ADHD & How Anyone Can Improve Their Focus | Huberman Lab Podcast #37

- 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 Medical School. Today we are going to talk all about attention deficit disorder, hyperactivity disorder or ADHD. We are also going to talk about normal concentration levels. What are normal levels of concentration and how can all of us, whether we have ADHD or not,

improve

our ability to

focus

and screen out distractions? It turns out that they are two different things, besides remembering information better. We're also going to talk about how we can learn to relax while concentrating, which turns out to be a critical component of learning new information and generating new creative ideas.

So whether or not you have ADHD or know someone who does, or if you're someone who feels like you don't have ADHD, but would simply like to

improve

your ability to

focus

or be more creative. This episode is definitely for you too. Let's talk about the medication-based tools that exist. Let's talk about behavioral tools. We'll talk about the role of diet and supplements, and we'll talk about new emerging brain-machine interface devices, such as transcranial magnetic stimulation. If you don't know what that is, don't worry, I'll explain it to you. These are non-invasive methods to rewire your brain to make focusing more natural for you and teach you how to increase your depth of focus.

Now, just a quick reminder that whenever we talk about a psychiatric disorder, it's important for us to remember that we are all tempted to diagnose ourselves or diagnose others. So while I list some of the symptoms of ADHD, some of them may sound familiar to you. You might think, oh, maybe I have ADHD or you might decide that someone you know definitely has ADHD. However, it is very important that you do not diagnose yourself or someone else; The clear and true diagnosis of ADHD must be made by a well-trained psychiatrist, doctor or clinical psychologist. There are clear criteria for what constitutes full-blown ADHD.

However, many of us have a constellation of symptoms that make us look something like someone with ADHD and if we have difficulty concentrating today, as many people do, due to stress, due to smartphone use, which results that can induce ADHD in adults. We'll talk about that. Then we will pay attention to the symptoms. You may actually need professional treatment and you may not; Equally important is to remember that some of the terms we cover, such as impulse control and attention and concentration, are somewhat subjective and can change over time. Sometimes we have a better level of attention than others.

Maybe it depends on how we sleep or other events that happen in our lives that are something we are not aware of. The important thing to remember is that we can all improve our attention span. We can all reconfigure the circuits that make high levels of concentration more accessible to us. We can do this through multiple types of interventions, and today we will cover all of those interventions. Before moving on to the material, I would like to remind you that this

podcast

is independent of my teaching and research duties at Stanford. However, it is part of my desire and effort to bring zero-cost information about science and science-related tools to the general public.

And continuing with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Roka. Roka manufactures eyeglasses and sunglasses of the highest quality. I have spent my entire life working on the visual system and I can tell you that there are many functions built into our visual system that allow us to see things clearly, whether or not we are in the shade or in sunlight, etc. Many sunglasses have the problem that you have to constantly take them off and put them back on, due to changes in the luminance of the background, as we call it Roka, sunglasses have solved this problem.

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Belcampo is a regenerative farm in Northern California that grows organic, grass-fed, and certified humanely finished meat. I tend to eat meat about once a day. I usually fast until noon or one and then my lunch is a small piece of meat or chicken and some salad and then I tend to eat carbs in the evening before I go to sleep. Sometimes, and especially lately, I eat protein earlier in the day because I'm playing around with some of the findings surrounding protein intake earlier in the day. But anyway, I eat meat about once a day. For me, it is extremely important that any meat I consume comes from humanely raised animals and that the meat is of the highest quality.

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to get up to $200 off your mattress and two free pillows. So, let's talk about ADHD, attention deficit hyperactivity disorder. Let's also talk about focus and attention and everyone's ability to concentrate 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 improve their level of concentration and attention.

Now, ADHD used to be called attention deficit disorder. We have records of ADD in medical literature dating back to 1904. Now, there is nothing special about 1904. It is just the first time it appears in 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 who has ADHD, there is a much higher chance that you have ADHD, and that chance increases depending on how closely related you are to that person. So, for example, if you are an identical twin and your twin has ADHD, there is a very high concordance, as we say, a very high probability that you have ADHD, up to a 75% chance.

If you have a twin with ADHD, that number drops a little, to 50 to 60%, and so on. If you have one parent with ADHD, that number ranges from 10 to 25% chance that you have ADHD if you have two parents and so on, okay? So there is a genetic component that turns out to be directly related to how specific neural circuits in the brain are wired, the chemicals they use, and the way they use those chemicals, a topic we're going to discuss in depth today. Now, if you have a close family member with ADHD, that does not mean that you are discolored from having ADHD and if you have ADHD, there are ways to overcome those symptoms of inattention, impulsivity, etc.

Another important point about ADHD is that it has nothing to do with intelligence, whether or not we are talking about intelligence measured by a standard IQ test. A fairly controversial topic, as many of you probably know, there are many forms of intelligence that a standard IQ test simply doesn't detect emotional intelligence, musical intelligence, spatial intelligence, and all kinds of intelligences. None of them are related to ADHD. Being very high functioning does not make you more likely to have ADHD, and having ADHD does not necessarily mean you have a low IQ. So there are people with ADHD who have a low IQ, people with ADHD who have a high IQ, people with ADHD who have a high emotional IQ or who have a low IQ on the emotional scale, it's all over the place.

The important point is that your ability to pay attention and concentrate is not related to how smart you are or your IQ of any kind, not just a standard IQ. The name change from ADD to ADHD took place in the mid-to-late 1980s, when the psychiatric and psychological community began to better realize the fact that so-called hyperactive children also had attention problems. This may seem obvious, but there has been extensive and ongoing review of the criteria for designating a psychiatric disorder and this remains an ongoing process even today. So in the mid-1980s we started hearing about ADHD and then gradually that term was phased out.

However, simply changing the name from 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. Current estimates range from 10%, one in 10, to 12%. Now, fortunately, about half of them will resolve with proper treatment, but the other half usually won't. The other thing we are seeing a lot of today is increasing levels of ADHD in adults and there are questions about whether those adults had ADHD that went undetected during their childhood or whether ADHD is now emerging in adulthood due to The way we interact with the world, particularly the use of smartphones, the combination of email, text messages, real-world interactions, multiple applications and media streams and social networks, all arrive at the same time trying to manage life.

All the things that are happening are creating a kind of pole cloud in our attention, so it begs the question of whether or not we are creating ADHD in adults who never had ADHD before they were adults. So let's talk about attention and first define what we mean by attention in the scientific literature and in discussions about ADHD, we will hear things like attention and concentration and impulse control for the sake of today's discussion, attention, concentration, and concentration are essentiallythe same, okay? We could have doubts and the scientific literature does in this regard. But if we want to understand the biology and we want to have a direct conversation about ADHD, if I say attention or concentration, I basically mean the same thing, unless I specify otherwise, okay?

This is why people with ADHD have problems maintaining attention. What is attention? Well, attention is perception. This is how we perceive the sensory world. A little basic neurobiology: we feel things all the time. There is information reaching our nervous system all the time. For example, right now you are listening to sound waves. You are seeing things, you are feeling things against your skin, but you are only paying attention to some of them and what you are paying attention to are your perceptions. So if you hear my voice, you are perceiving my voice. You're not paying attention to your other senses right now, okay?

You could even be outside with a breeze and until I said that, you might not be feeling that breeze, but your body felt it all the time. So attention and focus are pretty much the same thing, but impulse control is separate because impulse control requires taking off or putting on blinders to sensory events in our environment. It means lack of perception, impulse control is about limiting our perception. People with ADHD have low attention spans and high levels of impulsivity and are easily distracted. But the way this manifests itself is very surprising. You might think that people with ADHD simply can't attend anything.

They can't really concentrate, even if they really wanted to, but that's simply not the case. People with ADHD do get distracted. Yes, they are impulsive. Yes, they get easily upset by things happening in the room. Sometimes they also have a high level of emotionality. Not always, but often people with ADHD can have hyperfocus and an incredible ability to focus on things they really enjoy or that intrigue them. Now, this is a very important point because we normally think of someone with ADHD as being really wild and hyperactive, or not having any ability to sit still and pay attention, 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 they love to draw, or if an adult really loves a particular type of movie or a person , you will get laser focus without any effort.

That tells us that people with ADHD have the ability to pay attention, but they can't devote that attention to things they don't really want to do and, as we all know, much of life, whether or not you're a child or a Adult involves doing many things that we do not want to do, much of our education involves doing things that we would rather not do and, in a way, forcing ourselves to do it, to attend, even though we are not very interested in what we are attending. There are a couple more things that people with ADHD display quite frequently.

One is challenges with time perception. Now, time perception is a fascinating aspect of how our brain works and later we will talk about time perception and how you can improve your time perception. There's a good chance that right now you're doing things that interfere with your optimal perception of time, and I'll tell you how to adjust your ability to measure time with your brain. People with ADHD are often late. They often procrastinate, but the interesting and surprising thing is that if they are given a deadline, they can actually perceive time very well and can often concentrate very well if the consequences of not completing a task or not attending are. serious enough.

It's a bit like the way people with ADHD can really focus if they like something. Well, if they are scared enough of the consequences of not attending, many times not always, but many times they can attend. If they are not really worried about a deadline or a consequence, then they tend to lose track of time and tend to underestimate how long things will take. Now a lot of people do that, not just people with ADHD, but people with ADHD have challenges understanding how to align the activities of their day to meet given deadlines, even if it's something simple, like finishing a set of tasks early. lunch, many times they will remember that lunch starts at noon, but somehow they can't fill the time in between in a way that is productive and they may become obsessed with the next deadline, for example, we will talk about how to remedy this.

Also, their spatial organization skills are usually mediocre, not always, but you will often find that someone with ADHD uses what is called the stack system to organize things, they take a lot of belongings and this could be in the kitchen or in their home. bedroom or in their office or in any space and they will begin to stack things according to a categorization system that makes sense to them and only them. It doesn't really have any logical framework. Now, a lot of people use the battery system, and if you use the battery system, that doesn't mean you have ADHD, in fact, if you're unpacking a house or you've recently moved, or you've received a lot of money. presence recently, the stilt system makes a lot of sense to organize your space.

But people with ADHD tend to organize things according to the battery system all the time, and that battery system doesn't work for them. Well, that's the key distinction: they use a filing system, and they're not really files, they're accumulating things in a way that makes sense to them, but then doesn't work for them in terms of the tasks they perform. I really need to perform. They can't find things or if someone moves one thing, it's very detrimental to their overall plan because, first of all, their overall plan doesn't really work. So that's a common phenotype as we call it.

By the way, a phenotype is just an expression of a particular set of underlying genetic or psychological components, okay? So we say the phenotype. So a phenotype could be brown hair and green eyes, like for me, a phenotype could also be someone using the stacking system, okay? The other thing that people with ADHD have real problems with is so-called working memory. Now, you might think that people with ADHD would have very poor memories, but in reality, that is not the case. People with ADHD can often have excellent memory for past events and can remember future events quite well.

His 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 short or immediate term. A good example of this would be if you meet someone, they tell you their name, they give you their phone number verbally and you have to go back to your phone and enter it. People without ADHD may have to put in a little effort, it may seem a little complicated, but they will usually be able to recite that phone number in their mind over and over and then save it on their phone.

