ADHD techniques for brain development

Context for this post's purpose: 

I have several friends who have various "prefrontal cortex" development issues that have the general label of ADHD, and they have different approaches to managing this: 

• some are diagnosed and use a combination of prescription drugs, and 
• some are not diagnosed and use a combination of coping skills.

In addition, I recently read the following:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894421/ Note that it is published in 2009, so this has been known for almost 15 years as of the date of this blog post. I have looked for similar articles that have been published more recently, but they were behind a paywall (https://link.springer.com/article/10.1007/s40474-019-00182-w), so I kept to the 2009 version.

In addition, I skimmed the following https://www.nature.com/articles/s41386-021-01132-0 as it describes everything we know so far about the PFC.

Tl;dr : read only the parts highlighted yellow.

This post's purpose:

I wanted to make a regimen of activities that are specifically designed to strengthen and develop the areas that are underdeveloped/atrophied in ADHD individuals as it would directly be able to help if they didn't have access to meds or coping skills were not working.

Exhibited Behaviors of ADHD

• Inattention: Difficulty sustaining attention, easily distracted, appearing not to listen.
• Impulsivity: Acting without thinking, difficulty waiting for turns, interrupting others.
• Hyperactivity: Excessive fidgeting, squirming, running around, inability to sit still.

Underlying Brain Structure

• Prefrontal Cortex (PFC):
  • Involved in attention regulation, behavior control, and emotion management.
  • enables organization, planning, and inhibition of responses to distractions to achieve a goal.
  • Right hemisphere is crucial for behavioral inhibition.
  • Underactive PFC observed in ADHD patients.
  • Smaller PFC size and weaker connectivity reported in ADHD individuals.
  • Slower PFC maturation in some ADHD cases
  • often comorbid with aggression and oppositionality
• Parietal and Temporal Cortices:
  • Involved in "bottom-up" attention, processing stimuli based on salience.
  • determines "what" something is
  • determines "where" things are and if moving
  • determines "orientation"
  • right side determines "visual space"
  • left side determines "time"
  • Potential role in some ADHD cases, especially those without hyperactivity or impulsivity.
• Basal Ganglia and Cerebellum:
  • Connected to PFC and involved in behavioral control.
  • Some studies report smaller size in ADHD patients.
• Catecholamine System:
• Norepinephrine (NE) and dopamine (DA) essential for optimal PFC function.
• Genetic variations affecting catecholamine transmission common in ADHD.
• Imaging studies suggest reduced NE and DA levels in ADHD brains.

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Understanding of the Prefrontal Cortex (PFC)

There are at least 4 models that try to explain and predict the PFC functions. The Predicted Response Outcome model has the most versatility and is suggested to capture the most important functions of the entire PFC. Duncan and colleagues’ MD framework incorporates goal-maintenance/biasing.

PFC development that comes before any higher thinking (childhood development):

- accurate representation of task goals (spatial and time) to be able to discern what task-irrelevant information/stimuli can be inhibited

- ability to monitor the environment (internal i.e. body and external) to be able to signal when the goal is no longer relevant

Note that if those two childhood development of PFC are not developed, then goal oriented cognition will result in frustration as the effort will be often on "inactive or ineffective" goals. There is some evidence that people who have compulsions/addictions are from a general impairment in goal-directed behavior (habitual tendencies and exacerbated by a loss of top-down control i.e. fixation on a "loud" goal). Related disorders are internalizing (depression and anxiety), externalizing (antisocial behavior and substance abuse), and thought disorders (schizophrenia, bipolar, OCD), but they are only correlated (not causal).

The PFC generally does:

1) general cognitive control (CC)

2) mental set shifting 

       - task switching (ability to switch context when changing tasks)

       - multitasking (focus on one task and keep track of others)

3) working memory updating

       - goal maintenance

4) motivation ("cool" and "hot")

5) response inhibition

       - associated with spatial working memory

6) other tasks that are not the focus of scientific studies

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My conclusions from those articles and my experience:

Development of the Parietal and Temporal Cortices (see bullet above) are the prerequisite to development of the PFC. Individuals who have not developed parts of those, will have "weird" cascade effects on their approach toward problem solving (fluid intelligence). From my experience, these individuals can be well adapted generally, but often have a behavioral addiction/compulsion.

Note that the different approach toward "what is" as determined by the development in the temporal and parietal lobes means that these people could sit next to a neurotypical person, and they would have a completely different experience and therefore different takeaways. This means that the PFC takes a focusing lens to an entirely different perspective/assumptions on the world, and this is either "garbage in/ garbage out" or "value add diversity of perspective". 

