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 IS THE PREFRONTAL CORTEX?

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 BRAIN-BASED DISORDER

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.

ADD/ADHD Brain SPECT Scan

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

ADD/ADHD AND THE PREFRONTAL CORTEX

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.

2. 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.

3. 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.

4. 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.

5. 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.

SUPPORT THE PREFRONTAL CORTEX

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.