People with ADHD tend to lose or lack the ability to remember things that they only need to hold in line for anywhere from 10 seconds to a minute or two, okay? So a string of numbers like 6, 4, 3, 7, 8, 1 for most people would be pretty easy. 6, 4, 3, 7, 8, 1, 6, 4, 3, 7, 8, 1, you can probably remember it within a minute without writing it down. But if you add one more number to that 6, 4, 3, 7, 8, 1, 3, it becomes more difficult, okay? So there is a reason why phone numbers are usually seven digits, of course there is an area code, but remembering information that contains more than seven numbers or a sentence or two is a challenge for most people, People with ADHD have severe challenges. even with much smaller batches of information over even much smaller periods 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, so it won't be a surprise that later on, when we talk of treatments, supplements, and other tools for ADHD, that many of those treatments, supplements, and tools for ADHD are similar to those that work for age-related cognitive decline. Well, we've more or less established the type of menu items that people with ADHD tend to have. Some have only a subset of them. Its severity can range from very severe to mild, but generally, it involves challenges with attention and focus, challenges with impulse control, and being easily upset.

They have a kind of impulsiveness, they cannot concentrate on the task. The perception of time may be wrong, they use the stacking system or a system that does not work well for them to organize their things in physical space and they have a hard time with anything mundane that does not really interest them. But again, I just want to highlight that people with ADHD can get high levels of focus, even hyperfocus, on things that they find exciting and that they really want to participate in. So now you have an idea of ​​what ADHD is. It is, and if you don't have ADHD, you should also ask yourself what aspects of ADHD are similar to things I've experienced before.

Because what we know about the healthy brain is that there are also a variety of abilities to concentrate. Some people concentrate very well on any task. You give them a task and they can focus on that task. Other people who have to fight an internal battle have to convince themselves that it is important or interesting. They have to be encouraged internally. Other people don't matter, they might be bored to tears with the information, but they may do so simply because they are "very disciplined people." We tend to admire those people, but as you'll see later, it's not clear if that's the best way to manage your care system.

There may be something in this business of having higher levels of attention for the things you are most interested in or excited about. So let's delve into the question of why people with ADHD can actually focus very intensely on things they enjoy and are curious about. Now, enjoyment and curiosity are psychological terms, they're not even really psychological terms. They are simply the way we describe our human experience of liking things and wanting to know more about them. But from a neurobiological perspective, they have a very clear identity and signature: dopamine. Dopamine is released from neurons, it is what we call a neuromodulator and as a neuromodulator it changes the activity of circuits in the brain so that certain circuits are more active than others and in particular dopamine creates a greater state of concentration.

It tends to contract our visual world and tends to make us pay attention to things that are outside and beyond the confines of our skin. That's what we call exteroception. Dopamine also tends to put us in a state of motivation and wanting things outside the confines of our skin. So whether or not we are searching for something physical in our world, or whether we are searching for information in our external world or not, dopamine is largely responsible for our ability and our drive to do so. But dopamine as a neuromodulator is also involved in changing the way 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 released in our brain, tends to activate areas of our brain that narrow our visual focus and our auditory focus, so it creates an auditory attention cone, which is very narrow, it creates a visual attention tunnel which is very narrow. Whereas when we have less dopamine, we tend to see the whole world, we tend to see the whole scene we're in, we tend to hear everything at the same time.

As I describe this, I hope you are already beginning to see and understand how the release of dopamine can allow a person, whether ADHD or not, to direct their attention to particular things in their environment, okay? 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're giving it a neural circuit identity and, to put it a little bit, As for the taste and the details about what neurocircuits they are, I want to discuss two general types of neurocircuits that dopamine tends to improve.

So let's talk about neurocircuits and for those of you who love to listen to neuroscience and nomenclature, you are going to eat this part and for those of you who don't like a lot of brain area names, I invite you to tune out or just try to grab the outline superior of this. I'll describe it in pretty general terms, but I'll give some details because I know there are some of you who really want to dig into what theexact structures and connectivities, okay? So there are two main types of circuits we need to think about in regards to ADHD: attention and dopamine.

The first is called default mode networking. The default mode network is the network of brain areas in your brain and in my brain and in everyone's brain that is active when we are not doing anything when we are just sitting idle at rest. Now it is very difficult not to think about anything, but when you are not engaged in any kind of specific task, that is, you are not driving, you are not playing a video game, you are not trying to study, you are not thinking about anything. You're not trying to listen, you're just sitting there letting your brain go wherever it wants to go.

Your default mode network is the basis for that state of mind. The other set of circuits that we're going to think about and talk about with respect to ADHD are the task networks, the networks in the brain that make you goal oriented, or at least are trying to make you goal oriented, and those are a completely different set. different from areas of the brain. However, the default mode network and these task networks communicate with each other and they do so 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 here again feel free to ignore it if you don't want this level of detail, but the default mode network includes an area called the dorsolateral prefrontal cortex, frontal cortex, no surprises up front and you have a dorsal cortex. , the superior lateral and dorsolateral lateral part, prefrontal cortex. You have one on each side of your brain, right? And then you have an area of ​​the brain 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 because,These are three areas of the brain that are normally synchronized in their activity.

So when one of these areas is active in a typical person, the other areas will be active as well. So it's a little bit like a symphony or a band like a three-piece band that plays drums, guitar and bass together, okay? So that's how in a typical person and a person with ADHD, or even a person who has subclinical ADHD or any human being who hasn't slept well, what you find is that the default mode network is out of sync. These areas of the brain simply do not work well together. Task networks now include a different set of structures.

It still involves the prefrontal cortex, but it's a different part of the prefrontal cortex, okay? It tends to be the medial prefrontal cortex, and there are other areas of the brain that the medial prefrontal cortex communicates with all the time, primarily to suppress impulses. It is turning off the desire to get up or scratch the side of your cheek or nose, if you are trying not to do that, at any time you are restricting your behavior. These task-directed networks are very active, okay? Now, normally in a person without ADHD, the task networks and the default mode networks operate in a kind of seesaw, they are actually what we call anticorrelated.

So it's not just that they are uncorrelated, but they are actually opposed to each other, they are anticorrelated. In a person with ADHD, the default mode networks and task networks are actually more coordinated. That might be surprising, I think we all have this tendency to jump to conclusions and assume that someone who doesn't have an easy time paying attention or has ADHD, her brain must be completely incoherent and not functioning well. and because everything is out of control, but there is something interesting about people with ADHD where the task networks and the default mode networks are actually working together in a way that is correlated and that is what is abnormal.

So this would be like the guitar, bass and drums playing together in a way where the bass doesn't keep the backbeat and the drums don't keep the backbeat they're playing together, they're all playing the melodies and harmonies. in a way that just doesn't sound right. That's what happens in the brain of someone with ADHD, and we can now say with confidence, based on brain imaging studies, that when someone gets better, when they get treatment for ADHD, or when they age out, as is sometimes the case, the networks from the default mode and task networks tend to become anticorrelated again, okay?

That's the underlying neurobiology, but you'll notice I didn't mention dopamine at all. What dopamine does in this context is act as a driver. Dopamine says this circuit should be active and then that circuit should be active. It should be the default mode network and then when the default mode network is not active, it should be the task network. So it's actually acting like a conductor saying: go, now go, now go, now go. And in ADHD, there's something in the dopamine system that doesn't allow it to drive these networks and make sure that they stay, what engineers or physicists or mathematicians would say, out of phase to be anticorrelated, okay?

Outdated and anticorrelated, essentially the same thing, at least for the purposes of this discussion. So that raises two questions: could it be that dopamine isn't at high enough levels or could it be that dopamine is just doing it all wrong? In other words, is there no conductor or does the conductor play with little sticks and that's why the instruments can't see what they're supposed to do? They can't receive the instruction because it's just not strong enough, so to speak, or it could be that the information is being disseminated, but the information that is being disseminated is incorrect, the driver is there, but the driver is in a very good situation. at the address.

We can now get an idea of ​​how the system works and fails and how to treat it by looking at some of the current and previous treatments for ADHD, as well as some of the recreational drugs that people with ADHD tend to use and like now. I'm certainly not a fan of people with ADHD taking drugs recreationally, that's not what this is about, but if you look at their drug-seeking behavior and combine that drug-seeking behavior with their desire to remedy their attention deficit, you begin to really win something. Interesting information about how dopamine regulates these circuits under normal circumstances and in people with ADHD.

So what exactly is happening with the dopamine system in people with ADHD and what is happening with the dopamine system in people who have fantastic levels of attention for any task? Well, in 2015 an important article came out. The first author is Spencer, he appeared in a journal called Biological Psychiatry and formalized the so-called low dopamine hypothesis of ADHD. The idea that dopamine was somehow involved or not at appropriate levels in people with ADHD had been around for quite some time, but a formal proposal of the low dopamine hypothesis led to some really important experiments and an understanding of what that works poorly in ADHD.

It turns out that if dopamine levels are too low in certain brain circuits, there is unnecessary activation of neurons in the brain that are unrelated to the task one is trying to perform and unrelated to the information one is dealing with. trying to concentrate. So if you think back, you have this default mode network and a task-related network, and they need to be in this kind of concert of anticorrelation and ADHD, they're activating together. Well, the problem seems to be that when dopamine is low, certain neurons activate when they shouldn't, this is like a band, right?

We'll go back to our band, there's a guitar, a bass, and the person playing the drums and it's like one of those or several of those instruments are playing notes when they shouldn't be playing, right? Pauses and music are as important as the actual execution of the 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 to look anecdotally at what people with ADHD have been doing for decades, not just recently since the low dopamine hypothesis was proposed, but what they were doing in the past. 1950s and then in the 1940s and 1960s.

What we find is that they tend to use recreational drugs or they tend to use non-drug stimulants. So things like drinking, six cups of coffee or quadruple espressos, or when it was more prominent to smoke half a pack of cigarettes and drink four cups of coffee a day or if the person had access to it by using cocaine as a recreational drug or amphetamine. as a recreational drug. All of those substances that I just described, in particular cocaine and amphetamine, but also coffee and cigarettes, increase the levels of multiple neurotransmitters, but they all have the quality of increasing dopamine levels in the brain and, in particular, in the brain regions that regulate Attention and these task-related networks and in default mode, okay?

Now, fortunately, young children don't have access to those types of stimulants most of the time and all of those stimulants have a high potential for abuse in adults. So we'll talk about the potential for abuse in a few minutes. But if you look at children, even the youngest ones with ADHD, they show things like a preference for sugary foods, which also act as dopamine-inducing stimulants. Now, of course, once they have access to soda, coffee and tea, they start to enjoy them more than other people. For a long time, it was thought that children with ADHD ate too many sugary foods or drank too many sodas or that adults with ADHD used recreational drugs like methamphetamine or cocaine or drank too much coffee or smoked too much cigarettes because they had low levels. lack of attention and because they couldn't make good decisions, they were too impulsive and so on, and while that certainly could be the case, knowing what we now know about dopamine, and the fact that it requires having enough dopamine to coordinate these circuits neural networks that allow concentration and quality decision making.

