What if ADHD isn’t about attention at all? It might be more about motivation and staying engaged
Evidence suggests that it really affects what psychiatrists like me call sustained engagement – an important difference in understanding how to think about the condition.
New research challenges the notion that ADHD is primarily a disorder of attention. A major study published in Cell magazine examined how stimulant medications impact brain circuits in children with ADHD. The findings revealed that these drugs affect brain networks associated with salience, reward, and arousal, but do not alter the brain's attention networks.
This suggests that the prevailing medical model, which views ADHD as a deficit of attention that stimulants correct, may be inaccurate. Instead, the researchers propose that a more accurate understanding of ADHD lies in recognizing that "attention" encompasses different concepts in the clinic versus the neuroscience lab.
Clinicians generally refer to attention as the selective amplification of relevant information, measured through laboratory tasks assessing a person's ability to ignore distractions and focus on a target. However, the core challenges faced by individuals with ADHD often involve sustained engagement—staying focused on tasks and goals over time. This involves keeping one's attention on the same target for extended periods, which is a different concept from selective attention.
By appreciating this distinction, the results of the Cell study no longer appear contradictory. Stimulants improve attention and focus not by filtering out distractions but by enhancing the salience of mundane activities, making tasks like homework and housework appear more worthwhile to the brain. This also explains why stimulants can calm hyperactive children who may be restless because a task lacks sufficient reward.
The idea that ADHD could stem from a deficit in sustained engagement has been proposed since the 1990s. A 1992 study by developmental psychologist Edmund Sonuga-Barke found that hyperactive children preferred immediate rewards over delayed ones, indicating an aversion to waiting. This suggests that ADHD may arise from various factors, such as difficulty stopping actions once they start, a strong aversion to waiting, and disruptions in the brain's ability to track events over time.
These insights emphasize that the diagnosis of ADHD should not solely rely on a deficit of attention. Instead, clinicians should consider a broader range of symptoms, including difficulties with sustained engagement, emotional regulation, and impulse control. By broadening the definition of ADHD to include these factors, individuals who struggle with lateness, boredom, emotional volatility, and starting tasks without pressure from deadlines might receive appropriate diagnoses and support.
Written by urgent.news from Channel News Asia's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
