradrenaline adrenaline, those names of the
same and to some extent to increase levels of serotonin in the brain and
blood, but not so much serotonin that
Kind of a small smidgen of
effect. Okay, so dopamine way up
norepinephrine and adrenaline way up, so that 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
Dr. Stimulants, and they look very
much. Like, 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
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 am aware that
up to 25% of college students
and perhaps as many as 35 percent 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
percent 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. And we could 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 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,
People have always been self-medicating to increase Focus.
Right?
Caffeine, which I 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, a MP
phosphodiesterase pathway. Remember anytime you see you here in a sec. That's an enzyme phosphodiesterase is involved in the conversion of things like cyclic, A and P into
Energy for cells, and so
forth. Basically coffee gives you energy, and 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 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
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 an 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 and it ought to make them hyper hyper active 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. Where was the 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 there.
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 ten minutes and they just despite their best efforts. They simply cannot do it. They're highly distractible.
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? Its speed. That's really what it is. What are the long-term consequences? Where the short-term consequences?
Quinces,
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 there 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 and kids
of
All ages, from Age 3 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, you know, on the face of it, it seems crazy but provided that the lowest possible dose is used and that that dosage is
modulated 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 is 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, you know, why
wouldn't you wait until your kid reaches puberty? I mean, we know that in boys and girls that are increases in testosterone and estrogen during puberty that
Matically 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.
Around a lot their shit there. I don't say Shifty because 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 two puppies, everything is 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,
neural plasticity is greatest in childhood and tapers off after about age 25,
but neuroplasticity from Age 3 until age 12 or 13 is exceedingly high and they're
When you sit back and you look at the literature on neuroplasticity, you'd say,
childhood plasticity in 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, their 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 fronto circuits. These tasks 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.
That all of these things have been purported
to improve symptoms
of ADHD and people, and parents with ADHD.
Go to fnatic lengths, to try and find the
exact foods that are causing problems. And the exact foods that 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 Willie 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,
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 a hundred 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
Design 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 studies. They will be 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 change is an effects due to individual differences. In any case, hundred 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 talked 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 .05 chance. Essentially of
the effect being due to
chance. However, in this study every single, one of the effects is p less than point zero zero, zero one, very, very
Be infinitesimally, 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 all ago, antigenic diet. It was a died in
Each kid took a test to determine which
foods, they had antibodies for meaning that they were mildly allergic to
now, in this study 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 they had mild allergies to.
So, basically, what this 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, Etc. Large number of subjects
set the world on fire people. We're 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 reanalysis of these data and I
To be fair in saying that the data in the paper, look good, but there are criticisms of the overall structural
design in the study. I don't want to go into
all the details, exactly. Because it gets really nuanced about some of the statistics
in 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 ask the simple question.
Do you see an effective 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. Well, 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
Oligo antigenic 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 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 oligo antigenic diet is the appropriate one, however,
out of the for
neurologist and psychiatrist 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
Listing allergies to Foods. They already consumed might be a good idea. At least that's what
this paper. The pellicer
at. All 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-analyses 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 would 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
What are called, Omega 3, fatty acids. I talked many times on this podcast about the known benefits of omega-3 fatty acids. In particular getting one gram, 1000 milligrams or more. Even as much as 2,000 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's are very beneficial. Typically that's done through fish oil, liquid fish oil is going to be the most cost-efficient but their capsule forms.
For those of you who don't like fish oil.
You can adjust this. Through other means you can get from certain algae's or Krill, etcetera. You have to make, make it compatible with your particular diet, whether or not you're vegan or vegetarian or omnivore
etcetera.
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 where by ingestion of
Omega-3 fatty acids of a
grammar 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's of a thousand 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 modulator.
Roll just like good, sleep
plays a supportive and module
ettore 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,
Bility to feel motivated. And to attend to
focus is mediated by the circuits in the brain that release dopamine.
However, attention is also
modulated 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 modulated the circuits in your brain that respond to various things and you will be highly distractible. You will be highly emotional, you will feel like garbage,
but that
Don't mean that sleep, mediates, focus and attention. It. Modulates it indirectly likewise. I think these omega-3 fatty
acids in particular, the epa's, which are so beneficial for mood and apparently also for attention. They don't 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 and 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 that 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,
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, you are going to be bombarded with the ADHD diet. The only go antigenic diet, the elimination this, the, this supplement that EPA, and you, I
Think it's very important to understand whether 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 circuitry's and the neurochemistry. He's 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 oligo antigenic 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 only go antigenic 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.
