ADHD & How Anyone Can Improve Their Focus | Huberman Lab Podcast #37

Introduction & Note About Diagnosis (00:00:00)

• The Huberman Lab podcast focuses on scientific discussions and providing science-based tools for everyday life.
• The host, Andrew Huberman, is a professor at Stanford School of Medicine, specializing in neurobiology and ophthalmology.
• The topic of discussion revolves around Attention Deficit Hyperactivity Disorder (ADHD), focus, concentration, and how improvements can be made in these areas.
• Apart from ADHD, the episode discusses general focus and attention, including methods and tools for their improvement, such as drug-based tools, behavioral tools, dietary considerations, and even neurotech like transcranial magnetic stimulation.
• ADHD and its symptomology are explored, but listeners are warned against self-diagnosis or diagnosing others; professional diagnosis is strongly advised due to specific criteria for diagnosing ADHD.
• The impact of stress, smartphone use, and other factors on attention and focus are mentioned.

ADHD vs. ADD: Genetics, IQ, Rates in Kids & Adults (00:07:56)

• ADHD, which was previously called Attention Deficit Disorder (ADD), has been documented in medical literature since 1904.
• ADHD has a genetic component with higher probabilities for those with close relatives suffering from the disorder.
• ADHD is not tied to a person's intelligence, whether it be measured by standard IQ tests or various forms of intelligence such as emotional or spatial intelligence.
• The renaming of ADD to ADHD happened in the mid to late 1980s and this change has improved diagnosis and detection rates.
• Current estimates suggest about 1 in 10 children may have ADHD with higher rates emerging in adults, possibly because of increased smartphone use and how our attention is drawn in multiple directions.

Attention & Focus, Impulse Control (00:13:00)

• The discussion defines attention, focus, and concentration as the same thing for this context, representing how we are perceiving the sensory world around us.
• Impulse control differs from attention and focus as it relates to limiting our perception.
• People with ADHD generally struggle with attention and have high levels of impulsivity, leading to distractibility.

Hyper-focus (00:14:57)

• Despite common belief, people with ADHD can often display 'hyper-focus', especially on topics or activities they enjoy or find intriguing.
• This capacity for focused attention in people with ADHD appears to be selective and generally hard to engage for activities they find uninteresting.

Time Perception (00:16:45)

• People with ADHD often face challenges with time perception, frequently running late or procrastinating.
• However, when the consequences of not meeting deadlines are severe enough, people with ADHD may display an ability to perceive time accurately and maintain focus.

The Pile System (00:18:25)

• People with ADHD often have subpar spatial organization skills and tend to use the 'pile system' to organize things. This system involves piling up belongings in categories that only make sense to the individual but doesn't necessarily have a logical framework.
• While the pile system can be used effectively in certain situations such as unpacking a house, those with ADHD tend to apply it all the time which eventually doesn't work for them as it prevents them from locating things and performing tasks.
• It's worth noting that using the pile system is not exclusive to ADHD and is a common 'phenotype' that can manifest due to different underlying genetic or psychological components.

Working Memory (00:20:00)

• Another common challenge for those with ADHD is difficulties with working memory. This is not to be confused with overall memory capacity, as people with ADHD can have an excellent memory for past events and upcoming plans.
• The issue is with keeping specific information active in the mind for a short term, like recalling a phone number given verbally.
• ADHD individuals often struggle with maintaining batches of information for a short term which could be a string of numbers or a couple of sentences.
• Similar issues with working memory can also be seen in cases such as frontotemporal dementia and age-related cognitive decline.
• As a whole, ADHD is characterized by challenges with attention and focus, impulse control, organization, and a hard time with mundane tasks, but can achieve heightened levels of focus for tasks that trigger their interest.

Hyper-Focus & Dopamine (00:24:10)

• People with ADHD may have a heightened ability to focus on tasks that they find particularly interesting or enjoyable. This enjoyment and curiosity are linked with the neuromodulator, dopamine, which promotes focus and motivation.
• Dopamine changes the activity of brain circuits, leading to certain circuits being more active than others and creating a heightened state of focus towards things outside of us, known as 'exteroception'.
• High levels of dopamine can also change perception, leading to a more focused view of our environment and intensifying our interest and motivation towards certain tasks or information.
• Hence, dopamine plays a critical role in managing attention, narrowing our visual and auditory focus to pay attention to particular things in our environment, whether or not a person has ADHD.

