ADHD & How Anyone Can Improve Their Focus

00:00:00.000 | Welcome to Huberman Lab Essentials,

00:00:02.220 | where we revisit past episodes

00:00:04.040 | for the most potent and actionable science-based tools

00:00:07.220 | for mental health, physical health, and performance.

00:00:10.000 | I'm Andrew Huberman,

00:00:12.880 | and I'm a professor of neurobiology and ophthalmology

00:00:15.560 | at Stanford School of Medicine.

00:00:17.080 | Today, we are going to talk all about

00:00:19.740 | attention deficit hyperactivity disorder, or ADHD.

00:00:23.180 | Now, just a quick reminder

00:00:25.140 | that anytime we discuss a psychiatric disorder,

00:00:28.640 | it's important that we remember

00:00:30.500 | that all of us have the temptation to self-diagnose

00:00:33.960 | or to diagnose others.

00:00:35.320 | The clear and real diagnosis of ADHD

00:00:39.600 | really should be carried out by a psychiatrist,

00:00:42.460 | a physician, or a very well-trained clinical psychologist.

00:00:46.900 | So right now, the current estimates

00:00:49.480 | are that about one in 10 children,

00:00:51.960 | and probably more, have ADHD.

00:00:54.960 | Now, fortunately, about half of those

00:00:57.880 | will resolve with proper treatment,

00:00:59.920 | but the other half typically don't.

00:01:02.540 | The other thing that we are seeing a lot nowadays

00:01:05.120 | is increased levels of ADHD in adults.

00:01:09.560 | For sake of today's discussion,

00:01:11.520 | attention, focus, and concentration

00:01:14.000 | are essentially the same thing.

00:01:15.660 | So people with ADHD have trouble holding their attention.

00:01:21.060 | What is attention?

00:01:23.380 | Well, attention is perception.

00:01:26.140 | It's how we are perceiving the sensory world.

00:01:30.260 | For instance, right now, you're hearing sound waves.

00:01:33.080 | You are seeing things.

00:01:34.440 | You are sensing things against your skin,

00:01:36.060 | but you are only paying attention to some of those.

00:01:38.960 | And the ones that you're paying attention to

00:01:42.020 | are your perceptions.

00:01:43.160 | So if you hear my voice, you are perceiving my voice.

00:01:46.220 | You are not paying attention to your other senses

00:01:49.020 | at the moment, okay?

00:01:50.640 | You might even be outside in a breeze.

00:01:52.420 | And until I said that,

00:01:53.580 | you might not be perceiving that breeze,

00:01:55.440 | but your body was sensing it all along.

00:01:57.400 | So attention and focus are more or less the same thing,

00:02:01.320 | but impulse control is something separate

00:02:04.140 | because impulse control requires pushing out

00:02:07.760 | or putting the blinders on to sensory events

00:02:11.180 | in our environment.

00:02:11.900 | It means lack of perception.

00:02:13.800 | Impulse control is about limiting our perception.

00:02:16.480 | People with ADHD have poor attention

00:02:19.680 | and they have high levels of impulsivity.

00:02:22.260 | Yes, they are distractible.

00:02:24.060 | Yes, they are impulsive.

00:02:26.520 | Yes, they are easily annoyed

00:02:28.560 | by things happening in the room.

00:02:30.340 | They sometimes have a high level of emotionality as well.

00:02:33.020 | However, people with ADHD can have a hyper focus,

00:02:37.300 | an incredible ability to focus on things

00:02:40.700 | that they really enjoy or are intrigued by.

00:02:44.120 | Now, this is a very important point

00:02:46.680 | because people with ADHD have the capacity to attend,

00:02:50.360 | but they can't engage that attention

00:02:53.160 | for things that they don't really, really want to do.

00:02:56.440 | There are a couple of other things

00:02:58.280 | that people with ADHD display quite often.

00:03:01.340 | One is challenges with time perception.

00:03:04.660 | People with ADHD often run late.

00:03:07.700 | They often procrastinate.

00:03:09.740 | But what's interesting and surprising

00:03:11.900 | is that if they are given a deadline,

00:03:13.740 | they actually can perceive time very well.

00:03:16.660 | And they often can focus very well

00:03:19.340 | if the consequences of not completing a task

00:03:22.540 | or not attending are severe enough.

00:03:24.520 | If they're not really concerned

00:03:26.440 | about a deadline or a consequence,

00:03:29.180 | well, then they tend to lose track of time

00:03:31.020 | and they tend to underestimate

00:03:32.760 | how long things will take.

00:03:34.360 | The other thing that people with ADHD

00:03:36.320 | have real trouble with is so-called working memory.

00:03:39.900 | Now, you might think that people with ADHD

00:03:41.680 | would have really poor memories,

00:03:43.200 | but in fact, that's not the case.

00:03:44.640 | People with ADHD often can have a terrific memory

00:03:48.200 | for past events.

00:03:49.280 | They can remember upcoming events quite well.

00:03:51.760 | Their memory is clearly working.

00:03:54.240 | However, one aspect of memory in particular

00:03:56.520 | that we call working memory is often disrupted.

00:03:59.400 | Working memory is the ability

00:04:01.440 | to keep specific information online,

00:04:04.200 | to recycle it in your brain over and over again

00:04:06.540 | so that you can use it in the immediate or short term.

00:04:09.500 | A good example of this would be you meet somebody,

00:04:12.160 | they tell you their name,

00:04:13.380 | they give you their phone number verbally,

00:04:15.220 | and you have to walk back to your phone

00:04:17.240 | and enter it into your phone.

00:04:18.360 | People without ADHD might have to put some effort into it.

00:04:22.820 | It might feel like a bit of a struggle,

00:04:24.060 | but typically they would be able to recite

00:04:25.740 | that phone number in their mind over and over

00:04:27.460 | and then put it into their phone.

