Paying Attention: Multi-tasking, ADHD and the Beauty of Dopamine

Six years ago I remember standing in the kitchen of my 13-year old "little brother" (I was part of a big-brother-little brother program at the time), watching him simultaneously participate in 6 IM chats on AOL. I watched in disbelief as he responded to each of his friends. How on earth could he focus on 6 conversations at once? My mind could not grasp that possibility. Was this a new kind of mind, a new type of consciousness? Suddenly I felt like my parents must feel when they call on me to help them understand some new technological development. I felt dated.

Today there are more attentional demands made on us than at any previous time in our history. More and more messages bombard us from every direction, competing for our attention. At Hampton University’s commencement address President Obama cited the incessant flow of information and messaging as a potential diversion, a distraction. Messages are already coming to us more quickly, and in smaller packages. Paper letters have given way to e-mails and then finally to text messages. Everything is being reduced to sound-bytes. Is everyone ADHD these days? LOL

If Jason Watson and David Strayer, psychology researchers at the University of Utah, are right, then my little brother was not demonstrating his superior processing abilities and evolutionary advantage: he was simply processing multiple conversations in a shallow, superficial fashion, sequentially jumping from one conversation to the next, depriving each conversation of depth, clarity or cohesion of thought. Their research made me feel better and slightly more adequate in the face of the rising wave of technology.

According to Watson and Strayer, true multi-tasking is incredibly rare. The Supertaskers who can carry out multiple cognitive demands and experience no loss in efficiency make up a measly 2.5% of the population. The other 97.5% of us, sadly, cannot multi-task, and likely will never be able to. We can play mental ping-pong, and learn to speed up our transition times between tasks, but we’ll never be able to truly parallel process like those cape-wearing supertaskers. We’ll have to wait for evolution to catch up with the current environmental conditions. Maybe our grandchildren will be supertaskers? We can only hope.

Last month I travelled to Washington DC to attend a conference dedicated primarily to the art and science of paying attention. Learning and the Brain has two conferences per year, and the topic for the spring conference was: Focused minds: enhancing student attention, memory and motivation. For three days I listened to neuroscientists, MDs, psychologists and educational researchers explore the connections between the brain and attention, memory and motivation. Many of their ideas have application to our work with students and shed some light on what’s happening inside the brains of our students as they struggle to learn and master new concepts.

Selection and Prediction: Turning Up the Dopamine!

Dr. Judy Willis, a board-certified neurologist, middle school teacher, and presenter at Learning and the Brain, loves dopamine. She just can’t get enough of the stuff! And she knows that her students are dopamine junkies as well. Dopamine is one of the most important neurotransmitters in the realm of attention, inhibition and focus. Whatever stimulus gives our brain a splash of dopamine, our attention will surely go there.

Dr. Willis makes the point that attention is a process of selection. Before anything can be learned, it has to be selected by the brain. She showed her audience a really fun video to demonstrate the power of attention and selection. I found similar videos posted online.

Dr. Willis showed off her neurology chops and outlined the brain structures that are involved in attending. The primary player is the Reticular Activating System (RAS) which plays an essential role in arousal and awareness and helps regulate the cortex, the center of rational thought. The RAS, which has a limited capacity to process information, is on the lookout for several things. First and foremost, the RAS is highly alert to novel inputs, thereby allowing us to identify threats. If you’re on a hike, you may attend to a series of inputs: tree, tree, tree, tree, bear. Bear!!!! Novel input!! Pay attention!!!

Clearly, this can come in handy. If no threatening stimuli are present, the RAS will then select inputs based on curiosity, pleasure or the promise of something good. “Hmmm, this might be worth pursuing,” says the RAS. If there is nothing threatening and nothing stimulating, the RAS will begin to look inside for stimulation in order to keep itself occupied. If you are giving a lecture to a bunch of students who don’t seem tuned in to you, know that the “students are attending to sensory input, just not yours.”

One of Willis’ most interesting ideas has to do with the power of predictions to keep the RAS tuned in and turned on. Willis argues that making predictions is one of the most powerful ways to maintain students' attention and help them encode material into long-term memory.

Why are predictions so powerful and stimulating? It has to do with the dopamine circuitry. When you make a prediction, and it is correct, dopamine (the main neurotransmitter of the executive functioning system) is released from the nucleus accumbens, (a big ole’ sack of dopamine AKA the pleasure center) which finds its way up to the prefrontal cortex. Correct predictions jack up the dopamine levels, (more pleasure!), and incorrect predictions decrease the dopamine levels. This encourages the system to rewire the neural pathways to make better predictions the next time. Making correct predictions leads to learning, changes in the neural networks (neuroplasticity!) and the strengthening of those new connections.