During adolescence and onward into adulthood, this is probably developed when the intense infatuation hormones make "loud" thoughts regarding sex, pain, food, and emotion. Teenagers frequently use superlatives because they are feeling the "biggest" they have ever felt before, and they tend to make more impulsive decisions (impulsivity is a multi-dimensional construct like the PFC's interactions with the rest of the brain based on the inconsistent findings from research). These observations are possibly due to the default of "bottom up" attention that was predominant during early childhood as the PFC was not fully developed. 

From my experience, there will always be frequent "loud" thoughts after adolescence. With these "loud" thoughts, there becomes a choice, to choose attending to goals or to "loud" thoughts.

Note that ADHD can be managed with "coping skills" to "work with" it.

Note that ADHD can be managed with prescription drugs to get into a "sweet spot" of the various neurotransmitters.

Note that my friends have recently have had both prescription drugs and coping skills fail to meet the demands of their day jobs.

Exercises to ameliorate ADHD symptoms

Ways to improve cognition

1) meditation after determining your goals and noting that the "loud" thoughts are to be ignored and the "goal oriented" thoughts are to be engaged with.

2) journaling to reflect on how the day went and how you attended (attention) to either "loud" or "goal oriented" thoughts.

3) planning the day to think about space, time, goals, resources (mental and physical) before during and after any endeavor.

4) gratitude requires recall and reflection (like journaling), and acknowledgement of all context (like Planning), and it is an inherently linked with positive things so it is a driver of happiness.

5) perform chores. This involves practicing bias toward goals and/or goal maintenance that dynamically involves planning and prioritization of stimuli that are less "loud".

6) periodically "notice" thoughts and discern which are "loud" and which ones are "goal oriented" then make a choice.

7) perform daily maintenance. Shower, shave, brush teeth, eat, get into bed on time, plug in your phone.

8) For each of the above cognitive process practice sets, they will likely be very difficult with a ADHD PFC. As such, they should be considered a "workout" like going to the gym but for the mind. Additionally, the best way to keep track of completing a difficult task is to write it down. 

1. For meditation, write down the themes in the "goal oriented" thoughts that you noticed. Do the same for the "loud" thoughts that you noticed.
2. For reflecting on the day, write down the "what happened and when" then highlight the "loud" parts and the "goal oriented" parts aka ADHD PFC specific journaling.
3. For planning the day, write down the space, time, goals, resources and allocate ahead of time. Pull out this planning sheet when something goes awry and resiliently change plans.
1. Consider checking the weather forecast
2. Consider the traffic forecast
3. Consider the changing mental/physical state of those involved (2:30 sleepy at office, tired 2hrs before bedtime, dehydrated/sore from exercise, etc.
4. To aid in multitasking & task context switching, have a running "to do" list ranked by priority. While performing a task and needing to switch, journal where a task was at on this list before you put it down. Refer to this journal when resuming the original task/context.
4. For gratitude, write down the context, actions, and results of various "loud" and "goal oriented" parts of the day. Get to a place where you can say "thank you for this experience" for each one and write it down.
5. For chores, write down the ones that you intend to do across the next few days. Plan what materials you will need and the time you will need and write down how it will fit into your schedule.
6. For these "notice" sanity checks, make a tally on a piece of paper or your hand to note how often you are "loud" oriented or goal oriented.
7. Create a "balanced scorecard" that you put the daily maintenance goals on. Create a column that specifically says what "goal" you are working toward e.g. teeth brushing is "social power/confidence"

The primary theme in these ways to improve cognition is that it isn't "general intelligence". It is practicing biasing your attention from loud emotions and ideas to goal oriented ones.

Exercises to exacerbate ADHD symptoms

Generally symptoms of depression and anxiety exacerbate ADHD symptoms.

1) Frame your thoughts in a manner where "you have no control" is a common theme. Reduce efforts to think differently and contemplate anxiety and depression from the lack of emotional regulation.

2) Drink a depressant (like alcohol) or get sleep in a manner that doesn't fit your genetics and age (Sleep time, interruptions, and body condition e.g. hydration)

3) Use technology to make a "loud" beep for every thing that you should attend to. Stress and anxiety should build from this "bottom up patched with one off planning" attention approach.

      -note that you can obtain this same level of stress by working in a managerial position at a "fast paced" job environment