The Prefrontal Cortex and ADD

The Prefrontal Cortex and ADD

The prefrontal cortex (PFC) is the most evolved part of the brain. It occupies the front third of the brain, behind the forehead. It is often divided into three sections: the dorsal lateral section (on the outside surface of the PFC), the inferior orbital section, (on the front undersurface of the brain), and the anterior cingulate gyrus, (which runs through the middle of the frontal lobes).

Thoughtfulness and impulse control are heavily influenced by the PFC. The ability to think through the consequences of behavior–choosing a good mate, interacting with customers, dealing with difficult children, spending money, driving on the freeway–is essential for effective living in nearly every aspect of human life. Without proper PFC function, it is difficult to act in consistent, thoughtful ways, and impulses can take over.

ADD, also called ADHD, typically occurs as a result of neurological dysfunction in the prefrontal cortex. When people with ADD try to concentrate, PFC activity decreases rather than increases as it does in the normal brains of control group subjects. As such, people with ADD can have poor internal supervision, short attention span, distractibility, disorganization, and hyperactivity (although only half the people with ADD are hyperactive), impulse control problems, difficulty learning from past errors, lack of forethought, and procrastination.

Here are some common characteristics of ADD that clearly connect this disorder to the PFC:

The Harder You Try, The Worse It Gets.

Research has shown that the more people with ADD try to concentrate, the worse things get for them. Instead of increasing as it should, the activity in the PFC will actually decrease. This means that when a parent, teacher, Supervisor, or manager puts more pressure on a person with ADD to perform, he or she often becomes less effective. Too frequently when this happens, the parent, teacher or boss interprets this decreased as willful misconduct, and serious problems arise. While it is true that almost all of us perform better with praise, I’ve found that it is essential for people with ADD. When the boss encourages him to do better in a positive way, he becomes more productive. In parenting, teaching, supervising, or managing someone with ADD, it is much more effective to use praise and encouragement that are highly interesting or stimulating and relatively relaxed.

Short Attention Span

A short attention span is the hallmark of this disorder. People with ADD have trouble sustaining attention and effort over prolonged periods of time. Their attention tends to wander and they are frequently off task, thinking about or doing things other than the task at hand. Yet one of the things that often fool inexperienced clinicians assessing this disorder is that people with ADD do not have a short attention span for everything. Often, people with ADD can pay attention just fine to things that are new, novel or highly stimulating, interesting, or frightening. These things provide enough intrinsic stimulation that they activate the PFC so the person can focus and concentrate.


As mentioned above, the PFC sends inhibitory signals to other areas of the brain, quieting stimulation from the environment so that you can concentrate. When the PFC is underactive, it doesn’t adequately dampen the sensory parts of the brain, and too many stimuli bombard the brain as a result. Distractibility is evident in many different settings for the person with ADD. In class, during meetings, or while listening to a partner, the person with ADD tends to notice other things going on and has trouble staying focused on the issue at hand. People with ADD tend to look around the room, drift off, appear bored, forget where the conversation is going and interrupt with extraneous information. Their distractibility and short attention span may also cause them to take much longer to complete their work.


Lack of impulse control gets many ADD people into hot water. They may say inappropriate things to parents, friends, teachers, supervisors, colleagues, or customers. Poorly thought-out decisions also relate to impulsivity. Rather than thinking a problem through, many ADD people want an immediate solution and act without the necessary forethought. In a similar vein, impulsivity causes these people to have trouble going through the established channels at work. They often go right to the top to solve problems, rather than working through the system.

Conflict Seeking

Many people with ADD unconsciously seek conflict as a way to stimulate their own PFC. They do not know they are doing it. They do not plan to do it. They deny that they do it. And yet they do it just the same. The relative lack of activity and stimulation to the PFC craves more activity. Hyperactivity, restlessness, and humming are common forms of self-stimulation. Another way that people with ADD will “try to turn on their brains” by causing turmoil. If they can get their parents or spouses to be emotionally intense or yell at them, that might increase activity in their frontal lobes and help them to feel more tuned in. Again, this is not a conscious phenomenon, but it seems that many ADD people become addicted to the turmoil.


ADD is not a single or simple diagnosis and no one treatment method will work for everyone.  At the Amen Clinics, we can help you understand your brain and create a treatment plan that is targeted to your brain’s unique needs.  Call us today at 888-288-9834 or visit our website to schedule an appointment.


  • texastarheel

    Any plans to bring an Amen Clinic to the Fort Worth Metroplex area in the near future? (or Chicago?) Thanks

  • Fran Gourdet

    I couldn’t help but think about what ive learned from a Christian Education Seminar that i recently attwnded. Dr. Jane Healy was cited numerous times along with references to Raymond Moore’s book, “Better Late Than Early” about how early education can inhibit proper organization of Brain functions. Children. Being forced to concentrate sooner than their brains are ready…before it has completely developed and ready for intense study can cause permanent damage. Makes me wonder if our current education system and pressures for our children to learn to read early are contributing factors in the rise of ADD. Too many children are not out in the open country air just being children and we are keeping them from becoming fully functional adults.

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