Welcome to the Huberman Lab Podcast,

where we discuss science

and science-based tools for everyday life.

I’m Andrew Huberman,

and I’m a professor of neurobiology and ophthalmology

at Stanford School of Medicine.

Today, we are going to talk all about

attention deficit hyperactivity disorder, or ADHD.

We are also going to talk about normal levels of focus.

What are normal levels of focus?

And how all of us,

whether or not we have ADHD or not,

can improve our ability to focus,

our ability to rule out distraction,

turns out those are two separate things,

as well as remember information better.

We are also going to talk about

how we can learn to relax while focusing,

which turns out to be a critical component

of learning new information

and for coming up with new creative ideas.

So whether or not you have ADHD or know someone who does,

or if you’re somebody who feels that they do not have ADHD,

but would simply like to improve their ability to focus

or to be more creative,

this episode is definitely for you as well.

We are going to talk about

drug-based tools that are out there.

We are going to talk about behavioral tools.

We will talk about the role of diet and supplementation,

and we will talk about

new emerging brain machine interface devices

things like transcranial magnetic stimulation.

If you don’t know what that is, don’t worry,

I will explain it to you.

These are non-invasive methods for rewiring your brain

in order to make focusing more natural for you

and to teach you how to increase your depth of focus.

Now, just a quick reminder

that anytime we discuss a psychiatric disorder,

it’s important that we remember

that all of us have the temptation to self-diagnose

or to diagnose others.

So as I list off some of the symptomology of ADHD,

some of that symptomology might resonate with you.

You might think, oh, maybe I have ADHD,

or you might decide that someone you know

definitely has ADHD.

However, it is very important that you don’t self-diagnose

or diagnose somebody else.

The clear and real diagnosis of ADHD

really should be carried out by a psychiatrist,

a physician, or a very well-trained clinical psychologist.

There are clear criteria

for what constitutes full-blown ADHD.

However, many of us have constellations of symptoms

that make us somewhat like somebody with ADHD.

And if you’re struggling with focus nowadays,

as a lot of people are, because of stress,

because of smartphone use,

which turns out can induce adult ADHD,

we’ll talk about that,

well, then pay attention to the symptomology.

You may actually require professional treatment.

You might not.

Equally important is to remember

that some of the terms that we cover,

like impulse control and attention and concentration

are somewhat subjective, and they can change over time.

Sometimes we have a better level of attention than others.

Maybe it depends on how we slept

or other events going on in our life,

or something that we’re entirely unaware of.

The important thing to remember

is that we can all improve our attentional capacity.

We can all rewire the circuits

that make heightened levels of focus more accessible to us.

We can do that through multiple types of interventions,

and we are going to cover all those interventions today.

Before we march into the material,

I’d like to remind that this podcast is separate

from my teaching and research roles at Stanford.

It is, however, part of my desire and effort

to bring zero cost to consumer information

about science and science-related tools

to the general public.

In keeping with that theme,

I’d like to thank the sponsors of today’s podcast.

Our first sponsor is Athletic Greens.

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I’ve done a couple of episodes now

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So let’s talk about ADHD,

Attention Deficit Hyperactivity Disorder.

Let’s also talk about focus and attention

and everybody’s ability to focus and attend,

not just people with ADHD.

We are also going to talk about tools

that would allow anyone, whether or not they have ADHD

or not, to enhance their level of concentration and focus.

Now, ADHD used to be called ADD,

Attention Deficit Disorder.

We have record of ADD in the medical literature

dating back to as early as 1904.

Now, there’s nothing special about 1904.

That’s just the first time that it showed up

in the standard medical literature.

We have to believe that ADD, which we now call ADHD,

existed before 1904 and probably long before 1904.

Why?

Well, because it has a strong genetic component.

If you have a close relative that has ADHD,

there’s a much higher probability that you will have ADHD.

And that probability goes up

depending on how closely related to that person

you happen to be.

So for instance, if you’re an identical twin

and your twin has ADHD,

there’s a very high concordance, as we say,

a very high probability that you will have ADHD,

up to 75% chance.

If you have a fraternal twin with ADHD,

that number goes down a bit in the 50 to 60% range

and so on.

If you have a parent with ADHD,

that number ranges anywhere from 10 to 25% likelihood

that you will have ADHD.

If you have two parents and so on and so on.

Okay, so there’s a genetic component.

That genetic component, it turns out,

relates directly to how specific neural circuits

in the brain wire up, the chemicals they use

and the way they use those chemicals,

a topic that we are going to discuss in depth today.

Now, if you have a close relative with ADHD,

that does not mean that you are fated to have ADHD.

And if you happen to have ADHD,

there are ways to overcome those symptoms

of lack of attention, impulsivity, and so on.

Another important point about ADHD

is that it has nothing to do with intelligence.

Whether or not we’re talking about intelligence

measured by a standard IQ test,

a rather controversial issue, as many of you probably know,

there are lots of forms of intelligence

that a standard IQ test just wouldn’t pick up.

Emotional intelligence, musical intelligence,

spatial intelligence, all sorts of intelligences.

None of them are related to ADHD.

Being very high functioning

doesn’t make you more likely to have ADHD.

And being ADHD doesn’t necessarily mean

that you have a low IQ.

So there are people with ADHD who have low IQs,

people with ADHD with high IQs,

people with ADHD with high emotional IQ

or with low IQ in the emotional scale.

It’s all over the place.

The important point is that your ability to attend and focus

does not relate to how smart you are

or your IQ of any type, not just a standard IQ.

The renaming of ADD to ADHD

took place in the mid to late 1980s

when the psychiatric community

and the psychological community

started taking better notice of the fact

that so-called hyperactive kids also had attentional issues.

This might seem obvious,

but there’s been extensive and ongoing revision

of the criteria for designating a psychiatric disorder.

And this is still an ongoing process even today.

So in the mid 80s, we started hearing about ADHD

and then gradually that term ADD has been dropped away.

However, just the renaming of ADD to ADHD

has led to much better diagnosis and detection of ADHD.

So right now, the current estimates

are that about one in 10 children

and probably more have ADHD.

The current estimates are anywhere from 10%, one in 10,

to as high as 12%.

Now, fortunately, about half of those will resolve

with proper treatment,

but the other half typically don’t.

The other thing that we are seeing a lot nowadays

is increased levels of ADHD in adults.

And there’s some question

as to whether or not those adults had ADHD

that went undetected during their childhood,

or whether or not ADHD is now cropping up in adulthood

due to the way that we are interacting with the world.

In particular, smartphone use,

the combination of email, text, real world interactions,

multiple apps and streams of media and social media

all coming in at once, trying to manage life,

all of the things that are going on

are creating a kind of cloud of pulls on our attention.

And so there is this question

to whether or not we are creating ADHD in adults

that never had ADHD prior to being an adult.

So let’s talk about attention.

And first, let’s just define what we mean by attention.

Out there in the scientific literature

and in discussions about ADHD,

we will hear things like attention and focus

and concentration and impulse control.

For sake of today’s discussion,

attention, focus and concentration

are essentially the same thing.

Okay, we could split hairs

and the scientific literature does split hairs about these,

but if we want to understand the biology

and we want to have a straightforward conversation

about ADHD, if I say attention or focus,

I’m basically referring to the same thing

unless I specify otherwise, okay?

So people with ADHD have trouble holding their attention.

What is attention?

Well, attention is perception.

It’s how we are perceiving the sensory world.

So just a little bit of neurobiology 101,

we are sensing things all the time.

There’s information coming into our nervous system

all the time.

For instance, right now, you’re hearing sound waves.

You are seeing things,

you are sensing things against your skin,

but you’re only paying attention to some of those.

And the ones that you’re paying attention to

are your perceptions.

So if you hear my voice, you are perceiving my voice.

You are not paying attention

to your other senses at the moment, okay?

You might even be outside in a breeze.

And until I said that,

you might not be perceiving that breeze,

but your body was sensing it all along.

So attention and focus are more or less the same thing,

but impulse control is something separate

because impulse control requires pushing out

or putting the blinders on

to sensory events in our environment.

It means lack of perception.

Impulse control is about limiting our perception.

People with ADHD have poor attention

and they have high levels of impulsivity.

They are easily distractible.

But the way that shows up is very surprising.

You might think that people with ADHD

just simply can’t attend to anything.

They really can’t focus, even if they really want to,

but that’s simply not the case.

People with ADHD, yes, they are distractible.

Yes, they are impulsive.

Yes, they are easily annoyed

by things happening in the room.

They sometimes have a high level of emotionality as well,

not always, but often.

However, people with ADHD can have a hyper-focus,

an incredible ability to focus on things

that they really enjoy or are intrigued by.

Now, this is a very important point

because typically we think of somebody with ADHD

as being really wild and hyperactive

or having no ability whatsoever to sit still and attend.

And while that phenotype, as we call it,

that contour of behavior and cognition can exist,

many people, if not all people with ADHD,

if you give them something they really love,

like if the child loves video games

or if a child loves to draw

or if an adult loves a particular type of movie

or a person very much,

they will obtain laser focus without any effort.

So that tells us that people with ADHD

have the capacity to attend,

but they can’t engage that attention

for things that they don’t really, really want to do.

And as we all know, much of life,

whether or not you’re a child or an adult

involves doing a lot of things that we don’t want to do.

Much of our schooling involves doing things

that we would prefer not to do

and sort of forcing ourselves to do it, to attend,

even though we are not super interested

in what we are attending to.

There are a couple other things

that people with ADHD display quite often.

One is challenges with time perception.

Now, time perception is a fascinating aspect

of how our brain works.

And later, we’re going to talk about time perception

and how you can actually get better at time perception.

It’s very likely that right now you are doing things

that get in the way of optimal time perception.

And I will tell you how to adjust your ability

to measure time with your brain.

People with ADHD often run late.

They often procrastinate.

But what’s interesting and surprising

is that if they are given a deadline,

they actually can perceive time very well.

And they often can focus very well

if the consequences of not completing a task

or not attending are severe enough.

It’s a little bit like the way that people with ADHD

can really focus if they like something.

Well, if they’re scared enough

about the consequences of not attending,

oftentimes, not always, but oftentimes they can attend.

If they’re not really concerned

about a deadline or a consequence,

well, then they tend to lose track of time

and they tend to underestimate how long things will take.

Now, many people do that, not just people with ADHD,

but people with ADHD have challenges

understanding how to line up the activities of their day

in order to meet particular deadlines.

Even if it’s just a simple thing

like finishing one set of tasks before lunch.

Oftentimes, they will remember

that lunch starts at noon,

but somehow they aren’t able to fill the intervening time

in a way that’s productive.

And they can obsess about the upcoming deadline,

for instance.

We will talk about how to remedy this.

In addition, their spatial organization skills

are often subpar, not always,

but often you will find that somebody with ADHD

uses what’s called the pile system

in order to organize things.

They will take many belongings,

and this could be in the kitchen or in their bedroom

or in their office or in any space,

and they will start piling things up

according to a categorization system

that makes sense to them and only them.

It doesn’t really have any logical framework.

Now, many people use the pile system,

and if you use the pile system,

that doesn’t mean that you have ADHD.

In fact, if you’re unpacking a house

or you’ve moved recently

or you’ve received a lot of presents recently,

the pile system makes perfect sense to organize your space.

But people with ADHD tend to organize things

according to the pile system all the time,

and that pile system doesn’t work for them.

Okay, so that’s the key distinction,

that they use a filing system, and it’s not really files.

They’re piling things up in a way that makes sense to them,

but then it doesn’t work for them

in terms of what tasks they actually need to perform.

They can’t find things, or if anyone moves one thing,

then it’s very disruptive to their overall plan

because their overall plan

doesn’t really work in the first place.

So that’s a common phenotype, as we call it.

A phenotype, by the way,

is just an expression of a particular set

of underlying genetic or psychological components, okay?

So we say the phenotype.

So a phenotype could be brown hair and green eyes.

Like for me, a phenotype could also be

that somebody uses the piling system, okay?

The other thing that people with ADHD

have real trouble with is so-called working memory.

Now, you might think that people with ADHD

would have really poor memories,

but in fact, that’s not the case.

People with ADHD often can have a terrific memory

for past events.

They can remember upcoming events quite well.

Their memory is clearly working.

However, one aspect of memory in particular

that we call working memory is often disrupted.

Working memory is the ability

to keep specific information online,

to recycle it in your brain over and over again

so that you can use it in the immediate or short term.

A good example of this would be you meet somebody,

they tell you their name,

they give you their phone number verbally,

and you have to walk back to your phone

and enter it into your phone.

People without ADHD might have to put some effort into it.

It might feel like a bit of a struggle,

but typically they would be able to recite

that phone number in their mind over and over

and then put it into their phone.

People with ADHD tend to lose the ability

or lack the ability to remember things

that they just need to keep online

for anywhere from 10 seconds to a minute or two, okay?

So a string of numbers like 643781

for most people would be pretty easy,

643781, 643781.

