Attention is one of the brain’s most central cognitive control functions — the ability to selectively process relevant information while suppressing irrelevant information. Attention involves three subsystems (Posner’s model): the alerting network (maintaining arousal), the orienting network (directing attention to specific stimuli), and the executive control network (resolving conflicts, suppressing interference). The prefrontal cortex and anterior cingulate cortex are core nodes of the executive control network.
## The Neurobiological Basis of ADHD
**Definition and subtypes**: ADHD is divided into three subtypes — Predominantly Inattentive (informally called ADD), Predominantly Hyperactive-Impulsive, and Combined (most common). Diagnostic criteria: symptoms present before age 12, exist in at least two settings (e.g., school and home), cause substantial impairment in social or academic functioning, and cannot be better explained by another condition (anxiety, depression, bipolar disorder).
**Dopamine and norepinephrine dysregulation**: ADHD’s core neural mechanism involves dysregulated dopamine and norepinephrine signaling in the prefrontal cortex — specifically insufficient D1 receptor function, causing reduced working memory capacity, impaired impulse inhibition, and excessive immediate reward preference (high delay discounting). This explains why ADHD children struggle to suppress immediate impulses (playing) for future rewards (good grades), yet can focus for extended periods on immediately interesting things (games — because games’ immediate dopamine activation compensates for prefrontal dopamine deficiency).
## Evidence for Pharmacological and Non-Pharmacological Interventions
**Central stimulants**: methylphenidate (Ritalin) and amphetamine (Adderall) are first-line ADHD medications, improving prefrontal function by increasing synaptic dopamine and norepinephrine. Meta-analyses show effect sizes (ES ≈ 0.8-1.0) far exceeding most psychiatric medications, considered the most effective interventions for childhood and adult ADHD.
**Behavioral intervention**: for childhood ADHD, behavioral therapy (reward systems, structured schedules, immediate feedback) combined with medication yields best results. Executive function training (organizational skills, time management, task decomposition) is the core of non-pharmacological intervention.
**Exercise**: attention test scores improve approximately 20% after a single aerobic exercise session, with effects specifically targeting executive control (not simply arousal effects). Regular exercise is considered an important non-pharmacological ADHD management tool.
See [Flow State Psychology](https://sunqi.org/flow-state-psychology-en/) and [Huberman Lab ADHD episode](https://hubermanlab.com/tools-for-managing-adhd-and-improving-focus/).