00:04:29.140 | People with ADHD tend to lose the ability

00:04:32.000 | or lack the ability to remember things

00:04:35.000 | that they just need to keep online

00:04:36.660 | for anywhere from 10 seconds to a minute or two.

00:04:39.960 | Okay, so we've more or less established

00:04:41.660 | the kind of menu of items

00:04:43.540 | that people with ADHD tend to have.

00:04:45.540 | Some have all of them,

00:04:46.680 | some have just a subset of them.

00:04:48.400 | Their severity can range from very intense to mild,

00:04:53.160 | but in general,

00:04:54.560 | it's challenges with attention and focus,

00:04:57.220 | challenges with impulse control.

00:04:59.140 | They get annoyed easily.

00:05:00.660 | They have kind of an impulsivity.

00:05:02.180 | They can't stay on task.

00:05:03.520 | Time perception can be off.

00:05:06.020 | And they have a hard time with anything that's mundane

00:05:09.000 | that they're not really interested in.

00:05:11.080 | But again,

00:05:12.040 | I just want to highlight

00:05:12.880 | that people with ADHD are able

00:05:14.900 | to obtain heightened levels of focus,

00:05:16.940 | even hyper-focus for things that are exciting to them

00:05:20.000 | and that they really want to engage in.

00:05:21.900 | So let's drill into this issue

00:05:23.960 | of why people with ADHD

00:05:25.480 | actually can focus very intensely

00:05:27.700 | on things that they enjoy

00:05:29.260 | and are curious about.

00:05:30.640 | Now,

00:05:31.540 | enjoyment and curiosity,

00:05:33.440 | they're just the way

00:05:34.420 | that we describe our human experience

00:05:36.320 | of liking things,

00:05:37.500 | wanting to know more about them.

00:05:39.320 | But from a neurobiological perspective,

00:05:41.840 | they have a very clear identity and signature,

00:05:45.040 | and that's dopamine.

00:05:46.920 | Dopamine is released from neurons.

00:05:49.540 | It's what we call a neuromodulator.

00:05:51.260 | And in particular,

00:05:52.720 | dopamine creates a heightened state of focus.

00:05:56.720 | It tends to contract our visual world

00:05:59.540 | and it tends to make us pay attention

00:06:01.980 | to things that are outside

00:06:03.560 | and beyond the confines of our skin.

00:06:06.240 | It's what we call exteroception.

00:06:08.000 | So as I mentioned earlier,

00:06:09.680 | you have all these senses coming in

00:06:11.240 | and you can only perceive some of them

00:06:13.700 | because you're only paying attention

00:06:14.860 | to some of them.

00:06:15.780 | Dopamine,

00:06:17.400 | when it's released in our brain,

00:06:19.480 | tends to turn on areas of our brain

00:06:22.340 | that narrow our visual focus

00:06:24.520 | and our auditory focus.

00:06:26.180 | So it creates a cone of auditory attention

00:06:28.840 | that's very narrow.

00:06:29.640 | It creates a tunnel of visual attention

00:06:32.100 | that's very narrow.

00:06:32.960 | Whereas when we have less dopamine,

00:06:35.180 | we tend to view the entire world.

00:06:37.340 | We tend to see the whole scene that we are in.

00:06:39.480 | We tend to hear everything all at once.

00:06:41.400 | So as I describe this,

00:06:43.340 | hopefully you're already starting to see

00:06:46.220 | and understand how having dopamine release

00:06:49.340 | can allow a person,

00:06:51.840 | whether or not they have ADHD or not,

00:06:53.940 | to direct their attention to particular things

00:06:57.380 | in their environment.

00:06:58.120 | All right.

00:06:59.040 | So now what we're doing

00:07:00.320 | is we're moving away from attention

00:07:02.180 | as this kind of vague, ambiguous term,

00:07:04.780 | and we're giving it a neurochemical identity, dopamine,

00:07:07.840 | and we are giving it a neural circuit identity.

00:07:10.560 | And just to put a little bit of flavor and detail

00:07:14.320 | on which neural circuits those are,

00:07:16.060 | I want to discuss two general types of neural circuits

00:07:19.060 | that dopamine tends to enhance.

00:07:20.780 | The first one is called the default mode network.

00:07:24.120 | The default mode network

00:07:25.980 | is the network of brain areas

00:07:28.260 | in your brain, in my brain,

00:07:29.440 | and in everybody's brain

00:07:30.500 | that is active when we're not doing anything,

00:07:34.360 | when we're just sitting there idle at rest.

00:07:37.280 | The other set of circuits

00:07:38.700 | that we're going to think about

00:07:40.300 | and talk about with respect to ADHD

00:07:41.900 | are the task networks,

00:07:44.440 | the networks of the brain

00:07:46.220 | that make you goal-oriented.

00:07:48.020 | And those are a completely different set of brain areas.

00:07:51.020 | However, the default mode network

00:07:54.100 | and these task networks

00:07:56.220 | are communicating with one another,

00:07:58.340 | and they're doing that in very interesting ways.

00:08:00.460 | Frontal cortex, no surprises in the front,

00:08:03.460 | and you have a dorsal, the top,

00:08:05.440 | and side, lateral part,

00:08:06.800 | dorsolateral prefrontal cortex.

00:08:08.620 | And then you have a brain area

00:08:10.160 | called the posterior cingulate cortex.

00:08:11.940 | And then you have an area

00:08:13.380 | called the lateral parietal lobe.

00:08:14.860 | Again, you don't need to remember these names,

00:08:16.540 | but these are three brain areas

00:08:17.680 | that normally are synchronized in their activity.

00:08:20.800 | So when one of these areas is active

00:08:22.620 | in a typical person,

00:08:23.920 | the other areas would be active as well.

00:08:26.000 | And in a person with ADHD,

00:08:27.580 | or even a person who has subclinical ADHD,

00:08:30.800 | or in any human being who hasn't slept well,

00:08:34.600 | what you find is the default mode network

00:08:36.460 | is not synchronized.

00:08:37.480 | These brain areas are just not playing well together.