Neural Circuits In ADHD: Default Mode Network & Task-Related Networks (00:26:40)

• There are two types of neurocircuits related to ADHD: the default mode network and task-related networks.
• The default mode network is a network of brain areas that is active when we're not engaged in any specific task.
• Task-related networks are the brain areas that make us goal-oriented and they're a completely different set of brain areas from the default mode network.
• The default mode network and the task-related networks communicate with one another. In a typical person, these networks are anti-correlated, meaning they oppose each other.
• In a person with ADHD, these networks are more coordinated, which is abnormal.
• Dopamine acts as a conductor, signaling which circuit should be active at which time.
• In ADHD, there's something about the dopamine system that is not allowing it to conduct these networks properly.

Low Dopamine in ADHD & Stimulant Use & Abuse (00:32:57)

• The low dopamine hypothesis of ADHD emerged in 2015, suggesting that low dopamine levels could be causing ADHD.
• Low dopamine levels can lead to unnecessary firing of neurons in the brain that are unrelated to the task at hand.
• Anecdotally, people with ADHD have been known to use recreational drugs or indulge in non-drug stimulants that tend to increase dopamine levels.
• Substances like cocaine, amphetamines, coffee, and cigarettes increase levels of dopamine in the brain, particularly in regions that regulate attention.
• Young children with ADHD often show a preference for sugary foods, which also act as dopamine-inducing stimulants.

Sugar, Ritalin, Adderall, Modafinil & Armodafinil (00:37:10)

• Previously children with ADHD were thought to consume excessive sugar or adults used recreational drugs due to poor attention levels and decision-making abilities.
• Newly gained understanding about the role of dopamine suggests that these children and adults might be self-medicating to increase focus and aid better decision making.
• When children with ADHD consume anything increasing dopamine levels, they tend to be calmer and able to focus more, unlike children without ADHD who can become hyperactive.
• Low levels of dopamine are seen as a cause for ADHD. This led to the development of drugs like Ritalin, Adderall and Modafinil which serve to increase dopamine levels and improve focus.
• These drugs are commonly used to treat ADHD as well as narcolepsy.
• The drugs used to treat ADHD are stimulants and they closely resemble some street drugs. However, at the right dosage and prescription from a board certified MD, many people with ADHD find relief with these drugs.
• It's important to consider why these drugs are prescribed and the implications of taking these drugs for those not diagnosed with ADHD. It's estimated that 25% to 35% of individuals between 17 and 30 are taking Adderall, often obtained via a black market, despite not having ADHD diagnosis.

Non-Prescribed Adderall, Caffeine, Nicotine (00:47:00)

• Consumption of Adderall without prescription is higher than the consumption of cannabis, hinting at a lot of stimulant use in the young demographic.
• People have self-medicated using caffeine and nicotine to increase focus and alertness. Caffeine is consumed widely and nicotine use has shifted from cigarettes to vapes due to health concerns.

How Stimulants “Teach” the Brains of ADHD Children to Focus (00:49:18)

• Stimulants can calm children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), as it allows the forebrain task-related network to become more active.
• The stimulant induces a state of focus artificially, teaching children how to prioritize focus even for tasks that do not interest them.
• Most children with ADHD struggle with higher distractibility and find it challenging to stay seated or remain silent during classes.
• The use of dopamine-inducing stimulants, like amphetamines, helps these children focus, but raises questions about short-term and long-term consequences, and the implications for people using these drugs without a clinical need.

When To Medicate: A Highly Informed (Anecdotal) Case Study (00:52:00)

• A pediatric neurologist, specializing in epilepsy and ADHD, believes that medication can benefit children if dosages are kept low and adjusted as the child grows older.
• The neurologist considers giving medication to their own child who shows signs of ADHD.
• Puberty triggers changes in the brain, improving the ability to focus and control behaviors. The neurologist postulates that giving drugs to help a child learn to control these abilities early on might help retain this ability as they age.
• Neuroplasticity is much higher in children aged from 3 to 12, providing an opportunity to reshape the brain at an accelerated rate. Early treatment under the guidance of a quality physician can allow frontal circuits to function appropriately and help children learn focus.

