Updated: Dec 4, 2019
What's in a name? Well, some researchers, principally Dr. John Gray, believe that Attention Deficit Hyperactivity Disorder is a somewhat misleading title for this ever increasing phenomenon. It's not that people with ADHD have an actual deficit in attention, like they have less of it than the average person. Rather, it's an issue with how that attention is allocated and Dr. Gray prefers to use a term that gets at the neurological underpinnings of ADHD, which is low or inhibited dopamine functioning.
Dopamine is the main neurotransmitter for our brain's reward system, which in turn dictates functions such as memory, motivation, focus, and interest. Simplified, whenever we feel pleasure it is because of dopamine. If our dopamine functioning is diminished (through causes I will mention later) then we begin to rely on more intense experiences to stimulate higher levels of dopamine production. Without those intense experiences (think immediate gratification) we feel bored, distracted, and restless.
So is ADHD over diagnosed? If we think of it in terms of low dopamine functioning, it's actually not! Perhaps I'm projecting but I would say most, if not virtually all, of us have some level of low dopamine functioning that effects our ability to find pleasure in life experiences whose rewards come more gradually. Think of our propensity to eat something quick and high caloric instead of the slow release pleasure of preparing a healthy, home-cooked meal. Our need for alcohol or other addictive drugs to sooth us at the end of a long day. Video games and movies instead of books. Sensationalist headlines and memes instead of long, thoughtfully written essays or reports.
In our age of immediate gratification we could all use an enhancement in our dopamine functioning.
What are the causes?
We can't pinpoint one root cause. But there's a cycle of discomfort from boredom, to seeking high dopamine stimulation, which leads to an increased dependence on highly stimulating activities while simultaneously losing the ability to enjoy lower but longer lasting stimulation. The brain needs balance. Highly stimulating experiences are not bad for us but our brains need to recover through relaxation, healthy diet, sleep, and social bonding. If we spend too much time and neurological energy on stimulation then we effect the quality of these other aspects of our life.
Children with low dopamine functioning are more likely to misbehave and ignore their parents because they lose the ability to feel the normal dopamine stimulation that comes from pleasing your parents. Parents then use high intensive bribes (like ice cream or video games) to motivate their behaviour, exacerbating the problem.
John Gray, in his contribution to Warren Farrell's book entitled "The Boy Crisis," provides a list of environmental contributing factors of low dopamine functioning. I will share only some of these factors as I am not certain the research is conclusive on all of them. I think this theory needs to be further fleshed out by other researchers, so don't consider this definitive fact.
For example, apparently acetaminophen might lower our ability to restore dopamine production. This is largely due to research that linked ADHD in children with mothers who took fever suppressants or painkillers during pregnancy. Acetaminophen also inhibits the production of glutathione, a key hormone for healing brain injuries.
High blood sugar levels can injure the brain. Baby's brains can be overstimulated, especially in utero, from high blood sugar and this can result in a decrease in dopamine receptor sites. It's as if their brain is going, "Hmmm it appears the environment out there is highly stimulating, I better hold back on some of these receptors so I'm not overwhelmed when I get out there."
Other potential offenders include induced labour, pesticides, plastics, pornography, video games, sedentary lifestyle, chronic stress, stimulant drugs, zinc deficiencies, food sensitivities, and concussions.
So, what are the solutions?
I'm not ready to fully endorse every solution presented in his book but there are a few key behavioural and dietary changes that are bound to make a difference in your dopamine functioning:
Exercise increases blood flow to the brain, reduces stress, boosts the immune system, and is typically a slow release dopamine activity. Sweating also helps rid the body of toxins. For mental health and dopamine functioning it seems to me that a balance between intense workouts and longer, more leisurely exercise (like walking, hiking, etc.), is probably the ideal regimen.
Gut health is paramount for our mental health but I still don't know enough to give a clear outline as to how to guarantee a healthy GI system. I do know that a diet high in sugar feeds the wrong bacteria which could lead to all sorts of problems, one of which is low dopamine functioning. Cut the sugar from you and your kids' diets and the ability to delay gratification will surely improve. Also, it seems to me that more people than we think have severe food intolerances to things like unfermented soy, pasteurized dairy, and gluten. If you suspect this is the case, an elimination diet could drastically improve your ability to focus and maintain motivation.
And most importantly... do things the hard and slow way when feasible. We need practice finding pleasure in things that we need to wait for. Instead of bingeing your favourite Netflix show, set up a schedule so that you watch it weekly just like we had to back in the stone ages. Read more. Sit outside and appreciate the sky and the environment. Put your phone away when you talk to people. In fact put your phone away most of the time. Walk to the store if you have time. Meditate. Do one thing at a time.
One of children's number one motivations is to avoid boredom. If video games are an option they will always go to them but if they aren't an option, after the tantrum is over, they will find something else to do. We need to allow our children to get bored enough to spark their curiousity and hungry enough to eat their vegetables.
So, to be clear, I'm not arguing against the DSM definition of ADHD, but if we take a step back and call it by its neurological cause, we see that it is more prevalent than we think. We all have physical health in varying levels of quality and we all have mental health. How well our dopamine fueled reward system functions depends largely on some key lifestyle and dietary choices. When we think of it in these terms, ADHD ceases to be a label we throw at misbehaving children. Rather it becomes a call to a problem we all share to some extent.