00:08:40.080 | Now, the task networks include

00:08:43.700 | a different set of structures.

00:08:45.920 | It still involves the prefrontal cortex,

00:08:47.940 | but it's a different part of the prefrontal cortex, okay?

00:08:51.320 | Tends to be the medial prefrontal cortex.

00:08:53.820 | And there are some other brain areas

00:08:55.780 | that the medial prefrontal cortex

00:08:57.100 | is communicating to all the time,

00:08:59.140 | mainly to suppress impulses.

00:09:01.660 | Anytime you're restricting your behavior,

00:09:03.380 | these task-directed networks are very active, okay?

00:09:07.120 | Now, normally in a person without ADHD,

00:09:10.780 | the task networks and the default mode networks

00:09:15.300 | are going in kind of seesaw fashion.

00:09:17.580 | They are actually what we call anti-correlated.

00:09:20.260 | In a person with ADHD,

00:09:21.900 | they actually tend to be more correlated.

00:09:24.520 | The default mode networks

00:09:26.180 | and the task networks are actually more coordinated.

00:09:29.080 | And we can now confidently say,

00:09:31.720 | based on brain imaging studies,

00:09:33.000 | that when somebody gets better

00:09:34.900 | when they're treated for ADHD

00:09:36.520 | or when they age out of ADHD,

00:09:38.640 | as sometimes is the case,

00:09:40.180 | that the default mode networks

00:09:42.900 | and the task networks

00:09:44.060 | tend to become anti-correlated again.

00:09:46.100 | What dopamine is doing in this context

00:09:48.300 | is dopamine is acting like a conductor.

00:09:51.040 | Dopamine is saying this circuit should be active,

00:09:53.900 | then that circuit should be active.

00:09:55.060 | It should be default mode network.

00:09:56.520 | And then when the default mode network is not active,

00:09:58.680 | then it should be the task network.

00:10:00.360 | And in ADHD,

00:10:01.400 | there's something about the dopamine system

00:10:03.400 | that is not allowing it to conduct these networks

00:10:07.680 | and make sure that they stay,

00:10:09.220 | what the engineers or physicists or mathematicians

00:10:12.300 | would say out of phase,

00:10:13.460 | to be anti-correlated.

00:10:15.620 | So what exactly is going on

00:10:17.000 | with the dopamine system in people with ADHD?

00:10:19.140 | And what's going on with the dopamine system

00:10:21.660 | in people that have terrific levels of attention

00:10:24.400 | for any task?

00:10:25.520 | Well, in the year 2015,

00:10:28.600 | an important paper came out

00:10:30.340 | and it formalized the so-called

00:10:32.480 | low dopamine hypothesis of ADHD.

00:10:35.220 | It turns out that if dopamine levels are too low

00:10:39.420 | in particular circuits in the brain,

00:10:41.560 | that it leads to unnecessary firing

00:10:44.640 | of neurons in the brain

00:10:46.420 | that are unrelated to the task

00:10:48.900 | that one is trying to do

00:10:50.160 | and that is unrelated to the information

00:10:53.000 | that one is trying to focus on.

00:10:54.600 | So if you think back before,

00:10:56.200 | you've got this default mode network

00:10:57.980 | and a task-related network

00:10:59.280 | and they need to be in this kind of concert

00:11:01.900 | of anti-correlation and in ADHD,

00:11:03.980 | they're firing together.

00:11:05.120 | Well, the problem seems to be

00:11:07.500 | that when dopamine is low,

00:11:09.060 | neurons fire more than they should

00:11:11.880 | in these networks that govern attention.

00:11:13.560 | This is the so-called low dopamine hypothesis.

00:11:17.220 | And if you start looking anecdotally

00:11:20.840 | at what people with ADHD have done for decades,

00:11:24.800 | what you find is that

00:11:26.820 | they tend to use recreational drugs

00:11:30.000 | or they tend to indulge in non-drug stimulants.

00:11:36.180 | So things like smoking a half a pack of cigarettes

00:11:39.280 | and drinking four cups of coffee a day.

00:11:41.340 | Or if the person had access to it,

00:11:43.820 | using cocaine as a recreational drug

00:11:46.440 | or amphetamine as a recreational drug.

00:11:48.520 | All of those substances that I just described,

00:11:51.400 | in particular cocaine and amphetamine,

00:11:54.000 | but also coffee and cigarettes,

00:11:56.200 | increased levels of multiple neurotransmitters,

00:11:59.560 | but all have the quality

00:12:01.580 | of increasing levels of dopamine in the brain

00:12:03.880 | and in particular in the regions of the brain

00:12:06.540 | that regulate attention

00:12:07.940 | and these task-related and default mode networks.

00:12:10.960 | Now, young children fortunately don't have access

00:12:13.400 | to those kinds of stimulants most of the time,

00:12:16.120 | but if you look at children,

00:12:18.640 | even very young children with ADHD,

00:12:20.980 | they show things like preference for sugary foods,

00:12:24.620 | which also act as dopamine-inducing stimulants.

00:12:28.360 | For a long time,

00:12:29.440 | it was thought that children with ADHD

00:12:30.840 | consumed too many sugary foods

00:12:32.660 | or drank too much soda,

00:12:33.820 | or adults with ADHD would take recreational drugs

00:12:38.440 | like methamphetamine or cocaine,

00:12:40.020 | or would drink coffee to excess

00:12:42.640 | or smoke cigarettes to excess

00:12:44.140 | because they had poor levels of attention

00:12:46.680 | and because they couldn't make good decisions.

00:12:49.700 | They were too impulsive and so forth.

00:12:51.660 | Knowing what we now know about dopamine

00:12:53.900 | and the fact that having enough dopamine

00:12:56.680 | is required in order to coordinate these neural circuits

00:12:59.840 | that allow for focus and quality decision-making,

00:13:02.700 | an equally valid idea is that these children

00:13:07.100 | and these adults are actually trying to self-medicate

00:13:10.100 | by pursuing these compounds, right?