Saying 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 I'm 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 relate. 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
By Daniel, goleman and Richard Davidson, and I should just mention that Goldman is a well-known author has written books on emotional intelligence. And so forth. Richard Davidson is a also a PhD, he's a professor of psychology and Psychiatry, and that he's at a University of Wisconsin-Madison. It'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
Goldman and Davidson wrote about this, so beautifully, I'd rather paraphrase from them, then 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? They're bunch of people and
objects and things in a picture. And somewhere in there,
is Waldo with the striped hat, and the glasses and going to 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 well. Those 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,
Buying 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
are they see, the are they register it consciously
and they tend to miss the Z.
Just like in the wall, though, type example. Now, of course, the numbers are going by pretty quickly, but they can spot. The are
they could also spot the Z
if you told them beforehand, just spot the Z and the numbers are moving through.
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 attention only 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 the 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 distractibility or the distractibility of somebody with ADHD could exist because they are over
focusing on certain elements and they 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.
Is something that's described in the book that I just refer 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
are in this string of numbers, and the example that I just gave, or if you're very excited about, something you're 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 gay 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. It's frame rate is higher.
So you've seen slow-motion video and you've seen standard video, slow motion video.
Dio gives you that slow motion look because it's a
higher frame rate. Your 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 are and they can see the Z and they can see additional things.
So this is something that can be trained up.
People can practice whether or not they have ADHD or not. What it 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 going to 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
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 reduce 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
Interoception that allow them in a wareness. 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 blanks
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
Twenty 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 intercepting 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 meditations 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, this so-called open monitoring that allows the brain to function in a way that it
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 a
synchrony between the default mode Network. In 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.
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. This might come across as somewhat obvious, but you can do
fast. What are called spontaneous blinks? And they are 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.
Are analyzing information dreaming Etc, is variable when you were in sleep, sometimes it's very fast.
Meaning, you experience 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.
Forever. Because your frame rate is higher. You're analyzing time. We're finally conversely. If you are very relaxed or even
sleepy, you wake up and you have to think about 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.
She, the first author is Terhune. Trhu. Any,
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
A movie, you know, and they clap the clap thing. They start it take you know, 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. Unfortunately. 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 finally.
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 the physical space
around them.
They're disorganized in time.
Their dopamine is low. We know that as well and so they are under estimating 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 is actually been done.
There's a study. Again. I'll link to the study entitled Improvement of attention in elementary school students through fixation focus 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. These school children to greatly
enhance their ability to focus.
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 that 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 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.
Just ask 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 to frankly but kids need it more. Because the circuits in the brain that control
Reflexive movements. And as we say, kind of rhythmic undulate in 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 have 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 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'd done that when I was a
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 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 a 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 surgery is that the brain is 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 you're sort of
Baseline level of autumn.
Arousal, some of you may find that you can hold out your hand, it absolutely rock-solid others, will shake a little bit more.
Doesn't mean you're nervous. 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
promoter activity, the number of commands to move that are being sent through the system. And that's what I mean by Reverb, ettore activity.
And it does seem that kids with ADHD and adults with
ADHD have a lot of Reverb. Reverb ettore 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 a 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 handshake even
more but provided that it's subtle, what it does. It did. 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 are 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 just to collating can help.
It's not a matter of
quote-unquote moving energy out of the body that doesn't actually
happen. What it is is you're engaging, those Prix
motor 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
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 etcetera. Is that
most all of the drugs, Ritalin Adderall, and recreational drugs
that increase dopamine, even coffee and
tea and other forms of
Laughing. 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.
Mm,
and they are there to regulate how long
you are bringing information into your nervous system. And in what bins how widely or finally You are bidding 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 Crosshair 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 in 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 decrease spontaneous eye. Blink rates.
He's in chronic cannabis users evidence for striatal 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 we'll 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 and 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, I'm not a proponent of this. I personally
am not 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. And in some
places, it is
Is legal, but th see 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. Wow, 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.
