Not every attention deficit is ADHD*

Attention is not a single process in our brain. Let’s think about that for a moment. The fact that languages have one word for a phenomenon does not mean that, at the level of biological processes, it constitutes one unified phenomenon. In cognitive psychology as well as in clinical psychology, very different things are studied under the label of “attention”—we can focus attention, sustain attention, switch attention, as well as use selective and divided attention [1, 2]. All of these are supposedly measured with different tests (which in reality can never fully assess them separately), and most of the findings in our research about these individual functions are also based on such test-driven (theoretical) distinctions. Just as we cannot neatly separate the different forms of attention, these forms of attention are not clearly distinguishable from other mental functions such as working memory or executive functions either. As we discussed in the previous post—the psyche functions as a whole. (Pro tip: the next time you read an article about attention, ask yourself whether it defined what attention is, and whether that definition was the same as in the previous or next article you read).

What we cleim in everyday life and in non-scientific language to be “attention deficit” is not always a problem with attention processes. We say we have trouble concentrating when we read a page of a book but then don’t remember what we just read (was that a lapse of attention, working memory, or memory retrieval?), when we walk into a room and forget what we went there to get (note the word “forget” here—why isn’t this a memory or a planning problem?), when we cannot fully attend to a friend’s story because our head is full of other thoughts or because phone notifications keep grabbing our attention (is that a problem of attention or executive functioning?), or when we procrastinate on uncomfortable or difficult tasks (could that actually be an emotion regulation issue?). In fact, these might not even be meaningful questions to ask, because if the psyche functions as a whole, it’s quite inevitable that if one part has major difficulties, the other parts (and the whole system) are affected as a result. But just because we notice or can describe (or have language for) a type of problem does not mean that is the real source of the problem.

Attention deficits arise for many reasons. We’ve all probably noticed that after a very poor night’s sleep, all attention processes are impaired the next day. The same happens when we are very hungry or when our body temperature is elevated. This means that attention problems can arise from biological causes—when the body does not have enough resources to cope with environmental demands (because resources are lower than noirmal for some reason). Attention difficulties can also occur when the incoming flow of information exceeds the brain’s ability to manage or process it at any given time. We all have a range within which we can operate and when its upper limit is reached our ability drops ( even a computer eventually crashes if too many programs are running at the same time). This can happen when we are preoccupied with worries, have taken on too many (or too complex, or both) tasks, or simply because our phones and the internet constantly bombard us with too much information we feel we must keep up with. Likewise, pathological states/symptoms not directly related to attention deficit disorder— such as anxiety, obsessive thoughts, or intrusive traumatic memories—can also overload the brain’s resources. Of course, attention difficulties can also result from a nervous system that has developed with significantly lower-than-average attentional capacity, where even ordinary or minor demands become overwhelming—this is the condition for which the ADHD diagnosis was originally created. But this accounts for only a very small portion of the widely spread attention deficit problems today.

Since attention difficulties in most cases are a sign of overloaded resources—whether in the body as a whole or more specifically for the cognitive functions —effective intervention and solutions also require addressing the body's resources, environmental demands, and their balance. Medication can only temporarily support these resources, because the human organism is highly adaptive—if it senses more resources are available, it will gradually start demanding more of itself again and often end up back at the starting point. Unless the person understands the causes of their attention difficulties and changes the underlying mechanism. If the cause of attention difficulties is, for example, constant anxiety, worry, or traumatic memories consuming resources, then boosting resources with medication can actually backfire—now there are even more resources for worrying or ruminating. (In fact, the same logic applies to other mental disorders, not just attention problems.) [3]

This is also why it does not seem reasonable to me to label attention difficulties in adults, caused by nervous system overload, with the same diagnosis as a developmental condition where the nervous system formed with lower-than-normal attentional capacity. (An analogy from physical health would be diabetes: type I and type II are clearly distinguished diagnoses.) Effective interventions for managing these difficulties differ, and the prognosis is also very different. Personally, I also do not support labeling normal, inevitable processes as a disorder (though if we look at the diabetes analogy again,, it may in cases when it has devastating effects on health make sense—since the dramatic increase of type II diabetes is most likely the body’s adaptive reaction to changes in food composition). Attention difficulties that arise from information overload or from (self- or socially-imposed) performance expectations that exceed what the human mind can actually handle rarely have a devastating effect in and of themselves. The harm arises beforehand, in the processes that trigger the attention problems.

It’s important to remember here that just because something is not pathological or a mental disorder does not mean that a person is not struggling with it or that they wouldn’t deserve help in managing the situation. There are loads of things one can do to helo this situation. None of them in the form of a pill though, as inconvenient as that may be. Similarly, type II diabetes is often reversible with lifestyle changes, and without such changes it is usually poorly controlled by medication alone. On the positive side, improvements in attention processes can be achieved with simple means and don't even necessarily require years and years of therapy. What this might look like is possibly discussion for another blog post. And if the source of the attention deficit is another physical or psychological issue, the proper intervention should target that directly, not treat the indirect symptom.

In many ways, attention deficit is very similar to a fever— both are noticeable symptoms that require little knowledge to report, but are not a disease in themselves. The cause of the fever must be determined by a specialist through careful investigation, and rarely can a person figure this out reliably on their own. And only very rarely is the cause of a fever that the brain’s temperature regulation center itself is malfunctioning.

*ADHD = Attention Deficit Hyperactivity Disorder

References

[1] Krauzlis, R. J., Wang, L., Yu, G., & Katz, L. N. (2023). What is attention?. Wiley Interdisciplinary Reviews: Cognitive Science, 14(1), e1570.

[2] Hommel, B., Chapman, C. S., Cisek, P., Neyedli, H. F., Song, J. H., & Welsh, T. N. (2019). No one knows what attention is. Attention, Perception, & Psychophysics, 81(7), 2288-2303.

[3] Shaffer, C., Westlin, C., Quigley, K. S., Whitfield-Gabrieli, S., & Barrett, L. F. (2022). Allostasis, action, and affect in depression: insights from the theory of constructed emotion. Annual review of clinical psychology, 18(1), 553-580.