An equally valid idea is that these children and these adults are actually trying to self-medicate with these compounds, right? Things like cocaine cause huge spikes in dopamine. Well, what happens is that when someone with ADHD takes that drug, it turns out that they actually get higher levels of concentration, their ability to concentrate on things other than what they care about intensely increases, in the same way, children who use any Anything that increases their dopamine levels, if those children have ADHD, they tend to be calmer, they tend to be able to concentrate more. Now, this is very different from what happens with children who do not have ADHD.

When they consume too much sugar, they tend to become super hyperactive. When they consume any type of stimulant, they tend to go crazy and run like crazy. In fact, I have an anecdote about this just to illustrate it. I have a friend, he has two kids who are now in their teens and twenties, but when they were little, I once brought them a chocolate just as a gift, when I showed up at their house and within 30 minutes, the kids were running around like crazy, I mean , they were high energy kids, but they were going crazy and that's when the mom, my friend at the time, unfortunately, was still looking at the chocolate and realized it was chocolate with espresso beans. in that.

It was like dark chocolate with espresso beans, so I was really at fault, you don't want to give kids dark chocolate with espresso beans, but what you're really seeing is that hyperactivity that is dopamine, okay? It's the sugar combined with the caffeine in this case, combined with some other compounds that exist in chocolate, that really increases our alertness levels and our tendency to want to move a lot, okay? So dopamine and low dopamine levels are apparently what's wrong with 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 way your ability to concentrate and, if you look at the major medications that were developed and now marketed by pharmaceutical companies for the treatment of ADHD, those medications have names like Ritalin.

Nowadays, it's typically things like Adderall, Modafinil, and some of the other derivatives, all of which serve to increase dopamine levels, particularly dopamine in the networks that control task-directed behavior and that coordinate the default mode network and these task-related networks. Many of you have probably heard of Ritalin. Ritalin is a prescription stimulant that is prescribed for both ADHD and narcolepsy. Narcolepsy is a condition in which people tend to fall asleep during the day, quite a lot, excessive daytime sleepiness, not from lack of sleep during the night, but they also tend to stay asleepasleep when they get excited, if they are really emotionally excited or about to eat or any other type of activity that would normally excite and alert someone.

People with narcolepsy tend to fall asleep or tend to become what is called cataplegic. They tend to become loose in the muscles. So it's this invasion of daytime sleep. He is dysregulated by emotion. You can imagine why a stimulant, something that wakes you up, makes you very alert, focused and motivated, would be a good treatment for narcolepsy. Adderall is also used to treat ADHD and narcolepsy, as Modafinil is also used to treat ADHD and narcolepsy. So you're sensing a theme here. So what are the differences and similarities between these medications and what can that tell us about ADHD?

Well, Ritalin was one of the first generation medications that were prescribed for ADHD in order to address this dopamine hypothesis head-on. This idea that in ADHD the dopamine levels are too low. Today, Adderall is the most prescribed medication for ADHD and it has to do with so-called pharmacokinetics, the rate at which those medications enter the system and how long they last in the system. So, for example, Ritalin was a drug that came in various extended-release formulations. While initially Adderall was only released in a form that had a very short life, meaning it wasn't in the bloodstream for very long and didn't affect the brain for very long, so doses could be controlled in a more typical. without going into many tangential details.

As you all know, at different times of the day you tend to be more or less alert. So a sustained, extended-release drug may seem like a really great thing. If that medication has the effect of making you more alert and is released during many hours of the day, there may be periods of the day when you feel overly alert, periods of the day when you feel fine, and periods of the day when you feel very alert. . day, when you wanted to be more alert. These are some of the pharmacokinetics, that is, the movement of different compounds within the bloodstream and brain that could, as you could imagine in a very real way, affect whether or not someone would feel really well on one of these drugs. or whether they would feel too anxious or too sleepy, etc.

Let's step back for a second and ask ourselves: what are these medications? We know they increase dopamine, but what are they really? Well, Ritalin, also called methylphenidate, is very similar to amphetamine speed, or what is normally called speed in street drug nomenclature. Adderall, which has other names, okay? So Adderall, Adderall XR, my dialysis, things like that. Adderall is basically a combination of amphetamine and dextroamphetamine. Some of you probably realize this, that Adderall is amphetamine, but I suppose there are a good number of you out there, maybe even parents and children who don't realize that these drugs, like cocaine and amphetamine, methamphetamine, are incredibly dangerous, addictive, and have a high potential for abuse.

Well, the pharmaceutical versions of those are exactly what is used to treat ADHD and they are not exactly like cocaine or methamphetamine, but they are structurally and chemically very similar and their net effect on the brain and body is essentially the same, which is to increase dopamine mainly, but also to increase the levels of a neuromodulator called epinephrine or norepinephrine also called norepinephrine and adrenaline those names are the same and to some extent increase the levels of serotonin in the brain and blood, but not as much serotonin , that's just kind of a small effect, okay? So dopamine increases, norepinephrine and adrenaline increase.

That's motivation, 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. Basically, what I'm saying is that the medications used to treat ADHD are stimulants and are very similar. In fact, almost identical to some of the so-called street drugs, stimulants that we all have here, they are so terrible. However, I want to emphasize that with the appropriate dosages and working with a quality psychiatrist, neurologist or family doctor, it needs to be a certified doctor who prescribes these things, many people with ADHD get excellent relief from these medications, not all . them, but many of them do, especially if these treatments are started early in life.

So now that we know what these medications are, I want to raise the question of why prescribe them? I mean, everyone has to make a decision for themselves or their kids about whether they're going to do these things or not. I also want to acknowledge that many people, many, many people, are taking these medications, even though they have not been clinically diagnosed with ADHD when I say these medications, I am specifically referring to Ritalin, Adderall, and Modafinil. but the most common is Adderall, okay? People who use cocaine and amphetamines recreationally are a completely different beast and indeed it is a beast and something I strongly advise against.

However, I am aware that up to 25% of college students, and perhaps up to 35% of all people between the ages of 17 and 30, take Adderall on a regular or semi-regular basis to work, to study, and to function and concentrate in your daily life. Even if they haven't been diagnosed with ADHD, there is a whole black market for it. They get it from people with a prescription. I'm not here to judge. I just want to emphasize how these medications work. Some of the things they do to improve cognition and concentration are really helpful for the brain in certain individuals and can be very detrimental in others.

I kind of overlooked it. But the fact that over 25% of young people are taking things like Adderall, despite not having a clinical diagnosis of ADHD. Well, that's a ridiculously high number. A few years ago, Adderall and Ritalin use without a diagnosis of ADHD was estimated to be second in incidence after cannabis, but in reality over-the-counter Adderall use is now higher than cannabis use in that age group. So what that means is that there is a lot of stimulant use in that age group and there are a lot of adults who also use and abuse stimulants to concentrate.

Then we can have a whole discussion about whether life is becoming more demanding or not, whether the need for concentration is excessive or not and that's why people do it. But frankly, it's an interesting discussion, but it won't give us any answers. Rather, I'd like to focus on the ways people now and always have self-medicated to increase concentration, right? Caffeine, which I may enjoy a little bit, I don't think I can access, has long been used as a stimulant to increase dopamine, increase norepinephrine, increase focus and energy, and on top of that, it works through the called cyclic amplifier, phosphodiesterase. via, remember that every time you see or hear an ASE, it is an enzyme.

Phosphodiesterase is involved in converting elements such as cyclic amperage into energy for cells, etc. Basically, coffee gives you energy, makes you feel good and increases concentration due to the circuits it activates in the brain. People have been taking caffeine and continue to take it for years. People also used to smoke cigarettes and nicotine to help them concentrate. Nowadays, that's less common because of concerns, pretty valid concerns about lung cancer from smoking, but there's a lot of vaping out there. There are currently many people who consume nicotine, which is the active substance in cigarettes and most nicotine vaporizers that stimulates the brain to be more focused and alert.

So the idea of ​​taking stimulants or smoking things to increase alertness is not a new idea. It's just that in ADHD it's surprising that these things work, right? I mean, if the problem is attention deficit hyperactivity disorder, which we're really talking about here, or children who are prescribed a medication that should be a stimulant, it should make them hyperactive and instead of doing that , it actually goes some way to calming them down a bit, or at least allowing them to concentrate. Here's why: Children have a brain that is very plastic, meaning it can remodel 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 the task-related network of the forebrain to come online, be active at appropriate times, and because those children are young, allows them to learn what focus and order. to continue or enter that tunnel of focus. Now, when you take a drug, you create concentration artificially, you don't create concentration because you are very interested in something that chemically induces, a state of concentration, and let's face it, a lot of childhood and school and becoming an adult Functional is about learning to concentrate even if 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 trick myself into thinking it was the most interesting thing in the world. I would just lie to myself and say, okay, this, I won't mention the themes, I love this. I just told myself that I loved it and I realized that that selective or deliberate activation of that circuit of the desire to know, whatever it was in my brain, it definitely involved dopamine, it allowed me to focus and remember the information and Somewhat surprisingly or perhaps not surprisingly, I often fell in love with information.

I think that was my favorite class. So it was what I wanted to learn the most. That's one way to do it artificially, but kids with ADHD can't do it, right? They are told to stay still and end up getting up 11 times. They are told they can't talk in class or that they have to stay in their seats for 10 minutes and they, despite their best efforts, just can't do it, they get so distracted. So what are we to make of this whole scenario that we need more dopamine, but these kids with ADHD get their dopamine through a drug, which is amphetamines for everyone, right?

It's speed, that's really what it is. What are the long-term consequences, what are the short-term consequences, and what should we do about people who take these medications without a clinical need? What are the consequences there? Well, to get to some of those answers, I went to one of my colleagues, this is a colleague that I've known for a long time, I was their teaching assistant when they were undergraduates, they went on to get a medical degree, a medical degree and a doctorate and become a pediatric neurologist who specializes in the treatment of epilepsy and ADHD in children of all ages, from three to 21 years old, that is the age range, a fairly wide age range and has extensive knowledge in this and what makes them particularly interesting for this discussion is that they have a son, a toddler, who is now showing signs of ADHD and they are on the threshold of trying to decide whether to prescribe him Adderall or not. or something similar.

So we had a conversation about this and before we found out that her son might have ADHD. I asked him the following questions. First, I asked: what do you think about giving amphetamine to young children? And his answer was, at first glance, it seems crazy, but as long as the lowest possible dose is used and that dose is modulated as they grow and develop those powers of attention, his observation was that children have seen more They benefit from that. I'm certainly not saying what people should do. Obviously you have to go to a doctor because as I always say I'm not a doctor, I don't prescribe anything, I'm a teacher so I profess things and here I am professing that you talk to your doctor, If you are considering giving Ritalin or Adderall or any type of stimulant to your child Of course, what could be more important than your child's health?

But it was a very interesting answer because normally we hear that yes, the doctor does not give medicine. We rarely hear that medication needs to be adjusted throughout life and in a particular way. Now, the fact that this person, this now friend of mine and colleague of mine, has so much experience in the way the brain works and is considering giving his son that medication. I said, why wouldn't you wait until your child hits puberty? I mean, we know that in boys and girls there are increases in testosterone and estrogen during puberty, which drastically change the appearance of the body.

But that also drastically changes the way the brain works; In particular, we know this: that puberty triggers the activation of so-called executive functioning related to frontotemporal tasks. That's just sophisticated scientific talk about being able to concentrate, beable to direct your attention, be 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. Little kids move around a lot, I don't want to say sly, because that makes it look like they're up to something bad, which they might be, but they don't have to be up to anything bad. , they get very worried.

