I understand the energy of stimulant medications may help *inattentive type* ADHD people to focus: but how would they help someone who is already *hyperactive*?
It sounds counter-intuitive : ELI5?
In: 8
Our brains make a chemical called dopamine. It has many functions, including regulating our movements and making us feel rewarded when we use our brains to plan or to keep doing something when it’s not really interesting to us. People with ADHD have trouble with motivation and concentration because our brains aren’t able to make and use dopamine as effectively as others’, and this can make us constantly seek new experiences to create more dopamine, and sometimes to move in repetitive or compulsive ways. Stimulant medication works by making sure our brains don’t reabsorb all of our dopamine, and sometimes by also encouraging our brains to release a little more, and this helps both our concentration and regulation of our fine motor skills.
The way I describe stimulants for my ADHD is that they’re like high octane gas for my brain.
Your prefrontal cortex, which is at the front of your brain, regulates what’s known as “executive functions”. It’s the sensible, logical processing part of your brain and it helps manage your control.
Think of ADHD as your prefrontal cortex being like a faucet that’s clogged up. All these brain inputs are trying to flow through the prefrontal cortex, but it’s not able to process everything effectively, resulting in sputtering, ie. impulsive behaviors, hyperactivity, speaking out of turn, inattentiveness, all these things we associate with ADHD. Your brain is processing, trying to get everything out, but your prefrontal cortex can’t keep up with it and regulate it.
As the “high octane gas”, stimulants help kickstart that prefrontal cortex into the right speed. It brings it in sync with the rest of the brain, so that there are no “knocks and pings” and crazy ADHD things. Suddenly the faucet is unclogged and things can flow normally.
Adhd is more accurately described as an inability to regulate attention. Hyperactivity is just a common consequence of that deficit, mainly in children–people with adhd often grow out of obvious hyperactivity once they reach teens or adulthood, and plenty of people never show this symptom!
Stimulant medications help the adhd brain regulate attention by increasing levels of dopamine. You can think of the adhd brain as inherently dopamine-starved, and as a result it’s always looking for its next fix. Dopamine is the fuel for our reward center. Its generally released in response to pleasurable things and things that are good for us. You might get some dopamine release from a hug or good food, but also from cleaning the house. The feeling of satisfaction from a job well done? Dopamine. In this dopamine-starved environment, however, the reward system is dysfunctional/disregulated. The adhd brain always wants more, more, more dopamine and that means if its under-stimulated, it’s distracted by anything and everything that seems more interesting, exciting, or novel, and if it finds something hyper-stimulating, it cant stop. The artificial dopamine release from stimulants makes that brain environment a bit more like a neurotypical one.
We think of stimulants as, well, stimulating because in a neurotypical brain adding dopamine raises levels to a supernormal state instead of normalizing them. That creates extra energy, and hyperfocus where *everything* seems ultra-interesting/motivating. This can happen with adhd too if one takes more than the therapeutic amount.
For more reading about the science of adhd and stimulants, I highly reccomend the work of Dr. Russel Barkely, to whom I credit the information above.
Jack Panksepp discovered the play circuitry in mammals and was able to successfully suppress this circuitry using stimulants
The stimulants stop you from wanting to play, so when you no longer want to play you are less curious and more obedient and since you are less curious the brain does not go wandering and is able to better focus on a single taks
I’m sure there are plenty of other things that the drug does and so the above could just be a side effect but it is pretty interesting what happens to a person who is not able to develop the play circuitry fully …
Brains run on dopamine. It’s the reward chemical for doing things we’re supposed to do. Most brains have a properly set tolerance for dopamine; they can feel the reward at a reasonable level.
ADHD brains generally have a higher tolerance for dopamine, they need more to achieve the same effect neurotypical people experience. This is partially why ADHD brains hyper-fixate on things they find interesting. ADHD brains are STARVING for dopamine, so whenever they find something that can produce enough to reach their threshold, they fixate on it.
Stimulants raise the overall level of dopamine in the brain to make it easier for additional dopamine to reach ADHD level thresholds.
Fabulous question! We all find a certain level of stimulation rewarding, and in its absence, we experience boredom, which propels us to seek stimulation. That sensation of reward from stimulation comes from the reward circuit in the brain, which is activated by dopamine. Kids with ADHD have to work extra hard to switch their reward circuit on, and their hyperactivity is usually in pursuit of novel stimulation. If we give stimulants, it provides dopamine, which makes it easier to activate the reward circuit, so the novelty seeking behaviour, including hyperactivity, calms down.
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I have two ELI5 analogies I like to use:
1) Imagine there is a gauge in your head that measures how bored or attentive you are; “maddeningly bored” at one end “overstimulated” at the other. Now, Imagine being stuck in a boring place. As you stay there longer, you start to get bored and your interest gage starts to go down. As this happens, you start to get antsy and you need something, *ANYTHING* to stop the boredom. If you find something interesting, you calm down and your gauge goes up. Now Imagine being at a big party. There’s so much going on that you might start to feel overwhelmed. This is what it means to be overstimulated.
How does this relate to ADHD? Simple, ADHD brains get to that bored and antsy state much easier than normal people. Their meter will be at “bored” when other people are at “neutral”. Giving them a stimulant will artificially push their interest meter to neutral. Meanwhile, a person without ADHD can take the same stimulant and it’ll push their meter from “neutral” toward “overstimulated”.
2) Imagine your brain is a corporation (there have been quite a few cartoons to use this, so I think you get the gist.) Different parts of your brain are all doing their own tasks as different branches of the corporation. The head of this company is the Chief Executive Officer, the prefrontal cortex.
As the CEO, it’s the PFC’s job to take in the info from other parts of Brain Co., decide what the company should do, tell the rest of the brain how to do it, and repeat. In short, the PFC’s “function” is decide what the body should “execute” (hence “executive functioning”).
Now, there is simply too much work for the PFC to review every little detail. So, the PFC allows different brain departments to work with varying degrees of oversight. The “keep the heart beating” department doesn’t hear from the PFC often, but the speech center is constantly in touch. Some parts of the brain might decide that the PFC takes too much time and things need to happen now! If you touch a hot pan, for example, your spinal cord will have already told your body to move before your brain gets the memo. Various parts of the brain that deal with emotions can also do this if you aren’t careful. If you’ve ever been so mad that you don’t realize what you are doing, it’s because your PFC has lost control.
A person with ADHD has a decreased blood flow to the PFC. In other words, their CEO’s office is understaffed, underfunded, and the other departments are more likely to ignore it. Their CEO can issue orders and the rest of the brain will generally follow, but other parts are able to much more easilly talk over the poor PFC at corporate meetings.
Stimulants increase blood flow. This gives the CEO gets more resources to get the rest of the brain under control.
The short answer is that hyperactivity is simply the adhd-brains way of creating more energy. With medication your brain can focus on more important things instead
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