00:13:12.420 | Things like cocaine lead to huge increases in dopamine.

00:13:15.420 | Well, what happens when somebody with ADHD takes that drug?

00:13:19.020 | It turns out they actually obtain heightened levels of focus.

00:13:23.040 | Their ability to focus on things other than things

00:13:25.740 | they absolutely care intensely about goes up.

00:13:29.460 | Likewise, children who consume anything

00:13:32.740 | that increases their levels of dopamine,

00:13:34.620 | if those children have ADHD,

00:13:37.000 | they tend to be calmer.

00:13:39.820 | They tend to be able to focus more.

00:13:41.900 | So dopamine and low levels of dopamine

00:13:45.620 | apparently are what's wrong in people with ADHD.

00:13:48.820 | That dopamine hypothesis is what led to the idea

00:13:52.700 | that treating people, children and adults included,

00:13:55.820 | with dopaminergic compounds

00:13:58.660 | would somehow increase their ability to focus.

00:14:02.100 | And if you look at the major drugs that were developed

00:14:05.740 | and now marketed by pharmaceutical companies

00:14:08.320 | for the treatment of ADHD,

00:14:10.000 | those drugs have names like Ritalin.

00:14:13.820 | Nowadays, it's typically things like Adderall,

00:14:17.220 | Modafinil, and some of the other derivatives.

00:14:20.660 | They all serve to increase levels of dopamine,

00:14:23.800 | in particular dopamine in the networks

00:14:25.900 | that control task-directed behavior

00:14:28.180 | and that coordinate the default mode network

00:14:30.800 | and these task-related networks.

00:14:33.040 | Let's take a step back for a second

00:14:34.920 | and just ask, what are these drugs?

00:14:36.840 | We know they increase dopamine,

00:14:38.120 | but what are they really?

00:14:40.160 | Well, Ritalin, also called methylphenidate,

00:14:44.680 | is very similar to amphetamine, speed,

00:14:48.840 | or what's typically called speed

00:14:50.440 | in the street drug nomenclature.

00:14:53.260 | Adderall is basically a combination

00:14:55.680 | of amphetamine and dextroamphetamine.

00:14:58.340 | Now, some of you probably realize this,

00:15:01.300 | that Adderall is amphetamine,

00:15:02.940 | but I'm guessing that there are a good number of you out there,

00:15:05.660 | perhaps even parents and kids that don't realize

00:15:08.080 | that these drugs like cocaine and amphetamine,

00:15:10.880 | methamphetamine, which are incredibly dangerous

00:15:14.240 | and incredibly habit-forming and have high potential for abuse.

00:15:19.100 | Well, the pharmaceutical versions of those

00:15:22.240 | are exactly what are used to treat ADHD.

00:15:25.400 | Now, they're not exactly like cocaine or methamphetamine,

00:15:27.980 | but they are structurally and chemically very similar,

00:15:30.660 | and their net effect in the brain and body

00:15:33.680 | is essentially the same,

00:15:35.040 | which is to increase dopamine primarily,

00:15:37.620 | but also to increase levels of a neuromodulator

00:15:40.140 | called epinephrine or norepinephrine,

00:15:42.360 | also called noradrenaline and adrenaline.

00:15:44.280 | Those names are the same.

00:15:45.160 | So what I'm essentially saying

00:15:46.400 | is that the drugs that are used to treat ADHD are stimulants,

00:15:50.080 | and they look very much like,

00:15:51.820 | in fact, nearly identical

00:15:53.720 | to some of the so-called street drug stimulants

00:15:56.260 | that we all hear are so terrible.

00:15:58.340 | However, I do want to emphasize

00:16:00.680 | that at the appropriate dosages

00:16:03.140 | and working with a quality psychiatrist

00:16:06.640 | or neurologist or family physician,

00:16:09.180 | it does have to be a board-certified MD

00:16:11.040 | that prescribes these things,

00:16:12.180 | many people with ADHD achieve excellent relief

00:16:17.100 | with these drugs.

00:16:17.800 | Not all of them, but many of them do,

00:16:19.560 | especially if these treatments are started early in life.

00:16:22.880 | So now knowing what these drugs are,

00:16:24.980 | I want to raise the question of why prescribe these drugs?

00:16:28.440 | Children have a brain that's very plastic,

00:16:30.960 | meaning it can remodel itself

00:16:33.680 | and change in response to experience

00:16:35.160 | very, very quickly compared to adults.

00:16:37.500 | Taking stimulants as a child,

00:16:40.520 | if you are a child diagnosed with ADHD,

00:16:42.940 | allows that forebrain task-related network

00:16:46.860 | to come online, to be active at the appropriate times.

00:16:50.460 | And because those children are young,

00:16:53.500 | it allows those children to learn what focus is

00:16:56.560 | and to sort of follow or enter that tunnel of focus.

00:17:00.100 | Now, by taking a drug,

00:17:02.080 | it's creating focus artificially.

00:17:04.260 | It's not creating focus

00:17:05.880 | because they're super interested in something.

00:17:07.680 | It's chemically inducing a state of focus.

00:17:10.480 | And let's face it,

00:17:12.540 | a lot of childhood and school

00:17:14.100 | and becoming a functional adult

00:17:15.440 | is about learning how to focus

00:17:16.620 | even though you don't want to do something.

00:17:18.160 | So what are we to make of this whole picture

00:17:19.920 | that we need more dopamine,

00:17:21.460 | but these kids with ADHD,

00:17:22.940 | they're getting their dopamine by way of a drug,

00:17:26.000 | which is for all the world, amphetamines.

00:17:28.520 | What are the long-term consequences?

00:17:30.200 | What are the short-term consequences?

00:17:31.540 | Well, in order to get to some of those answers,

00:17:34.120 | I went to one of my colleagues,

00:17:36.320 | a pediatric neurologist that specializes

00:17:38.920 | in the treatment of epilepsy and ADHD

00:17:41.520 | in kids of all ages from age three to 21.