So for puppies, everything is encouragement as animals and humans grow, they learn to control their behavior and sit, stay, listen and concentrate even if they don't want to. Therefore, giving a medication that allows the child to access that stillness from the beginning will allow him to maintain that ability over time. But I decided to go a little further and said, well, why would you do it now and not during puberty or after puberty? And their answer was very specific and I think very important, what they said was: look, neuroplasticity is greatest in childhood and decreases approximately after age 25, but neuroplasticity from three years old to 12 or 13 years old is extremely high and they are right.

When you sit back and look at the literature on neuroplasticity, I would say that childhood plasticity and young adult plasticity is much greater than adult plasticity, but that early childhood plasticity is by far the period in which can remodel the brain at an accelerated rate. This agrees very well with the clinical literature. Not surprisingly, there are doctors who consider early treatment to be key. If you have the opportunity to work with a quality doctor and treat these things early, these medications can allow these frontal circuits, these task-related circuits, to reach their appropriate levels of functioning and allow children to learn to focus on a variety of tasks. of different situations. contexts.

Now, is that the only thing they should do? Of course not. So the next question I asked was what should we do about all this diet stuff, right? I've heard before that the so-called elimination diet or not eating sugar, dairy or gluten, all of these things are supposed to improve ADHD symptoms and people and parents with ADHD go into fanatic lanes to try to find the exact foods that are causing problems and the exact foods kids can eat to try to wire their brain the right way and avoid ADHD for life and your answer was really interesting.

But before I tell you your answer, I want to tell you the studies and the data related to this question of whether the foods and the constellation of foods that one avoids and will eat have anything to do with our levels of attention and in particular. , whether or not it can be used as a stepping stone 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 consume sugary foods or any type of food that increases their dopamine levels.

They are naturally drawn to those foods, whether they realize it or not, presumably as a way of trying to treat their lack of concentration and impulsivity. So, in this study that I am about to share with you, there was no drug treatment, it was simply a study, which manipulated the diet and involved 100 children, 50 in the group of the so-called elimination diet, the special diet in which certain foods are eliminated. eliminated and 50 in the so-called control group. However, being a well-designed randomized controlled trial, this study also included a crossover, that is, where the children would serve as their own control or control group in a certain part of the study.

So there will be in one group where they will eliminate certain foods and then after a period of time in the study they will switch to the other group. This is a powerful way to design a study for reasons you can imagine, because you begin to eliminate changes and effects due to individual differences. In any case, 100 children make 50 in each group in any period of time and the effects they observed were extremely dramatic. In the world of statistics and scientific data analysis, we talk about P values, probability values. What is the probability of something happening by chance?

Typically, the cutoff would be something like P less than 0.05, meaning essentially a probability of less than 0.05 that the effect is due to chance. However, in this study, each of the effects is P less than 0.0001, a very, very small decimal probability that the observed effect could be due to chance. So what were these effects? These effects were a greater ability to concentrate, less impulsivity and even less tendency to move when trying to stay still. So everything from mental focus to the ability to control their bodies improved when they were on the elimination diet group, what was eliminated?

Well, the elimination diet in this particular study was the so-called oligoantigenic diet. It was a diet in which each child underwent a test to determine which foods he had antibodies to, that is, which foods he was mildly allergic to. Now, in this study, it was very important that the children were not extremely allergic to any food because, as I mentioned before, they actually served as a control at a time in the study where they ate all types of foods, including foods that they were allergic to. mild to. Basically, what the study said was that eliminating foods that children have allergies to can dramatically improve their ADHD symptoms.

And this study, as expected because it was published in such a high-quality journal like Lancet, etc., a large number of topics set the world on fire. People were very excited about these results because, in the absence of any drug treatment, a significant improvement in ADHD symptoms was seen and then came the criticism. After this many papers were published that specifically dealt with the reanalysis of this data and I want to be fair in saying that the data in the paper look good, but there are criticisms of the overall structural design of the study. I don't want to go into all the details exactly because there are a lot of nuances about some of the statistics and the way one looks at this type of data, but there was skepticism and in science, skepticism is healthy, especially when making decisions. about whether to treat or feed children one food or another, or give them one medicine or another.

Now I want to go back to the story of my friend, who is a pediatric neurologist who treats ADHD and has a son who is on the verge of maybe starting ADHD medication. I asked a simple question: do you see any effects from the diet? That is, when parents monitor their children's diet, is there a positive, negative, or no difference in terms of how children respond to ADHD, to medications like Ritalin and Adderall, or whether or not it can help them avoid the treatment with those medications? entirely? And her answer was very simple, she said: Eliminating simple sugars has a dramatic, positive effect.

She's seen that over and over again in many dozens, if not hundreds, of patients, okay? Now, that's not a peer-reviewed study, that's a statement I'm relaying to you anecdotally, but it's very, very informed. I said, what's up with these elimination diets? She said, and I found other sources that support this, that these oligoantigenic diets are controversial. There are many people who really believe in identifying all the things you are allergic to and making sure that you and especially your children avoid those foods. However, there is another field that is starting to emerge in the peer-reviewed scientific literature, which shows that when children are not exposed to certain foods, particularly nuts and things like that, they develop allergies to those foods and then when are exposed to them later, causing real problems.

So there is a whole galaxy of debates, controversies and open fights about allergies and children and whether the oligoantigenic diet is appropriate or not. However, of the four neurologists and psychiatrists I spoke to about ADHD in preparation for this, all said that children with ADHD should be encouraged, as much as possible, to avoid foods high in sugar and simple sugar of most types and, if you can find particular foods that exacerbate your symptoms, obviously eliminating those foods is beneficial and the foods that exacerbate your symptoms change over time. That's why I don't like to give a complicated answer, but I also don't like to give an incomplete answer.

What this tells me is that children, especially young children who have ADHD, probably shouldn't eat a lot of sugar, particularly simple sugars. In addition to that, it might be a good idea to explore whether or not they have allergies to the foods they already eat. At least that's what this article, Pelsser et. The Al Lancet article seems to talk, and I should mention that that article was published in 2011. Since then, there have been many dozens of studies exploring the same thing, as well as meta-analyses of all that data, and it seems that diet may play a very big role. important in eliminating or at least reducing the symptoms of ADHD, to the point that some of the children may not take any medications or eventually stop taking them as young adults and adults.

An interesting question is whether adults should modify their diet to increase their concentration levels, if they already have normal concentration levels, but we would like more or we would like to reduce existing ADHD in adults, that is an interesting question. This topic, and even more controversial, takes us directly to the area of ​​​​the so-called omega-3 fatty acids. I've talked many times on this podcast about the known benefits of omega-3 fatty acids in particular, getting a gram of 1,000 milligrams or more, even up to 2,000 milligrams each day of the so-called EPA component of omega-3 fatty acids. acids that are known to have antidepressant effects, mood-enhancing effects, and that are known to have important effects that protect the cardiovascular system.

I think it is now clear that the immune system also benefits from omega-3 fatty acids that include a gram or more of EPA, which are very beneficial and are normally obtained through fish oil; Liquid fish oil will be the most cost-effective, but they are capsule forms for those of you who don't like fish oil, you can ingest it by other means, you can get it from certain algae or krill, etc. You have to make it compatible with your particular diet, whether or not you are vegan, vegetarian, omnivorous, etc. Omega-3s have been shown to have all of these positive health benefits.

Do they have positive effects on focus and attention? And the answer is that you can find studies that support that claim and the effects are significant, but modest. You may also find studies that show no effect, as with omega-3s and antidepressants, where omega-3 fatty acid intake of one gram or more of EPA per day allows people with major depression to take higher doses. withdrawal of antidepressant medication. It appears that adult intakes of omega-3 fatty acids that include EPA at 1,000 milligrams or more may allow adults with ADHD or mild attention deficit problems to function well on lower doses of medication and, in rare cases, eliminate the medication completely.

So what this says is, once again, omega-3 fatty acids are beneficial, will they cure or eliminate ADHD? I think it's safe to say no, they are playing a supporting or what we call modulating role. Just like sleeping well, it plays a modulating and supportive role for essentially everything, your immune system, your ability to think, your ability to regulate your emotions, it's modulating that process. It's extremely important to highlight this component of modulation and I think I want to take a moment on it because it's especially important in the context of ADHD and all the information out there.

There are biological processes that are mediated by particular compounds such as dopamine. Thus, for example, the ability to feel motivated and concentrate is mediated by brain circuits that release dopamine. However, attention is also modulated depending on how rested you are. If you want to eliminate your ability to think straight, just stay up two nights and don't sleep at all, right? If you do that, you will modulate the circuits in your brain that respond to various things and you will become very distracted. You will be very excited. You will feel like garbage, but that does not mean that sleep will mediate concentration and attention.

It modulates it indirectly. Likewise, I think these omega-3 fatty acids, particularly EPA, are so beneficial for mood and apparently also attention, they directly mediate attention and mood, what they do is modulate those circuits. , they make dopamine more available. They make any available dopamine more likely to bind to the various receptors that are present on neurons,etc., and I think this is very important because, in the same way, diet, in any discussion of nutrition, has to include this framework of diet, elimination. Does diet, whether or not some other diet or esoteric diet, ketogenic diet, modulate or mediate a process?

And most likely, in the context of ADHD, it is modulating that process. So if ADHD is mild or if it is caught early enough, or if it is combined with pharmacology with a prescribed treatment, then it could help guide the child or adult to a better place to be able to focus. But it won't be the switch that changes everything. Now, that doesn't mean that eating the wrong foods, sugary foods, or foods you're allergic to is a good idea; will continue to be harmful. So I hope that that conceptual framework helps because if you go online, whether you're someone with ADHD or not, you're going to be bombarded with the ADHD diet, the oligoantigenic diet, the elimination of this, this supplement that the EPA and I think It's very important. to understand whether or not you are talking about something that mediates a process or modulates it.

Now drugs like Ritalin, drugs like Adderall, are tapping into the circuits and neurochemicals that mediate attention and concentration. They are not the only alternatives nor the only options for the treatment of these circuits and the improvement 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

trying to modulate or mediate something within their own brain. If any of you are interested in this oligoantigenic diet, as it relates to ADHD, and want to explore a more recent study besides the classic 2011 Lancet study, that's pretty controversial.

There is an article that was published in Frontiers in Psychiatry last year, 2020. The title of the article is: “Oligoantigenic Diet Improves Children's ADHD Rating Scale Scores Reliably in Additional Video Ratings.” The added video rating is just that they are using an additional measure of focus and attention. Again, that's Frontiers in Psychiatry, 2020, I'll put a link in the title, and that's a more recent study for you to read carefully. So we've talked about the neural circuits of focus and the chemistry of focus, but we haven't talked yet about what would make us better at focusing and what focusing better actually is.

So let's take a step back and think about how we focus and how to improve our focus, and I'm going to share with you a tool that there is excellent research data on that will allow you, in a single session, to improve your ability to focus on theory forever. What I'm about to read to 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 like that, the book is called "Altered Traits." Science reveals how meditation changes your mind, brain, and body, and no, I'm not going to try to convince you to meditate.

