The Prefrontal Cortex and ADD

The Prefrontal Cortex and ADD

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: 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). Did you know that the brain is the most evolved organ in the universe?

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. Damage to the prefrontal cortex can have far reaching effects, such as with YouTube star Logan Paul.

ADD/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.

ADD/ADHD & the Frontal Lobe

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 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. While it is true that almost all of us perform better with praise, I’ve found that praise 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, such as in Type 2 ADD or Inattentive ADD. 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 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.


  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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