00:17:45.320 | I asked the following questions.

00:17:47.200 | First of all, I asked,

00:17:48.240 | what do you think about giving young kids amphetamine?

00:17:51.000 | Provided that the lowest possible dose is used

00:17:55.080 | and that that dosage is modulated as they grow older

00:17:58.820 | and develop those powers of attention,

00:18:00.760 | their observation was that they've seen more kids benefit

00:18:05.320 | than not benefit from that.

00:18:08.800 | Now, the fact that this person,

00:18:10.500 | this now friend of mine and colleague of mine

00:18:12.620 | has so much expertise in the way that the brain works

00:18:16.020 | and is considering putting their child on such medication,

00:18:20.140 | I said, you know,

00:18:22.280 | why wouldn't you wait until your kid reaches puberty?

00:18:25.560 | I mean, we know that in boys and in girls,

00:18:28.840 | there are increases in testosterone and estrogen

00:18:30.700 | during puberty that dramatically change

00:18:33.600 | the way that the body appears,

00:18:35.280 | but also that dramatically change the way

00:18:37.400 | the way that the brain functions.

00:18:38.320 | In particular, we know this,

00:18:40.500 | that puberty triggers the activation

00:18:43.360 | of so-called frontotemporal task-related

00:18:47.020 | executive functioning.

00:18:48.120 | That's just fancy science speak for being able to focus,

00:18:51.360 | being able to direct your attention,

00:18:52.700 | being able to control your impulses.

00:18:54.360 | And their answer was very specific

00:18:56.920 | and I think very important.

00:18:57.900 | What they said was,

00:18:59.340 | look, neuroplasticity is greatest in childhood

00:19:03.480 | and tapers off after about age 25,

00:19:05.920 | but neuroplasticity from age three

00:19:09.240 | until age 12 or 13 is exceedingly high.

00:19:13.900 | If you have the opportunity to work with a quality physician

00:19:17.160 | and treat these things early,

00:19:18.620 | these drugs can allow these frontal circuits,

00:19:22.140 | these task-related circuits,

00:19:23.260 | to achieve their appropriate levels of functioning

00:19:26.860 | and for kids to learn how to focus

00:19:28.820 | in a variety of different contexts.

00:19:30.760 | So we've talked about the neural circuits of focus

00:19:33.060 | and the chemistry of focus,

00:19:34.740 | but we haven't talked yet about

00:19:37.300 | what would make us better at focusing

00:19:39.800 | and what focusing better really is.

00:19:41.740 | So let's take a step back

00:19:42.900 | and think about how we focus

00:19:45.820 | and how to get better at focus.

00:19:47.420 | And I'm going to share with you a tool

00:19:49.500 | for which there are terrific research data

00:19:52.380 | that will allow you in a single session

00:19:55.200 | to enhance your ability to focus

00:19:57.220 | in theory forever.

00:19:59.600 | What we're about to talk about

00:20:02.320 | is when attention works

00:20:04.580 | and when attention falters.

00:20:06.780 | And what we are specifically going to talk about

00:20:09.140 | are what are called attentional blinks.

00:20:11.640 | It's not actual eye blinks.

00:20:13.280 | Attentional blinks are really easy to understand

00:20:15.280 | if you think about a where's Waldo task.

00:20:17.120 | You know this task, where's Waldo,

00:20:18.720 | where there are a bunch of people

00:20:20.780 | and objects and things in a picture

00:20:22.440 | and somewhere in there is Waldo

00:20:24.020 | with the striped hat and the glasses

00:20:25.640 | and kind of a skinny dude

00:20:27.000 | and you have to find Waldo.

00:20:28.620 | And so it's a visual search

00:20:30.100 | and it's visual search for an object

00:20:32.520 | that has distinct features

00:20:33.700 | but is embedded in this ocean

00:20:35.220 | of other things

00:20:37.080 | that could easily be confused as Waldo.

00:20:39.140 | So you tend to look, look, look, look, look, look, look, look.

00:20:41.080 | When you find Waldo

00:20:42.720 | or when you search for a target

00:20:44.720 | in some other visual search task,

00:20:46.980 | at that moment,

00:20:48.000 | your nervous system celebrates a little bit

00:20:50.720 | and it celebrates through the release of neurochemicals

00:20:53.680 | that make you feel good.

00:20:54.620 | You found it and you pause.

00:20:56.280 | Now the pause is interesting

00:20:58.720 | because when you pause,

00:21:00.640 | what we know from many experiments

00:21:03.300 | is that in that moment of pause

00:21:05.680 | and mild celebration,

00:21:07.060 | however mild,

00:21:08.740 | you are not able to see another Waldo

00:21:13.280 | sitting right next to it.

00:21:14.620 | So what this means is

00:21:16.520 | in attending to something,

00:21:18.220 | in searching,

00:21:19.140 | and in identifying a visual target,

00:21:22.440 | your attention blinked.

00:21:24.380 | It shut off for a second.

00:21:25.840 | If you see something that you're looking for

00:21:28.940 | or you're very interested in something,

00:21:30.580 | you are definitely missing other information

00:21:33.240 | in part because you're over-focusing on something.

00:21:37.480 | And this leads to a very interesting hypothesis

00:21:40.000 | about what might go wrong in ADHD

00:21:42.500 | where we've always thought that they cannot focus,

00:21:46.360 | and yet we know they can focus on things

00:21:48.220 | they care very much about.

00:21:50.340 | Well, maybe, just maybe,

00:21:52.360 | they are experiencing more attentional blinks

00:21:55.520 | than people who do not have ADHD.

00:21:57.820 | And indeed, there are data now

00:22:00.480 | to support the possibility

00:22:01.920 | that that's actually what's happening.

00:22:03.620 | So what they really need

00:22:05.620 | is this property that we call open monitoring.

