The Prefrontal Cortex and ADD

This post has been updated from it’s original publish date.

If you have ADHD, also called ADD—or if you have a child with ADHD—it can make life more challenging in so many ways. For example, people may think you’re lazy because you show up late for work, or because you wait until the last minute to start your household chores or work assignments.

Your child may impulsively say rude things, which makes it hard for them to make friends. And that can have a negative effect on the trajectory of their life. It can make them feel like a failure.

What you may not realize is that attention-deficit/hyperactivity disorder (ADHD), or attention-deficit disorder (ADD), isn’t your fault. It’s due to faulty brain activity in an area called the prefrontal cortex.

Learning more about this important brain region and how it functions in people with the mental health disorder can change the way you view yourself or your child. And it can lead the way to better control over ADD/ADHD symptoms.

What you may not realize is that ADD/ADHD isn’t your fault. It’s due to faulty brain activity in an area called the prefrontal cortex. Click To Tweet


The prefrontal cortex (PFC), also known as the brain’s “executive center,” 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:
• Dorsal lateral section—on the outside surface of the PFC
• Inferior orbital section—on the front undersurface of the brain
• Anterior cingulate gyrus—which runs through the middle of the frontal lobes

The PFC is involved in many functions, such as:
• Focus and attention
• Planning
• Organization
• Forethought
• Judgment
• Empathy
• Impulse control
• Learning from mistakes
• Follow-through

Healthy PFC activity helps people think through the consequences of their behavior, which is essential for effective living in nearly every aspect of life. It impacts decisions related to:
• Choosing a good mate
• Interacting with customers
• Dealing with difficult children
• Spending money wisely
• Driving safely on the freeway

Without proper PFC function, it’s difficult to act in consistent, thoughtful ways, and impulses can take over. Damage to the prefrontal cortex can have far-reaching effects, such as with YouTube star Logan Paul. The YouTuber’s decision-making often lands him in hot water and made him the most hated celebrity in 2018.


ADD/ADHD is a neurodevelopmental disorder. Functional brain imaging with SPECT scans shows that it is associated with abnormal function in the prefrontal cortex.

On SPECT scans of people with healthy brain function, the act of concentrating increases activity in the PFC. However, when those with ADD/ADHD try to concentrate, PFC activity decreases rather than increases.

Healthy Brain SPECT Scan

In the healthy brain, there is full, even, symmetrical blood flow/activity.


In the ADD/ADHD brain, there is low blood flow/activity in the prefrontal cortex. In the image here, the holes indicate areas of low blood flow.

Due to low activity in the PFC, people can struggle with a range of ADD/ADHD symptoms, such as:

  • Poor internal supervision
  • Short attention span
  • Distractibility
  • Disorganization
  • Hyperactivity (although only half the people with ADD are hyperactive)
  • Impulse control problems
  • Difficulty learning from past errors
  • Lack of forethought
  • Procrastination


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

  1. The harder you try, the worse it gets.

Research has shown that the more people with ADD/ADHD 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 the person or student 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.

Although it is true that almost all of us perform better with praise, praise is especially impactful for people with ADD/ADHD. When the boss encourages an employee to do better in a positive way, it is more likely to lead to greater productivity.

In parenting, teaching, supervising, or managing someone with ADD/ADHD, it is much more effective to use praise than harsh criticism.

  1. You have difficulty paying attention.

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 fools inexperienced clinicians assessing this disorder is that people with ADD/ADHD do not have a short attention span for everything.

Often, people with the disorder can pay attention just fine to things that are new, novel, highly stimulating, interesting, or frightening. These things provide enough intrinsic stimulation that they activate the PFC so the person can focus and concentrate.

  1. You get easily distracted.

The prefrontal cortex sends inhibitory signals to other areas of the brain, quieting stimulation from the environment so you can concentrate. When the PFC is underactive, it doesn’t adequately dampen the sensory parts of the brain. This means that too many stimuli bombard the brain as a result.

Distractibility is evident in many different settings for the person with ADD/ADHD. In class, during meetings, or while listening to a partner, people with ADD/ADHD tend to notice other things going on and have trouble staying focused on the issue at hand.

These are the individuals who 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.

  1. You say and do things impulsively.

Lack of impulse control gets many ADD/ADHD 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, these 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.

  1. You like drama.

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” is by causing turmoil. If they can get their parents or spouses to be emotionally intense or yell at them, it may increase frontal lobe activity. This helps them to feel more tuned in.

Again, this is not a conscious phenomenon, but it appears that many children and adults with ADHD become addicted to the turmoil.


Anyone with ADD/ADHD needs to support the brain for better prefrontal cortex function. Strategies to optimize the PFC include:

  • Neurofeedback: Studies show that neurofeedback treatment improves ADD/ADHD symptoms.
  • Goal setting: Knowing what you want out of life can help you match your behavior to achieve your goals.
  • Meditation: Studies show that meditation enhances function in the PFC.
  • Higher-protein diet: Eating a diet that is higher in protein and lower in simple carbohydrates improves focus.
  • Nutraceuticals: Take supplements, such as omega-3 fatty acids, rhodiola, green tea extract, zinc, ginseng, and ashwagandha.

Some people may also benefit from stimulant medication to optimize brain function and control ADD/ADHD symptoms. Work closely with a mental health professional who uses functional brain imaging to ensure you get the most effective treatment.

ADD/ADHD and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.


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

    Comment by texastarheel — October 24, 2016 @ 5:43 PM

  2. 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.

    Comment by Fran Gourdet — October 24, 2016 @ 5:49 PM

  3. Wondering how this would manifest in someone with Ring of Fire ADD? Would the overstimulation (including of the prefrontal cortex) have these same symptoms with decreased impulse control, etc?