You could probably remember that a minute from now

without writing it down.

But if you add one more number to that 6437813,

it gets tougher, okay?

So there’s a reason why phone numbers

typically have seven digits in them.

Of course, there’s an area code,

but remembering information

that strings out longer than seven numbers

or a sentence or two, that’s challenging for most people.

People with ADHD have severe challenges

even with much smaller batches of information

over even much smaller batches of time.

Deficits in working memory are also something

that we see in people who have frontotemporal dementia,

so damage to the frontal lobes

or age-related cognitive decline.

And so it will come as no surprise

that later when we discuss treatments,

supplements, and other tools for ADHD,

that many of those treatments, supplements,

and tools for ADHD are similar to the ones

that work for age-related cognitive decline.

Okay, so we’ve more or less established

the kind of menu of items that people with ADHD tend to have.

Some have all of them, some have just a subset of them.

Their severity can range from very intense to mild,

but in general, it’s challenges with attention and focus,

challenges with impulse control.

They get annoyed easily.

They have kind of an impulsivity.

They can’t stay on task.

Time perception can be off.

They use the piling system or a system

that doesn’t work well for them

in order to organize their things in physical space.

And they have a hard time with anything that’s mundane

that they’re not really interested in.

But again, I just want to highlight

that people with ADHD are able to obtain

heightened levels of focus, even hyper-focus,

for things that are exciting to them

and that they really want to engage in.

So now you have the contour of what ADHD is.

And if you’re somebody who doesn’t have ADHD,

you should also be asking yourself

which aspects of ADHD are similar

to things I’ve experienced before.

Because what we know about the healthy brain

is that there’s also a range of abilities to focus.

Some people focus very well on any task.

You give them a task, they can just laser in on that task.

Other people, they have to kind of fight an internal battle.

They have to convince themselves

that it’s important or interesting.

They have to kind of incentivize themselves internally.

Other people, doesn’t matter.

They could be bored to tears with the information,

but they can do it just because they are quote unquote,

very disciplined people.

We tend to admire those people,

but as you’ll see a little bit later,

it’s not clear that that’s the best way

to run your attentional system.

There might be something to this business

of having heightened levels of attention

for the things that you are most interested or excited by.

So let’s drill into this issue of why people with ADHD

actually can focus very intensely

on things that they enjoy and are curious about.

Now, enjoyment and curiosity are psychological terms.

They’re not even really psychological terms.

They’re just the way that we describe

our human experience of liking things,

wanting to know more about them.

But from a neurobiological perspective,

they have a very clear identity and signature,

and that’s dopamine.

Dopamine is released from neurons.

It’s what we call a neuromodulator.

And as a neuromodulator,

it changes the activity of the circuits in the brain

such that certain circuits are more active than others.

And in particular,

dopamine creates a heightened state of focus.

It tends to contract our visual world,

and it tends to make us pay attention

to things that are outside

and beyond the confines of our skin.

It’s what we call exteroception.

Dopamine also tends to put us in a state of motivation

and wanting things outside the confines of our skin.

So whether or not we’re pursuing

something physical in our world,

or whether or not we’re pursuing information

in our outside world,

dopamine is largely responsible for our ability

and our drive to do that.

But dopamine as a neuromodulator

is also involved in changing the way

that we perceive the world.

So as I mentioned earlier,

you have all these senses coming in,

and you can only perceive some of them

because you’re only paying attention to some of them.

Dopamine, when it’s released in our brain,

tends to turn on areas of our brain

that narrow our visual focus and our auditory focus.

So it creates a cone of auditory attention

that’s very narrow,

creates a tunnel of visual attention that’s very narrow.

Whereas when we have less dopamine,

we tend to view the entire world.

We tend to see the whole scene that we are in.

We tend to hear everything all at once.

So as I describe this,

hopefully you’re already starting to see and understand

how having dopamine release can allow a person,

whether or not they have ADHD or not,

to direct their attention to particular things

in their environment, right?

So now what we’re doing is we’re moving away from attention

as this kind of vague, ambiguous term,

and we’re giving it a neurochemical identity, dopamine,

and we are giving it a neural circuit identity.

And just to put a little bit of flavor and detail

on which neural circuits those are,

I want to discuss two general types of neural circuits

that dopamine tends to enhance.

So let’s talk neural circuits.

And for those of you that love

hearing neuroscience nomenclature,

you’re going to eat this part up.

And for those of you that don’t like

a lot of names of brain areas,

I invite you to tune out

or just try and grab the top contour of this.

I will describe it in pretty general terms,

but I will give some detail

because I know there are some of you out there

who really want to dig deeper into

what the exact structures and connectivities are.

So there are two main types of circuits

that we need to think about with respect to ADHD,

attention, and dopamine.

The first one is called the default mode network.

The default mode network is the network of brain areas

in your brain, in my brain, and in everybody’s brain

that is active when we’re not doing anything,

when we’re just sitting there idle at rest.

Now, it’s very hard to not think about anything,

but when you’re not engaged in any type of specific task,

so you’re not driving, you’re not playing a video game,

you’re not trying to study, you’re not trying to listen,

you’re just sitting there,

letting your brain kind of go wherever it wants to go,

your default mode network underlies that state of mind.

The other set of circuits that we’re going to think about

and talk about with respect to ADHD are the task networks,

the networks of the brain that make you goal-oriented

or that are at least trying to make you goal-oriented.

And those are a completely different set of brain areas.

However, the default mode network and these task networks

are communicating with one another,

and they’re doing that in very interesting ways.

So first I want to describe how these two sets

of brain areas, the default mode network

and the task networks normally interact, okay?

So little bit of naming here.

Again, feel free to ignore it

if you don’t want this level of detail,

but the default mode network includes an area

called the dorsolateral prefrontal cortex.

Frontal cortex, no surprises in the front,

and you have a dorsal, the top and side lateral part,

dorsolateral prefrontal cortex.

You got one on each side of your brain, right?

And then you have a brain area

called the posterior cingulate cortex.

And then you have an area called the lateral parietal lobe.

Again, you don’t need to remember these names,

but these are three brain areas

that normally are synchronized in their activity.

So when one of these areas is active in a typical person,

the other areas would be active as well.

So it’s a little bit like a symphony

or a band, like a three-piece band.

It’s like drums, guitar, and bass.

They’re playing together, okay?

That’s how it is in a typical person,

in a person with ADHD,

or even a person who has subclinical ADHD,

or in any human being who hasn’t slept well,

what you find is the default mode network

is not synchronized.

These brain areas are just not playing well together.

Now, the task networks include a different set of structures.

It still involves the prefrontal cortex,

but it’s a different part of the prefrontal cortex, okay?

Tends to be the medial prefrontal cortex.

And there are some other brain areas

that the medial prefrontal cortex

is communicating to all the time,

mainly to suppress impulses.

It’s shutting down the desire to stand up

or to scratch the side of your cheek or your nose,

if you’re trying not to do that.

Anytime you’re restricting your behavior,

these task-directed networks are very active, okay?

Now, normally, in a person without ADHD,

the task networks and the default mode networks

are going in kind of see-saw fashion.

They are actually what we call anti-correlated.

So it’s not just that they are not correlated,

they are actually opposing one another.

They are anti-correlated.

In a person with ADHD,

the default mode networks and the task networks

are actually more coordinated.

That might come as surprising.

I think that we all have this tendency

to kind of jump to conclusion

and assume that somebody who doesn’t have

an easy time paying attention or has ADHD,

that their brain must be completely incoherent,

that it’s not working well

because everything’s out of whack.

But there’s something interesting about people with ADHD

whereby the task networks and the default mode networks

are actually working together in a way that’s correlated

and that is what’s abnormal.

So this would be like the guitar, bass, and the drums

playing together in a way

where the bass isn’t keeping the backbeat

and the drums aren’t keeping the backbeat,

that they’re playing together,

they’re all playing the melodies and harmonies

in a way that just doesn’t sound right.

That’s what’s going on in the brain of somebody with ADHD.

And we can now confidently say,

based on brain imaging studies,

that when somebody gets better when they’re treated for ADHD

or when they age out of ADHD, as sometimes is the case,

that the default mode networks and the task networks

tend to become anti-correlated again, okay?

So that’s the underlying neurobiology.

But you’ll notice that I didn’t mention dopamine at all.

What dopamine is doing in this context

is dopamine is acting like a conductor.

Dopamine is saying this circuit should be active,

then that circuit should be active.

It should be default mode network

and then when the default mode network is not active,

then it should be the task network.

So it’s really acting as a conductor saying,

you go, now you go, now you go, now you go.

And in ADHD, there’s something about the dopamine system

that is not allowing it to conduct these networks

and make sure that they stay what, you know,

the engineers or physicists or mathematicians

would say out of phase to be anti-correlated, okay?

Out of phase and anti-correlate,

essentially the same thing,

at least for purposes of this discussion.

So that raises two questions.

Could it be that dopamine is not

at sufficiently high levels

or could it be the dopamine is just doing it all wrong?

In other words, is there no conductor

or is the conductor playing with like little tiny toothpicks

and so the instruments can’t see

what they’re supposed to do.

They can’t get the instruction

because it’s just not loud enough, so to speak.

Or could it be that the information is getting out

but the information that’s getting out is wrong.

The conductor is there

but the conductor isn’t very good at conducting.

Now we can gain insight into how this system works

and fails and how to treat it by looking at some

of the current and previous treatments for ADHD,

as well as some of the recreational drugs

that people with ADHD tend to pursue and like.

Now I’m certainly not a proponent of people

with ADHD taking drugs recreationally.

That’s not what this is about.

But if you look at their drug seeking behavior

and you couple that drug seeking behavior

to their desire to remedy their attention deficit,

you start gaining some really interesting insight

into how dopamine is regulating these circuits

in normal circumstances and in people with ADHD.

So what exactly is going on with the dopamine system

in people with ADHD?

And what’s going on with the dopamine system

in people that have terrific levels

of attention for any task?

Well, in the year 2015, an important paper came out.

The first author is Spencer and it came out

in a journal called Biological Psychiatry.

And it formalized the so-called low dopamine hypothesis

of ADHD.

The idea that dopamine was somehow involved

or not at the appropriate levels in people with ADHD

had been around for a pretty long time.

But a formal proposition of the low dopamine hypothesis

led to some really important experiments

and understanding of what goes wrong in ADHD.

It turns out that if dopamine levels are too low

in particular circuits in the brain,

that it leads to unnecessary firing of neurons in the brain

that are unrelated to the task that one is trying to do

and that is unrelated to the information

that one is trying to focus on.

So if you think back before,

you’ve got this default mode network

and a task related network,

and they need to be in this kind of concert

of anti-correlation and in ADHD,

they’re firing together.

Well, the problem seems to be that when dopamine is low,

certain neurons are firing when they shouldn’t be.

This is like a band, right?

We’ll go back to our band,

that’s a guitar, a bass and a person playing the drums.

And it’s as if one of those or several of those instruments

are playing notes when they shouldn’t be playing, right?

The pauses in music are just as important

as the actual playing of notes.

When dopamine is too low,

neurons fire more than they should

in these networks that govern attention.

This is the so-called low dopamine hypothesis.

And if you start looking anecdotally

at what people with ADHD have done for decades,

not just recently since the low dopamine hypothesis

has been proposed,

but what they were doing in the 1950s

and then the 1940s and the 1960s,

what you find is that they tend to use recreational drugs

or they tend to indulge in non-drug stimulants.

So things like drinking six cups of coffee

or quadruple espressos,

or when it was more prominent,

smoking a half a pack of cigarettes

and drinking four cups of coffee a day.

Or if the person had access to it,

using cocaine as a recreational drug

or amphetamine as a recreational drug.

All of those substances that I just described,

in particular, cocaine and amphetamine,

but also coffee and cigarettes,

increased levels of multiple neurotransmitters,

but all have the quality of increasing levels of dopamine

in the brain and in particular,

in the regions of the brain that regulate attention

and these task-related and default mode networks, okay?

Now, young children, fortunately,

don’t have access to those kinds of stimulants.

Most of the time.

And those stimulants all have high potential

for abuse in adults.

So we will talk about the potential for abuse

in a few minutes.

But if you look at children,

even very young children with ADHD,

they show things like preference for sugary foods,

which also act as dopamine inducing stimulants.

Now, of course, once they get access to soda pop

and coffee and tea,

they start to indulge in those more than other people.

For a long time, it was thought that children with ADHD

consumed too many sugary foods or drank too much soda,

or adults with ADHD would take recreational drugs

like methamphetamine or cocaine,

or would drink coffee to excess

or smoke cigarettes to excess

because they had poor levels of attention

and because they couldn’t make good decisions.

They were too impulsive and so forth.

And while that certainly could be the case,

knowing what we now know about dopamine

and the fact that having enough dopamine is required

in order to coordinate these neural circuits

that allow for focus and quality decision-making,

an equally valid idea is that these children

and these adults are actually trying to self-medicate

by pursuing these compounds, right?