00:22:09.140 | First of all,

00:22:10.120 | your visual system has two modes of processing.

00:22:15.780 | It can be highly focused,

00:22:17.540 | a soda straw view.

00:22:18.680 | However, there's also a property of your visual system

00:22:21.580 | that allows you to dilate your gaze

00:22:23.300 | to be in so-called panoramic vision.

00:22:24.840 | Panoramic vision is actually mediated

00:22:27.320 | by a separate stream or set of neural circuits

00:22:30.540 | going from the eye into the brain.

00:22:32.180 | And it's a stream or set of circuits

00:22:34.340 | that isn't just wide angle view.

00:22:36.620 | It also is better at processing things in time.

00:22:40.060 | Its frame rate is higher.

00:22:41.840 | You can use panoramic vision

00:22:44.000 | to access the state that we call open monitoring.

00:22:46.480 | So when people do that, they are able to attend to

00:22:50.860 | and recognize multiple targets.

00:22:54.060 | So this is something that can be trained up

00:22:56.540 | and people can practice,

00:22:57.480 | whether or not they have ADHD or not.

00:23:00.020 | What it involves is learning

00:23:01.440 | how to dilate your gaze consciously.

00:23:02.880 | That's actually quite easy for most people.

00:23:04.800 | You can consciously go into open gaze,

00:23:06.660 | and then you can contract your field of view as well.

00:23:09.880 | That might not seem like a significant or unusual practice

00:23:13.300 | or that it would have any impact at all.

00:23:15.580 | But remarkably, just doing that once for 17 minutes,

00:23:20.580 | significantly reduced the number of attentional blinks

00:23:24.820 | that people would carry out.

00:23:26.240 | In other words, their focus got better in a near permanent way,

00:23:29.780 | without any additional training.

00:23:32.280 | Now let's talk about actual blinks,

00:23:34.360 | the sort that you do with your eyelids.

00:23:36.320 | Believe it or not,

00:23:37.740 | your perception of time is also changed on a rapid basis,

00:23:41.960 | moment to moment basis, by how often you blink.

00:23:45.900 | I want to just emphasize one study in particular,

00:23:48.160 | which is quite appropriately titled,

00:23:51.120 | time dilates after spontaneous blinking.

00:23:53.780 | They examined the relationship between fluctuations

00:23:57.360 | in timing and blinking.

00:24:00.220 | And to make a long story short,

00:24:02.420 | what they found is that right after blinks,

00:24:06.160 | we reset our perception of time.

00:24:08.400 | Now what's interesting,

00:24:10.000 | and will immediately make sense to you

00:24:11.980 | as to why this is important,

00:24:14.520 | is that the rate of blinking is controlled by dopamine.

00:24:20.120 | So what this means is that dopamine is controlling attention,

00:24:23.300 | blinks relate to attention and focus,

00:24:26.060 | and therefore the dopamine and blinking system

00:24:28.700 | is one way that you constantly modulate

00:24:32.480 | and update your perception of time.

00:24:35.600 | And fortunately, it's also one that you can control.

00:24:38.840 | So the basic takeaway of this study

00:24:40.900 | was that blinking controls time perception,

00:24:42.980 | but also that levels of dopamine can alter your sense of time

00:24:47.740 | and, stay with me here,

00:24:50.080 | and that blinking and dopamine are inextricably linked.

00:24:54.700 | They are working together to control your attention.

00:24:57.900 | Let's remember back to the very beginning of the episode,

00:25:00.680 | what's going on in people with ADHD.

00:25:02.820 | They are not good at managing their time.

00:25:06.080 | They tend to run late or they are disorganized.

00:25:08.480 | Their dopamine is low.

00:25:10.180 | We know that as well.

00:25:11.680 | And so they are underestimating time intervals.

00:25:14.500 | And so it makes perfect sense that they would be late.

00:25:17.020 | It makes perfect sense that they would lose track of time

00:25:19.360 | or the ability to focus.

00:25:21.280 | This is really exciting,

00:25:22.400 | because what it means is that children with ADHD,

00:25:25.700 | adults with ADHD,

00:25:26.980 | or people with normal levels of focus

00:25:28.800 | that want to improve their ability to focus,

00:25:31.560 | can do so through a training that involves learning,

00:25:35.680 | how often to blink and when,

00:25:37.920 | and how to keep their visual focus on a given target.

00:25:41.480 | And it turns out this study has actually been done,

00:25:43.900 | entitled Improvement of Attention in Elementary School Students

00:25:47.680 | Through Fixation-Focused Training Activity.

00:25:50.380 | And I won't go through all the details,

00:25:51.840 | but what they found was a short period of focusing

00:25:56.520 | on a visual target allowed these school children

00:26:00.260 | to greatly enhance their ability

00:26:02.300 | to focus on other types of information.

00:26:05.280 | And a significant component of the effect was due to the way

00:26:08.220 | that they were controlling the shutters on their eyes,

00:26:10.680 | their eyelids, and controlling their blinks.

00:26:13.360 | So what they did in the study is they had these kids

00:26:15.860 | focus their visual attention on some object

00:26:18.440 | that was relatively close,

00:26:19.660 | like their hand, for a minute or so,

00:26:22.300 | which actually takes some effort if you try and do that.

00:26:24.520 | They were allowed to blink.

00:26:26.360 | It only took a few minutes each day to do this,

00:26:29.020 | 30 seconds in one condition or maybe a minute,

00:26:31.460 | and then at another station of looking a little bit further out

00:26:34.260 | and a little bit further out.

00:26:35.520 | However, there was an important feature of this study

00:26:38.160 | that is definitely worth mentioning,

00:26:40.340 | which is before they did this visual focus task or training,

00:26:45.340 | they did a series of physical movements with the kids

00:26:49.160 | so that the kids could sort of eliminate or move out

00:26:52.280 | some of their desire to move

00:26:54.380 | and would thereby enhance their ability to sit still.

