Understanding Attention in People with ADHD

Attention is a cognitive process that allows us to select and concentrate on specific stimuli while ignoring others. This ability is crucial for navigating daily life, managing tasks, and responding to our environment. However, for those of us with Attention Deficit Hyperactivity Disorder (ADHD), managing attention can be a constant battle, often leading to chaotic and overwhelming experiences.

The Multifaceted Nature of Attention

Attention is not a singular process but a collection of sub-processes that function together. According to the hierarchical model proposed by Sohlberg and Mateer, attention can be divided into several distinct types:

• • Arousal: Our level of alertness and activation, whether we feel energized or tired.

• • Focused Attention: The ability to concentrate on a specific stimulus.

• • Sustained Attention: The capacity to focus on a stimulus or activity over an extended period.

• • Selective Attention: The ability to focus on one particular stimulus while ignoring distractions.

• • Alternating Attention: The skill of shifting focus between different tasks or stimuli.

• • Divided Attention: The ability to simultaneously pay attention to multiple stimuli or tasks.

 The Neuroanatomy of Attention

Attention involves various systems and brain regions. The neuroanatomical model by Posner and Petersen outlines three key attentional systems:

• • Reticular Activating System (RAS): Responsible for arousal and sustained attention involving the reticular formation, frontal areas, limbic systems, thalamus, and basal ganglia.

• • Posterior Attentional System (PAS): Manages focused and selective attention, particularly visual stimuli, and involves the posterior parietal cortex, lateral pulvinar nucleus of the thalamus, and superior colliculus.

• • Anterior Attentional System (AAS): Handles selective, sustained, and divided attention linked to the prefrontal, dorsolateral cortex, orbitofrontal cortex, anterior cingulate cortex, supplementary motor area, and neostriatum.

 Attention in Daily Life

Attention is fundamental in many aspects of daily life. For instance, driving requires almost all types of attention: staying awake (arousal), focusing on the road (focused attention), maintaining attention over long periods (sustained attention), ignoring irrelevant stimuli (selective attention), switching focus between the road, mirrors, and dashboard (alternating attention), and managing multiple actions like steering, accelerating, and checking mirrors (divided attention).

In academic settings, attention is vital for learning and retaining information. Sustained attention helps students remain focused during long study sessions, while selective and alternating attention aids in managing multiple sources of information and distractions.

Professionally, different jobs demand various types of attention. For instance, an air traffic controller needs high levels of divided and alternating attention, while a writer may rely more on sustained and selective attention.

 ADHD and the Battle for Attention

ADHD is characterized by difficulties controlling and directing attention and managing behavior. The brains of those of us with ADHD show anatomical differences in several regions, including the nucleus accumbens, striate nucleus, putamen, amygdala, hippocampus, prefrontal areas, and thalamus. These differences are linked to delays in brain maturation and contribute to the symptoms of ADHD.

A unique aspect of attention in ADHD is the phenomenon often referred to as “hyperfocus.” However, this term can be misleading as it encompasses two different mental states: flow and perseveration.

• • Flow: This is a positive, beneficial state of deep immersion and high engagement in a task or activity, typically accompanied by enjoyment. It is a universal human experience and is not unique to individuals with ADHD.

• • Perseveration: This is a characteristic of ADHD. It represents the inability to switch between tasks or mental activities, often leading to spending excessive time on a single activity, even when moving on to something else is necessary.

Other conditions also affect attention, such as anxiety and depression, which can heighten attention to negative stimuli, or brain injuries, which can lead to issues like distractibility or conditions like hemineglect.

Imagine being unable to tear yourself away from a task, even as your world crumbles around you. That’s the harsh reality of perseveration in ADHD. It’s not just a quirky trait—it’s a debilitating struggle that can disrupt every aspect of life.

In closing

Attention is a complex and essential cognitive process that affects every aspect of our daily lives. For those of us with ADHD, managing attention can be particularly challenging due to underlying neuroanatomical differences and the unique phenomenon of perseveration. However, understanding these challenges can lead to better strategies and support for those of us with ADHD, ultimately helping us navigate our daily lives more effectively.