So what does this mean? You need to get your students guessing and predicting. Put them in situations where they have to take some risks and stake out a position: get them to put their egos on the line. This makes intuitive sense. Are there any gamblers out there? Have you ever made a prediction, made a bet, and then found yourself disinterested by the outcome? Unlikely. More likely you were jacked up on dopamine after you placed the bet and eagerly anticipating the outcome.

I can relate this to my recent experience of our March Madness office pool. Normally I’m the farthest thing from a sports fan. For the sake of office camaraderie, I agreed to plunk down my $2 for the office pool and fill out a bracket. Holy cow! What a difference that made! The sheer power of filling out a bracket, making a prediction and a tiny wager: suddenly my dopamine system was plugged in. Last year, I didn’t watch a single game. This year I watched numerous games, checked the scores and my ESPN bracket daily, trash-talked on our ESPN office pool page, and even followed score updates on my iPhone, getting the play-by-play. Making a simple prediction turned me into an avid sports-fan, if only for three weeks.

It seems that when you can get the dopamine flowing, many good things follow. Researchers have found that increasing dopamine levels leads to heightened pleasure, curiosity, inspiration, motivation, persistence, perseverance, and creative imagination.

Dr. Willis mentioned other ways, in addition to using predictions, to keep the novelty and the dopamine flowing in the classroom. Engage the students’ senses: use photos and other visual images; write with different colored pens to communicate a hierarchy of informational importance; make videos online, make puzzles, show your kids fun images. She has more tools online at her website.

ADHD: It’s All About Inhibition

Like Dr. Willis, Dr. Martha B. Denckla is a dopamine fan, but her primary focus is on inhibition. She feels ADHD is more appropriately conceptualized as Attention Allocation Disorder, recognizing that there’s certainly no deficit in attention for students with ADHD; the attention is simply misallocated. When students are engaging in intrinsically rewarding activities, it is much easier for them to allocate and sustain attention. When students experience mastery over tasks, dopamine levels rise.

The challenge for ADHD students is inhibition. Inhibition tends to develop with age. Young children have a much harder time inhibiting their bodies, just as they have a harder time inhibiting their attention.

Below is a hilarious video of children struggling to inhibit themselves, which replicates Walter Mischel’s now celebrated Marshmallow Study (one marshmallow now, or two in 15 minutes). Self-regulation and the ability to inhibit are not inborn, but they develop over time.

Denckla provided other examples to illustrate her point about the stage development of inhibition. For example, when children are starting to write, they often move their tongues, echoing the movement of their hands. When children are asked to walk on their heels or on the outside edges of their feet, they will also hold their hands in a way to echo the movements of their feet.

I tried two of Denckla’s experiments with my 30-month old nephew, Elliott. I asked him to touch his thumb and index finger together, and he was unable to inhibit the other 3 fingers from moving. I also asked him to lift his left hand and touch his thumb and index finger together, then his thumb and his middle finger, then his thumb and his ring finger and so on, simulating counting on one hand. And like clockwork, as he did this “counting task” with his left hand, his right hand unconsciously echoed the movements.

Over time, Elliott will (hopefully) be able to inhibit these motor impulses and be more specific in his motor movements, just as he will eventually be able to inhibit his attention and gain more mastery over his cognitions. But for children with ADHD, the ability to inhibit motor reflexes and attention is greatly delayed. The inability to inhibit, which first manifests physically, especially in boys, will later manifest in impulsivity in other areas, including cognitive areas. For those kids who struggle with inhibitory tasks, it will take nearly all of their cognitive resources just to sit still. According to Denckla, if you let them wiggle and jiggle, move and fidget, they will no longer have to inhibit their motor control and will be able to better focus their cognitive energies.

Denckla outlined the development cycle for our various brain systems, which have a great deal of overlap and interaction. Motor control lives next to cognitive control, which lives next to emotional display control. These systems come to maturity sequentially. Motor control tops out at 15 years +/- 2 years. Cognitive control tops out at 25 +/- 2 years. Emotional Control tops at 32 +-/2. By the time you are 34, you should be humming along, with all systems fully mature: at least according to the brain researchers.

When it comes to the quality of attention experienced by students with ADHD, they have more of a “radar sweeping” or scanning kind of attention than do most other children. Thom Hartmann, offered the hypothesis that this scanning kind of attention may have been highly adaptive when we humans were in our hunter/gatherer mode. But in a classroom, a different kind of attention is required: the ability to narrow and focus your attention like a spotlight. Students with ADHD can certainly narrow their attention on a target that is intrinsically interesting or rewarding. However, if the target is not inherently interesting, these students will seem quite distractible. Denckla argues that if we give these students gratifying mastery experiences and choose intrinsically motivating topics whenever possible, we will have a greater success in activating their dopamine systems and engaging their full attention.