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 have been using it chronically for 10 years. In other words,
people who 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 men,
Rwanda 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. Interceptive
awareness is one sense of One's Own internal State
heartbeat breathing. Contact of skin with a given surface, etc
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 interceptive 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
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 intercept of 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 adult, they are aware of what's
going on. Inside them just as much as anyone elses and the
typical measure of interoceptive awareness,
is one's ability to count their own heart
beats. 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, you know, six minute interaction at the table or whether or not a child who somehow has to venture off every moment or a co-worker of yours.
Who's an adult who's constantly fidgeting or moving things around that somehow, they are
unaware, that they are oblivious. They are not oblivious to how they feel. Chances are.
Every 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 has a seed of choline 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.
An excellent peer-reviewed studies.
So before moving to some of the newer, a typical compounds and things sold over-the-counter. I'd like to just briefly returned to the classic drugs that are used to treat ADHD.
These are the ones I mentioned earlier. Methylphenidate also called Ritalin, modafinil are modafinil is another one and Adderall. Again, all of these
work by increasing levels of dopamine and norepinephrine.
Typically, they are 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 and 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.
Yes, 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 at all Frontier.
And biosciences. 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 hear, 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 liked 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
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, you know, men have trouble achieving an
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 had lump caffeine
back into the, into the mix.
In addition. They almost
Kerry cardiac effects, right? The 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 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. Oh 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.
An amphetamine
because of the large amounts of dopamine, the 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, end 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 because 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 in being able to turn focus on and off at will that's an unrealistic
expectation right?
More likely the best use of things like
adderal modafinil are modafinil. And Ritalin
is going to be to combine those treatments with
behavioral exercises
that actively
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
from?
For what's helpful for depression,
Etc. 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. Mean, you have to take quite a lot of fish oil in order to get above that 1,000 milligram or
Thousand 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 phosphatidyl steering 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
module ettore way, but it appears that phosphatidylserine taken for two months for 200 milligrams per day was able to reduce the symptoms of ADHD.
Children, it has not been looked at in adults yet. It's 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 phosphatidyl staring 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 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 1, to 6, or 7 to 12, and it was a fairly large number of subjects. So a hundred forty seven subjects. In one
case in 36, and the
other, the takeaway is that getting sufficient levels
of epa's in particular. There's 300 milligram threshold of DH a
plus, if you are interested in it, and it's right for you 200 milligrams of. Phosphatidyl steering 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 Balboa, which has been shown to have minor effects and improving the symptoms of ADHD. Not nearly as effective as ritalin and adderall. Ginkgo Balboa is
not appropriate for many people.
I am one such person. I don't have ADHD, but when I taking Ginkgo 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 Balboa,
and you will see a lot of claims about Ginkgo Balboa, for attention and 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 are
modafinil. That's a are
- no,
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 to typically was very expensive. You know, 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 nine hundred dollars, or even a thousand dollars a month.
Our modafinil is a far less expensive version. That's chemically slightly. Different than modafinil,
regardless of price. People are taking mode after known are
modafinil, want to emphasize that unlike Ritalin and
All modafinil and our modafinil are
weak dopamine reuptake
Inhibitors and that's how they lead to increases in dopamine. So whereas Ritalin and adderal
amphetamines and cocaine lead to Big increases in dopamine.
Also through reuptake mechanisms. And so forth. Modafinil is
is a weaker dopamine reuptake stimulator. And so what that means is that it leaves more dopamine
around to be active at the synapse, the, 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 say gee nishino
at Stanford, some years ago. They identified the biological basis of narcolepsy and it's a disruption.
In the cellar, Exon
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
are modafinil 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 our modafinil 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 our modafinil. It
was just prescribed to me. I took that half dose and I gave my lecture and then I
Around to answer questions and then
4 hours later. A friend of
mine came up to me and said, you know, 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. So it wasn't being recorded. So I
have first-hand 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 ingested is some coffee and some yerba mate 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 our
modafinil. 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 is or modest
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 our modafinil for me was 0 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, 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 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 acetyl, choline 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, you just heard
closely step out from the rest of my sentence. No doubt. There was a seat of choline
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 the all this is working.