Elimination Diets & Allergies In ADHD (00:56:35)

• An elimination diet, or a diet free of sugars, dairy, or gluten, has been suggested to improve symptoms of ADHD.
• Research indicates that persons with ADHD naturally gravitate towards sugary foods, which boost dopamine levels and might help self-manage issues like lack of focus and impulsivity.
• A well-designed study involving diet manipulation in children with ADHD revealed significant results (P < 0.0001). When children were placed on an elimination diet (eliminating foods they were mildly allergic to), there was a drastic enhancement in focus, reduction in impulsivity, and improved physical control.
• Skepticism and criticisms about the study's overall structural design and data analysis were potential limitations.
• A pediatric neurologist noted a marked positive effect in children with ADHD who eliminated simple sugars from their diets.
• Elimination diets are considered controversial, with some suggesting that lack of exposure to certain foods can lead to development of allergies.
• Many neurologists and psychiatrists concur that ADHD patients should, wherever possible, avoid high-sugar foods and eliminate foods known to exacerbate symptoms.

Omega-3 Fatty Acids: EPAs & DHAs (01:04:46)

• Omega-3 fatty acids, specifically the EPA component, are known to have antidepressant effects, mood-enhancing effects, and importance in protecting the cardiovascular and immune systems.
• Regarding ADHD, studies have produced varied results; some show moderate positive effects on focus and attention, others show no effect.
• Similar to the use of omega-3s in depression, ingestion of omega-3 fatty acids (1000 milligrams or more of EPA daily) may potentially allow adults with ADHD or mild attention deficit issues to function well on reduced medication doses, and in rare cases, eliminate medication entirely.
• Omega-3 fatty acids are beneficial in a supportive or modulatory role, but will not cure or eliminate ADHD.

Modulation vs Mediation of Biological Processes (01:07:00)

• Just like sleep, certain factors play a supportive and modulatory role for various biological processes like the immune system, emotional regulation, and thinking skills.
• Certain biological processes are mediated by specific substances, for example, focus and motivation are mediated by dopamine.
• However, the ability to focus can also be modulated by the state of being well-rested. An extreme lack of sleep can negatively impact the ability to focus.
• Omega-3 fatty acids, specifically EPA, modulate attention and mood by making dopamine more available.
• In the context of ADHD, diet likely modulates the process rather than mediating it. This means that while it can aid in improving focus, it is not a cure-all solution.
• Prescription drugs like Ritalin and Adderall intervene with the circuits and neurochemistries that mediate attention and focus but they aren't the only options for treatment.

Attentional Blinks (01:10:50)

• We haven't discussed what would make us better at focusing. A tool backed by research data can enhance your ability to focus, theoretically, forever.
• Attentional blinks are when your attention "shuts off" for a moment, and during this moment, you tend to miss things right next to what you are focused on.
• This phenomenon can be observed during a "where's Waldo" task, or when trying to spot multiple letters in a string of random numbers.
• People with ADHD tend to have many more attentional blinks than those without the condition.
• It's suggested that people with ADHD might not only be unable to focus on all things but may be over-focusing on certain things, leading to them missing other crucial elements. This could be a part of how ADHD works and could also be a key to improving focus and attention.

Open Monitoring & 17 minute Focus Enhancement (01:16:56)

• Open monitoring refers to a state of enhanced attention often achieved by individuals who have practiced methods such as Vipassana meditation or open gaze visual analysis and thinking.
• Achieving open monitoring can be accomplished through two visual processing modes: highly focused (soda straw view) or panoramic vision.
• Panoramic vision allows you to see beyond your direct line of sight by consciously dilating your gaze to see more simultaneously.
• Panoramic vision is linked to a higher frame rate of visual processing, allowing for better recognition of multiple targets or details.
• Research has highlighted a simple practice of just sitting quietly for about 15 to 17 minutes and focusing on interoception (how your body feels) can reduce the number of attentional blinks, therefore improving focus permanently.
• As people age and experience cognitive decline, the number of attentional blinks increases, suggesting that this simple practice could also help offset age-related cognitive decline.