Things like cocaine lead to huge increases in dopamine.

Well, what happens when somebody with ADHD takes that drug?

It turns out they actually obtain

heightened levels of focus.

Their ability to focus on things

other than things they absolutely care intensely about

goes up.

Likewise, children who consume anything

that increases their levels of dopamine,

if those children have ADHD, they tend to be calmer.

They tend to be able to focus more.

Now, this is very different

than children who do not have ADHD.

When they consume too much sugar,

they tend to become super hyperactive.

When they consume any kind of stimulant,

they tend to go wild and run around like crazy.

I actually have an anecdote about this,

just to illustrate it.

I have a friend, he has two children

that are now in their teens and 20s,

but when they were little,

one time I brought them some chocolate just as a gift

when I showed up at their house,

and within 30 minutes,

the kids were running around like crazy.

I mean, they were pretty high energy kids,

but they were going bonkers.

And that’s actually when the mother,

my friend at the time, unfortunately still now,

looked at the chocolate and realized

that it was chocolate with espresso beans in it.

It was like dark chocolate, espresso beans.

So I was really at fault there.

You don’t want to give kids dark chocolate

with espresso beans,

but what you’re really seeing, that hyperactivity,

that is dopamine, okay?

It’s the sugar combined with the caffeine in this case,

combined with a few other compounds that exist in chocolate

that really increase our levels of alertness

and our tendency to want to move around a lot.

Okay, so dopamine and low levels of dopamine

apparently are what’s wrong in people with ADHD.

That dopamine hypothesis is what led to the idea

that treating people, children and adults included,

with dopaminergic compounds

would somehow increase their ability to focus.

And if you look at the major drugs that were developed

and now marketed by pharmaceutical companies

for the treatment of ADHD,

those drugs have names like Ritalin.

Nowadays, it’s typically things like Adderall,

modafinil and some of the other derivatives.

They all serve to increase levels of dopamine,

in particular dopamine in the networks

that control task-directed behavior

and that coordinate the default mode network

and these task-related networks.

So many of you have probably heard of Ritalin.

Ritalin is a prescription stimulant

that is prescribed for ADHD as well as for narcolepsy.

Narcolepsy is a condition

in which people tend to fall asleep during the daytime

quite a lot.

It’s excessive daytime sleepiness,

not due to lack of sleep at night,

but also tend to fall asleep when they get excited.

If they’re really emotionally excited or about to eat

or any other kind of activity

that would normally get somebody really aroused and alert,

people with narcolepsy tend to fall asleep

or they tend to become what’s called cataplectic.

They tend to just sort of go limp in the muscles.

So it’s this invasion of sleep into the daytime.

It’s dysregulated by emotion.

You can imagine why a stimulant,

something that would wake you up,

make you very alert, focused, and motivated

would be a good treatment for narcolepsy.

Adderall also is used to treat ADHD

and to treat narcolepsy.

Things like modafinil also used to treat ADHD

and narcolepsy.

So you’re sensing a theme here.

So what are the differences and similarities

between these drugs?

And what can that tell us about ADHD?

Well, Ritalin was one of the first generation drugs

that was prescribed for ADHD

in order to deal head-on with this dopamine hypothesis,

this idea that in ADHD, dopamine levels are too low.

Nowadays, Adderall is the more typically prescribed drug

for ADHD.

That has to do with some of the so-called pharmacokinetics,

the rate at which those drugs enter the system

and how long they last in the system.

So for instance, Ritalin was a drug

that was packaged into various time-release formulas,

whereas initially Adderall was only released

in a form that had a very short life.

So meaning that it wasn’t in the bloodstream very long

and didn’t affect the brain for very long.

And so the dosages could be controlled

in a more typical way

without going into a lot of tangential detail.

As you all know, at different times of day,

you tend to be more or less alert.

So a long sustained release drug

while that might sound like a really terrific thing,

if that drug is having an effect of making you more alert

and it’s released across very many hours of your day,

there might be periods of your day when you feel too alert,

periods of your day when you feel just right,

and periods of your day

when you wished that you were more alert.

These are some of the pharmacokinetics,

kinetics meaning movement,

of the different compounds within the bloodstream and brain

that you could imagine in a very real way

would impact whether or not someone would feel really good

on one of these drugs

or whether or not they would feel too anxious

or too sleepy and so on.

Let’s take a step back for a second

and just ask what are these drugs?

We know they increase dopamine, but what are they really?

Well, Ritalin, also called methylphenidate,

is very similar to amphetamine, speed,

or what’s typically called speed

in the street drug nomenclature.

Adderall, which goes by various other names, okay?

So Adderall, Adderall-XR, Midas,

Midiasis, things like that.

Adderall is basically a combination of amphetamine

and dextroamphetamine.

Now, some of you probably realize this,

that Adderall is amphetamine,

but I’m guessing that there are a good number of you

out there, perhaps even parents and kids,

that don’t realize that these drugs

like cocaine and amphetamine, methamphetamine,

which are incredibly dangerous

and incredibly habit-forming

and have high potential for abuse.

Well, the pharmaceutical versions of those

are exactly what are used to treat ADHD.

Now, they’re not exactly like cocaine or methamphetamine,

but they are structurally and chemically very similar,

and their net effect in the brain and body

is essentially the same,

which is to increase dopamine primarily,

but also to increase levels of a neuromodulator

called epinephrine or norepinephrine,

also called noradrenaline.

Those names are the same.

And to some extent, to increase levels of serotonin

in the brain and blood, but not so much serotonin.

That’s just kind of a small smidgen of effect, okay?

So dopamine way up, norepinephrine and adrenaline way up.

So that’s motivation, drive, focus, and energy.

And to some extent, a little bit of serotonin,

which is really more about feeling calm and relaxed.

And you could imagine why that would be

a good balancing effect for dopamine and norepinephrine.

So what I’m essentially saying is that the drugs

that are used to treat ADHD are stimulants,

and they look very much like, in fact,

nearly identical to some of the so-called

street drug stimulants that we all hear are so terrible.

However, I do want to emphasize

that at the appropriate dosages

and working with a quality psychiatrist

or neurologist or family physician

that does have to be a board certified MD

that prescribes these things,

many people with ADHD achieve excellent relief

with these drugs.

Not all of them, but many of them do,

especially if these treatments are started early in life.

So now knowing what these drugs are,

I want to raise the question of why prescribe these drugs.

I mean, everyone has to make a decision for themselves

or for their child as to whether or not

they’re going to take these things or not.

I also want to acknowledge that many people out there,

many, many people out there are taking these drugs,

even though they have not been clinically diagnosed

with ADHD.

When I say these drugs,

I’m specifically referring to ritalin and Adderall

and modafinil, but more typically it’s Adderall, okay?

People using cocaine and amphetamine

for recreational purposes,

that’s a completely different beast,

and it is indeed a beast,

and it’s something that I strongly discourage.

However, I am aware that up to 25% of college students

and perhaps as many as 35% of all individuals

between the ages of 17 and 30 are taking Adderall

on a regular or semi-regular basis in order to work,

in order to study, and in order to function

and focus in their daily life,

even though they have not been diagnosed with ADHD.

There’s a whole black market for this.

They’re getting it from people with prescriptions.

I’m not here to pass judgment.

I just want to emphasize how these drugs work,

some of the things that they do to enhance cognition

and focus that actually serve the brain well

in certain individuals,

and how they can be very detrimental in other individuals.

I sort of blew right past it,

but the fact that in upwards of 25% of young people

are taking things like Adderall,

despite not having a clinical diagnosis of ADHD,

well, that’s a ridiculously high number.

A few years ago, it was estimated that Adderall use

and Ritalin use without diagnosis of ADHD

was second in incident only to cannabis.

But actually now the consumption of Adderall

without prescription is higher than the consumption

of cannabis in that age group.

So what that means is that there’s a lot of stimulant use

in that age group.

And there are a lot of adults also using

and abusing stimulants in order to gain focus.

Now we could have a whole discussion

about whether or not life is becoming more demanding,

whether or not the need for focus is excessive,

and that’s why people are doing that.

Frankly, it’s an interesting discussion,

but it’s not one that would deliver us to any answers.

Rather, I’d like to focus on the ways that people now

and people have always been self-medicating

to increase focus, right?

Caffeine, which I indulge some,

I don’t think to access,

has long been used as a stimulant to increase dopamine,

increase norepinephrine, increase focus and energy.

And in addition to that,

it works through the so-called cyclic AMP,

phosphodiesterase pathway.

Remember anytime you hear an ASE, that’s an enzyme.

Phosphodiesterase is involved in the conversion

of things like cyclic AMP into energy for cells

and so forth.

Basically coffee gives you energy, it makes you feel good.

And it increases focus because of the circuits

that it engages in the brain.

People have been taking caffeine

and continue to take caffeine for ages.

People also used to smoke cigarettes, nicotine,

in order to gain focus.

Nowadays, that’s less common because of the concerns,

quite valid concerns about lung cancer from smoking,

but there’s a lot of vaping out there.

There are a lot of people now consuming nicotine,

which is the active substance in cigarettes

and in most nicotine vapes that stimulates the brain

to be more focused and more alert.

So the idea of taking stimulants, of consuming things

or smoking things in order to increase alertness

is not a new idea.

It’s just that in ADHD,

it’s surprising that these things would work, right?

I mean, if the problem is attention deficit

hyperactivity disorder,

what we’re really talking about here are children

that are prescribed a drug

that ought to be a stimulant.

It ought to make them hyper, hyperactive.

And rather than doing that,

it actually somehow serves to calm them a bit

or at least allow them to focus.

Here’s the reason.

Children have a brain that’s very plastic,

meaning it can remodel itself and change in response

to experience very, very quickly compared to adults.

Taking stimulants as a child,

if you are a child diagnosed with ADHD,

allows that forebrain task-related network to come online,

to be active at the appropriate times.

And because those children are young,

it allows those children to learn what focus is

and to sort of follow or enter that tunnel of focus.

Now, by taking a drug, it’s creating focus artificially.

It’s not creating focus

because they’re super interested in something.

It’s chemically inducing a state of focus.

And let’s face it, a lot of childhood and school

and becoming a functional adult

is about learning how to focus

even though you don’t want to do something.

In fact, when I was in college,

I had this little trick that may or may not work

for some of you, which is,

if I couldn’t focus on the material I was trying to learn,

I would delude myself into thinking

that it was the most interesting thing in the world.

I would just kind of lie to myself and tell myself,

okay, this, I won’t mention the subjects.

I absolutely love this.

I would just, I would tell myself that I loved it.

And I noticed that just that selective

or deliberate engagement of that desire to know circuit,

whatever that is in my brain, no doubt involves dopamine,

allowed me to focus and remember the information.

And somewhat surprisingly, or perhaps not surprisingly,

I would often fall in love with the information.

I’d find that that was my favorite class.

It was what I wanted to learn the most.

So that’s one way you can do it artificially,

but kids with ADHD, they can’t do that, right?

They’re told to sit still

and they end up getting up 11 times.

They are told that they can’t speak out in class

or that they have to remain in their seats for 10 minutes.

And they just, despite their best effort,

they simply cannot do it.

They’re highly distractible.

So what are we to make of this whole picture

that we need more dopamine, but these kids with ADHD,

they’re getting their dopamine by way of a drug,

which is for all the world, amphetamines, right?

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 make of people taking these drugs

without a clinical need?

What are the consequences there?

Well, in order to get to some of those answers,

I went to one of my colleagues.

This is a colleague that I’ve actually known

for a very long time.

I was their teaching assistant

when they were an undergraduate.

They went on to get an MD, a medical degree,

as well as a PhD and have become a pediatric neurologist

that specializes in the treatment of epilepsy and ADHD

in kids of all ages, from age three to 21.

That’s the age range, pretty broad age range,

and has extensive knowledge in this.

And what makes them particularly interesting

for sake of this discussion is that they have a child,

a young boy, who’s now showing signs of ADHD,

and they are on the threshold of trying to decide

whether or not they will prescribe Adderall

or something similar.

So we had a discussion about this,

and prior to learning that their child may have ADHD,

I asked the following questions.

First of all, I asked,

what do you think about giving young kids amphetamine?

And their answer was, you know, on the face of it,

it seems crazy,

but provided that the lowest possible dose is used

and that that dosage is modulated as they grow older

and develop those powers of attention,

their observation was that they’ve seen more kids benefit

than not benefit from that.

Now, I’m certainly not saying what people should do.

You obviously have to go to a doctor

because as I always say, I’m not a doctor.

I don’t prescribe anything.

I’m a professor, so I profess things.

And here I’m professing that you talk to your doctor

if you’re considering giving Ritalin or Adderall

or any type of stimulant to your child, of course.

What could be more important than the health of your child?

But it was a very interesting answer

because typically we hear yes, medicate or don’t medicate.

Rarely do we hear that the medication should be adjusted

across the lifespan and in any particular kind of way.