Not surprisingly then drugs that increase, cholinergic or acetylcholine transmission will increase focus and cognition. One such compound is so called
Alpha GPC which is a form
of choline and
increases
acetylcholine transmission dosages as high
as 1200 milligrams per day, which is a very high dosage spread out typically its 300 or 400 milligram spread out throughout the
day have been
I shown to offset some of
the effects of age-related. Cognitive decline, improve, 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.
Creating more focused by way of this, cholinergic system. It stimulates called acetylcholine release from both of those liquid locations. The PPN in the back of the brain and nucleus bacillus 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 in 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 dosage in can be very tricky to dial in, sometimes it makes people feel to
euphoric or too jittery or to alert that they are then.
Able to focus. Well, so, the dosage range is are
huge. You see evidence for a hundred 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 psyche,
psychiatric or mood disorder because dysregulation of the dopamine system is,
you know, Central to many of the
mood disorders such as depression, but also, especially Mania Mania, bipolar disorder, or schizophrenia things of that sort. So, it's
Nothing that really should be approached with caution. Nonetheless in exploring, what's out there? And even some studies online that we're done. Either
animal studies are human studies. It's clear. That
l-tyrosine is being explored for that purpose,
as is Peña and phenylethylamine, which is a essentially Peña, 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,
A, 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 Peña 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 owns relate specifically, to ADHD and cognitive focus
and last but
Not least in terms of these different compounds. I do want to mention the racetam S. 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 racetam Czar illegal. In certain countries. They are gray Market in other countries, and they are sold over the counter in this country in the US.
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. You know, at 10 milligrams, twice daily can be more effective than some of the other racetam shows. What is new pep new pepped 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
To those heightened states of cognitive capacity. And there are these studies one in particular comparative. Studies of new pepped in press, the Tam in the treatment of patients, with mild cognitive disorders and brain disease 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
ischemia of any kind because neurons need
blood when the blood supply.
Cut off two 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 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 in.
Piracetam 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
Mission or acetylcholine as we call it in.
The brain is one of the things associated with cognitive decline in 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 a typical treatments for ADHD
compounds to 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 on at all, Ahn.
When 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 racetam and adderall and Ritalin and various forms of dopaminergic agents and cholinergic agents spells out whether or not, they are sold over the counter or
prescription, and really lines them up in all their affects their drawbacks,
Etc,
refer you to that study. It's available.
It's full length form online for free.
It's on at all that the journal is neuroplasticity neuro,
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, Etc. 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.
D 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 in 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
And magnetic stimulation into the brain. 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.
Its spatial Precision is not
remarkable.
That doesn't mean it's not of use but it is not a super fine grain tool. Okay, it's not a cannon, 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 is 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 is 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 in there for 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 are 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 they are 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 non-invasive 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 engage these circuits through pharmacologic mechanisms. So, very exciting times for TMS very
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
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.
Besides 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 their, your attentional window
is grabbing it near infinite. Number of bits of information, colors movies. If a
picture is worth a thousand 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 and school relationships, Etc. 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
long-standing 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 7,000 and 102 adolescents. There's a huge study of population-based cross-sectional study and you will be probably surprised and somewhat dismayed to hear.
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'm 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 is
Probably higher.
Meaning, if you're an adult. I could have, I'm gonna
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 experienced 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 out 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
For 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 realize that covered a lot of
information about ADHD and the
g 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
Actions 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 + 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 time-stamped 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.
15 minute session to enhance your ability to focus their after presumably forever.
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Talked a lot about supplement based compounds if you're interested in supplements and you want to see the supplements that I personally take you can go to Thorn. That's th o RN e / the letter U / hubermann and you can see everything that I take and you can get 20% off any of those supplements. Or if you navigate into the thorn site through that portal, you can get 20% off any of the supplements that thorn makes supplements aren't for
everybody. You, by no means have to take
supplements. But if you are going to take supplements, it's important that you take.
Supplements from a source that's
reputable and which the ingredients are very
high quality and in which the amount of the ingredients that
listed on the bottle actually matches. What's in the bottle? That's
why we partnered with Thorn because they have the highest levels of stringency in terms of quality
and specificity of the ingredients.
And finally I want to thank you for your time and your attention. And as always, thank
you for your interest in science.