Blinking, Dopamine & Time Perception; & Focus Training (01:22:50)

• Attentional blinks refer to the moments your mind shuts off and misses information; these can be controlled by dopamine levels in the brain.
• Regular blinks - the physical closing of your eyelids - also contribute to our perception of time and are tied to dopamine levels, forming part of the system that modulates and updates your perception of time.
• High levels of dopamine are associated with time perceived in slow motion mode, while low dopamine makes time seem to go by faster.
• People with ADHD, who typically have lower dopamine levels, often underestimate time intervals, making them prone to disorganization and lateness.
• The study titled "Improvement of attention in elementary school students through fixation focused training activity" demonstrated that student's attention improved when they underwent focus training on a target with controlled blinking. This required students to override the instinct to blink, thereby further enhancing focus.
• Activating physical movement in students before the focus training was an important factor in enhancing the effectiveness of the exercise. This aligns with the known need for recess and the benefits of physical activity for focus in children. Adult could also benefit from incorporating more physical activities into their routine.

Reverberatory Neural & Physical Activity (01:30:10)

• The use of fidgeter toys or activities, such as a rubber band attached to a desk, has become prevalent in schools to help children with ADHD stay focused and manage their physical energy.
• Ancillary physical activity, like tapping one's foot or bouncing a knee, can be beneficial for adults too and can enhance focus and precision in various tasks.
• This activity helps shuttle some of the activity from premotor circuits to other places in the body, which can aid in maintaining focus.

Adderall, Ritalin & Blink Frequency (01:33:40)

• Most drugs, like Ritalin and Adderall, and substances that increase dopamine, such as coffee or tea, tend to make us blink less.
• Blinking frequency is not just a reflex; it is a complex function that regulates the amount of information entering the nervous system and how it is processed.
• Being tired or sleepy tends to make us blink more frequently.

Cannabis (01:35:00)

• Regular cannabis use can changes the rates of eye-blinking; chronic users blink less frequently.
• It has been found that cannabis use may increase dopamine transmission in the brain, which may enhance the ability to focus.
• However, cannabis use is also known to affect memory in a negative way.

Interoceptive Awareness (01:37:30)

• People with ADHD have interoceptive awareness, meaning they are equally aware of their internal state (heartbeat, breathing, etc.) as anyone else.
• Interoceptive awareness in itself is not a determinant or factor of an individual's ability to focus or process information.
• The ability to coordinate task-directed networks, regulated by neurochemicals like dopamine, norepinephrine, serotonin and acetylcholine, plays a vital role in cognitive focus for people with ADHD.

Ritalin, Adderall, Modafinil, Armodafinil; Smart Drugs & Caffeine: Dangers (01:41:15)

• Prescription drugs such as methylphenidate (Ritalin), Modafinil/Armodafinil and Adderall are often used to treat ADHD and enhance focus by increasing levels of dopamine and norepinephrine.
• The correct dosages vary per individual based on the severity of their condition and age.
• These drugs carry notable side effects including addiction, abuse, cardiovascular issues, and sexual side effects such as issues achieving an erection.
• The effects of these prescription drugs are similar to the effects of street drugs like cocaine and amphetamine.
• Modern treatment methods for ADHD is exploring drug scheduling and combining the drugs with behavioral exercises to train the brain to focus.
• The objective is to eventually taper off the drugs so that the patient can focus without the need for chemical intervention.

DHA Fatty Acids, Phosphatidylserine (01:48:05)

• Consumption of omega-3 fatty acids, specifically over 300 milligrams of DHA per day, and 200 milligrams of phosphatidylserine per day, can have positive effects on attention and focus.
• This regimen can reduce symptoms of ADHD in children, however studies in adults are yet to be conducted.
• These effects are greatly enhanced with the simultaneous consumption of omega-3 fatty acids, and can be achieved through over-the-counter dietary supplements.

Ginko Biloba (01:50:54)

• Ginkgo Biloba can have minor effects on improving symptoms of ADHD, but it is not nearly as effective as prescription drugs like Ritalin or Adderall.
• Consumption of Ginkgo Biloba carries a risk of causing headaches due to its potent vasoconstrictive and vasodilating properties.
• When considering Ginko Biloba for attention or ADHD, the risks associated with vasodilation, vasoconstriction and headaches should be considered.

