What is ADD?
UPDATE: Here’s another article by Thomas Brown, taking the view that ADD is or is one of a spectrum of executive function impairment disorders. Really good article. I’ll blog it later.
I just read a really interesting article about what Jeffrey Tate, a doctor specializing in ADD, thinks the core symptom of the disorder is. He thinks that it’s about not being able to focus on important tasks, as opposed to interesting tasks. Normally, either importance or interest are enough to allow us to focus on something, but for ADD sufferers, interest is all that suffices.
Now, this seems like it might be a bit off to me. Doesn’t everyone have trouble focusing on boring but important things? Or is that really pretty unusual? So, if you’re reading this, please answer these two questions:
1. Do you find it (a) easier (b) as easy, or (c) harder to focus on important tasks (things that need to be done) versus interesting tasks (that are entertaining, but not necessary)?
2. When there is something quite important but relatively uninteresting to be done, do you find it (a) easy (b) moderately easy (c) moderately hard, or (d) hard to get it done?
If I’m right, most people would answer C on the first question, and C or D on the second. Wouldn’t that make it so most people suffer from ADD? And what is “important”, in this context? Is it our conscious determination of the importance of the task? Unlikely. It’s probably some heuristic based on urgency, using cues from peer pressure (who wants you to do the task?) and the perceived immediate consequences of not doing the task. If someone is breathing down your neck about doing something, it can be a pretty powerful motivator.
Perhaps it’s simply the case that while a person’s “interesting” activities are drawn from the huge pool of all popular entertainment options from television, the internet, and local culture, a person’s “important” activities are drawn from the vastly more limited pool of those activities furthering the person’s career or personal goals. Because there are so many more “interesting” things to choose from than there are “important” things, the ones with the strongest dopamine responses, that tend to be chosen the most often, are almost entirely drawn from the “interesting” pool of activities.
But if ADD is only a problem for about 1 in 12 Americans, and the above analysis holds, that must mean that “important” elicits a much stronger dopamine response than “interesting” for most people in most circumstances. Perhaps it’s the case that most people live in situations where their goals align with the expectations that others have for them, and so they don’t have to rely on conscious determination to set the importance, and thus the attentional salience, of their goal-oriented activities. Their salience is determined by the amount of pressure they feel from others to do the task. In this situation face-to-face interaction would produce much more motivation.
Can money motivate someone to give attention to something that they would otherwise not be able to pay attention to? Fear of consequences?
Let me speculate wildly. Amphetamine-based medications for ADD work by raising the dopamine levels (currently in the brain as a whole, though theoretically more targeted medications would be as effective with fewer side effects). But a steady, increased level of dopamine leads to resistence in the brain. (This is the mechanism that causes habitual users of alcohol, cigarettes, marijuana, and other drugs to require higher doses to feel a high as use continues.) This probably occurs on a whole brain-level. Could this make addictive actions (like web surfing or puzzles) and behaviors (like substance abuse, gambling, and shopping) relatively less appealing overall? Then important actions would be relatively more appealing than they were before the treatment, but not more appealing in the absolute. Wouldn’t a more appropriate treatment be one that increased dopamine levels in the particular part of the brain responsible for focusing our attention on important tasks?
Also, I’m a bit confused. Reuptake inhibitors work by blocking receptors on the postsynaptic neuron. But doesn’t the action of the signal chemical depend on the chemical pathways activated by the presence of the transmitter in the synaptic cleft of the postsynaptic neuron? So while reuptake inhibitors increase interneuronal presence of the transmitters, they only do so by making the transmitters just sit around not doing anything.
Ahh, no. Reuptake is the absorption (without channel activation) of the transmitter by the presynaptic terminal, and reuptake inhibitors make it so that a higher percentage of the transmitter is used to activate the channels on the postsynaptic terminal. Or something like that.
Anyway, this medication has helped a lot, but there are still some really boring things that I really need to do but find it almost impossible to force myself to do. Staring at them, doing nothing else (and catching myself every two minutes when I try to start doing something else, which only works about 80% of the time at best) and I just can’t make any progress. And the task isn’t even that difficult, in the right state of mind. Very frustrating.