00:26:58.400 | Now it should make perfect sense

00:26:59.800 | that these shutters on the front of your eyes,

00:27:01.540 | they aren't just there for winking

00:27:03.380 | and they aren't just there for cosmetic purposes.

00:27:06.000 | They are there to regulate the amount of information

00:27:09.360 | going into your nervous system,

00:27:10.740 | and they're there to regulate how long

00:27:14.180 | you are bringing information into your nervous system,

00:27:17.020 | and in what bins, how widely or finely you are binning time,

00:27:22.100 | is set by how often you blink,

00:27:24.000 | and how widely or specifically you are grabbing attention

00:27:28.800 | from the visual world is set by whether or not

00:27:30.380 | you're viewing things very specifically,

00:27:31.960 | like a crosshair or through a soda straw view like this,

00:27:34.840 | or whether or not you are in this panoramic,

00:27:37.080 | sort of whole environment mode,

00:27:40.220 | this kind of fisheye lens or wide angle lens mode.

00:27:43.620 | So now I want to switch back to talking about some of the drugs

00:27:46.920 | that are typically used to access those systems,

00:27:49.500 | prescription drugs,

00:27:50.400 | and I want to talk about some of the new and emerging

00:27:52.660 | non-prescription approaches to increasing the levels of dopamine,

00:27:56.580 | acetylcholine and serotonin in the brain using various supplement type compounds,

00:28:00.840 | because several of them are showing really remarkable efficacy in excellent peer reviewed studies.

00:28:06.960 | So before moving to some of the newer atypical compounds and things sold over-the-counter,

00:28:12.260 | I'd like to just briefly return to the classic drugs that are used to treat ADHD.

00:28:19.980 | These are the ones I mentioned earlier.

00:28:22.020 | Methylphenidate, also called Ritalin.

00:28:25.100 | Modafinil.

00:28:26.800 | R-modafinil is another one.

00:28:29.040 | And Adderall.

00:28:30.880 | Again, all of these work by increasing levels of dopamine and norepinephrine.

00:28:35.520 | I think it is important to understand the extent to which they all carry

00:28:39.440 | more or less the same side effect, such as high propensity for addiction and abuse,

00:28:44.240 | amphetamines of any kind, as well as cocaine can cause sexual side effects

00:28:49.680 | because they're vasoconstrictors.

00:28:51.280 | So these drugs are not without their consequences.

00:28:53.760 | In addition, they almost all carry cardiac effects, right?

00:28:57.760 | They increase heart rate, but they also have effects on constriction of blood vessels

00:29:02.800 | and arteries and veins and so forth in ways that can create cardiovascular problems.

00:29:07.600 | The best use of things like Adderall, Modafinil, R-modafinil, and Ritalin is going to be to combine

00:29:16.160 | those treatments with behavioral exercises that actively engage the very circuits that you're

00:29:21.760 | trying to train up and enhance.

00:29:23.680 | And then perhaps, I want to highlight perhaps tapering off those drugs so that then one can

00:29:28.800 | use those circuits without any need for chemical intervention.

00:29:32.400 | So despite any controversy that might be out there, I think it's fair to say that

00:29:37.040 | the consumption of omega-3 fatty acids can positively modulate the systems for attention and focus.

00:29:43.760 | So then the question becomes how much EPA, how much DHA, does that differ for what's helpful for

00:29:52.240 | depression, et cetera?

00:29:53.840 | And actually it does differ.

00:29:55.120 | In reviewing the studies for this, it appears that a threshold level of 300 milligrams of DHA

00:30:02.320 | turns out to be an important inflection point.

00:30:05.200 | So typically fish oils or other sources of omega-3s

00:30:08.880 | will have DHA and EPA.

00:30:11.920 | And typically it's the EPA that's harder to get at sufficient levels, meaning you have to

00:30:16.880 | take quite a lot of fish oil in order to get above that 1,000 milligram or 2,000 milligram

00:30:21.600 | threshold to improve mood and other functions.

00:30:24.640 | But for sake of attention, there are 10 studies that have explored this in detail.

00:30:30.480 | And while the EPA component is important, the most convincing studies point to the fact that getting

00:30:36.240 | above 300 milligrams per day of DHA is really where you start to see the attentional effects.

00:30:42.240 | Now, fortunately, if you're getting sufficient EPA for sake of mood and other biological functions,

00:30:47.200 | almost without question, you're getting 300 milligrams or more of DHA.

00:30:53.120 | What's interesting is that there's another compound, phosphatidyl sterine,

00:30:56.800 | that has been explored for its capacity to improve the symptoms of ADHD.

00:31:02.480 | Phosphatidyl sterine taken for two months for 200 milligrams per day was able to reduce the

00:31:10.240 | symptoms of ADHD in children.

00:31:12.000 | It has not been looked at in adults yet, at least as far as I know,

00:31:16.880 | but that this effect was greatly enhanced by the consumption of omega-3 fatty acids.

00:31:22.560 | So now we're starting to see synergistic effects of omega-3 fatty acids and phosphatidyl sterine.

00:31:28.560 | So I'd like to talk about the drug modafinil and the closely related drug R-modafinil.

00:31:33.520 | That's A-R-modafinil because modafinil and R-modafinil are gaining popularity out there,

00:31:39.920 | both for treatment of ADHD and narcolepsy, but also for communities of people that are trying to stay awake long periods of time.

00:31:48.480 | So it's actively used in the military by first responders.

00:31:52.640 | It's gaining popularity on college campuses and people are using it more and more as an alternative

00:31:58.080 | to Adderall and Ritalin and excessive amounts of coffee.

00:32:03.280 | It does increase focus and to a dramatic extent.

00:32:06.480 | I want to emphasize that unlike Ritalin and Adderall, modafinil and R-modafinil are weak dopamine reuptake

00:32:14.640 | inhibitors and that's how they lead to increases in dopamine.

00:32:18.000 | Now you may notice that I haven't talked much about acetylcholine.