Now, the fact that this person,

this now friend of mine and colleague of mine

has so much expertise in the way that the brain works

and is considering putting their child on such medication,

I said, you know,

why wouldn’t you wait until your kid reaches puberty?

I mean, we know that in boys and in girls,

there are increases in testosterone and estrogen

during puberty that dramatically change

the way that the body appears,

but also that dramatically change the way

that the brain functions.

In particular, we know this,

that puberty triggers the activation

of so-called frontotemporal task-related

executive functioning.

That’s just fancy science speak for being able to focus,

being able to direct your attention,

being able to control your impulses.

Look at a small child or look at a puppy

and then look at an older child

or look at a dog.

Very different levels, patterns of spontaneous behavior.

Young children move around a lot.

They’re, I don’t want to say shifty

because that makes it sound like they’re up

to something bad, which they might be,

but they don’t have to be up to something bad.

They fidget a lot.

So do puppies.

Everything’s a stimulus.

As animals and humans get older,

they learn how to control their behavior and sit still,

listen and focus, even if they don’t want to.

So giving a drug that allows a child

to access that stillness early on,

it’s thought will allow them to maintain that ability

as time goes on.

But I decided to push a little bit further.

I said, well, why would you do it now

as opposed to during puberty or after puberty?

And their answer was very specific

and I think very important.

What they said was, look,

neuroplasticity is greatest in childhood

and tapers off after about age 25,

but neuroplasticity from age three

until age 12 or 13 is exceedingly high.

And they’re right.

When you sit back and you look at the literature

on neuroplasticity,

you’d say childhood plasticity and young adult plasticity

is much greater than adult plasticity,

but that early childhood plasticity

is far and away the period in which

you can reshape the brain at an accelerated rate.

So this lines up really well with the clinical literature,

not surprisingly, they’re a clinician,

that early treatment is key.

If you have the opportunity to work with a quality physician

and treat these things early,

these drugs can allow these frontal circuits,

these task-related circuits

to achieve their appropriate levels of functioning

and for kids to learn how to focus

in a variety of different contexts.

Now, is that the only thing that they should be doing?

Of course not.

So the next question I asked was,

what should we make of all this diet-related stuff, right?

I’ve heard before that the so-called elimination diet

or ingesting no sugars or no dairy or no gluten,

that all of these things have been purported

to improve symptoms of ADHD.

And people and parents with ADHD go to fanatic lengths

to try and find the exact foods that are causing problems

and the exact foods that the kids can eat

in order to try and get their brain wired up right

and correctly and to avoid lifelong ADHD.

And their answer was really interesting.

But before I tell you their answer,

I want to tell you the studies

and the data related to this question

of whether or not food and the constellation of foods

that one avoids and will eat

has anything to do with our levels of attention

and in particular, whether or not that can be used

as a leverage point to treat ADHD.

So you can imagine the challenges of exploring the role

of diet and nutrition in any study,

but especially in a study on ADHD.

Why?

Well, because as I mentioned before,

children with ADHD and it turns out adults with ADHD

tend to pursue sugary foods or any types of food

that increase their levels of dopamine.

They are naturally drawn to those foods,

whether or not they realize it or not,

presumably as a way to try and treat

their lack of focus and impulsivity.

So in this study that I’m about to share with you,

there was no drug treatment.

It was just a study manipulating diet

and involved a hundred children,

50 in the so-called elimination diet group,

the special diet where certain foods were eliminated

and 50 in the so-called control group.

However, being a well-designed randomized controlled trial,

the study also included a crossover,

meaning where the kids would serve as their own control

or control group at a certain portion of the studies.

They would be in one group

where they eliminated certain foods.

And then after a period of time in the study,

they would swap to the other group.

This is a powerful way to design a study

for reasons that you can imagine

because you start to eliminate changes

and effects due to individual differences.

In any case, a hundred children total,

50 in each group at any one period in time.

And the effects that they observed were extremely dramatic.

In the world of statistics and analysis of scientific data,

we talk about P values, probability values.

What’s the likelihood that something could happen

according to chance?

And typically the cutoff would be something

like P less than 0.05.

That’s less than 0.05 chance,

essentially of the effect being due to chance.

However, in this study,

every single one of the effects is P less than 0.0001.

Very, very infinitesimally small probability

that the effect observed could be due to chance.

So what were these effects?

These effects were enhanced ability to focus,

less impulsivity, even less tendency to move

when trying to sit still.

So everything from mental focus

to the ability to control their bodies

improved when they were in the elimination diet group.

What was eliminated?

Well, the elimination diet in this particular study

was a so-called oligoantigenic diet.

It was a diet in which each kid took a test

to determine which foods they had antibodies for,

meaning that they were mildly allergic to.

Now in this study,

it was very important that the kids

not be extremely allergic to any food

because as I mentioned before,

they actually served as a control at one point in the study

where they were eating all sorts of foods,

including foods that they had mild allergies to.

So basically what this study said

was that eliminating foods to which children have allergies

can dramatically improve their symptoms of ADHD.

And this study, not surprisingly,

because it was published in such a high quality journal,

Lancet, et cetera, large number of subjects,

set the world on fire.

People were extremely excited about these results

because here in the absence of any drug treatment,

there was a significant improvement

in ADHD symptoms observed.

And then came the criticisms.

So many papers were published after this,

specifically dealing with reanalysis of these data.

And I want to be fair in saying that

the data in the paper look good,

but there are criticisms

of the overall structural design of the study.

I don’t want to go into all the details exactly

because it gets really nuanced

about some of the statistics

and the way that one examines these types of data,

but there was skepticism.

And in science, skepticism is healthy,

especially when making decisions

about whether or not to treat or feed children

one food or another, or give them one drug or another.

Now I want to return to the story of my friend

who is a pediatric neurologist and treats ADHD

and has a child who is on the precipice

of perhaps starting to take drugs for the treatment of ADHD.

I asked the simple question,

do you see an effect of diet?

Meaning when parents control the diet of their children,

does it make a positive or negative or no difference

in terms of the way that the kids respond to ADHD drugs

like Ritalin and Adderall,

or whether or not it can help them avoid

treating with those drugs entirely.

And her response was very straightforward.

She said, elimination of simple sugars

has a dramatic and positive effect.

She’s observed that over and over and over again

in many dozens, if not hundreds of patients.

Okay, now that’s not a peer reviewed study.

That’s a statement that I’m conveying to you anecdotally,

but it’s a highly, highly informed one.

I said, what about these elimination diets?

She said, and I found other sources to support this,

that these oligo-antigenic diets are controversial.

There are many people who really believe

in identifying all the things that you’re allergic to

and making sure that you and especially your kids

avoid those foods.

However, there’s another camp that’s starting to emerge

in the peer reviewed scientific literature,

showing that when kids are not exposed to certain foods,

in particular nuts and things of that sort,

they develop allergies to those foods.

And then when exposed to them later,

they cause real problems.

So there’s a whole galaxy of discussion and controversy

and outright fighting about allergies in kids

and whether or not the oligo-antigenic diet

is the appropriate one.

However, out of the four neurologists and psychiatrists

that I spoke to about ADHD in preparation for this,

every single one said, children with ADHD,

as much as possible should be encouraged to avoid

high sugar and simple sugar foods of most kinds.

And if they can find particular foods

that exacerbate their symptoms,

obviously eliminating those foods is beneficial.

And the foods that exacerbate their symptoms

change over time.

So I don’t like giving a complicated answer,

but I also don’t like giving an incomplete answer.

What this tells me is that children,

and especially young children who have ADHD

should probably not eat much sugar

in particular simple sugars.

In addition to that, exploring whether or not

they have existing allergies to foods they already consume

might be a good idea.

At least that’s what this paper,

the Pelser et al Lancet paper seems to speak to.

And I should mention that that paper was published in 2011.

Since then, there have been many dozens of studies

exploring the same thing,

as well as meta-analyses of all those data.

And it does appear that diet can have

a highly significant role in eliminating

or at least reducing the symptoms of ADHD.

So much so that some of the children

are able to not take medication at all

or eventually wean themselves off medication

as young adults and as adults.

One interesting question is whether or not

adults should modify their diet

in order to increase their levels of focus

if they’re already having normal levels of focus,

but would like more,

or would like to reduce existing adult ADHD.

That’s an interesting and even more controversial topic.

It brings us right into the realm

of what are called omega-3 fatty acids.

I’ve talked many times on this podcast

about the known benefits of omega-3 fatty acids,

in particular, getting one gram, 1,000 milligrams or more,

even as much as 2,000 milligrams each day

of the so-called EPA component of omega-3 fatty acids,

known to have antidepressant effects,

mood elevating effects,

known to have important effects

protecting the cardiovascular system.

I think it’s now clear

that the immune system also benefits

that omega-3 fatty acids

that include a gram or more of EPAs are very beneficial.

Typically, that’s done through fish oil.

Liquid fish oil is going to be the most cost-efficient,

but there are capsule forms.

For those of you that don’t like fish oil,

you can ingest this through other means.

You can get it from certain algaes or krill, et cetera.

You have to make it compatible with your particular diet,

whether or not you’re vegan or vegetarian

or omnivore, et cetera.

Omega-3s have been shown

to have all these positive health benefits.

Do they have positive effects on focus and attention?

And the answer is you can find studies

that support that statement,

and the effects are significant,

but the effects are modest.

You can also find studies that show no effect.

However, much like with omega-3s and antidepressants,

whereby ingestion of omega-3 fatty acids

of a gram or more of EPA per day

allows people with major depression

to get away with taking lower doses

of antidepressant medication,

it does seem that ingestion of omega-3 fatty acids

in adults that include EPAs of 1,000 milligrams or more

can allow adults with ADHD

or mild attention deficit issues

to function well on lower doses of medication

and in rare cases to eliminate medication entirely.

So what this says is once again

that the omega-3 fatty acids are beneficial.

Will they cure or eliminate ADHD?

I think it’s safe to say no.

They are playing a supportive

or what we call a modulatory role.

Just like good sleep plays a supportive

and modulatory role for essentially everything,

your immune system, your ability to think,

your ability to regulate your emotion,

it’s modulating that process.

This component of modulation

is extremely important to highlight,

and I think I want to spend a moment on it

because this is especially important

in the context of ADHD

and all the information that’s out there.

There are biological processes

that are mediated by particular compounds like dopamine.

So for instance,

the ability to feel motivated and to attend to focus

is mediated by the circuits in the brain

that release dopamine.

However, attention is also modulated by how rested you are.

If you want to eliminate your ability to think well at all,

just stay up for two nights and don’t sleep at all, right?

If you do that,

you will have modulated the circuits in your brain

that respond to various things

and you will be highly distractible.

You will be highly emotional.

You will feel like garbage,

but that doesn’t mean that sleep

mediates focus and attention.

It modulates it indirectly.

Likewise, I think these omega-3 fatty acids,

in particular the EPAs,

which are so beneficial for mood

and apparently also for attention,

they don’t directly mediate attention and mood.

What they do is they modulate those circuits.

They make dopamine more available.

They make whatever dopamine is available

more likely to bind to the various receptors

that are present on neurons and so forth.

And I think this is very important because likewise,

diet and any discussion about nutrition

has to include this framework of,

is the diet, the elimination diet,

or whether or not it’s some other diet

or esoteric diet, ketogenic diet,

is it modulating or mediating a process?

And most likely in the context of ADHD,

it’s modulating that process.

So if the ADHD is mild or if it’s caught early enough,

or if it’s in conjunction with pharmacology,

with a prescription treatment,

well, then it might help guide the child or adult

to a better place of being able to focus.

But it’s not going to be the switch that flips everything.

Now, that does not mean that consuming the wrong foods,

sugary foods or foods that you happen to be allergic to

is a good idea.

It will still be detrimental.

So I hope that conceptual framework helps

because if you go online,

if you’re somebody with ADHD or not,

you are going to be bombarded with the ADHD diet,

the oligoantigenic diet, the elimination,

this supplement, that EPA.

And I think it’s very important to understand

whether or not you’re talking about

something mediating a process or modulating a process.

Now, drugs like Ritalin, drugs like Adderall,

they are tapping into the circuitries

and the neurochemistries that mediate attention and focus.

They are not the only alternatives

or the only choices rather for treatment of these circuits

and enhancement of the circuits for focus.

I’m going to talk about other alternatives

and some behavioral alternatives that are not very well known

but are very, very effective in a few minutes.

But I really want to make this clear distinction

between modulation and mediation

because it’s vital for anyone that’s trying to modulate

or mediate anything within their own brain.

If any of you are interested in this oligoantigenic diet

as it relates to ADHD,

and you want to explore a more recent study,

besides that classic 2011 Lancet study

that’s rather controversial,

there’s a paper that was published

in Frontiers in Psychiatry just last year, 2020.

The title of the paper is

Oligoantigenic Diet Improves Children’s ADHD Rating

Scale Scores Reliably in Added Video Rating.

The added video rating is just that they’re using

an additional measure of focus and attention.

Again, that’s Frontiers in Psychiatry, 2020.