I am going to share with you a small passage from the book that relates some research data related to the approach that is very important. If you want to meditate, that is your choice. That is a separate matter. This is a book by Daniel Goleman and Richard Davidson and I just have to mention that Goleman is a well-known author who has written books on emotional intelligence etc. Richard Davidson is also a doctor. He is a professor of psychology and psychiatry, and is at the University of Wisconsin Madison. He's done fantastic work on brain states and modulation of brain states and so on.

What we're going to talk about is when attention works and when attention fails, and what we're going to talk about specifically is what's called attention blinks, not actual blinks. We'll talk about that in a few minutes, but we'll talk about attention blinks. I'm paraphrasing here because Goleman and Davidson wrote about this so beautifully. I'd rather paraphrase them than try to invent a new way of saying it that's less interesting or less good, but I want to give them credit. Attention blinks are really easy to understand, if you think of a where is Waldo task, you know this where is Waldo task, there are a lot of people, objects and things in a picture and somewhere there is Waldo with the striped hat. and glasses and go skinny, and you have to find Waldo, so it's a visual search and it's a visual search for an object that has distinct characteristics, but is embedded in this ocean of other things that could easily be confused with Waldo. .

So you tend to look, look, look, look, look, look, look, look, look, and then you find Waldo. Children can do this, they like to do it. 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 celebrates by releasing feel-good neurochemicals, 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 slight, albeit slight, celebration, you cannot see another Waldo sitting right next to you.

So what this means is that as you pay attention to something, as you look for and identify a visual target, your attention blinked on and off for a second and there's a more formal, more laboratory way in which we see this. The most typical way to do this is to give someone a string of letters or a string of numbers and first tell them to look out for the letters R and Z, okay? You'll just see this string of numbers pass by and there will be a letter R there, and there will be a letter Z there and you'll try to detect both and what you'll find is when you present that string of numbers. , and then they see the R, they see the R, they consciously register it, and they tend to overlook the Z, like in the Waldo guy example.

Now, of course, the numbers go by quite quickly, but they can detect the R. They could also detect the Z, if you told them beforehand, they only detect the Z and the numbers move at the same rate in both conditions. So what that means is that in all cases, you are able to see the R or the Z; It is when you try to see both that seeing the first prevents you from seeing the second, it is what we call an attention blink. We do this all the time and people with ADHD tend to have many more attention blinks than people without ADHD and this is true for both children and adults.

This is an important point. So important that I want to emphasize it twice in case you blinked carefully. If you see something you're looking for, or you're very interested in something, you're definitely missing out on other information, partly because you're focusing too much on something, and this leads to a very interesting hypothesis about what could go wrong in ADHD, where we've always Thought they can't focus and yet we know they can focus on things that matter a lot to them, well, maybe they're just experiencing more attentional blinks than people who don't have ADHD and in fact there is data now that they support the possibility that that is really what is happening and that should be exciting for anyone who has ADHD.

It should also be exciting for anyone who cares about increasing their concentration and their ability to attend. What this means is that. These circuits, which underlie focus in our ability to pay attention and our ability to eliminate distractions, are not simply failures of focus. That's just a semantic way of describing the result. They focus too much on certain things and therefore miss out on others. And so our distraction or the distraction of someone with ADHD could exist because they focus too much on certain elements and are there to miss other elements that they should be paying attention to.

So what they really need is this property that we call open monitoring. Now, open monitoring is something that is described in the book that I just referred to and that is generally associated with people who have done a lot of meditation, so-called Vipassana meditation, or who have spent a lot of time learning to do what is called open look. Visual analysis and open-minded thinking. But there is a simpler version of this that allows us to avoid all that. First, your visual system has two processing modes. It can be a very concentrated vision, like a soda straw.

So if you're looking for the R in this string of numbers in the example I just gave, or if you're really excited about something, you're in that soda straw view of the world and you're missing out on other things, okay, that's high. levels of attention. However, there is also a property of your visual system that allows you to dilate your gaze, to be in the 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 I'm doing it, but even though I'm still looking directly at you, I'm not consciously dilating my gaze so I can see the ceiling, the floor. and the walls around me.

That panoramic vision is actually mediated by a separate stream or set of neural circuits that goes from the eye to the brain and is a stream or set of circuits that is not just wide-angle vision. He is also better at processing things on time. Its frame rate is higher. You've seen slow motion videos and you've seen standard videos, slow motion videos give you that slow motion look, because it's a higher frame rate. You're cutting time, okay? You can use the panoramic view to access the state we call open monitoring. When people do that, they can attend to and recognize multiple targets within this chain of numbers.

They can see the R and the Z and they can see additional things. So this is something that can be trained and that people can practice whether they have ADHD or not. What it entails is learning to consciously dilate your gaze, that's actually pretty easy for most people, whether you wear corrective lenses or contact lenses or not, you can consciously open your gaze and then you can also contract your field of vision. vision. There have also been studies where people were taught to think in a particular way for a very short period of time, and that forever changed their ability to limit or reduce the number of these attentional blinks.

There are now published accounts in the literature of a simple practice performed for about 15 minutes, where subjects were asked to simply sit quietly with their eyes closed and do something akin to meditation, but without directing their mind to any state or particular place. , but just thinking about your breathing and focusing on your so-called interoception, focusing on how your body feels, your mind drifted to bring it back, okay? It's basically meditation for about 15 minutes. It may not seem like a significant or unusual practice or one that would have any impact. But surprisingly, simply doing that once for 17 minutes significantly reduced the number of attentional blinks people would perform.

In other words, their concentration improved almost permanently without the need for additional training. There's something about that practice of reducing the amount of visual information coming in and learning to pay attention to one's internal state, what we call interoception, that allows you such awareness that when you need to look for visual targets, when you need to focus. at multiple things in sequence, they didn't experience the same number of attention blinks and I should mention, not coincidentally, that as people get older and their working memory gets worse and their ability to concentrate gets worse, the number of attention blinks they perform decreases and there are now studies exploring whether the simple meditation practice of about 15 to 20 minutes of sitting and resting quietly and paying attention to your breathing and internal state can also compensate for some of what is called what is called age. . cognitive impairment.

So what this data tells me is that, regardless of whether you are a child or an adult, whether or not you have ADHD, whether or not you are experiencing age-related cognitive decline, or whether we simply want to avoid age-related cognitive decline. age, a simple practice of taking 17 minutes sitting and paying attention to your internal state, simply interocepting, recording your breathing, recording the contact of your skin with whatever surface you are on, can forever rewire your brain to pay better attention and possibly even offset some of that age-related attention 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 endure a meditation session of about 17 minutes, and if there were ever a tool capable of rewiring our attention circuits in a powerful way. This seems to be all and, in addition, the ability to take a panoramic view, to dilate our gaze, the so-called open monitoring that allows the brainwork so that you can detect more information more quickly, it's a powerful tool like Well, and the good thing about that tool is that it works the first time and it works every time.

Now, it's not clear how exactly it works. Is it, for example, about orchestrating this synchrony or asynchrony between the network in default mode and networks related to tasks that we do not know about? Those studies have not yet been carried out. However, the effects are significant, long-lasting, and seem to exist after just one 17-minute session of this silent interoception, which to me makes it seem like something worth doing for everyone. So we just talked about attention blinks, which are essentially blinks of thinking that are your mind shutting down for a moment and losing information. Now let's talk about real blinks, the kind you do with your eyelids.

Now this may seem like an obvious thing but you can do it quickly which is 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 a very long blink and I'm not joking. When you go to sleep at night, you close your eyelids and limit the amount of information coming in, and your perception of time begins to drift as you fall asleep. Your perception of time changes from very fast, at any given moment, to very slow, which means that the frame rate at which you analyze information while you are dreaming, etc., is variable when you are asleep, sometimes it is very fast.

Which means you experienced things in slow motion. Sometimes it's very fast. As you wake up to your experience, time can sometimes be very fast and sometimes very slow. Typically, the more alert you are, the higher the frame rate will be, reducing your experience. This has probably happened to you. If you're ever really stressed and waiting for something or someone, it seems like it takes forever because your frame rate is higher and you're analyzing time more accurately. On the contrary, if you are very relaxed or even sleepy, you wake up and have to think about all the things you have to do.

It will seem like the world is going very, very fast and that you are moving very slowly. Time goes at the same pace, but your perception of time is what has changed. As strange as it may seem. Your perception of time also changes rapidly. Moment by moment based on 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 are unsubstantiated, the science of blinking as it relates to time perception has very good data that supports it. I just want to emphasize one study in particular, which is very appropriately titled "Time Dilation After Spontaneous Blinking." This is an article that was published in current biology.

The first author is Terhune, T-E-R-H-U-N-E. It is a wonderful article. They examine the relationship between fluctuations in time and blinking, and to summarize, what they found is that right after blinking, we reset our perception of time, okay? So the blinks in that sense are a little like the curtain that goes down in a scene between scenes of a play or shots of a movie, and they clap, they applaud, they start to catch our, what do they say, action and then at the end they do the thing and they click down and say, it's a shot, when you blink it's a shot, okay?

Now what's interesting and you'll immediately understand why this is important is that the rate of blinking is controlled by dopamine. So what this means is that dopamine controls attention. Blinks are related to attention and concentration and therefore dopamine and the blink system are a way to constantly modulate and update your perception of time and fortunately it is also a way that you can control. So the basic conclusion of this study was that blinking controls time perception, but also that dopamine levels can alter the sense of time and stay with me here, and that blinking and dopamine are inextricably linked.

They are working together to control their attention. When dopamine levels increase, people tend to overestimate how long something lasted, why? Because they process time more accurately, it is slow motion mode. When dopamine levels are lower, we tend to underestimate time intervals. Let's remember from the beginning of the episode, what happens to people with ADHD: they are not good at managing their time, they tend to be late or they are disorganized. They are not only disorganized in space, that is, in that physical space, around them, they are disorganized in time. Their dopamine is low, we know that too, so they are underestimating the time intervals, so it makes a lot of sense that they are late.

It makes perfect sense that they lose track of time or the ability to concentrate. This is really exciting because what it means is that children with ADHD, adults with ADHD, or people with normal concentration levels who want to improve their ability to concentrate can do so through training that involves learning how often and when to blink, and how to keep your visual focus on a given target and it turns out that this study has actually been done. There is a study again, I will link to the study, titled "Improving attention in primary school students through a training activity focused on fixation." I won't go into all the details, but what they found was that a short period of focusing on a visual target allowed school children to greatly improve their ability to focus on other types of information, and a major component of the effect was due to to the way they controlled the shutters of his eyes, his eyelids and controlled his blinks.

So what they did in this study was they had these kids focus their visual attention on some object that was relatively close, like their hand, for about a minute, which actually takes some effort, if you try to do that, they were allowed to blink. . However, it is known from other work that if people can consciously override the desire to blink, at least to the point where they feel they have to, or if their eyes become dry, that can actually increase attention even more and They have 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 in another station looking a little further and a little further, however, there was an important feature of this study. It's definitely worth mentioning, and that is that before doing this approach, task, or visual training, they did a series of physical movements with the children so that they could eliminate or eliminate some of their desire to move and therefore improve. his ability to stay still. It's been known for a long time now that children need recess, they need time to run and play and roll around, do whatever it is they do to be able to sit still.

