ADHD 2.0 : New Science and Essential Strategies for Thriving with Distraction—From Childhood Through Adulthood

by Edward M. Hallowell

The connectome that lights up when you’re engaged in a task is called the task-positive network, or TPN. Aptly named, the TPN gets you down to work. You’re deliberately doing something and you are intent on it, unaware of much beyond the bounds of what you’re doing.

Unfortunately, the TPN is akin to a muscle that atrophies when not used. So as we mentally flit around, the TPN weakens and our attention span shortens.

this other connectome is called the default mode network (DMN). The DMN allows for expansive, imaginative, and creative thinking. The back half of the DMN—called the posterior cingulate—facilitates your autobiographic memory, your personal history. This allows you to think back, draw upon, and pick apart the past. The front part, the medial prefrontal cortex, is the opposite. It enables you to look forward and to think about, imagine, and plan for the future. It is in the DMN mode that you can daydream (and miss your exit on the highway) or make interesting connections between concepts (helpful when appreciating riddles or jokes or solving crossword puzzles, or coming up with the Next Big Thing).

In a neurotypical brain, when the TPN is turned on and you’re on task, the DMN is turned off. But in the ADHD brain, the fMRI shows that when the TPN is turned on, the DMN is turned on as well, trying to muscle its way in and pull you into its grasp, thereby distracting you. In ADHD, therefore, the DMN competes with the TPN, which in most people it does not do.

“If there is one takeaway in distilling down the complexity of the DMN and the TPN, it boils down to the fact that the toggle switches between them are off in those with ADHD.”

Another extremely common problem when caught in the DMN is what we call “pirouette syndrome,” a circling back to make sure you’ve done something you’ve already done.

Still another curse of the Demon is catastrophic thinking.

In other words: Spend more time in the TPN focusing on a single task. We know what you might be thinking: The whole point is that I can’t focus on a single task! But you can—you are already a master of distraction, so now distract yourself. Productivity isn’t the point here. Moving the toggle switch is.

The point is: Focus on anything external to yourself. Activating the TPN will shut down the DMN.

Don’t feed the Demon. Shut off its oxygen by denying it your attention. Do something else that engages your mind. Stay in action!

During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness. Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking fifteen cigarettes a day and even greater than that associated with obesity. Loneliness is also associated with a greater risk of cardiovascular disease, dementia, depression, and anxiety. At work, loneliness reduces task performance, limits creativity, and impairs other aspects of executive function such as reasoning and decision making. For our health and our work, it is imperative that we address the loneliness epidemic quickly.

Allen’s superpower is that he’s a problem solver. And as long as he is intellectually challenged by the problem and is meeting interesting people and learning how things work, there’s almost no one better at turning chance into opportunity.

What three or four things are you best at doing? What three or four things do you like doing the most? What three or four activities or achievements have brought you the most praise in your life? What are your three or four most cherished goals? What three or four things would you most like to get better at? What do others praise you for but you take for granted? What, if anything, is easy for you but hard for others? What do you spend a lot of time doing that you are really bad at? What could your teacher or supervisor do so that your time could be spent more productively? If you weren’t afraid of getting in trouble, what would you tell your teacher or supervisor that he or she doesn’t understand about you?

There are some supplements everyone can agree to recommend: a multivitamin; vitamin D; magnesium; B complex; vitamin C (ascorbic acid, as well as Connect!); calcium; zinc.

OmegaBrite also manufactures a CBD product called OmegaBrite CBD, which they began selling in March 2020. Early reports are that it is calming without being sedating. Dr. Hallowell takes it every day and reports that it reduces his reactivity, his tendency to get annoyed too quickly.

Notice how you feel when you leave a person. That’s a good indicator of whether it’s worth spending more time with that person.

Originally released in 1966 as an antiviral agent, Amantadine is another stimulant-like medication worth mentioning. It was also originally used to help with Parkinson’s symptoms like tremors, stiffness, and attention difficulties. Amantadine has an effect on the dopamine system; it acts weakly like a dopamine surrogate. It also stimulates another neurotransmitter that assists in increasing the actual concentration of dopamine. It has recently been used to treat attention difficulties in Alzheimer’s, in head trauma, and in ADHD with some positive effect. While not yet FDA-approved for ADHD, it is being investigated with an eye toward full approval. The positives of Amantadine include a smooth effect that can last for up to twenty-four hours, with few side effects. It is not addictive and not a controlled substance, which means it can be prescribed with refills.

Tempus stands out from the crowd because it uses what’s called “whole exome sequencing.” A strand of DNA contains exons, which are the coding sites—the sites that dictate the action—as well as introns, whose function is debated. Right now the intron seems to be a spectator to the action, but nature rarely creates spectators, so some essential function will likely be found. But we know for sure the exons matter a lot. Taken together, the exons form an exome.