Essentials: ADHD & How Anyone Can Improve Their Focus

This Essentials episode looks at attention deficit hyperactivity disorder (ADHD). It opens with a caution: people are tempted to self-diagnose or to diagnose others, but a clear diagnosis should come from a psychiatrist, a physician or a very well-trained clinical psychologist. The figures given are that about one in 10 children have ADHD, "and probably more", that roughly half of those cases resolve with proper treatment while the other half typically don't, and that ADHD is increasingly being seen in adults.

For this discussion, attention, focus and concentration are treated as essentially the same thing. Attention is defined as perception: of everything the senses take in, we perceive only what we attend to. The example is a breeze on the skin. The body senses it the whole time, but the listener may not perceive it until it is mentioned.

Impulse control is presented as something separate, almost the opposite. It requires "putting the blinders on" to sensory events in the environment. In the episode's words, "Impulse control is about limiting our perception." ADHD is described as combining both problems: poor attention and high impulsivity.

The symptom picture includes distractibility, impulsivity, being easily annoyed by things happening in the room, and sometimes heightened emotionality. A key qualification runs through the episode, though: people with ADHD can show hyperfocus on things they enjoy and find intriguing. As it is put, "people with ADHD have the capacity to attend, but they can't engage that attention for things that they don't really, really want to do."

Time perception is the second feature. People with ADHD often run late and procrastinate. Yet when there is a deadline, or when the consequences of not attending are severe enough, they can perceive time well and focus well. Without that pressure, they tend to lose track of time and underestimate how long things will take.

The third feature is working memory. The episode stresses that memory overall is not poor: people with ADHD can remember past and upcoming events well. The specific problem is keeping information "online" for the short term, roughly 10 seconds to a minute or two. The example is hearing someone's phone number and holding it in mind while walking back to your phone to enter it. People without ADHD may find this a bit of an effort, but they can usually manage it.

The summary profile, with the caveat that some people have all of these traits, some only a subset, and severity ranges from very intense to mild: - Challenges with attention and focus - Challenges with impulse control and getting annoyed easily - Difficulty staying on task - Time perception that can be off - Difficulty with mundane tasks that hold no real interest - Alongside all this, a capacity for heightened focus or hyperfocus on exciting things

To explain hyperfocus, the episode recasts enjoyment and curiosity in neurobiological terms. Their clear signature is dopamine, a neuromodulator released from neurons. Dopamine is said to create a heightened state of focus, contract the visual world, and direct attention outward to things beyond the skin, which the episode calls exteroception.