Adults probably need this too, frankly, but children need it more because the circuits in the brain that control reflex movements and, as we say, kind of rhythmic waving behavior and things like that, are actively suppressed and children have less built circuits. until they reached 15 or 16 years old. So they had the kids move a little bit and then do this concentration training. This brings me to another treatment that is actively used today in schools for children with ADHD, but is also beginning to be used by many children and parents to keep their children focused and not going crazy in the car or acting out. bad in general. and that is the prevalence of these so-called fidget toys or things that children can do actively and repetitively to eliminate some of their underlying reverberant activity in their nervous system.

So what you will find is that some children with ADHD now have a rubber band placed on their desk, literally a rubber band that is attached to their desk and they can pull on it, even slam it against the desk, if they had I did that. When I was a kid, I think my teachers kicked me out of class, but I think it's cool that they let them do this now as a way to get some of their physical energy out or engage it. Rather, rather than trying to sit still all the time and pay attention, and it turns out that improves these children's ability to mentally focus when they have some physical activity to attend to, and it turns out that it can work for adults too.

I will share with you the related anecdote because it illustrates the underlying mechanism. I have had the great privilege of being able to perform several surgeries and brain surgeries during my career. So one thing you discover when you do brain surgeries is that the brain is quite small, regardless of the species you're working on and you're there and you're trying to do something very specific and the more you try to keep your hands very steady, the more They want to shake, okay? So it's not natural for any of our limbs to stay perfectly still, depending on how much coffee you've had, how well-rested you are, and your kind of baseline level of autonomic arousal.

Some of you may find that you can hold out your hand, absolutely rock solid, others may be a little more shaky. It doesn't mean you are if you are shaking, it doesn't mean you are calm if you are still. What it relates to is the amount of what we call premotor activity, the amount of commands to move that are sent through the system and that's what I mean by reverberant activity and it seems that children with ADHD and adults with ADHD They have a lot of reverberating activity in their nervous system and that is that constant desire to move, they find it difficult to stay still and therefore it is difficult for them to attend, to take advantage of their attention.

When you do surgery and you find that your hands are shaking, what you learn from your mentors, which I did and what works extremely well, whether you're doing surgery or not, is that you just tap your foot or bounce a little bit, which you might think would make your hand shake even more, but as long as it's subtle. What it does is it transfers some of the activity of those premotor circuits to other parts of the body and then you can sit much more still with your hand, you can perform the surgery with much more precision.

You are able to write with much better handwriting and for those of you who speak in public, if you are ever too nervous, that is why pacing back and forth while speaking in public helps if you are nervous, that is why doing bouncing the knee behind the podium works well. Therefore, nodding your head and gesturing can be helpful. It's not about "taking energy out of the body." That doesn't actually happen, which is what you're activating those premotor circuits that send commands. It's like trying to put things, a lot of things through a funnel, and that creates this tension, so you are giving an outlet to the neural circuit to be able to move something and thus be able to maintain other components of your body and your body. engaged mental attention fixed on something we call focus.

One thing related to this whole thing about blinking and focusing and training yourself to focus and not blink, etc., is that most drugs, Ritalin, Adderall, and recreational drugs that increase dopamine, even coffee, tea, and other forms of caffeine, tend to make us blink less and when we get tired, we tend to blink more. Now this is kind of a no-brainer, right? But having your eyes wide open with excitement or fear or with your eyes barely able to keep them open, it should now make perfect sense that these shutters in front of your eyes aren't there just to wink and they aren't.

It's not just there for cosmetic purposes. They are there to regulate the amount of information that enters your nervous system and they are there to regulate how long you take information into your nervous system and in what containers, how broadly or finely you are grouping the time is set by how often you blink. and how broadly or specifically you're engaging the visual world depends on whether or not you're seeing things very specifically like a cross-sectional area through a soda straw view like this, or whether or not you were in this kind of panoramic view. . full environment mode, this type of fisheye lens or wide angle lens and to be fair to pharmacology and circuitry, while dopamine and elevated levels of alertness and arousal tend to make us blink less and pay more attention.

In fact, there is a study that looked at other neurochemical systems and medications and how they relate to blinking, so all of this will be obvious from the title of the article I'm about to share with you. This is an article titled “Decreased spontaneous blink rates in chronic cannabis users, evidence for cannabinoid-dopamine interactions.” Well, 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, one couldthink, well, why would they do that? Because I thought that an increase in dopamine is actually what will lead to higher levels of attention and that's what these people in children crave.

Well, it turns out that cannabis also increases dopamine transmission in the brain, but because of other chemicals it increases, namely serotonin and some components of the cannabinoid and opioid system, it creates that kind of alert, but calm feeling, and again, here I am not a fan of this, I am personally not a THC or cannabis user. It's just not my thing and it's obviously illegal in some places so you have to determine that for yourself for medical purposes, in some places it's legal but THC increases dopamine and increases neurochemicals that can also create a calm state .

So it's that kind of middle ground and this article has a beautiful demonstration that not only as long as people use cannabis, but depending on how long they've used cannabis over their lifetime, blink rates change. So if we look at the number of years that people have been using cannabis on a regular basis, whether daily or even, excuse me, weekly or even daily, what we find is that for people who have not used cannabis at all, or have only been using it for about two years, their blink rates are much higher than people who have been using it chronically for 10 years.

In other words, people who can use cannabis for 10 years don't blink very often. Now, cannabis has well-known effects on memory depletion, but it appears to activate the attention and blinking system in a way that increases concentration. Basically what I'm saying is that marijuana seems to increase people's concentration, but then they can't remember what they were concentrating on. Something I would like to briefly discuss is the so-called interoceptive awareness that is present in people with ADHD, both children and adults. Interoceptive consciousness is a sensation of one's own internal state of heartbeat, respiratory contact of the 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 were feeling, that they were somehow not registering everything that was happening inside them, changes in heart rate, etc. so they were behaving in a way that was dysregulated or seemed dysregulated, and that if they could learn to better attend to their internal state, they would somehow function better in the world. Now, earlier we described a process, literally a 17-minute interoceptive exercise that appears to lead to improvements in the ability to concentrate over a longer period of time.

However, it is highly unlikely that this was due to increased interoceptive awareness per se. It probably wasn't because people acquired a much greater or improved ability to understand what's going on internally. In fact, you can imagine how that could prevent one from paying attention to things in the outside world. So while it's beneficial to just sit there and be still, as they say, or focus on your breathing and internal state to then access information in the external world, a really interesting study called interoceptive awareness and attention deficit disorder e Hyperactivity disorder explored whether or not interoceptive awareness was different in people with ADHD or not, and the findings were essentially that there is no difference in whether people with ADHD, children and adults, are as aware of what's going on inside them as anyone else. person. and the typical measure of interoceptive awareness is the ability to count one's own heartbeat.

This is actually challenging for some people and very easy for others, regardless of their attention span. Some people can simply feel their heartbeat without taking their pulse, others cannot, and these tests are fairly simple to perform. You ask people to sit there and count their heartbeats, and then you monitor their heartbeats and can assess how accurate they are. That's why 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 accept the demands placed on them and enter a cognitive or mental state that allows them to access the information they need to access; in other words, whether they can concentrate or not, but it is absolutely wrong to think that the child who gets up 11 times during a brief six-minute interaction at the table, or a child who somehow has to venture out every moment or a co-worker of yours who is an adult who is constantly fidgeting or moving things around them that they are somehow unaware that they don't realize, they are not oblivious to how they feel.

Chances are they feel very challenged in the situations they find themselves in and are doing everything they can to try to regulate their attention. So I think it's an important study to highlight because it really highlights the fact that something else is going on and something else has a lot to do with this ability to coordinate these network-directed tasks, and coordinate them in the appropriate way with that ability. default. network mode and that is a process, as you know, that is exquisitely regulated by certain neurochemicals and in particular the neurochemicals, dopamine, norepinephrine and serotonin, and a fourth that I would like to add to the mix, which is acetylcholine , which is very vital for the cognitive approach.

So now I want to talk again about some of the medications that are typically used to access those systems, prescription medications, and I want to talk about some of the new and emerging over-the-counter approaches to increasing levels of dopamine, acetylcholine, and serotonin in the brain. using several supplement-type compounds, because several of them are showing truly remarkable effectiveness in excellent peer-reviewed studies. So before we move on to some of the newer atypical compounds and those sold over the counter, I would like to briefly return to the classic medications that are used to treat ADHD. These are the ones I mentioned above, Methylphenidate also called Ritalin, Modafinil or Armodafinil is another and Adderall, again, they all work by increasing dopamine and norepinephrine levels.

They are usually taken orally in pill form or sometimes in capsule form. Appropriate doses vary depending on the severity of a given person's condition and their age. This is a complicated scenario for each individual. They have to discover the pharmacology that is best for them. Some people even take a long time to release Ritalin with Adderall in smaller doses, it can get quite complex or quite simple if you are really interested in these medications and how they work and would like to take a look. a table of all the results of all the studies of which there are now hundreds, there is an excellent review on these drugs and their use and their comparison with similarly structured drugs, in particular MDMA, cocaine and amphetamine, i.e. 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 entire article. I'm here so you don't have to read these articles, but in case you want a lot of information, the article is Esposito et al Frontiers and bio-sciences. , is an excellent, excellent review of all the literature. It's quite long. I can put a link to that study in our title, 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. These medications are not simply referred to as ADHD treatment. Actually, it means that they use language that I normally don't like very much, but that I will accept here, which is so-called smart drugs or nootropics.

It also covers caffeine, which again, as I mentioned earlier, increases dopamine, norepinephrine, and to some extent serotonin, but what I like so much about this review is that by putting these drugs of abuse, methamphetamine and cocaine, along with these drugs, like Ritalin and Adderall and also caffeine, we begin to realize that the distinction between drugs of abuse and the distinction between drugs of treatment is actually a very fine and sometimes even blurred line, and in thinking Whether or not one wants to use these prescription drugs I want to emphasize the prescription, not of drugs of abuse, but of prescription medications for the treatment of one's attention span.

I think it's important to understand the extent to which they all carry more or less the same side effects. The only exception is caffeine. The side effects of caffeine can be anxiety if you drink too much, insomnia if you drink too late in the day, but it usually won't cause the major side effects of the other drugs, such as high propensity. for addiction and abuse. Amphetamines of any type, as well as cocaine, can cause sexual side effects because they are vasoconstrictors. Therefore, men have problems achieving an erection, often there may be an intense desire or libido to have sexual intercourse, but an inability to perform it.

So that's a problem with any type of stimulant. So these drugs are not without consequences. Also, here I would add caffeine back into the mix. Plus, almost all of them have cardiac effects, right? They increase the heart rate, but they also have effects on the constriction of blood vessels, arteries and veins, etc., so that they can create cardiovascular problems. Now, caffeine is a little complicated. I talked about this on a podcast a long time ago, but I'll just remind you that it turns out that if you're caffeine-adapted, in other words, if you're used to drinking caffeine, then ingesting caffeine will, more often than not, cause vasodilation. who actually allow more blood to flow.