ADHD: It’s Not Just For the Boys!

Dr. Patricia O. Quinn, the current director of the Center for Girls and Women with ADHD in Washington, DC, encouraged the conference members to reassess their gendered views about ADHD. During the ‘80s and ‘90s, the primary model for ADHD focused on white hyperactive males in elementary school. I remember well my hyperactive white male friends who acted as if they were "driven by a motor” before popping their daily doses of Ritalin. I always liked hanging out with those kids! Man did they have energy! And researchers focused their own energy on these “energizer bunny-esque” boys, the low-hanging fruit of the ADHD landscape. Accordingly, of the 1500+ studies conducted on ADHD before the year 2000, only 20 studies specifically studied girls with ADHD.

The reason girls were so frequently overlooked in early ADHD research, according to Dr. Quinn, is twofold. First, the inattentive type of ADHD is more difficult to recognize than the hyperactive type, which is more common among boys. Second, girls tend to compensate better than boys. Generally girls are better than boys at getting help and recruiting social support to compensate for their attentional deficits. And even if it takes them more time, girls will do the work necessary to maintain their grades: sleep and social fulfillment will frequently be sacrificed to the altar of academic performance. I have had many moms tell me how their daughters work until the wee hours of the night, and still cannot finish their assignments. These girls feel a strong desire to please their teachers and their parents, and this frequently leads to feelings of pressure and anxiety to perform.

For girls with ADHD, impulsivity, inattentiveness and executive function deficits may persist and become problematic. Overwhelmed by demands for organization, planning and time management, many girls with ADHD will begin to struggle in middle school, feel overwhelmed in high school, and no longer be able to compensate for their ADHD by the time they reach college. Anxiety and internal distress may result from their inability to keep up with the increasing demands placed on them. This may lead to decreased feelings of self-esteem, isolation, and even depression. According to Dr. Quinn, 60% of the anxiety and depressive symptoms experienced by these girls are reduced significantly when their ADHD is treated.

ADHD For Everyone!

So ADHD is not just for the boys. And it’s not just for the girls. It turns out it may be for us adults too! The drug companies have been aggressively pushing adults to consider if they too might benefit from an ADHD medication. I remember in 2005 when a professional colleague and friend in his late 30s told me he had recently been diagnosed with ADHD and was given a prescription for one of the stimulant medications. He hoped that the meds would help him function better at work and in his social life.

I was taken aback. How exactly are we defining high functioning? And what constitutes the diagnostic criteria: "clear evidence of clinically significant impairment in social, academic, or occupational functioning?" Are we putting too much trust in the pharmaceutical companies who are marketing their products aggressively to an uninformed public? Has the medical community cast its net too wide with its diagnostic criteria for ADHD? Are doctors too eager to prescribe the meds and insurance companies too eager to reimburse for this diagnosis? Or are we creating more diagnoses by simply demanding more of our children and ourselves?

In my line of work I get to work with many students who have received an ADHD diagnosis. Though the DSM IV TR (Diagnostic and Statistical Manual of Mental Disorders; fourth edition, text-revisited) notes the prevalence of Attention-Deficit/Hyperactivity Disorder at 3-7% of school-age children, of the students I've worked with since 2001, I'd estimate 20% of my students have come to me with an ADHD diagnosis. One of my tutors mentioned that every student she has worked with this year has been diagnosed with ADHD. Some of my students resist the ADHD label and want no accommodations for their “disorder” while others heartily identify with it. I remember as a camp counselor and unit-head, hearing my campers competing with each other, comparing their dosages of Adderall, Concerta and Ritalin. Who’s the king of the ADHD? Who wants the title?

The Wrap-up

However we conceptualize attention deficits, and no matter our political stance towards the increasing diagnosis of ADHD, as educators, we must find ways to serve all of our students—male and female, attentionally endowed and attentionally challenged—and help them improve their own academic outcomes.

For those students who are struggling with attentional issues (and for some students this is very real, and can even be debilitating) we must help them find strategies to self-regulate their focus and attention. If we explain to children how their brain systems function—how their attention, memory, and motivation systems actually operate—I feel like we can set these students up with information that will help them help themselves. And as educators, let’s work to stimulate as much dopamine as possible in the classroom through engaging lesson plans, intrinsically motivating tasks, more choice, more challenge, more predictions and more stimulation for our students. Now that we know more about how the brain works, let’s use that information to better serve our students and help them become better learners.