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

by Edward M. Hallowell

Hank experiences excessive worry. But because he also has ADHD, his worry has been magnified. Ironically for a condition commonly associated with lack of focus, many people with ADHD—or with the VAST characteristics—focus on their worry so much that it wears a rut in their thinking. And like a rut in the road, it can be hard to avoid.

epigenetics, the varying impact of environment upon the expression of genes.

is because of epigenetics that you may have been born with genes that predispose you to depression, but because of loving parents and a nurturing school system, those genes never get expressed.

You go through life never suffering from depression, even though you carry the genes that...

if you had unloving parents, if you never received nurturing and positive connections, or, worse, if you suffered trauma and abuse, then if you also inherited the genes that predispose you to depression or other pa...

Good nurture can dramatically reduce the influence of bad nature, bad genes; unfortunately, the reverse is also true: bad nurture, like cold or distant parents, ongoing conflict, or outright trauma while growing up, can suppress good nature, good genes.

Thanks to the work of many neuroscientists, we know that what you do, who you love, where you live, what you eat, how much you move, what kind of stress you experience, if you have a pet, whether you laugh a lot—all those and a zillion more bits of experience constantly change who you are in subtle ways. Your brain responds to all these cues in turn.

We can change who we are and where we’re headed. It’s not easy, but it can be done, and done at any age.

You can focus, but then not focus, or you’re forced into hyperfocus when you don’t want to be.

When you are engaged in a task of any kind, from frying an egg to writing an email to digging a hole, various clumps of neurons, together called a connectome, “light up” in your brain. We can see this through the exciting new science of fMRI, or functional magnetic resonance imaging. It’s like a live, moving X-ray, and it’s as close as we now can get to watching thought in motion.

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. In this state, you don’t consciously know whether you’re happy or not, which is just as good as being happy, if not better, because you’re not wasting any energy in self-assessment. You may become frustrated with what you’re doing and have moments of anger or dismay, but if you stay in the task, in the TPN, those moments will pass, and the TPN, buoyant connectome that it is, will carry you along. When you’re thinking with the TPN, you’re in the Angel mindset. But you can also get trapped in the TPN, doing a task from which you cannot disengage. This is the hyperfocused state that people with ADHD can fall into. Far from being helpful, it can keep you stuck in one task, unable to shut down the screen, turn off the TV, or move from one paragraph to the next. This is the often unrecognized downside of focus.

the reason that so many people are starting to look and act distracted, as if they all have ADHD or VAST, is that fewer and fewer people are spending time in the task-positive network. They are not spending enough time focusing on a single task, certainly not long enough to dig a deep enough hole or write an email longer than a sentence or two or do more than look at an egg, let alone fry one. Unfortunately, the TPN is akin to a mus...

When you allow your mind to wander from a task, or when you finish the task, or if you pause too long in anger or dismay while doing the task, the TPN in your brain defaults to a different connectome.

given that we default to this state—this other connectome is called the default mode network (DMN).

The back half of the DMN—called the posterior cingulate—facilitates your autobiographic mem...

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 ridd...

But as helpful as the DMN can be (angelic in its own right), it is also a Demon (as its initialism suggests!) for the ADHD or VAST brain because of our capacity for intractable rumination while captive in it.

While we are all wired to feel fear and imagine disaster far more than to feel comfortable and secure (along with our five senses, the imagination is our chief evolutionary danger detector), people who have ADHD or VAST are also particularly prone to head toward gloom and doom in their minds because they have stored up in their memory banks a lifetime of moments of failure, disappointment, shame, frustration, defeat, and embarrassment. Given a moment to reflect on what’s likely to happen next, life has taught people with ADHD to imagine and expect the worst.

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.

“Typically, people have synchrony in their default mode network. They go up and down together. Not so in the ADHD brain. They are off-kilter, out of sync.” That’s what’s meant by anticorrelation. Instead of working in unison, they work against each other.

“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.”

When the DMN brings lovely images, it is our golden tool. But when it jumps track into the TPN and hijacks consciousness, then the DMN becomes the Demon, the seat of misery, the disease of the imagination. Trapped in the past or future in the DMN, you’re likely to abandon projects you once started with enthusiasm, make careless mistakes, or, worse, fall into a state of misery and despair, for no good reason whatsoever. All creative people can recognize only too well the phenomenon of being on a roll—creating—only to have a negative voice trying to interrupt the process. That’s the faulty “toggle switch” allowing the DMN to intrude on the TPN. Being trapped in it is painful; the term “tortured artist” fits. Indeed, many of our greatest scientists, inventors, performers, and writers have struggled with glitchy connections, vacillating between creating great works and languishing in despair, often seeking relief in drugs, alcohol, or self-destructive compulsive activity.

We live with an itch at our core that can only be scratched in certain ways.