I’ll put a link to it in the caption.

And that’s a more recent study for you to peruse.

So we’ve talked about the neural circuits of focus

and the chemistry of focus,

but we haven’t talked yet about

what would make us better at focusing

and what focusing better really is.

So let’s take a step back and think about how we focus

and how to get better at focus.

And I’m going to share with you a tool

for which there are terrific research data

that will allow you in a single session

to enhance your ability to focus in theory forever.

What I’m about to read you is from an excellent book

that I recommend if any of you are interested

in neuroscience and things like meditation

and default mode networks and things of that sort.

The book is called Altered Traits.

Science Reveals How Meditation Changes

Your Mind, Brain and Body.

And no, I’m not going to try and convince you to meditate.

I’m going to share with you a small passage in the book

that relates some research data

related to focus that are very important.

If you want to meditate, that’s your choice.

That’s a separate matter.

This is a book by Daniel Goleman and Richard Davidson.

And I should just mention that Goleman

is a well-known author.

He’s written books on emotional intelligence and so forth.

Richard Davidson is also a PhD.

He’s a professor of psychology and psychiatry.

And he’s at a University of Wisconsin, Madison.

He’s done terrific work on brain states

and modulation of brain states and so forth.

What we’re about to talk about is when attention works

and when attention falters.

And what we are specifically going to talk about

are what are called attentional blinks,

not actual eye blinks.

We’re going to talk about that in a few minutes,

but we’re going to talk about attentional blinks.

I’m paraphrasing here

because Goleman and Davidson wrote about this so beautifully.

I’d rather paraphrase from them

than try and just make up a new way to say it

that is less interesting or less good,

but I want to credit them.

Attentional blinks are really easy to understand

if you think about a where’s Waldo task.

You know this task, where’s Waldo,

where there are a bunch of people and objects

and things in a picture.

And somewhere in there is Waldo with the striped hat

and the glasses and kind of a skinny dude.

And you have to find Waldo.

And so it’s a visual search.

And it’s visual search for an object

that has distinct features,

but is embedded in this ocean of other things

that could easily be confused as Waldo.

So you tend to look, look, look, look, look, look, look,

and then you find Waldo.

Kids can do this.

They enjoy doing this.

Adults may or may not enjoy it, but they can do it too.

They find Waldo.

When you find Waldo,

or when you search for a target

in some other visual search task,

at that moment, your nervous system celebrates a little bit.

And it celebrates through the release of neurochemicals

that make you feel good.

You found it and you pause.

Now the pause is interesting because when you pause,

what we know from many experiments

is that in that moment of pause and mild celebration,

however mild,

you are not able to see another Waldo

sitting right next to it.

So what this means is in attending to something,

in searching and in identifying a visual target,

your attention blinked.

It shut off for a second.

And there’s a more formal and more laboratory type way

that we look at this.

The more typical way to do this

is to give someone a string of letters

or a string of numbers.

And beforehand, you tell them,

be on the lookout for the letters R and Z.

Okay, you’re just going to watch

this string of numbers go by,

and there will be a letter R in there,

and there will be a letter Z in there,

and try and spot them both.

And what you find is when you present that string of numbers

and then they see the R, they see the R,

they register it consciously,

and they tend to miss the Z,

just like in the Waldo type example.

Now, of course, the numbers are going by pretty quickly,

but they can spot the R.

They could also spot the Z if you told them beforehand,

just spot the Z.

And the numbers are moving through at the same rate

in both conditions.

So what that means is that in every case,

you are capable of seeing the R or the Z.

It’s when you try and see both

that seeing the first one prevents you

from seeing the second one.

It’s what we call an attentional blink.

We do this all the time,

and people with ADHD tend to have many more

attentional blinks than people that don’t.

And this is true for children and for adults.

This is an important point,

so important that I want to emphasize it twice

in case you attentionally blinked.

If you see something that you’re looking for

or you’re very interested in something,

you are definitely missing other information,

in part because you’re over-focusing on something.

And this leads to a very interesting hypothesis

about what might go wrong in ADHD,

where we’ve always thought that they cannot focus,

and yet we know they can focus on things

they care very much about.

Well, maybe, just maybe,

they are experiencing more attentional blinks

than people who do not have ADHD.

And indeed, there are data now to support the possibility

that that’s actually what’s happening.

And that should be exciting to anyone that has ADHD.

It should also be exciting to anyone

that cares about increasing their focus

and their ability to attend.

What this is saying is that these circuits

that underlie focus and our ability to attend

and our ability to eliminate distraction,

they aren’t just failing to focus.

That’s just a semantic way of describing the outcome.

They are over-focusing on certain things

and thereby missing other things.

And so our distractibility or the distractibility

of somebody with ADHD could exist

because they are over-focusing on certain elements

and they are therefore missing other elements

that they should be attending to.

So what they really need is this property

that we call open monitoring.

Now, open monitoring is something that’s described

in the book that I just referred to.

And that typically is associated with people

who have done a lot of meditation,

so-called Vipassana meditation,

or have spent a lot of time learning how to do

what’s called open gaze visual analysis

and open gaze thinking.

But there’s a simpler version of this

that allows us to bypass all that.

First of all,

your visual system has two modes of processing.

It can be highly focused, a soda straw view.

So looking for the R in this string of numbers

in the example that I just gave,

or if you’re very excited about something,

you’re in that soda straw view of the world

and you’re missing other things, okay?

That’s high levels of attention.

However, there’s also a property of your visual system

that allows you to dilate your gaze,

to be in so-called panoramic vision.

Panoramic vision is something you can do right now,

no matter where you are.

And I can do it right now.

You won’t know that I’m doing it,

but even though I’m still looking directly at you,

I’m consciously dilating my gaze

so that I can see the ceiling, the floor,

and the walls all around me.

That panoramic vision is actually mediated

by a separate stream or set of neural circuits

going from the eye into the brain.

And it’s a stream or set of circuits

that isn’t just wide angle view.

It also is better at processing things in time.

Its frame rate is higher.

So you’ve seen slow motion video

and you’ve seen standard video.

Slow motion video gives you that slow motion look

because it’s a higher frame rate,

your thin slicing time, okay?

You can use panoramic vision to access the state

that we call open monitoring.

When people do that,

they are able to attend to and recognize multiple targets

within this string of numbers.

They can see the R and they can see the Z

and they can see additional things.

So this is something that can be trained up

and people can practice whether or not they have ADHD or not.

What it involves is learning

how to dilate your gaze consciously.

That’s actually quite easy for most people.

Whether or not you wear corrective lenses

or contacts or not,

you can consciously go into open gaze

and then you can contract your field of view as well.

There have also been studies done

where people were taught to think in a particular way

for a very short period of time

and that forever changed their ability

to limit or reduce the number of these attentional blinks.

There are now published accounts in the literature

of a simple practice done for about 15 minutes

where subjects were asked to just sit quietly,

eyes closed and do what is sort of akin to meditation

but to not direct their mind

into any particular state or place,

but simply to think about their breathing

and to focus on their so-called interoception,

focus on how their body feels,

if their mind drifted to bring it back.

Okay, so it’s basically meditation for about 15 minutes.

That might not seem like a significant or unusual practice

or that it would have any impact at all,

but remarkably, just doing that once for 17 minutes

significantly reduced the number of attentional blinks

that people would carry out.

In other words, their focus got better

in a near permanent way without any additional training.

There’s something about that practice

of reducing the amount of visual information coming in

and learning to pay attention to one’s internal state,

what we call interoception,

that allowed them an awareness

such that when they needed to look for visual targets,

when they need to focus on multiple things in sequence,

they didn’t experience the same number of attentional blinks.

And I should mention, not incidentally,

as people age and their working memory gets worse

and their ability to focus gets worse,

the number of attentional blinks

that they carry out goes up.

And there are now studies exploring

whether or not this simple meditation-like practice

of 15 to 20 minutes or so of sitting

and just quietly resting and paying attention

to one’s breathing and internal state

can also offset some of that age-related,

what is called cognitive decline.

So what these data tell me is that

regardless of whether or not you’re a child

or you’re an adult, whether or not you have ADHD or not,

whether or not you’re experiencing

age-related cognitive decline,

or you would simply like to avoid

age-related cognitive decline,

a simple practice of taking 17 minutes,

sitting and paying attention to your internal state,

just interocepting, registering your breathing,

registering the contact of your skin

with whatever surface you’re on,

can forever rewire your brain to be able to attend better

and possibly even offset

some of that age-related attentional drift.

Now, I don’t expect anyone to start meditating regularly.

I don’t expect anyone to do anything they don’t want to do,

but I think most of us could handle one meditation session

of 17 minutes or so.

And so if ever there was a tool that stood to rewire

our attentional circuitry in a powerful way,

this seems to be it.

And in addition, the ability to engage in panoramic vision,

to dilate our gaze, this so-called open monitoring

that allows the brain to function in a way

that it can detect more information faster,

that’s a powerful tool as well.

And the beauty of that tool is that it works the first time

and it works every time.

Now, how exactly it works is a little bit unclear.

Is it, for instance, orchestrating this synchrony

or asynchrony between the default mode network

and the task-related networks?

We don’t know.

Those studies have not yet been carried out.

Nonetheless, the effects are significant.

They are long-lasting and they appear to exist

after just one session

of this quiet 17-minute interoception,

which to me makes it seem like a very worthwhile thing

to do for everybody.

So we just talked about attentional blinks,

which are essentially blinks of thinking.

It’s your mind shutting off for a moment

and missing information.

Now let’s talk about actual blinks,

the sort that you do with your eyelids.

Now, this might come across as somewhat obvious,

but you can do fast, what are called spontaneous blinks,

and they are always coordinated between the two eyes,

or you can do long blinks,

like when you go to sleep at night,

you do one very long blink, and I’m not being facetious.

When you go to sleep at night, you are shutting your eyelids

and you are limiting the amount of information coming in,

and your perception of time starts to drift

as you go into sleep.

Your perception of time changes from very fast

at one moment to very slow,

meaning the frame rate at which you are analyzing

information, dreaming, et cetera,

is variable when you are in sleep.

Sometimes it’s very fast,

meaning you experience things in slow motion,

sometimes it’s very fast.

In waking too, your experience of time

can sometimes be very fast, sometimes be very slow.

Typically, the more alert you are,

the higher the frame rate,

you’re thin slicing your experience.

You’ve probably had this happen

if you’re ever very stressed

and you’re waiting for something or somebody,

it seems like it takes forever

because your frame rate is higher,

you’re analyzing time more finely.

Conversely, if you are very relaxed or even sleepy,

you wake up and you have to think about

all the things you have to do,

it will seem like the world is going by very, very fast

and that you are moving very slow.

Time is going at the same rate,

but your perception of time is what’s changed.

Believe it or not,

your perception of time is also changed on a rapid basis,

moment to moment basis by how often you blink.

This is a well-established literature

in the world of neuroscience

that unlike the literature and claims

about blinking and sociopathy, which have no basis,

the science of blinking as it relates to time perception

has some very good data to support it.

I want to just emphasize one study in particular,

which is quite appropriately titled

Time Dilates After Spontaneous Blinking.

This is a paper that was published in Current Biology.

The first author is Terhune, T-E-R-H-U-N-E.

It’s a wonderful paper.

They examined the relationship between fluctuations

in timing and blinking.

And to make a long story short,

what they found is that right after blinks,

we reset our perception of time, okay?

So blinks in that sense are a little bit

like the curtain coming down on a scene

between scenes in a play or takes in a movie.

You know, when they clap, the clap thing,

they start it, take, you know, or what do they say?

Action.

And then at the end they do the thing

and they click it down and they say, it’s a take.

That’s one take.

When you blink, it’s a take, okay?

Now what’s interesting

and will immediately make sense to you

as to why this is important

is that the rate of blinking is controlled by dopamine.

So what this means is that dopamine is controlling attention

blinks relate to attention and focus.

And therefore the dopamine and blinking system

is one way that you constantly modulate

and update your perception of time.

And fortunately, it’s also one that you can control.

So the basic takeaway of this study

was that blinking controls time perception,

but also that levels of dopamine

can alter your sense of time.

And stay with me here.

And that blinking and dopamine are inextricably linked.

They are working together to control your attention.

When dopamine levels go up,

people tend to overestimate how long something lasted.

Why?

Because they are processing time more finely.

It’s slow motion mode.

When dopamine levels are lower,

they tend to underestimate time intervals.

Let’s remember back to the very beginning of the episode,

what’s going on in people with ADHD.

They are not good at managing their time.

They tend to run late or they are disorganized.

They are not just disorganized in space,

meaning in the physical space around them,

they’re disorganized in time.

Their dopamine is low.

We know that as well.

And so they are underestimating time intervals.

And so it makes perfect sense that they would be late.

It makes perfect sense that they would lose track of time

or the ability to focus.

This is really exciting because what it means is that

children with ADHD, adults with ADHD,

or people with normal levels of focus

that want to improve their ability to focus

can do so through a training that involves

learning how often to blink and when,

and how to keep their visual focus on a given target.

