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The Core Issue in ADHD

If a person has ADHD, he or she may lament their “inability” to focus. Focus is the ability to place your brain’s processing on a desired topic, thought, or activity. The attention of some with ADHD may bounce around like a butterfly to various internal thoughts or emotions or any external people or objects. This makes sense to be called ADHD. However, the person with ADHD may be fixated (ruminating) on internal thoughts, desires or external distractions exclusively, at the expense of other important activities. This might be termed something like “attention excess,” or “attention prioritization deficit” yet still be under the ADHD umbrella. There are many different forms of ADHD, but the core problem can be conceptualized the same for all cases of ADHD.

Read the previous article in this series about the definitions of ADHD and ADD.

The core problem in ADHD is insufficient attentional strength compared to attentional load. Therefore, addressing ADHD involves improving an individual’s attentional strength while minimizing attentional load. ADHD treatment is fastest and most effective with an individualized approach. But before we get to treatments for ADHD (which I’ll discuss in separate articles), let’s define and discuss attentional strength and attentional load so you can start to understand your needs.

Attentional Strength

If attention is defined as the focus of a person’s mental processing, then attentional strength is the conscious mind’s energetic ability to focus on a desired topic.

Attentional strength is determined by the function of a part of the brain called the prefrontal cortex. The prefrontal cortex is the brain’s “attention control center.” The prefrontal cortex is wired to connect with many different parts of the brain and either activate them or suppress them. It acts much like an orchestra conductor, telling which parts to be active and when. When the prefrontal cortex (or conductor) is strong, it is able to communicate with all parts of the brain (or orchestra) in a compelling and controlling manner. The result is harmonious attention, thoughts, and behavior (or music). When the prefrontal cortex doesn’t function optimally, other parts of the brain become too active, resulting in ADHD, overstimulation, anxiety, distraction, etc. Too little attention may be paid to the thoughts or tasks the person wants to focus on (attention deficit), and too much attention may be paid to other distracting thoughts or tasks (attention excess).

Sometimes, despite a relatively strong prefrontal cortex, the other brain parts (or the orchestra players) are anxious, fearful, or overactive beyond the capability of the prefrontal cortex’s (conductor’s) ability to control them. An unruly brain (or orchestra) increases attentional load regardless of how strong the conductor is, which I’ll get to later in this article.

Just as an orchestra conductor is actually doing much more than just waving a wand at the orchestra, the prefrontal cortex has many, many different functions. Some people have overall weak prefrontal cortex activity, while others have strong activity for some prefrontal functions, yet weak activity in other prefrontal functions, hence one reason for the many different varieties of ADHD.

Improving Attentional Strength

The great news is that the prefrontal cortex can be healed and strengthened. When it is healed and strengthened, attentional strength is improved and the negative effects of ADHD are overcome. Attentional strength is determined primarily by two things: 1) the number and wiring pattern of the dopaminergic neurons emanating from the prefrontal cortex and 2) catecholamine levels and signaling rate in the brain. Therefore, a healing program for ADHD involves changing the brain’s wiring patterns while supporting healthy catecholamine levels naturally.

Treatment approaches will be discussed in other articles, but first let’s understand the other side of the attention deficit equation: attentional load. ADHD isn’t just a problem of reduced attentional strength. Attentional load is the other side of the ADHD coin.

Attentional Load

Attentional load is the amount of internal or external distractors vying for a person’s attention. This can be any internal thoughts, feelings, and intentions or any external sounds, objects, or people. In some people, the inner world of thoughts and feelings is “loud”, and dramatically drains the person’s prefrontal cortex’s attentional powers.

You can imagine how hard it would be for anyone to study if a full-grown lion walked into your classroom. It would be hard to focus. This is an example of an external attentional load. Less dramatic but just-as-pertinent forms of external attentional load include physical clutter, noises, talking, movement, television, interruptions, etc.

Outer sources of attentional load include:

  • Hectic or messy environment
  • Fast pace or frequent interruptions
  • Too many choices
  • Noise
  • Anything external that is interesting or distracting

Now to internal distractors. Some people with ADHD have brain (or body) parts outside the prefrontal cortex that are chronically overactive. The problem may not be so much in the prefrontal cortex itself as in the other parts of the brain or body. It’s not that the conscious brain truly perceives something else, whether internal or external, to be a higher priority for attention than what they “should” be focusing on, but rather the prefrontal cortex doesn’t have the ability to control one or more other parts of the brain because they’re “overactive” or have “run away.”

Internal distractors can be just as distracting as a lion walking into the room, yet, because the distraction is internal to the person, it may be hard for others to understand why the person is distracted. This leads to misunderstandings and frustration. The inattentive ADHD subtype is characterized by these internal distractors.

Inner sources of attentional load include:

  • Negative feelings such as psychological stress, fear, or tension (all too common)
  • Active, hyper-stimulated brain parts or “racing thoughts”
  • Neurotransmitter imbalances such as low serotonin, GABA, or dopamine; or high histamine or glutamate levels.

Keep in mind also that a combination of inner and outer attentional load can occur. Altered nervous system prioritization of external stimuli, such as in sensory integration disorders, can be a factor for some. People with these problems will be overly bothered by normal sensory stimuli such as sounds, clothing, lighting, motion, food textures, etc., which can increase attentional load and contribute to symptoms of ADHD. These disorders can be addressed through Functional Neurology.

Decreasing Attentional Load

When decreasing attentional load, it is important to identify where the biggest attentional drain (load) is coming from (inner or outer). This is where a skilled clinician can quickly help identify the sources of attentional load.

The bottom line is that we can address ADHD by increasing attentional strength and/or lowering the attentional load on the child’s brain. But first, it’s important to identify the potential areas for improvement, whether you need to improve your (or your child’s) external environment, or whether you need to improve brain health. Read the other articles in this series to learn how to address your loved one’s ADHD.

About Nicholas Hundley, MS, CNS

Nicholas Hundley is a nutritional biochemist and certified nutrition specialist. He is the main author for the MindWhale blog at MindWhale.com. He practices nutrition and can be found at NicholasHundley.com

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