However, if you are not adapted to caffeine, it will cause vasoconstriction due to an increased stress response. So if you're familiar with caffeine, caffeine may actually have a bit more of a relaxation response, although if you drink enough of it, it will give you a boost. These other drugs almost always cause vasoconstriction, increased heart rate, dilated pupils, decreased blinking, increased attention levels, which looks a lot like stress and, at its extremes, looks a lot like the effects of illegal drugs. , such as cocaine and amphetamines. . Due to the large amounts of dopamine that are released in the brain.

People tend to crave that state over and over again, and yet with each subsequent use they may get less and less of that euphoric feeling or that focused feeling. So something that is being widely explored now in the treatment of ADHD is pharmacological regimens. Whether or not people should take Adderall every day or every other day, whether or not they should take it only once in a while, whether young children can take it only a few times and participate in behavioral training of the type that I talked about before. , where they're doing it, maybe it's a 17-minute meditation-type exercise, but more likely it's movement followed by visual focus, because that's only done for 20, 30, 60 seconds.

Why would you do that? Well, in a chemically enhanced state, your brain is more plastic. Circuits are capable of being modified and learning better. That is the optimal time to focus in a very deliberate way. So taking a medication and expecting concentration to work at any time and being able to turn it on and off at will is an unrealistic expectation, right? Most likely the best use of things like Adderall, Modafinil, armodafinil and Ritalin is to combine those treatments with behavioral exercises that actively engage the same circuits that you are trying to train and improve and then you might want to highlight perhaps tapering off those medications so that These circuits can then be used without the need for chemical intervention.

So, despite any controversy that may exist, I think it is fair to say that the consumption of omega-3 fatty acids can positively modulate attention and concentration systems. So the question is how much EPA, how much DHA does it differ, what is useful for depression, etc. And, in fact, it does differ. In reviewing the studies on this, it seems that a threshold level of 300 milligrams of DHA is be an important turning point. Therefore, typically fish oils or other sources of omega-3s contain DHA and EPA, and it is usually the EPA that is most difficult to achieve in sufficient levels, meaning that you have to take quite a bit of fish oil to overcome those 1000 or 2000 milligrams.

Milligram threshold for improving mood and other functions. But to draw your attention, there are 10 studies that have explored this in detail and while the EPA component is important, the most compelling studies point to the fact that consuming more than 300 milligrams per day of DHA is really where you start to see the attention. effects. Now, fortunately, if you are getting enough EPA for mood and other biological functions, almost without a doubt,you're getting 300 milligrams or more of DHA. That usually checks that box without a problem. What's interesting is that there is another compound, phosphatidylserine, that has been explored for its ability to improve ADHD symptoms.

Again, I don't think this is in a direct way, but rather in a modulatory way, but it appears that phosphatidylserine taken for two months at a rate of 200 milligrams per day was able to reduce ADHD symptoms in children. It has not yet been observed in adults, at least as far as I know, but this effect was greatly enhanced by the consumption of omega-3 fatty acids. Now we're starting to see synergistic effects again of omega-3 fatty acids and phosphatidylserine, which was 200 milligrams per day. This is something that is sold over the counter in capsule form, at least in the United States there were two studies, both were double-blind studies.

I did it for between one and six months on both boys and girls and it was really boys and girls, not men and women. These were children from one to six years old or seven to 12 years old, and it was a fairly large number of subjects. So, 147 subjects in one case and 36 in the other, the conclusion is that obtaining sufficient levels of EPA and particularly there is a threshold of 300 milligrams of DHA, also, if you are interested and it is suitable for you, 200 milligrams of phosphatidylserine can be an important complement to improve ADHD symptoms. You will also find literature and many claims about so-called Ginkgo Biloba, which has been shown to have minor effects in improving ADHD symptoms, and is not as effective as Ritalin and Adderall.

Ginkgo Biloba is not appropriate for many people. I am one of those people, I don't have ADHD, but when I take Gingko, even at very low doses, I get terrible headaches. Some people do not experience such headaches, but it is known to have very potent vasoconstrictor and vasodilator properties that vary depending on when the compound was taken. So, for those of you who are exploring Ginkgo Biloba, and you'll see a lot of claims about Ginkgo Biloba for attention in ADHD, definitely take into consideration the vasodilation, vasoconstriction headache issue. So I would like to talk about the drug Modafinil and the closely related drug armodafinil which is AR Modafinil.

Because modafinil and armodafinil are gaining popularity, both for the treatment of ADHD and narcolepsy, but also for communities of people trying to stay awake for long periods of time. That's why it's actively used by first responders in the military, it's gaining popularity on college campuses, and people are increasingly using it as an alternative to Adderall and Ritalin and excessive amounts of coffee. It increases the concentration and to a large extent, modafinil was normally very expensive, I don't know if it's still that expensive, but when you have a prescription, it could still cost up to eight or $900, even $1000 a month. .

Armodafinil is a much less expensive and chemically slightly different version of Modafinil. Regardless of the price, people take modafinil and armodafinil. I want to emphasize that unlike Ritalin and Adderall, Modafinil and armodafinil are weak dopamine reuptake inhibitors and this is how they lead to dopamine surges. So while Ritalin and Adderall, amphetamine and cocaine cause large increases in dopamine also through reuptake mechanisms etc., Modafinil is a weaker stimulator of dopamine reuptake and what that means is that it leaves more dopamine available to be active. In short, the spaces between neurons, however, also activate other systems. It acts on the orexin system, which is actually a peptide that we talked about in the hunger episode, because it regulates hunger and appetite, and it regulates drowsiness and the feeling of drowsiness.

In fact, the, excuse me, orexin also called the hypocretin system, the orexin hypocretin system is what is altered in narcolepsy. That was the important discovery of my colleagues, Emmanuel Mignot and Seiji Nishino at Stanford a few years ago, they identified the biological basis of narcolepsy and it is an alteration in the hypocretin system and modafinil is one of the primary treatments for narcolepsy. It also has these other effects on the dopamine system and the norepinephrine system, although it does not lead to such intense levels of dopamine, excitement and concentration, it does have the property of raising levels of attention and concentration, and that is why people use it.

So it's a slightly milder form of Adderall. For some people, armodafinil works as well as modafinil and, as I mentioned before, it has a much lower cost for other people, but it doesn't. I have an experience, I mean, I have an experience that I will share with you with armodafinil. A few years ago I suffered from really terrible jet lag and was traveling abroad. I went to a meeting to give a talk, took half the prescribed dose of armodafinil. They prescribed it to me. I took that half dose and gave my lecture and then stayed to answer questions and then four hours later a friend of mine came up to me and said, you've been speaking for four and a half hours, and they're only a few people left. here.

Luckily there were still a few people, which was even stranger if the room was completely empty, because it wasn't being recorded. So I have firsthand knowledge of the types of cognitive effects it can create. Personally, I wouldn't want to be in that state for studying or learning or doing this podcast, for example, and I can honestly say that today, all I've adapted to is a little coffee, a little yerba tea latte, and a little water I do not take any of the compounds I described during the course of today's episode. You may be wondering why I took half the recommended dose of armodafinil and the reason is that I am someone who is quite hypersensitive to any type of medication, what you will find if you search the literature is that about 5% of people are hyperhyperactive. . sensitive to medication.

They require much lower doses of any medication than other people to experience the same effects. I'm someone who I think has, or a modest hypersensitivity if that kind of contradictory statement, but a modest hypersensitivity to medication. So I've almost always been able to get by, taking less than what I was prescribed and feeling fine or, in this case, feeling like it was still too much, it turned out that the correct dose of armodafinil for me was zero milligrams. Now you may notice that I haven't talked much about acetylcholine. Acetylcholine is a neurotransmitter that in the connections between neurons and muscles, the so-called neuromuscular junctions, intervenes in the generation of muscle contractions of all types for all movements.

Acetylcholine is also released at two sites in the brain. So a little bit of nomenclature here again, feel free to ignore the nomenclature, but there is a collection of neurons in the brainstem that send forward projections, kind of like a sprinkler system that is very diffuse to release acetylcholine and those neurons reside in an area or structure called the pedunculopontine nucleus, the PPN and then there is a separate collection of neurons in the basal forebrain unimaginably called the basal nucleus, the nucleus at the base and also hoses the brain with acetylcholine, but in a much more specific way .

So one is like a sprinkler system and the other is more like a fire hose to a particular place and those two sources of acetylcholine collaborate to activate particular places in the brain and really achieve a tremendous degree of concentration on whatever it is. . it's happening at those particular synapses. So, it could focus on visual information or auditory information, if you're listening carefully to what I'm saying right now and you just listened carefully to the rest of my sentence, acetylcholine was certainly released in the sites in your brain where the neurons that represent your recognition of the word, okay?

Now that you have an example and understand and hopefully have a picture in your mind of how this all works, it is not surprising that medications that increase cholinergic or acetylcholine transmission increase concentration and cognition. One of these compounds is the so-called alpha GPC, which is a form of choline and increases the transmission doses of acetylcholine up to 1200 milligrams per day, which has a very high distributed dose, generally it is 300 or 400 milligrams distributed throughout the day . It has been shown to offset some of the effects of age-related cognitive decline, improving cognitive functioning in people who do not have age-related cognitive decline, which is a very high dose.

Typically, when people use alpha-GPC to study or enhance learning of any kind, they will take between 300 and 600 milligrams, which is more typical. Again, you should consult with your doctor, you should decide if the safety margins are appropriate for you, obviously you'll want to check that, but alpha-GPC is effective in creating a more concentrated cholinergic system. It stimulates the release of acetylcholine from both places, the PPN in the back of the brain and the nucleus basalis in the front of the brain. There are two other over the counter compounds that are actively used for the treatment of ADHD and are used simply to try to improve concentration and the first is L-tyrosine, it is an amino acid that acts as a precursor to the neuromodulator dopamine and Now that we know everything What we know about dopamine, attention, and the circuits involved, it should be no surprise why people are exploring the use of L-tyrosine for that purpose.

L-tyrosine produces increases in dopamine. They last quite long and L-tyrosine can improve the ability to concentrate; however, the dosage can be very difficult to adjust. Sometimes it makes people feel too euphoric, too nervous, or too alert to not be able to concentrate well. So the dose ranges are huge, you see evidence from 100 milligrams to 1200 milligrams. It's something that really needs to be approached with caution, especially for people who have some sort of underlying psychiatric or mood disorder, because dysregulation of the dopamine system is central to a lot of mood disorders like depression, but also especially mania, bipolar disorder and schizophrenia. , things of that type.

So it's something that really needs to be approached with caution; However, by exploring what is out there and even some studies online that were done in animal or human studies, it is clear that L-Tyrosine is being explored for that purpose, as are PEA and Phenethylamine, which is essentially PEA, but with some related compounds. So there's a whole class of dopaminergic supplements or dopamine stimulants that people use to try to increase their dopamine levels over and over again, it's kind of a fine line between too little and too much. If you want to get the literature on those two compounds there, I'll direct you to this great website at examine.com just as it sounds and you can add L-tyrosine or PEA, and you can get the details on that.

But I highly recommend also going to their ADHD section to see how those particular comment OENs relate specifically to ADHD and the cognitive approach. And last but not least, in terms of these different compounds, I want to mention Racetams. These are somewhat esoteric and most of you probably haven't heard of them, but some of you probably know a lot about them and they are becoming more popular. They're called New Pepped and stuff like that. The Racetams. They are illegal in certain countries. They're on the gray market in other countries and they're sold over the counter in this country, in the US, so they have different margins of safety.