00:32:21.680 | Acetylcholine is a neurotransmitter that at the neuron to muscle connections, the so-called neuromuscular

00:32:27.120 | junctions is involved in generating muscular contractions of all kinds for all movements.

00:32:31.520 | Acetylcholine is also released from two sites in the brain.

00:32:36.080 | There is a collection of neurons in your brainstem that send projections forward,

00:32:39.920 | kind of like a sprinkler system that's very diffuse to release acetylcholine.

00:32:44.960 | And those neurons reside in an area or a structure that's called the pedunculopontine nucleus, the PPN.

00:32:51.920 | And then there's a separate collection of neurons in the basal forebrain called unimaginatively

00:32:57.840 | nucleus basalis, the nucleus at the base.

00:33:00.080 | And they also hose the brain with acetylcholine, but in a much more

00:33:05.680 | specific way.

00:33:06.720 | So one is sort of like a sprinkler system and the other one is more like a fire hose to a particular

00:33:10.880 | location.

00:33:11.360 | And those two sources of acetylcholine collaborate to activate particular locations in the brain and

00:33:18.880 | really bring about a tremendous degree of focus to whatever is happening at those particular

00:33:23.760 | synapses.

00:33:24.560 | So now you have an example and you have an understanding and hopefully a picture in your

00:33:27.600 | mind of how all this is working.

00:33:29.120 | Not surprisingly, then drugs that increase cholinergic or acetylcholine transmission

00:33:34.960 | will increase focus and cognition.

00:33:37.840 | One such compound is so-called alpha GPC, which is a form of choline and increases acetylcholine

00:33:45.280 | transmission.

00:33:46.320 | Dosages as high as 1200 milligrams per day, which is a very high dosage spread out.

00:33:51.840 | Typically it's 300 or 400 milligrams spread out throughout the day have been shown to offset

00:33:58.480 | some of the effects of age-related cognitive decline, improve cognitive functioning.

00:34:02.800 | People that don't have age-related cognitive decline, typically when people are using

00:34:06.560 | alpha GPC to study or to enhance learning of any kind, they will take somewhere

00:34:11.520 | between 300 and 600 milligrams.

00:34:13.920 | That's more typical.

00:34:14.960 | Again, you have to check with your doctor.

00:34:17.520 | You have to decide if the safety margins are appropriate for you.

00:34:20.480 | And there are some over-the-counter compounds that are in active use out there for treatment

00:34:26.560 | of ADHD and in use for simply trying to improve focus.

00:34:31.360 | L-tyrosine, it's an amino acid that acts as a precursor to the neuromodulator dopamine.

00:34:36.640 | The dosaging can be very tricky to dial in.

00:34:40.480 | Sometimes it makes people feel too euphoric or too jittery or too alert that they are then

00:34:45.920 | unable to focus well.

00:34:47.120 | So the dosage ranges are huge.

00:34:50.640 | You see evidence for a hundred milligrams all the way up to 1200 milligrams.

00:34:55.200 | It's something that really should be approached with caution, especially for people that have any

00:34:58.960 | kind of underlying psychiatric or mood disorder, because dysregulation of the dopamine system is

00:35:05.920 | central to many of the mood disorders such as depression, but also especially mania,

00:35:11.360 | mania bipolar disorder, schizophrenia, things of that sort.

00:35:14.880 | So it's something that really should be approached with caution.

00:35:17.920 | Everybody nowadays seems to have a smartphone.

00:35:20.240 | They grab our attention entirely, but within that small box of attention,

00:35:24.720 | there are millions of attentional windows scrolling by, right?

00:35:29.760 | So just because it's one device that we look at does not mean that we are focused.

00:35:33.360 | We are focused on our phone, but because of the way in which context switches up so fast within the phone,

00:35:40.480 | it's thought that the brain is struggling now to leave that rapid turnover of context.

00:35:45.840 | Even though there are trillions, infinite number of bits of information in the actual physical world,

00:35:51.360 | your attentional window, that aperture of constriction and dilating that visual window is the way in which

00:35:58.320 | you cope with all that overwhelming information typically.

00:36:01.840 | Well, within the phone, your visual aperture is set to a given width and within there,

00:36:08.960 | your attentional window is grabbing a near infinite number of bits of information, colors, movies.

00:36:15.200 | And so the question is, does that sort of interaction on a regular basis lead to deficits

00:36:21.280 | in the types of attention that we need in order to perform well in work and school relationships,

00:36:25.600 | et cetera? And the short answer is yes, we are inducing a sort of ADHD.

00:36:31.360 | I'm not here to tell you what to do, but I think whether or not you have ADHD or not,

00:36:36.000 | if you're an adolescent, limiting your smartphone use to 60 minutes per day or less,

00:36:41.840 | and if you are an adult to two hours per day or less is going to be among the very best ways to

00:36:49.840 | maintain your ability to focus at whatever level you can now. And as I always say,

00:36:55.760 | most of the things that we get recognized for in life, success in life, in every endeavor, whether

00:37:01.440 | or not it's school, relationships, sport, creative works of any kind are always proportional to the

00:37:08.400 | amount of focus that we can bring that activity. It is important to rest, of course, to get proper

00:37:13.200 | sleep, but I stand behind that statement. And I leave you with that about attention and cell phones and how

00:37:19.440 | cell phones are indeed eroding our attentional capacities. So I realized I covered a lot of

00:37:24.400 | information about ADHD and the biology of focus and how to get better at focusing. We talked about the

00:37:31.360 | behavioral and psychological phenotypes of ADHD. We talked about the underlying neural circuitry.

00:37:38.000 | We also talked about the neurochemistry and we talked about the various prescription drug treatments

00:37:43.280 | that are aimed at that neurochemistry and aimed at increasing focus in children and adults with ADHD.

00:37:49.280 | Music.

00:37:51.280 | you

00:37:51.780 | you

ADHD & How Anyone Can Improve Their Focus | Huberman Lab Essentials

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