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ADHD may have nothing to do with an individual’s levels of attention, a top psychiatrist has warned.
For decades, many have associated ADHD, which is short for attention-deficit/hyperactivity disorder, with the inability to pay attention, but in an article for The New York Times Dr Awais Aftab questioned if this was a misnomer.
‘The condition’s name notwithstanding, “attention deficit” may be the wrong conceptual framing for ADHD,’ he wrote.
Aftab emphasized the scientific consensus that ADHD is a genuine problem for which there are effective treatments. But he said the disorder is more about a person’s brain deeming a task worthy of attention in the first place, rather than struggling to filter out distractions.
ADHD is often treated using stimulants, such as Adderall, which help patients focus on the tasks at hand.
‘Stimulants create what looks like improved attention and focus, but they really do so by enhancing the salience of mundane activities – tricking the brain into assigning greater worth and significance to things like math homework and laundry,’ he wrote.
But the medication doesn’t actually affect the areas of the brain associated with attention, he wrote, citing a Cell study on stimulants. This suggests the disorder actually has less to do with the ability to focus and is more about the ability to assign the task enough value to complete it.
Aftab said the main problem patients with ADHD struggle with is not attention, as they can often focus on things that interest them, but rather their brains failing at ‘sustained engagement.’
Dr Awais Aftab said ADHD has little to do with attention, as medication doesn’t target that area of the brain. He believes the condition has more to do with assigning significance to tasks
Aftab emphasized the scientific consensus that ADHD is a genuine problem for which there are effective treatments
‘If attention is about the mind homing in on what’s relevant in a given moment, engagement is about keeping that spotlight pointed at the same target over time,’ he wrote.
Clinical Psychologist Thomas Brown takes a similar view, telling ADDitude Magazine in June that ADHD is a cognitive disorder that sees impairment to the executive functions (EFs) in the brain. EFs are the self-management system of the brain.
EF dysfunction can include the inability to start a task, sustain effort, impulsively jumping into things, and more, he said.
‘The old model thinks of ADHD as a behavioral disorder,’ he told the magazine.
‘But many individuals living with ADHD never had significant behavior problems; they have difficulty focusing their attention on necessary tasks and using working memory effectively.’
Brown said many EFs are outside of the DSM-5’s definition of ADHD.
Aftab also suggested that patients often reach for a medication in order to maintain lifestyles that are not suitable for them.
Today’s work environments often require an employee to multitask. Coupled with cell phones lowering people’s attention spans, it can be harder to keep up for those diagnosed with ADHD, he said.
Aftab also emphasized the strong evidence that treating ADHD with drugs is associated with reducing the chances of death, self-harm, transport accidents, criminality and addiction problems.
