Researchers continue to study ADHD in an ongoing attempt to understand what it is and how and why the treatments work. Many of our own patients comment that the meaning of ADHD remains unclear.
A recent study, reported in the New York Times1, looks at the effects on the brain of commonly prescribed stimulants that have observationally helped ADHD-afflicted children and adults concentrate better and access improved cognition. Surprisingly, the drugs don’t actually affect parts of the brain that are associated with “attention”. They seem to affect brain networks involved in salience (is this task important?), reward (is it worth it?), and arousal (am I motivated to work on it?).
This is not to say that ADHD is a “myth” or that the usual prescribed medications “don’t work”. Psychiatrists agree that there is a real disorder, and that the treatments are effective. As Dr. Awais Aftab, author of the article notes: “In observational studies, treating ADHD with medication is associated with reductions in death, self-harm, transport accidents, criminal convictions and substance misuse.”
However, the problem doesn’t seem to be “attention”, or a deficit thereof. People in the modern world seem to be increasingly burdened with a constellation of troubles including difficulty maintaining focus, memory loss, being disorganized, and not being able to complete tedious or repetitive tasks. Our modern environment, work and life don’t support us in coping, and people with ADHD are often and especially disabled by the demands of modern life.
Rather than a deficit of “attention”, other researchers have proposed that ADHD is better understood as a problem with impulsivity, and low tolerance for frustration. Thus, raising salience and motivation through stimulant use allows one to concentrate through a task to completion. Rather than attention, Dr. Aftab describes this as “sustained engagement”. This raises the question of whether medicating people to be able to complete mundane or tedious tasks is an appropriate response to modern schooling and employment. However, studies reliably show that stimulants have no effect on healthy children, and stimulant-taking does not improve cognitive ability.
Stimulants can mimic the effects of adequate sleep, and compensate for broken or reduced sleep. For this reason, it is important to continually screen for sleep deficits or problems sleeping while taking stimulants. They can replace a good night’s sleep in the short term, but should not take the place of healthy sleep.
As always, much remains to be learned about how our brains work. Attention may not be the key to better study and work habits, and there will be many new ways to figure out what’s going on in disordered and healthy brains alike.
- What if A.D.H.D. Isn’t About Attention at all? Awais Aftab. New York: New York Times. September 29, 2026.