    Comment by Kirsten — April 9, 2018 @ 4:12 AM

  4. What about the impact of trauma — emotional,?psychological trauma and that maybe some people with the diagnosis of ADD / ADHD are actually dealing with Complex PTSD? The prefrontal cortex shuts down due to high stress; brains of developing children who are chronically stressed develop differently. The Adverse Childhood Experiences Study (ACEs) shows that people with high ACE scores live with many of the consequences listed as those challenging people with ADHD. Is the cure the same for PTSD as it is for ADHD? Will stimulant meds help or hurt the PTSD person who has been diagnosed as having ADHD? Where do you stand on all of this? Thanks!

    Comment by Carey — April 9, 2018 @ 4:46 AM

  5. What are the best energizers

    Comment by Carol — April 9, 2018 @ 6:30 AM

  6. I am diagnosed, at 60 years old, with ADD. Ofcourse I had an abusing father, had to go to school early and had a stressfull childhood. But it was strssfull because of my ADD that came with diisfunctional motor skills. Accidents, missteps, nearly drowned and falling down from stairs. It was not because I had to go to school, not because my father was abusive. (He had ODD). It was just because this particulair braindisfunction is hereditary for the biggest part and a child is born this way. The stress comes because of the ADD not the other way around. Maybe that the symptoms seem to have an overlap with other conditions. But the cause of ADD is INNATE. So, if you know somebody with such a child, look at the rest of the family and I guarantee that you will find somebody else with ADD.
    And ofcourse, stress, accidents, lack of oxygen during birth and other horrible things changes the brain. Maybe forever. But it is a consequence of something. ADD in itself is a cause.

    Comment by Sietske — April 9, 2018 @ 9:59 PM

  7. Good article. We need to spread the word that Hyperactivity does not define ADD anymore. It’s just a fraction of the possible signs and symptoms.

    Comment by Debbie Unterman — April 11, 2018 @ 7:09 AM

  8. Yep, I definitely have ADHD

    Comment by Gabriel T — July 8, 2018 @ 8:58 AM

  9. I love that I was able to get help for my child at the Amen clinics. It is definitely worth every penny and the best treatment we have ever received from any psychiatrist. Amen clinics are a blessing! Thank you Dr. Amen and your team of doctors for your knowledge and approach and the services you offer.

    Comment by Victoria V — July 17, 2018 @ 10:50 PM

  10. I grew up with Inflexible-Explosive Disorder, which is like ADD+constant temper tantrums+rigid inflexible thinking and obsession over hot button issues. What burns me up in retrospect (even after four decades!)is that my Father’s solution was to be an a**hole to me, taking TV away from me(for not “respecting” him), spanking me, and screaming at me(he screamed at my Mother constantly as well). My Mother went out and got help for me, but the last thing my Dad would ever think of was casting out for constructive help for my behavior at home. He didn’t want to know that coercion and punishment weren’t working. I ultimately just had to age out of the worst of IED.

    Comment by Steve Burstein — August 13, 2018 @ 5:46 PM

  11. Having suffered from ADD all through my 60 years, and a plethora of related sicknesses, I believe I have found out the actual cause behind this issue. I have looked around my family and have identified more than 10 relatives suffering from it without them knowing about it, including my mother and her father, my two kids and many others.
    After some intense research based on what I know is happening inside my head and observing it on a daily basis, DYSAUTONOMIA is the cause that I have zeroed in on.
    It is basically a malfunction of our autonomic nervous system where body nervous strength (not what Neuroscience tells you) is inadequate to handle body nervous responses to sleep/hunger/but mainly excitement caused in our digestive system due to sour or spicy or fatty food intake.
    Our sympathic nervous system responds to it but our parasympathetic nervous system is unable to control this excitement and that results in overall nerves pull across the body badly affecting the brain, resulting in deactivated PFC and thus causing ADD.
    Don’t believe me: cut these food items from your diet for 15 days- no sour items like orange juices or other sour juices, no spices, no fatty food like Pizzas, and see the affect on your sleep, your mood but basically ADD. Stay away from acidic foods/ drinks like coffee etc.?
    Give it a try and share your experience!!!!!!!!

    Comment by Moin — October 6, 2018 @ 12:19 AM

  12. Does anyone have any sources for this article?

    Comment by Kelsey S — January 27, 2019 @ 10:21 AM

  13. I’d like to learn more. I believe it’s in my family.

    Comment by Robert Whiteley — July 23, 2019 @ 2:47 PM

  14. Thank you for this article. Everything listed was exactly like me. I’m always in turmoil and unknowingly seeking it. People that know me know that I have no filter. I’d rather get to the point of an issue than to take care of the process. I just want the feeling in my frontal cortex to stop when I an under stress. I can’t calm down for hours after. Even weed doesn’t help it just makes that feeling in my frontal cortex stay longer. I really want to figure out what is wrong with me so I can do something to help it. I’ve always been like this and I need it to change. I’m just not about that life of taking pills and “seeing what happens”.

    Comment by David Kolakowski — October 12, 2019 @ 5:38 PM

  15. If you want a more accurate idea of how ADHD’s diagnosed, check out the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). It contains the most up to date info on the diagnostic criteria for ADHD. If you’re lucky, you might be able to find it at your nearest university library.
    Otherwise, you can google the website ADDitude Mag. In my opinion, it is one of the most comprehensive sources of information about ADHD outside the DSM-5. It also has posts written by people with ADHD. Best of luck!

    Comment by Rose — October 27, 2019 @ 9:06 PM

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