Use the Prefrontal Checklist
licia’s report cards were consistent from year to year. In fourth grade she
A was told to pay more attention in class; in seventh, to focus her attention on
the lesson; in ninth, that she was “not making good use of class time.” By
her senior year, she was described as “a capable student who must work harder
to achieve her potential.”
Again and again we hear about adults like Alicia who struggled in school
and were told they could succeed if they only tried a little harder, paid a little
more attention, and goofed off less. When they become adults, their loved ones,
employers, and colleagues may say similar things about them. People with FAST
MINDS traits often get off track despite wanting and trying to accomplish things
they care about. In this chapter, we explore the major factors that derail peoplem,
the brain system responsible for staying focused, and how to create the
conditions under which this system works best.
Planning and Controlling Behavior
Differences in the function of the prefrontal cortex appear to contribute to
ADHD. Brain-imaging studies have shown that the prefrontal region is a key
part of the circuit that governs our ability to engage in tasks. In some people with
ADHD, this circuit may be less active during organization and attention tasks
than it is in those without the condition.1
The prefrontal region has been described as a mental “sketchpad,” because
this is probably where plans are made for thoughts and actions. This region goes
through substantial development in adolescence and early adulthood as we
become more able to organize and plan our lives independently. Differences in
“maturation” of the prefrontal region may explain why the attention and
behavior problems of ADHD persist into adulthood in some people and not
others.2
Medication is thought to be effective for ADHD because it increases levels
of the brain chemicals norepinephrine and dopamine, which activate brain
machinery—including prefrontal regions—that control focus and behavior. At
the right levels, the brain operates better. Stress can also increase norepinephrine
levels, and rewarding activities increase dopamine. Some people with ADHD
function well under stress or intensely rewarding experiences—such as working
on a stock-trading floor or in an emergency room. But such lifestyles can be
draining, and many everyday tasks are hard to make as stimulating or rewarding.
Much of our behavior requires active control. The prefrontal cortex allows us
to make—and stick with—a pattern of behavior, such as continuing to read this
book rather than calling a friend, or countless other things. Brain-imaging
studies show that some people with ADHD have clear impairment of their
prefrontal function. Even if someone has good prefrontal function, the presence
of FAST MINDS traits puts their ability to control their behavior in high demand
—the prefrontal region may have to work harder to allow a person to keep
reading this book if they are easily distracted.
Three factors commonly impair the operation of our center for planned
behavior: lack of clear plans to follow, internal distractions (such as emotions,
thoughts, or stress), and external distractions (sounds, sights, or demands from
the offices and other environments around us).
RECOGNIZING YOURSELF
Imagine that you are in an everyday situation, such as a classroom,
conversation, or job:
Do you often get sidetracked while doing tasks?
Does your mind feel busy or clouded?
Do you find that thoughts and ideas pop up and leave you
daydreaming or distracted?
Do you keep thinking about other things you need to do?
Does sound and activity around you make it hard to work or
converse?
UNCLEAR PLANS
The brain’s behavior control center operates best when there is a clear plan of
what the behavior should be. If you’ve ever watched a group of young teenagers
trying to decide where to go, you’ve seen how unproductive it is to operate
without a plan. Chaos is inherently distracting. Anyone is more productive when
they know what step to take next than when they don’t—but for someone with
FAST MINDS traits, it’s even more important that the next action can be easily
held in mind.
INTERNAL DISTRACTIONS
PHYSICAL DISTRACTIONS: The brain’s control center doesn’t function
well if someone is unhealthy, poorly nourished, or tired—making it hard to
concentrate and learn. Illness, pain, or lack of sleep can all undermine brain
performance.
EMOTIONAL DISTRACTIONS: Excitement or dread can be distracting
—think of the night before a big trip, a performance, meeting future in-laws for
the first time, or starting a new job. Everyone has many different states of mind,
even in the course of one day, some of which are counterproductive to doing
effortful mental work. The intensity and changes in emotion are themselves a
kind of internal distraction, as thoughts shift with feelings.
PACE: Some people with FAST MINDS also seem to have an internal
restlessness—like a metronome constantly ticking—that keeps them needing a
fast pace or moving on from one thing to the next. Others talk about constantly
being distracted by their own ideas; before they’ve had a chance to complete one
thought, another one pops into their head and they drop the first to pursue the
second.
Does ADHD Impact Emotional Behavior?
For many years pioneer researchers in ADHD, such as Dr. Paul Wender
and Dr. Russell Barkley, noted that many adults with ADHD struggled
to control how they express their emotions. Those initial insights have
been confirmed by more recent research showing that many people with
ADHD are more likely to express anger or upset toward others,3 and
that these traits run in their families.4
The prefrontal region of the brain helps control reactions to
emotions, which may be due to connections with emotional regions of the
brain such as the amygdala. The amygdala contributes to emotional
reactions, and recent research suggests it may communicate differently
with the prefrontal cortex in some people with ADHD.5
