Attention Regulation and ADD

September 9th, 2011

By Leslie Rouder, LCSW,CHt 

Very often I will hear a parent tell me that his child could not possibly have ADD because he is able to play video games for long hours without being distracted in the least.  Or that one’s spouse can watch a football game without ever being distracted. This can be very misleading and also accounts for a lot of arguments as people often interpret “ADDers” as being able to select what they can focus on depending on what they like.  Therefore, the conclusion is that they are either lazy, disinterested, or lack willpower in whatever else they “should” be focusing on (but are obviously not). ADD may appear to be all of the above, but in reality, it is not within the voluntary control of a person with this disorder, due to an impairment of the management system of the brain that regulates these kinds of behaviors. For this reason I often think of Attention Deficit Disorder (ADD) as Attention Regulatory Disorder, which is really a more accurate name for it.

To complicate this issue, brain chemistry can and does change very rapidly with perception of either a reward or imminent threat. This is because once the brain perceives either one of these; it immediately releases dopamine and/or norepinephrine from the limbic system that activates appropriate behavioral responses.

But with people with ADD, who have impaired executive functioning, the inability to self-regulate appears as laziness or lack of willpower. It clearly is not.  Many studies have indicated that when individuals with ADD are provided psycho stimulant medications, their level of executive functioning is greatly enhanced through the duration of the dosage of medication.  In fact, it has been established that they are able to sustain attention in the very same way they would in those circumstances in which they have a strong pressing interest.   

This is mostly because these medications improve the release and reuptake of the very same neurotransmitters that the brain produces during times of reward or imminent threat.  (Dopamine and/ or norepinephrine)  Furthermore, the results are in direct correlation to the timing of the medication, with impaired functioning returning when the medication has worn off. This further supports the idea that impaired executive functioning is not a lack of willpower, but rather directly related to the inadequate release or reuptake of these critical neurotransmitters in the brain.  Therefore, it is the alteration of this dynamic, through the use of proper medication that affects the improvement of one’s ability to focus and regulate attention, and definitely not willpower.


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