And it turns out this study has actually been done.

There’s a study, again, I’ll link to this study,

entitled Improvement of Attention

in Elementary School Students

Through Fixation-Focused Training Activity.

I won’t go through all the details,

but what they found was a short period of

focusing on a visual target

allowed these school children to greatly enhance

their ability to focus on other types of information.

And a significant component of the effect

was due to the way that they were

controlling the shutters on their eyes, their eyelids,

and controlling their blinks.

So what they did in this study is they had these kids

focus their visual attention on some object

that was relatively close, like their hand,

for a minute or so, which actually takes some effort

if you try and do that.

They were allowed to blink.

However, it’s known from other work

that if people can consciously override the desire to blink,

at least to the point where they feel like they have to,

or else their eyes would dry out,

that actually can increase attention even further.

And they had conditions where they would look

at a point further across the room

and even further across the room.

It only took a few minutes each day to do this,

30 seconds in one condition, or maybe a minute,

and then at another station

of looking a little bit further out

and a little bit further out.

However, there was an important feature of this study

that is definitely worth mentioning,

which is before they did this visual focus task or training,

they did a series of physical movements with the kids

so that the kids could sort of eliminate or move out

some of their desire to move

and would thereby enhance their ability to sit still.

Now, it’s long been known that kids need a recess.

They need time to run around and play and roll around,

do whatever it is that they do

in order to be able to sit still at all.

Adults probably need this too, frankly,

but kids need it more because the circuits in the brain

that control reflexive movements

and as we say, kind of rhythmic undulating behavior

and things like that, that’s an active suppression.

And kids have less of that circuitry built up

until they hit about age 15 or 16.

So they had the kids move around a bit

and then do this focus training.

That brings me to another treatment

that’s actively used nowadays in schools

for kids with ADHD,

but also starting to be used by many kids and by parents

in order to keep their kids focusing

and not going crazy in the car or not acting out in general.

And that’s the prevalence of these so-called fidgeter toys

or things that kids can do actively and repetitively

in order to move out some of their underlying

reverberatory activity in their nervous system.

So what you will find is that some kids with ADHD

are now given a rubber band on their desk,

literally a rubber band that’s attached to their desk

and they’re able to pull on it,

even snap it against the desk.

If I had done that when I was a kid,

I think my teachers would have thrown me out of class,

but I think it’s great that they’re allowing them

to do this now as a way of moving

some of their physical energy out

or engage their physical energy rather,

as opposed to trying to sit statue still

all the time and attend.

And it turns out that does enhance

these children’s ability to focus mentally

when they have some physical activity to attend to.

And it turns out it also can work for adults.

I’ll share with you a related anecdote

because it illustrates the underlying mechanism.

I’ve had the great privilege of being able to do

a number of surgeries, brain surgeries during my career.

So one thing you find when you do brain surgeries

is that the brain’s pretty small,

regardless of the species that you’re working on

and you’re in there and you’re trying to do

something very specific.

And the more you try and hold your hands really steady,

the more they want to shake, all right?

So it’s not natural for any of our limbs

to sit perfectly still,

depending on how much coffee you’ve had,

how well rested you are,

and your sort of baseline level of autonomic arousal.

Some of you may find that you can hold out your hand

at absolutely rock solid.

Others will shake a little bit more.

Doesn’t mean you’re nervous if you’re shaking,

doesn’t mean you’re calm if you’re still.

What it relates to is the amount of what we call

premotor activity, the number of commands to move

that are being sent through the system.

And that’s what I mean by reverberatory activity.

And it does seem that kids with ADHD and adults with ADHD

have a lot of reverberatory activity

in their nervous system.

And so that’s that constant desire to move.

It’s hard for them to sit still,

and therefore it’s hard for them to attend

to harness their attention.

When you do a surgery and you find that your hands

are shaking, what you learn from your mentors,

which I did, and what works extremely well,

whether or not you’re doing a surgery or not,

is that you simply tap your foot

or you bounce your knee a little bit,

which you might think would make your handshake even more,

but provided that it’s subtle,

what it does is it actually shuttles some of the activity

from those premotor circuits to elsewhere in the body.

And then you’re able to sit much more still with your hand.

You’re able to perform the surgery

with much more precision.

You are able to write with much better handwriting.

And for those of you who engage in public speaking,

if you’re ever too nervous,

that’s why pacing while you public speak helps.

If you’re nervous, that’s why bouncing your knee

behind the podium works as well.

That’s why nodding your head and gesticulating can help.

It’s not a matter of quote unquote,

moving energy out of the body.

That doesn’t actually happen.

What it is is you’re engaging those premotor circuits

that are sending through commands.

It’s like trying to stuff a bunch of stuff through a funnel

and it creates this tension.

So you’re giving it an outlet for the neural circuitry

to be able to move something so that you can keep

other components of your body and your mental attention

engaged and locked onto something, what we call focus.

One thing related to this whole business of blinking

and focus and training yourself to focus

and not blinking, et cetera,

is that most all of the drugs,

Ritalin, Adderall, and recreational drugs

that increase dopamine, even coffee and tea

and other forms of caffeine,

they tend to make us blink less.

And when we get tired, we tend to blink more.

Now, this is sort of a duh, right?

But being wide-eyed with excitement or fear,

or with your eyes barely being able to keep them open,

now it should make perfect sense that these shutters

on the front of your eyes,

they aren’t just there for winking

and they aren’t just there for cosmetic purposes.

They are there to regulate the amount of information

going into your nervous system.

And they’re there to regulate how long

you are bringing information into your nervous system.

And in what bins, how widely or finely you are binning time

is set by how often you blink,

and how widely or specifically you are grabbing attention

from the visual world is set by whether or not

you’re viewing things very specifically,

like a crosshair or through a soda straw view like this,

or whether or not you are in this panoramic

sort of whole environment mode,

this kind of fisheye lens or wide angle lens mode.

And in fairness to the pharmacology and the circuitry,

while dopamine and heightened levels of alertness

and excitement tend to make us blink less and attend more,

there’s actually a study that’s looked at

the other neurochemical systems and drugs

and how those relate to blinking.

And so this will all be obvious by the title of the paper

I’m about to share with you.

This is a paper entitled

Decreased Spontaneous Eye Blink Rates

in Chronic Cannabis Users,

Evidence for Striatal Cannabinoid Dopamine Interactions.

Okay, I’m not going to go into all the details here,

but one thing that is somewhat surprising

is that many people with ADHD use or abuse cannabis.

You might think, well, why would they do that?

Because I thought that a increase in dopamine

is actually what’s going to lead

to heightened levels of attention,

and that’s what these people and children crave.

Well, it turns out that cannabis

also increases dopamine transmission in the brain,

but because of the other chemicals it increases,

namely serotonin and some components

of the cannabinoid and opioid system,

it creates that kind of alert, but mellow feel.

And again, here, I’m not a proponent of this.

I personally am not a THC or cannabis user.

It’s just not my thing.

And obviously it’s illegal some places,

and so you have to determine that for yourself.

It does have medical purposes and in some places

it is legal, but THC increases dopamine

and increases neurochemicals

that can also create a state of calm.

So it’s that sort of middle ground.

And this paper has a beautiful demonstration

whereby not just while people are using cannabis,

but depending on how long they’ve been using cannabis

across their lifespan, the rates of eye blinking change.

So if you look at the number of years

that people have been using cannabis on a regular basis,

either daily or up to, excuse me, weekly or up to daily,

what you find is that for people

that have not been using cannabis at all

or have only been using it for about two years,

their rates of eye blinks are much higher

than people who’ve been using it chronically for 10 years.

In other words, people who’ve been using cannabis

for 10 years don’t blink very often at all.

Now, cannabis has well-known effects in depleting memory,

but it does seem to engage the focus and blinking system

in a way that increases focus.

So basically what I’m saying is

marijuana seems to increase people’s focus,

but then they can’t remember what they were focusing on.

Something I’d like to discuss just briefly

is the so-called interoceptive awareness

that’s present in people with ADHD,

both children and adults.

Interoceptive awareness is one sense

of one’s own internal state,

heartbeat, breathing, contact of skin with a given surface.

For a long time, there was this hypothesis,

this idea that people with ADHD

were just not in touch with how they felt,

that somehow they weren’t registering

all the stuff that was going on inside them,

changes in heart rate and so forth.

And so they were behaving in a way that was dysregulated

or appeared dysregulated.

And that if they could just learn to attend

to their internal state better,

that somehow they would function better in the world.

Now, before we described a process,

literally a 17 minute interoceptive exercise

that does seem to lead to improvements

in one’s ability to focus for a longer period of time.

However, it’s very unlikely that that was due

to increasing interoceptive awareness per se.

It probably wasn’t because people gain a much heightened

or improved ability to understand

what’s going on internally.

In fact, you can imagine how that might actually prevent

one’s ability to pay attention to things

in the outside world.

So while there is benefit to just sitting there

and being in stillness, as they say,

or focusing on one’s breathing and internal state

for sake of then accessing information

in the external world,

a really nice study called Interoceptive Awareness

in Attention Deficit Hyperactivity Disorder

explored whether or not interoceptive awareness

was different in people with ADHD or did not have ADHD.

And the findings were essentially

that there’s no difference,

that people with ADHD, children and adults,

they are aware of what’s going on inside them

just as much as anyone else is.

And the typical measure of interoceptive awareness

is one’s ability to count their own heartbeats.

This is actually challenging for some individuals

and very easy for other individuals,

regardless of their attentional capacity.

Some people just can really feel their heartbeat

without taking their pulse, other people cannot.

And these studies are pretty straightforward to do.

You ask people to sit there and to count their heartbeats,

and then you are monitoring their heartbeats

and you get to gauge how accurate they are.

So it’s important to understand that people with ADHD

are in touch with how they feel.

It’s really a question of whether or not

they can take the demands that are placed upon them

and enter a cognitive state, a mental state

that allows them to access the information

they need to access.

In other words, whether or not they can focus.

But it is absolutely wrong to think that the child

that’s getting up 11 times during a short six minute

interaction at the table, or whether or not a child

who somehow has to venture off every moment

or a coworker of yours who’s an adult

who’s constantly fidgeting or moving things around

that somehow they are unaware that they are oblivious.

They are not oblivious to how they feel.

Chances are they are very challenged

in the situations that they’re in,

and they’re doing everything they can

to try and regulate their attention.

So I think it’s an important study to highlight

because it really underscores the fact

that something else is going on,

and that something else has everything to do

with this ability to coordinate these task-directed networks

and to coordinate that in the proper way

with that default mode network.

And that is a process, as you now know,

that’s regulated exquisitely by certain neurochemicals,

and in particular, the neurochemicals dopamine,

norepinephrine, and serotonin.

And a fourth one I’d like to throw into the mix,

which is acetylcholine, which is very vital

for cognitive focus.

So now I want to switch back to talking about

some of the drugs that are typically used

to access those systems, prescription drugs,

and I want to talk about some of the new

and emerging non-prescription approaches

to increasing the levels of dopamine, acetylcholine,

and serotonin in the brain

using various supplement-type compounds,

because several of them are showing

really remarkable efficacy in excellent peer-reviewed studies.

So before moving to some of the newer atypical compounds

and things sold over the counter,

I’d like to just briefly return to the classic drugs

that are used to treat ADHD.

These are the ones I mentioned earlier,

methylphenidate, also called ritalin,

modafinil, armodafinil is another one, and Adderall.

Again, all of these work by increasing levels

of dopamine and norepinephrine.

Typically, they are taken orally in pill form,

or sometimes in capsule form.

The dosages that are appropriate

vary according to severity of the condition

for a given person and the age of the person.

This is a complicated landscape for each individual.

They have to figure out the pharmacology

that’s best for them.

Some individuals are even layering long

or time-to-release ritalin with Adderall in smaller doses.

It can get quite complex,

or it can be quite straightforward.

If you are really interested in these drugs

and how they work, and you’d like to get a glance

at a table of all the results from all the studies

of which there are now hundreds,

there’s an excellent review about these drugs

and their use and their comparison

to similarly structured drugs,

in particular MDMA and cocaine and amphetamine,

meaning street amphetamine,

to really illustrate the similarities of action

and some of the problems associated with long-term use.

I don’t expect you to read this article in full.

I’m here so that you don’t have to go read these articles,

but in case you want a ton of information,

the paper is Esposito et al., Frontiers in Biosciences.

It’s an excellent, excellent review

of the entire literature.

It is quite long.

I can put a link to that study in our caption.

And it essentially describes all the studies

that have been done, peer-reviewed, and published.

It refers to these drugs in an interesting way.

It doesn’t just refer to these drugs

as for treatment of ADHD.

It actually refers to them using language

that ordinarily I’m not very fond of,

but I’ll agree to here,

which is so-called smart drugs or nootropics.

It also covers caffeine, which again,

as I mentioned earlier, increases dopamine, norepinephrine,

and to some extent, serotonin.