Modafinil & Armodafinil: Dopamine Action & Orexin (01:51:45)

• Modafinil and its closely related counterpart, Armodafinil, are drugs gaining popularity in treating ADHD and narcolepsy.
• They are also being widely used by communities of people seeking to stay awake for extended periods, including the military, first responders, and college students.
• Modafinil and Armodafinil are effective alternatives to drugs like Adderall and Ritalin or excessive amounts of coffee.
• These drugs are weak dopamine re-uptake inhibitors leading to increased dopamine which in turn increases focus.
• Modafinil and Armodafinil also affect the orexin system, regulating hunger, appetite, and feelings of sleepiness.
• The orexin (hypocretin) system is disrupted in narcolepsy, making Modafinil a prime treatment.
• The less expensive Armodafinil has variable effectiveness for different individuals.

Acetylcholine: Circuits Underlying Focus; Alpha-GPC (01:56:19)

• Acetylcholine, a neurotransmitter, is released from two sites in the brain, the pedunculopontine nucleus (PPN) and nucleus basalis.
• The neurotransmitter enhances the degree of focus on specific information.
• Drugs increasing cholinergic or acetylcholine transmission, like the compound Alpha-GPC, can enhance focus and cognition.
• Alpha-GPC dosages as high as 1200 milligrams per day can offset age-related cognitive decline and improve cognitive functioning.

L-Tyrosine, (PEA) Phenylethylamine (01:59:04)

• L-Tyrosine and Phenylethylamine (PEA) are other over-the-counter compounds used for ADHD treatment and improving focus.
• L-Tyrosine, an amino acid, acts as a precursor to dopamine and can improve one's ability to focus.
• Dosage of L-Tyrosine can be tricky to regulate as too much can lead to feelings of euphoria or jitteriness, impeding focus.
• PEA and related compounds are being used as dopaminergic supplements to increase dopamine levels.
• Applications of these compounds can be explored at examine.com.

Racetams, Noopept (02:01:23)

• The Racetams are increasingly popular compounds that enhance cognitive function.
• They tap into the cholinergic, or acetylcholine system in the brain, which is related to focus and cognitive decline, particularly in aging or brain-damaged populations.
• Noopept, sold over the counter in the U.S and a subtype of Racetams, has been shown to be particularly effective and popular. It is, however, illegal in some countries.
• These compounds have been reported to improve focus in cases where there has been a loss of it due to head injury or certain vascular events like stroke.

Transcranial Magnetic Stimulation; Combining Technology & Pharmacology (02:05:15)

• Transcranial Magnetic Stimulation (TMS) is a tool for ADHD treatment gaining popularity.
• It is a non-invasive tool that influences brain activity by generating magnetic stimulation at different areas of the brain.
• TMS coils are placed on the head and increasing or decreasing the activity in certain brain areas is possible.
• Experimentation is ongoing that combines TMS with focused learning tasks in treating ADHD compared to traditional pharmacological methods.

Smart Phones & ADHD & Sub-Clinical Focus Issues In Adults & Kids (02:09:14)

• Technological advancements like smartphones may cause difficulty in focusing, leading to behavior resembling ADHD.
• The rapid context-switching involved, caused by quickly shifting between apps and web pages, overwhelms our attention span.
• A study of over 7,000 adolescents showed excessive smartphone use (more than 60 minutes per day) led to significant attentional deficits.
• In adults, the recommended maximum usage is approximately two hours per day.
• Overuse can greatly diminish focus and contribute to difficulties performing in work, school, and relationships.

Synthesis/Summary (02:14:30)

• The podcast discussed the biology of focus and methods to improve focus.
• It also touched upon the behavioral and psychological profiles of ADHD, along with the underlying neural circuitry and neurochemistry.
• Various prescription drug treatments aimed at the neurochemistry were explored, focusing on how they help increase focus in children and adults with ADHD.
• Over the counter compounds and the role of diets were discussed, particularly elimination diets, and how these can impact outcomes for ADHD and enhance focus.
• There was a general discussion about technology, specifically smartphones, and how they may hinder focus and increase the risk of ADHD.
• The podcast also acknowledged the irony of a long-form discussion on ADHD for individuals who may struggle with attention.
• It emphasizes that the podcast episodes are designed to be consumed in sections, according to personal preference.
• The podcast also discussed a tool that claims to enhance focus with one 17-minute session.
• The goal of the podcast is to provide educational information about ADHD and strategies to improve focus.