Sustained Engagement and ADHD

Image from wikipedia that seems scientific

Article in NYT:

What if A.D.H.D. Isn’t About Attention at All? (link) Evidence suggests that it really affects what psychiatrists like me call sustained engagement — an important difference in understanding how to think about the condition.

By Awais Aftab Dr. Aftab is a practicing psychiatrist and writer. This is the first edition of a new series called Therapeutic Window, which explores the science and debates behind mental health diagnoses.

The classic features of A.D.H.D. include things like not staying on task, losing the thread of a conversation and forgetting instructions. They are failures of “sustained engagement.” 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. Doing so may be less a matter of filtering out distractions and more a matter of whether the task registers in the brain as worth doing in the first place....

[on explaining why stimulants seem to help ADHD]. Once this distinction is appreciated, the results of the Cell study stop being contradictory. 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.

This also helps explain why stimulants like amphetamines calm down hyperactive children. People without A.D.H.D. who use amphetamines often find themselves jittery and revved up, so the calming effect may seem counterintuitive. However, if a child is restless and fidgeting because the task at hand isn’t rewarding enough, then it makes sense that stimulants would help that child sit still and stay engaged rather than seek stimulation elsewhere.

The prospect of using medications to help children sit still in class and focus on tedious coursework, or using medications to allow adults to tolerate periods of intense boredom and dreary housework, makes many people uncomfortable.

scientific investigations into causes and treatments point toward problems with impulse control and motivation more than a defective capacity for attention