But what I like about this review so much

is that in putting these drugs of abuse,

methamphetamine and cocaine,

right alongside these drugs like Ritalin and Adderall

and also caffeine, we start to realize

that the distinction between drugs of abuse

and the distinction between drugs of treatment

is actually a very fine and sometimes even a blurry line.

And in thinking about whether or not

one wants to use these prescription,

I want to emphasize prescription, not drugs of abuse,

but prescription drugs for treatment

of one’s own attentional capacity,

I think it is important to understand

the extent to which they all carry

more or less the same side effects.

The one exception being caffeine.

Caffeine side effects can be anxiety

if you ingest too much of it, insomnia,

if you drink it too late in the day,

but typically it will not cause the major side effects

of the other drugs,

such as high propensity for addiction and abuse.

Amphetamines of any kind, as well as cocaine,

can cause sexual side effects

because they’re vasoconstrictors.

So, you know, men have trouble achieving erection.

There can often be the intense desire or libido for sex,

but an inability to actually perform.

So that’s an issue with any kind of stimulant.

So these drugs are not without their consequences.

In addition, and here I’d lump caffeine back into the mix.

In addition, they almost all carry cardiac effects, right?

They increase heart rate,

but they also have effects on constriction of blood vessels

and arteries and veins and so forth

in ways that can create cardiovascular problems.

Now, caffeine is a bit of a complicated one.

I talked about this on a podcast long ago,

but I’ll just remind you that it turns out

that if you are caffeine adapted,

in other words, if you are used to drinking caffeine,

then the ingestion of caffeine

most often will cause vasodilation.

It will actually allow more blood flow through.

However, if you are not caffeine adapted,

it will cause vasoconstriction

due to an increased stress response.

So if you’re familiar with caffeine,

caffeine can actually have a little bit more

of a relaxation response.

Although if you drink enough of it,

it will make you amped up.

These other drugs almost always lead to vasoconstriction,

increased heart rate, dilation of the pupils,

less blinking, heightened levels of attention,

which looks very much like stress.

And at its extremes, looks very much like

the effects of street drugs like cocaine and amphetamine.

Because of the large amounts of dopamine

that are released in the brain,

people tend to crave that state over and over,

and yet with each subsequent use,

are able to get less and less of that euphoric feeling

or that really, really focused feeling.

So one thing that’s being explored quite extensively now

in the treatment of ADHD are drug schedules,

whether or not people should take Adderall every day

or every other day,

whether or not they should take it

only every once in a while,

whether or not young children can take it just a few times

and engage in behavioral training of the sort

that I talked about before,

where they’re doing,

maybe it’s a 17 minute meditation type exercise,

but more likely it would be the movement

followed by the visual focusing,

because that’s only done for 20 or 30 or 60 seconds.

Why would you do that?

Well, in a chemically enhanced state,

your brain is more plastic.

The circuits are able to modify and learn better.

That’s the optimal time to engage in focus

in a very deliberate way.

So just taking a drug and expecting focus

to just work at any point

and being able to turn focus on and off at will,

that’s an unrealistic expectation, right?

More likely the best use of things like Adderall,

modafinil, armodafinil and Ritalin

is going to be to combine those treatments

with behavioral exercises

that actively engage the very circuits

that you’re trying to train up and enhance.

And then perhaps, I want to highlight perhaps,

tapering off those drugs

so that then one can use those circuits

without any need for chemical intervention.

So despite any controversy that might be out there,

I think it’s fair to say that the consumption

of omega-3 fatty acids can positively modulate

the systems for attention and focus.

So then the question becomes how much EPA,

how much DHA, does that differ

for what’s helpful for depression, et cetera?

And actually it does differ.

In reviewing the studies for this,

it appears that a threshold level of 300 milligrams of DHA

turns out to be an important inflection point.

So typically fish oils or other sources of omega-3s

will have DHA and EPA.

And typically it’s the EPA

that’s harder to get at sufficient levels,

meaning you have to take quite a lot of fish oil

in order to get above that 1,000 milligram

or 2,000 milligram threshold to improve mood

and other functions.

But for sake of attention,

there are 10 studies that have explored this in detail.

And while the EPA component is important,

the most convincing studies point to the fact

that getting above 300 milligrams per day of DHA

is really where you start to see the attentional effects.

Now, fortunately, if you’re getting sufficient EPA

for sake of mood and other biological functions,

almost without question,

you’re getting 300 milligrams or more of DHA.

So that usually checks that box just fine.

What’s interesting is that there’s another compound,

phosphatidylsterine, that has been explored

for its capacity to improve the symptoms of ADHD.

Again, I don’t think this is any direct way,

but rather in a modulatory way.

But it appears that phosphatidylsterine

taken for two months for 200 milligrams per day

was able to reduce the symptoms of ADHD in children.

It has not been looked at in adults yet,

at least as far as I know,

but that this effect was greatly enhanced

by the consumption of omega-3 fatty acids.

So now we’re starting to see synergistic effects

of omega-3 fatty acids and phosphatidylsterine.

Again, that was 200 milligrams per day.

This is something that sold over the counter in capsule form

at least in the US.

There were two studies, both were double blind studies,

carried out for anywhere from one to six months

on both boys and girls.

And it really was boys and girls, not men and women.

This was kids age one to six or seven to 12.

And it was a fairly large number of subjects.

So 147 subjects in one case and 36 in the other.

The takeaway is that getting sufficient levels of EPAs,

in particular, this 300 milligram threshold of DHA,

plus if you are interested in it and it’s right for you,

200 milligrams of phosphatidylsterine

can be an important augment

for improving the symptoms of ADHD.

You’ll also find literature out there

and many claims about so-called ginkgo bilboa,

which has been shown to have minor effects

in improving the symptoms of ADHD,

not nearly as effective as ritalin and Adderall.

Ginkgo bilboa is not appropriate for many people.

I am one such person.

I don’t have ADHD, but when I’ve taken ginkgo,

even at very low doses,

I get absolutely splitting headaches.

Some people do not experience those headaches,

but it’s known to have very potent vasoconstrictive

and vasodilating properties that vary

depending on when you took the compound.

So for those of you that are exploring ginkgo bilboa,

and you will see a lot of claims about ginkgo bilboa

for attention in ADHD,

definitely take the vasodilation, vasoconstriction,

headache issue into consideration.

So I’d like to talk about the drug modafinil

and the closely related drug armodafinil,

that’s A-R modafinil,

because modafinil and armodafinil

are gaining popularity out there

both for treatment of ADHD and narcolepsy,

but also for communities of people

that are trying to stay awake long periods of time.

So it’s actively used in the military by first responders,

it’s gaining popularity on college campuses,

and people are using it more and more as an alternative

to Adderall and Ritalin and excessive amounts of coffee.

It does increase focus and to a dramatic extent.

Modafinil typically was very expensive.

I don’t know if it’s still this expensive,

but when one has a prescription for it,

it could still cost as much as eight or $900

or even a thousand dollars a month.

Armodafinil is a far less expensive version

that’s chemically slightly different than modafinil.

Regardless of price,

people are taking modafinil and armodafinil.

Want to emphasize that unlike Ritalin and Adderall,

modafinil and armodafinil

are weak dopamine reuptake inhibitors,

and that’s how they lead to increases in dopamine.

So whereas Ritalin and Adderall,

amphetamine and cocaine lead to big increases in dopamine,

also through reuptake mechanisms and so forth,

modafinil is a weaker dopamine reuptake stimulator.

And so what that means is that it leaves more dopamine

around to be active at the synapse,

the gaps between neurons.

However, it also activates other systems.

It acts on the orexin system,

which is actually a peptide that we talked about

in the episode on hunger,

because it regulates hunger and appetite,

and it regulates sleepiness and feelings of sleepiness.

In fact, the, excuse me,

orexin also called hypocretin system,

the orexin-hypocretin system

is what’s disrupted in narcolepsy.

That was the important discovery of my colleagues,

Emmanuel Mignon and Seiji Nishino at Stanford some years ago.

They identified the biological basis of narcolepsy,

and it’s a disruption in this orexin-hypocretin system.

And modafinil is one of the primary treatments

for narcolepsy.

It also has these other effects on the dopamine system

and on the norepinephrine system.

Even though it doesn’t lead to quite as intense levels

of dopamine and arousal and focus,

it does have the property

of raising levels of attention and focus,

and that’s why people are using it.

So it’s a somewhat milder form of Adderall.

Our modafinil for some people works as well as modafinil,

and as I mentioned before, it’s much lower cost.

For other people, it doesn’t.

I have an experience, meaning I do have an experience

that I’ll share with you with our modafinil.

A few years ago, I was suffering from jet lag

really terribly, and I was traveling overseas.

I went to a meeting to give a talk.

I took half of the prescribed dose of our modafinil.

It was prescribed to me.

I took that half dose, and I gave my lecture,

and then I stayed around to answer questions.

And then four hours later, a friend of mine came up to me

and said, you know, you’ve been talking

for four and a half hours,

and there are only a few people still here.

Luckily, there were still a few people.

It’d be a lot weirder if the room was completely empty,

since it wasn’t being recorded.

So I have firsthand knowledge

of the sorts of cognitive effects that it can create.

I personally would not want to be in that state

for sake of studying or learning

or for doing this podcast, for instance.

And I can honestly say that today,

all I’ve ingested is some coffee

and some yerba mate tea and some water.

I’m not on any of the compounds that I’ve described

during the course of today’s episode.

You might ask why I took half the recommended dose

of armodafinil, and the reason is that I’m somebody

who’s fairly hypersensitive to medication of any kind.

What you find if you look in the literature

is that about 5% of people

are hyper, hypersensitive to medication.

They require far lower doses of any medication

than other people in order to experience the same effects.

I’m somebody that I think is sort of modest, hyper,

if that sort of oxymoronic statement,

but a modest hypersensitivity to medication.

So I’ve almost always been able to get by

on taking less of whatever was prescribed for me

and feel just fine, or in this case,

to feel like it was still too much.

It turned out that the right dose of armodafinil for me

was zero milligrams.

Now, you may notice that I haven’t talked much

about acetylcholine.

Acetylcholine is a neurotransmitter

that at the neuron to muscle connections,

the so-called neuromuscular junctions,

is involved in generating muscular contractions

of all kinds for all movements.

Acetylcholine is also released from two sites in the brain.

So a little bit of nomenclature here.

Again, feel free to ignore the nomenclature,

but there is a collection of neurons in your brainstem

that send projections forward,

kind of like a sprinkler system that’s very diffuse

to release acetylcholine.

And those neurons reside in an area or a structure

that’s called the pedunculopontine nucleus, the PPN.

And then there’s a separate collection of neurons

in the basal forebrain

called unimaginatively nucleus basalis,

the nucleus at the base.

And they also hose the brain with acetylcholine,

but in a much more specific way.

So one is sort of like a sprinkler system,

and the other one is more like a fire hose

to a particular location.

And those two sources of acetylcholine

collaborate to activate particular locations in the brain

and really bring about a tremendous degree of focus

to whatever is happening at those particular synapses.

So it could be a focus on visual information

or auditory information.

If you’re listening closely to what I’m saying right now,

or you just heard closely,

step out from the rest of my sentence.

No doubt there was acetylcholine released at the sites

in your brain where the neurons

that represent your recognition of the word closely

occurred, okay?

So now you have an example and you have an understanding

and hopefully a picture in your mind

of how all this is working.

Not surprisingly then,

drugs that increase cholinergic

or acetylcholine transmission

will increase focus and cognition.

One such compound is so-called alpha-GPC,

which is a form of choline

and increases acetylcholine transmission.

Dosages as high as 1200 milligrams per day,

which is a very high dosage spread out.

Typically it’s 300 or 400 milligrams spread out

throughout the day,

have been shown to offset some of the effects

of age-related cognitive decline,

improve cognitive functioning.

People that don’t have age-related cognitive decline,

that’s a very high dose.

Typically when people are using alpha-GPC to study

or to enhance learning of any kind,

they will take somewhere between 300 and 600 milligrams.

That’s more typical.

Again, you have to check with your doctor.

You have to decide if the safety margins

are appropriate for you.

Obviously you’ll want to check that out,

but alpha-GPC is effective in creating more focus

by way of this cholinergic system.

It stimulates acetylcholine release

from both of those locations,

the PPN in the back of the brain

and nucleus basalis in the front of the brain.

There are two other over-the-counter compounds

that are in active use out there for treatment of ADHD

and in use for simply trying to improve focus.

And the first one is L-tyrosine.

It’s an amino acid that acts as a precursor

to the neuromodulator dopamine.

And now knowing everything you know about dopamine attention

and the circuits involved,

it should come as no surprise as to why people

are exploring the use of L-tyrosine for that purpose.

L-tyrosine does lead to increases in dopamine.

They are fairly long-lived

and L-tyrosine can improve one’s ability to focus.

However, the dosaging can be very tricky to dial in.