It took a minute to sink in. Uncle Ron suddenly realized that he had left Gretchen at the store. When he left the parking lot, he was so focused in the front part of his DMN, planning for the future, envisioning his garden, that he didn’t connect to the back part of his DMN, the history that revealed he had a wife he adored, and the memory that they had driven to the store together.

“pirouette syndrome,” a circling back to make sure you’ve done something you’ve already done.

Chances are you did lock the door, took the eggs off the stove, and had your sunglasses on top of your head, but because you weren’t focused in the moment, niggling doubt keeps you panicked until you can go back and check.

catastrophic thinking is a form of rumination. Your boss throws off a comment that you perceive as a slight. The rear part of the DMN spins into overdrive, looking back at what she said, taking it apart, wondering what you did to deserve that.

Spend more time in the TPN focusing on a single task.

Productivity isn’t the point here. Moving the toggle switch is. As a practical matter, this means that the minute you start to ruminate and slip into brooding negativity, look elsewhere. Do anything. Walk around. Yell. Dance a jig. Dice celery. Play the piano. Feed your dog. Sing “Row, Row, Row Your Boat” while standing on one leg. Tie your shoes. Whistle “Dixie.” Blow your nose. Jump rope. Bark like a dog, howl like a wolf, call a radio show and vent like a maniac. Do a crossword. Work your brain. Read a book.

After a few cycles, you will move out of the DMN.

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

Whoever came up with the expression “one track mind” was inadvertently describing the TPN.

Located at the base and back of the brain in two kumquat-shaped lobes, the cerebellum is small—it occupies only 10 percent of brain volume—but it is powerful: it contains a full 75 percent of the neurons of the brain.

just as toddlers do, our VCS comes on like gangbusters once it gets growing and helps us master new physical skills.

take the example of learning to ride a bike. At first, almost everyone has trouble finding their balance and coordinating the many small muscle movements needed to control wobbling and avoid falling. But gradually you learn to make the minute corrections that maintain your balance. Your VCS connects with your motor neurons, you lean a little this way or that, then voilà! You are soon off and cycling.

frontocortical thinking is about a hundred thousand times slower than the cerebellum’s calculations.)

the pathways the cerebellum lays down tend to last. Once you learn to ride a bike, you can stay off bikes for decades only to get on again and ride off with hardly a quiver. Hence the expression “It’s like riding a bike” to describe a skill you need to learn only once to have learned for life. Anyone deeply engaged in an endeavor that requires split-second decisions out of nowhere is relying on the vestibulocerebellar system to kick in: a concert pianist, a brain surgeon, an airline pilot in an emergency landing.

His decision, which we think of more as a supremely conditioned reflex than an actual decision,

This entire process—this cascade of brain bifurcation points and synaptic firings—comes under the purview of the magnificent, newly knighted cerebellum.

dysfunction of the cerebellum could cause us to lose not only our physical balance, but also our emotional equilibrium.

“so does it regulate the speed, capacity, consistency, and appropriateness of cognition and emotional processes.”

Schmahmann introduced the idea of a universal cerebellar transform (UCT) that acts as a stabilizer of thinking, emotion, and behavior. He called the UCT an “oscillation dampener,” which means it works to diminish the erratic fluctuations in our thinking, feeling, and behavior.

he described it as capable of automatically “smoothing out performance in all domains” without interrupting conscious thought, much as it does for the bicycle rider.

This explains, at least in part, how you can guide a thought through a series of revisions, interruptions, or challenges in your mind without getting confused. It also helps explain how you can reach a fever pitch in a declaration of love without becoming psychotic, or how you can sustain anger without becoming incoherent.

it’s not a big leap to postulate that by beefing up or returning the cerebellum to top working order, you might beef up your braking power, enhancing control over thought and emotion without losing any talents or capabilities in the process.

MRI studies that show that the central strip down the midline of the cerebellum—called the vermis—is ever so slightly smaller in people who have ADHD than in people who do not,*1 it makes sense to think that stimulating and challenging the cerebellum/VCS, the way lifting a weight stimulates and challenges a muscle, might help reduce the negative symptoms of ADHD.

Among all the regions of the brain, the cerebellum is the most plastic, the most changeable of all, able to promote the growth of existing neurons, making them look, on scans, bushier, with more interconnecting branches, like full treetops. Basically, it’s been shown that you can take your cerebellum to the cerebellar gym and beef it up.

An obvious way to improve vestibular health and possibly increase cerebellar strength is to work on one’s balance.

In Zing, the subject first goes through a physical assessment of eye tracking speed and accuracy as well as attention span, either in person or online.

The exercises include rotational stimulation, which has you turn around and around, the way you did as a kid, to make yourself dizzy, thus activating the vestibular system. Or lateral stimulation, which includes tilting from side to side with variations on that theme. And then vertical stimulation, which includes jumping and hopping in place or hopping forward.