You should definitely consult your doctor, especially if you have ADHD, but it has been shown that there are newer supplements when taken, at 10 milligrams, twice a day may be more effective than some of the other Racetams. What is Noopept? Noopept taps into the cholinergic system, the acetylcholine system, very similarly to alpha-GPC, but it seems to have a slightly higher affinity for some of the receptors involved and can lead to those elevated states of cognitive ability and there are these studies. in particular, comparative studies of new Racetams in the treatment of patients with mild cognitive disorders and brain diseases of vascular and traumatic origin.

That's a mouthful. What this study basically points out is the fact that people who are experiencing some degree of inability to concentrate due to a previous concussion or some vascular event, a stroke or a scheme of any kind, because the neurons need blood, when the blood supply is cut off. to the neurons, or when there is a hemorrhage in the brain. After that, challenges often arise in maintaining focus. This is very common in people who have played sports where there are a lot of head impacts, such as rugby, hockey, etc., but also in people who have experienced head impacts or who often overlook the fact that The most traumatic head injuries are actually not due to sports, not even football, butto things like construction work or high-impact jobs of that type.

So there seems to be some effectiveness with the new Pepped and Racetams. and things like that. It's an emerging area and as I mentioned, in the US these things are sold over the counter. Again, you have to figure out if it's right for you, but they're starting to show promise and I'm intrigued by how they tap into the cholinergic system, which is directly involved in focus and the ability to concentrate, but is also important for things related to age-related cognitive decline. So a decrease in cholinergic transmission or acetylcholine, as we call it in the brain, is one of the things associated with cognitive decline and it appears that increased cholinergic transmission may offset some of that cognitive decline and perhaps even more in conditions such as vascular damage. or concussion to the brain.

If you are interested in atypical treatments for ADHD compounds or improving concentration and related topics, and you like reading about this topic, there is an excellent review article that I can refer you to, written by Ahn et al, AHN, which was published in 2016. is a bit behind the times, although it is surprisingly comprehensive given that, which lines up all the various medications I have discussed, Racetams, Adderall and Ritalin, and various forms of dopaminergic agents and cholinergic agents, it explains whether or not they are sold without a prescription and it really aligns them in all their effects, their drawbacks, etc.

I will refer you to that study. It is available in its full version online for free. It is Hen et al. The journal is neuro plasticity, neural plasticity, 2016 should be very easy to find if you enter those keywords and while it is a review, it is a very comprehensive review. and if you really like this stuff and also want to learn a thing or two about how this stuff interacts with neurofeedback etc, there's information there too. I know I've already covered a lot of information, but there is one more category of technology for treating ADHD and improving concentration in anyone that I would like to emphasize and that is transcranial magnetic stimulation.

Transcranial magnetic stimulation, also called TMS, is gaining popularity today for the treatment of all types of neurological and psychiatric conditions. It's a non-invasive tool, it involves taking a coil, it's a device with a coil that is placed in particular places in the brain and then it sends magnetic stimulation to the brain and it can actually pass through the skull without having to drill into the skull. skull and today it can be used to both reduce the amount of activity and increase the amount of activity in specific areas of the brain. It is spatial, the precision is not remarkable.

That doesn't mean it's not useful, but it's not a super fine eco-friendly tool, okay? It's not a cannon, but it's not a needle either. It's somewhere in between. It can direct the activity of certain regions of the brain to certain depths and, as I mentioned, it can increase or decrease that activity. So, for example, I had a TMS coil placed on my head, not for therapeutic purposes - even if it was, I wouldn't tell you - but simply because, well, I'm a neuroscientist and I worked in a laboratory. 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 while moving objects on a table, just like I do now, was actually a pencil, not a pen and I was hitting the stylus and then the TMS coil came on and for the life of me, I couldn't move that stylus, okay? Because it was inhibiting my upper motor neurons in the portion of my cortex that controls voluntary activity. As soon as the coil went off I was able to hit the pencil again, nowadays it is possible to stimulate the motor cortex or any area of ​​the brain with some degree of precision that can create the impulse to move without actually making the decision to move. .

So, literally, certain neural circuits and therefore behaviors and certain thinking and emotional patterns can be activated by transcranial magnetic stimulation. This has vast and far-reaching implications, as you can probably imagine when talking about ADHD with a colleague who uses TMS, what they are doing is taking the TMS coil to children and adults who have ADHD, and they are using it for stimulation. the portions of the prefrontal cortex we talked about earlier that involve focused, task-directed states. So instead of using a medication that typically increases dopamine and some of the other chemicals involved, you use targeted stimulation of the circuits with TMS and fortunately, I was quite relieved to hear this, they are combining it with a task of focused learning.

So they are literally teaching the brain to learn in a non-invasive way, without any medication, and there are experiments and clinical trials going on right now comparing TMS of this type to pharmacological treatments of the type we described above that involve these. circuits. through pharmacological mechanisms. These are very exciting times for TMS, very exciting times for ADHD-related pharmacology and improving concentration in general, and when I say very exciting times, I mean, no drug is perfect, but the constellation of drugs that exist are becoming much larger. but because they tap into different aspects of their circuits, I believe we are well on our way to identifying ideal combinations of pharmacological treatments, technological treatments, and behavioral paradigms to increase attention in both children and adults with ADHD.

And as a final final point, I also want to mention something about technologies that make it harder for all of us to concentrate, regardless of whether we have pre-existing ADHD or not. You can probably guess where this is going. Everyone these days seems to have a smartphone. I'm sure there are some people who don't have a smartphone. However, most people have them. Most kids want one, as soon as they can get them and they are small, they completely grab our attention. But inside that little box of attention, there are millions of windows of attention scrolling around, right?

So just because it's a device we're looking at doesn't mean we're focused, we're focused on our phone, but because of the way the context changes so quickly within the phone, the brain is thought to be struggling now. leave that quick context switch, right? Many, many shows, many, many Instagram pages, many, many Twitter feeds, and many, many websites. Basically, everyone, at least in virtual form, is available inside that little box. Unlike any other technology humans have had to deal with before, even though there are billions of infinite bits of information in the real physical world, your window of attention, that constricting and dilating opening of that visual window, It's the way you handle all things.

That information is usually overwhelming. Well, inside the phone, your visual aperture is set to a certain width, it's that big, usually the phone seems to be getting bigger, but anyway, it's that big and in there, your attention window It captures about an infinite number of bits. of information, colors, movies. If a picture is worth 1000 words, a movie is worth a billion pictures, the brain loves visual movement and then the question is: does that type of regular interaction lead to deficits in the types of attention we need to have a good performance at work, at school, in relationships, etc., and the short answer is yes, it appears that we are inducing a type of ADHD and while studies on this are ongoing because the prominent use of smartphones really took off around 2010 and We are only in 2021.

Long-standing studies take time, which is essentially saying the same thing as long-standing ones. There are a few studies and one in particular that I would like to highlight, one that was carried out in early 2014. This is a study that explored smartphone use at the time when they called it mobile phone use, but the use of smartphones and inattention, difficulties. in serving 7,102 teens is a huge study, a cross-sectional population-based study, and you will probably be surprised and somewhat dismayed to learn that to avoid this decline in attention span, teens needed to use their smartphone for less than 60 minutes. per day, to stay focused and focused on your other tasks.

Otherwise, they started to have major problems. So 60 minutes is not much, I have a feeling that most young people use their phone more than 60 minutes a day, I know. I think for adults, the number probably has a higher meaning. If you're an adult, I'm just going to extrapolate from what I read in this study. It seems like probably two hours a day on the phone would be the upper limit beyond which you would probably experience pretty severe attention deficits. I'm a big fan of Cal Newport, who wrote the book "Deep Work." He has also written an excellent book, "A World Without Email." I've never met him, but I'm a big fan of his work and I'll paraphrase something he said much more eloquently than I could, which is that the brain doesn't do well with constant context switching, which means it can, but it diminishes our ability to do meaningful work of any other kind.

And then Cal, as I understand it, is our computer science professor at Georgetown, by the way, he is very structured and very disciplined about avoiding cell phone use. I think we all strive for it. I'm not here to tell you what to do, but I think whether you have ADHD or not, if you're a teenager you limit your smartphone use to 60 minutes a day or less and if you're an adult to two hours. per day or less will be among the best ways to maintain, just maintain your ability to concentrate at whatever level you can now and, as I always say, most of the things that we are known for in life, success in life, In every endeavor, whether it be school relationships, sports, creative work of any kind or not, they are always proportional to the amount of attention we can give to that activity.

Of course, it is important to rest to get enough sleep. But I back that statement and leave you with that study about attention and cell phones and how cell phones are eroding our attention span. Then I realized I covered a lot of information about ADHD and the biology of focus and how to improve it. We talked about the behavioral and psychological phenotypes of ADHD. We talked about the underlying neural circuits. We also talked about neurochemistry and talked about the various prescription drug treatments that target that neurochemistry and increase attention 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 talked about the interactions between these various characteristics in dictating ADHD outcomes and improving overall concentration, we also talked a little about emerging neurotechnologies and how Without a doubt, certain technologies like the smartphone are hindering our ability to concentrate and putting us at greater risk of developing ADHD at all ages.

I recognize the irony and, in some ways, the contradiction of doing a two-hour-plus episode about ADHD. If, in fact, people watching this are struggling with attention, I want to emphasize that this podcast, like all of our podcast episodes, is timestamped for a specific topic. reason. They are designed to be digested in the batch one chooses, right? You don't have to watch or listen to everything at once; However, if you have reached this point in the podcast, I want to thank you. I hope you have learned a lot about this condition. I hope you've also learned a lot about your own ability to focus and the things you can do to improve your concentration.

We're even talking about a tool that requires just one 17-minute session to improve your ability to concentrate thereafter, presumably forever. If you are enjoying this podcast and learning from it, please subscribe to our YouTube channel it really helps us. Additionally, in the YouTube comments section, you can leave suggestions for future podcast guests and suggestions for future podcast topics that we may not have covered or that you would like to see covered in the future. Also, subscribe to the podcast on Apple and Spotify and on Apple you have the opportunity to leave us a comment and a review of up to five stars.

Also, check out the sponsors mentioned at the beginning of the podcast, it's a great way to support us and for those of you who would like to support research into stress, neurobiology and human performance, you can visithubermanlab.stanford. edu, and there you can make a tax-deductible donation for neurobiology research in my laboratory. Additionally, we have a Patreon: patreon.com/andrewhuberman. There you can support the podcast at any level you want. During today's episode we talked a lot about supplement-based compounds. If you're interested in supplements and you want to see what supplements I personally take, you can go to Thorn, which is T-H-O-R-N-E, slash the letter U, slash Huberman and you can see everything I take and you can get 20% off any of them. supplements or if you navigate to the Thorn site through that portal you can get a 20% discount on any of the supplements that Thorn makes, supplements are not for everyone, there is no way you need to take supplements.

But if you are going to take supplements, it is important that you take them from a trusted source and whose ingredients are very high quality and where the amount of ingredients listed on the bottle actually matches what is in the bottle. That's why we partnered with Thorn because they have the highest levels of rigor in terms of ingredient quality and specificity. And finally, I want to thank you for your time and attention, and as always thank you for your interest in science.