Sometimes it makes people feel too euphoric

or too jittery or too alert

that they are then unable to focus well.

So the dosage ranges are huge.

You see evidence for 100 milligrams

all the way up to 1200 milligrams.

It’s something that really should be approached

with caution, especially for people

that have any kind of underlying psychiatric

or mood disorder, because dysregulation

of the dopamine system is central to many

of the mood disorders such as depression,

but also especially mania, mania bipolar disorder,

schizophrenia, things of that sort.

So it’s something that really should be approached

with caution.

Nonetheless, in exploring what’s out there

and even some studies online that were done

either animal studies or human studies,

it’s clear that L-tyrosine is being explored

for that purpose, as is PEA and phenolethylamine,

which is essentially PEA, but some related compounds.

So there’s a whole class of dopaminergic

or dopamine stimulating supplements that people are using

to try and get their dopamine levels up.

And again, it’s kind of a fine line

between too little, enough, and too much.

If you want to get the literature on those two compounds,

there, I will refer you to this great website

at examine.com, just as it sounds,

and you can put in L-tyrosine or PEA,

and you can get the details on that.

But I highly recommend also going to their section

on ADHD to see how those particular compounds

relate specifically to ADHD and cognitive focus.

And last but not least,

in terms of these different compounds,

I do want to mention the racetams.

These are somewhat esoteric,

and probably most of you haven’t heard about them,

but some of you probably know a lot about them,

and they are becoming more popular.

They go by names like Nupept and things of that sort.

The racetams are illegal in certain countries.

They are gray market in other countries,

and they are sold over the counter

in this country, in the US.

So they have different margins for safety.

You definitely need to consult your doctor,

especially if you have ADHD.

But Nupept has been shown,

when taken at 10 milligrams twice daily,

can be more effective than some of the other racetams.

What is Nupept?

Nupept taps into the cholinergic system,

the acetylcholine system,

in ways very similar to alpha-GPC,

but seems to have a slightly higher affinity

for some of the receptors involved

and can lead to those heightened states

of cognitive capacity.

And there are these studies,

one in particular,

comparative studies of Nupept and racetam

and the treatment of patients

with mild cognitive disorders

and brain disease of vascular and traumatic origin.

That’s a mouthful.

What this study basically points to

is the fact that people who are experiencing

some degree of inability to focus

due to prior concussion or some vascular event,

a stroke or ischemia of any kind,

because neurons need blood

when the blood supply is cut off to neurons

or when there’s a bleed in the brain.

Subsequent to that,

often there are challenges in maintaining focus.

This is very common for people that have done sports

where there’s a lot of running into each other

with your head, like rugby, football, hockey, and so forth,

but also people who have experienced head blows

or often overlooked is the fact

that most traumatic head injury

is not actually from sports, even football.

It’s from things like construction work,

from high-impact work of that kind.

So there does seem to be some efficacy

of Nupept and paracetam and things like it.

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 are beginning to show some promise.

And I’m intrigued by them because of the way

that they tap into the cholinergic system,

which is both directly involved in focus

and the ability to focus,

but is also important for things related

to age-related cognitive decline.

So a decline in cholinergic transmission

or acetylcholine as we call it in the brain

is one of the things associated with cognitive decline.

And it does seem that increasing cholinergic transmission

can offset some of that cognitive decline

and perhaps even more so in conditions

such as vascular damage or concussion to the brain.

If you’re interested in atypical treatments for ADHD,

compounds to improve focus and related themes,

and you like reading about this stuff,

there’s an excellent review article

that I can refer you to.

It’s by Ahn et al., A-H-N.

It was published in 2016.

So it’s a little bit behind the times,

although it’s surprisingly comprehensive given that,

which lines up all the various drugs that I’ve discussed,

racetams and Adderall and Ritalin

and various forms of dopaminergic agents

and cholinergic agents,

spells out whether or not they are sold over the counter

by prescription and really lines them up

and all their effects, their drawbacks, et cetera.

I’ll refer you to that study.

It’s available in its full length form online for free.

It’s Ahn et al.

The journal is Neuroplasticity, Neuroplasticity 2016.

Should be very easy to find if you put those keywords in.

And while it is a review, it is a very comprehensive review.

And if you’re really into this stuff

and you also want to learn a thing or two

about how these things interact with neurofeedback, et cetera,

there’s some information in there as well.

I know I’ve already covered a lot of information,

but there is one more category of technology

for the treatment of ADHD

and for enhancement of focus in anyone

that I would like to emphasize.

And that’s transcranial magnetic stimulation.

Transcranial magnetic stimulation, also called TMS,

is achieving increasing popularity nowadays

for the treatment of all sorts of neurologic conditions

and psychiatric conditions.

It is a non-invasive tool.

It involves taking a coil.

It’s a device with a coil

that’s placed over particular locations in the brain

and then sends magnetic stimulation into the brain.

It can actually pass through the skull

without having to drill through the skull.

And nowadays can be used to both lower the amount

of activity or increase the amount of activity

in specific brain areas.

It’s spatial precision is not remarkable.

That doesn’t mean it’s not of use,

but it is not a super fine grain tool, okay?

It’s not a cannon, but it’s also not a needle.

It is somewhere in between.

It can direct the activity of particular brain regions

at particular depths.

And as I mentioned,

it can increase or decrease that activity.

So for instance, I’ve had a TMS coil placed on my head,

not for therapeutic purposes,

even it was, I wouldn’t tell you,

but rather just for, well, I’m a neuroscientist

and I worked in a lab with one

for entertainment exploratory purposes.

Please don’t do this at home.

It was placed over my motor cortex,

which generates voluntary action.

And it was a coil that at that time

could only inhibit neurons.

And so what I was doing is I was moving objects around

on a table, just like I am now.

It was actually a pencil, not a pen.

And I was tapping the pencil

and then the TMS coil was turned on.

And for the life of me, I could not move that pencil, okay?

Because it was inhibiting my upper motor neurons

in the portion of my cortex

that controls voluntary activity.

As soon as the coil was turned off,

I could return to tapping the pencil again.

Nowadays, it’s possible to stimulate motor cortex

or any area of the brain with some degree of precision

that could create the impulse to move

without actually making the decision to move.

So you can literally engage certain neural circuits

and therefore behaviors and certain thought

and emotional patterns

by way of transcranial magnetic stimulation.

This has far reaching and vast implications

as you can probably imagine.

In discussing ADHD with a colleague that uses TMS,

what they are doing is they are taking the TMS coil

to children and adults that have ADHD.

And they’re using it to stimulate the portions

of the prefrontal cortex that we talked about earlier

that engage task-directed focused states.

So rather than using a drug that generally increases dopamine

and some of the other chemicals involved,

they’re using directed TMS stimulation of these circuits.

And fortunately, I was quite relieved to hear this,

they’re combining that with a focused learning task.

So they’re literally teaching the brain to learn

in a non-invasive way, no drug at all.

And right now there are experiments,

clinical trials going on comparing TMS of this sort

to the drug treatments of the sort that we described earlier

that engage these circuits through pharmacologic mechanisms.

So very exciting times for TMS,

very exciting times for pharmacology related to ADHD

and for enhancing focus in general.

And when I say very exciting times,

I mean, no drug is perfect,

but the constellation of drugs that’s out there

is getting much larger.

But because they tap into different aspects

of their circuitry, I do think that we are well on our way

to identifying the ideal combinations of drug treatments,

technological treatments, and behavioral paradigms

for increasing focus in both children and adults with ADHD.

And as a final, final point,

I also want to mention something about technologies

that are making it harder for all of us to focus

regardless of whether or not we have preexisting ADHD

or not.

You can probably guess where this is going.

Everybody nowadays seems to have a smartphone.

I’m sure there are a few individuals out there

that don’t have a smartphone.

Nonetheless, most people have them.

Most kids want one as soon as they can get them.

And they are small.

They grab our attention entirely,

but within that small box of attention,

there are millions of attentional windows scrolling by.

Right?

So just because it’s one device that we look at

does not mean that we are focused.

We are focused on our phone,

but because of the way in which context switches up so fast

within the phone,

it’s thought that the brain is struggling now

to leave that rapid turnover of context, right?

Many, many shows, many, many Instagram pages,

many, many Twitter feeds, many, many websites.

Basically the whole world, at least in virtual format,

is available within that small box.

Unlike any other technology humans

have ever dealt with before.

Even though there are trillions,

infinite number of bits of information

in the actual physical world,

your attentional window, that aperture of constriction

and dilating that visual window

is the way in which you cope

with all that overwhelming information typically.

Well, within the phone,

your visual aperture is set to a given width.

It’s about this big.

Typically the phone seemed to be getting bigger,

but nonetheless, it’s about that big.

And within there,

your attentional window is grabbing

a near infinite number of bits of information,

colors, movies.

If a picture is worth a thousand words,

a movie is worth a billion pictures.

The brain loves visual motion.

And so the question is,

does that sort of interaction on a regular basis

lead to deficits in the types of attention

that we need in order to perform well

in work and school relationships, et cetera?

And the short answer is, yes, it does appear so.

We are inducing a sort of ADHD.

And while the studies on this are ongoing

because prominent use of smartphones

really took off right around 2010,

and we’re only in 2021,

longstanding studies take time,

which is essentially to say the same thing as longstanding.

There are some studies,

and one in particular that I’d like to highlight.

One was actually carried out pretty early in 2014.

This is a study that explored smartphone use,

at the time they called it mobile phone use,

but smartphone use,

and inattention, difficulties in attending

in 7,102 adolescents.

This is a huge study,

a population-based cross-sectional study.

And you will be probably surprised and somewhat dismayed

to hear that in order to avoid

this decrease in attentional capacity,

adolescents needed to use their smartphone

for less than 60 minutes per day

in order to stay focused and centered on their other tasks.

Otherwise, they started to really run

into significant issues.

So 60 minutes is not much.

I have a feeling that most young people

are using their phone more than 60 minutes per day.

I know I am.

I think for adults, the number is probably higher,

meaning if you’re an adult,

I’m going to just extrapolate from what I read in this study.

It seems that probably two hours a day on the phone

would be the upper limit

beyond which you would probably experience

pretty severe attentional deficits.

I am a big fan of Cal Newport,

who wrote the book, Deep Work.

He’s also written the excellent book,

A World Without Email.

I’ve never met him, but I’m a huge admirer of his work.

And I will paraphrase something

that he said far more eloquently than I ever could,

which is that the brain does not do well

with constant context switching,

meaning it can do it,

but it diminishes our capacity

to do meaningful work of any other kind.

And so Cal, as I understand, is very,

he’s a computer science professor at Georgetown, by the way,

is very structured and very disciplined

in his avoidance of cell phone use.

I think we’re all striving to do that.

I’m not here to tell you what to do,

but I think whether or not you have ADHD or not,

if you’re an adolescent,

limiting your smartphone use to 60 minutes per day or less,

and if you are an adult to two hours per day or less

is going to be among the very best ways to maintain,

just to maintain your ability to focus

at whatever level you can now.

And as I always say,

most of the things that we get recognized for in life,

success in life, in every endeavor,

whether or not it’s school, relationships, sport,

creative works of any kind

are always proportional to the amount of focus

that we can bring that activity.

It is important to rest, of course, to get proper sleep,

but I stand behind that statement.

And I leave you with that study

about attention and cell phones

and how cell phones are indeed eroding

our attentional capacities.

So I realized I covered a lot of information about ADHD

and the biology of focus and how to get better at focusing.

We talked about the behavioral

and psychological phenotypes of ADHD.

We talked about the underlying neural circuitry.

We also talked about the neurochemistry

and we talked about the various prescription drug treatments

that are aimed at that neurochemistry

and aimed at increasing focus in children

and adults with ADHD.

We also talked about over-the-counter compounds,

the role of particular types of diets and elimination diets.

And we talked about interactions

between these various features

in dictating outcomes for ADHD

and enhancing focus in general.

We also talked a little bit about

emerging neurotechnologies

and how certain technologies like the smartphone

are no doubt hindering our ability to focus

and put us at greater risk of developing ADHD at all ages.

I do acknowledge the irony

and somewhat the contradiction

of doing a two-hour plus episode on ADHD,

if indeed people who are watching this

have challenges with attention.

I want to emphasize that this podcast,

like all of our podcast episodes,

are timestamped for a specific reason.

They are designed to be digested

in whatever batch one chooses, right?

You don’t have to watch or listen

to the entire thing all at once.

However, if you’ve gotten to this point in the podcast,

I want to thank you.

I do hope that you’ve learned a lot about this condition.

I hope you’ve also learned a lot

about your own capacity to focus

and things that you can do to enhance your focus.

We even talked about a tool

that takes just one 17-minute session

to enhance your ability to focus thereafter,

presumably forever.

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And as mentioned at the beginning of today’s episode,

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If you go to livemomentous.com slash Huberman,

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that have been discussed on various episodes

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And finally, I want to thank you for your time

and your attention, and as always,

thank you for your interest in science.