ADHD and a cognitive/emotional integration overview
By Sophia DiLavore UA’25 and Jim Stellar
We have been meeting and talking about ADHD (Attention Deficit Hyperactivity Disorder) for a while, starting with a first blog and again with another second blog. Now it is time for us to write this larger overview (third blog) featuring the chief topic of this blog series, cognitive emotional integration (neocortex and limbic system) and bringing in the role of experiences.
In the general blog series, these experiences apply to students in college doing internships and learning from them about their chosen career path through a college academic major. Here, we want to discuss the experience of ADHD in patients and how the gut-feelings of going through ADHD contribute to the cognitive interpretation of their own ADHD and its treatment. Of course the clinical hope is to improve their prospects going forward. For example, in considering research on meditation, CBT, or other behavioral ways to get one’s emotions under control, how does that work to help people with ADHD?
ADHD
Both adolescents and adults describe their experience with ADHD as chaotic and emotionally overwhelming especially because of their difficulties in regulating processes like attention, impulses, and emotions. People with ADHD often have an inner monologue that consists of many different ideas/thoughts occurring simultaneously and constantly which makes it difficult to focus and regulate emotions which we talked about in another blog with signal to noise ratio. These obstacles can lead to greater sensitivity to emotional cues or “gut-feelings” which could be described as poor cognitive emotional integration. The ADHD person may find it more difficult to align their immediate emotional responses with more rational long term thinking. These gut feelings often drive impulsive behaviors, poor decision making and emotional instability which can negatively (or positively) impact their cognitive interpretation of one’s own self worth and their condition.
First, what is Meditation and mindfulness?
Mindfulness is a practice originating from eastern meditation traditions which emphasizes paying attention to the present moment and has three basic elements: intention, attitude, and attention. In other words, someone practicing mindfulness will be intentionally aware of his/her current experience. Through practice, one can learn to be able to direct attention through intentional self regulation in each moment. Mindfulness is seen as a way of being that involves observing thoughts, emotions, and physical sensations without judgment. It is a skill developed over time. Mindfulness was originally used to treat pain, but since then it has been adapted for a variety of conditions including ADHD.
There are two types of meditation: focused attention and open monitoring. Focused attention meditation involves concentrating on a single point like a thought, image or physical body sensation while tuning out any other environmental distractions. Mindfulness of breathing is a more common example and it is when a person focuses entirely on their breath deliberately noticing when their mind wanders and refocusing their attention back onto their breath. This practice helps reduce distractibility and improves one’s ability to remain focused on a task. Open monitoring (aka receptive attention) involves being aware of whatever thoughts, feelings, or sensations arise without focusing on any one entirely or reacting. This kind of meditation can lead to improvements in self regulation and impulse control because the meditator can strengthen their ability to deliberately/purposefully shift their attention between stimuli.
Pharmacological intervention for ADHD is common and expected for the most part when it comes to treating ADHD, but methods like CBT and Mindfulness training are not as well known or often talked about. Research like the Mindfulness Awareness Program, shows that self regulation and MT exercises can ameliorate ADHD symptoms namely by enhancing attention and improving task completions, self regulation, and impulse control.
Mindfulness based cognitive therapy (MBCT)
MBCT combines therapy and meditation which gives the patient an explanation for their symptoms and about ADHD itself. It has an element of Neuropsychotherapy which links neuropsychology and psychotherapy through an approach that aims to target specific brain mechanisms unlike traditional therapy. MBCT also integrates cognitive behavioral therapy (CBT) with neurobehavioral treatment. According to a recent paper, MBCT changes brain connectivity. This begins with the idea that there are interconnected brain areas that function as units. For example, consider the Default Mode Network DMN), about which we have written a blog. The DMN is a brain network or circuit that was first discovered when people had nothing to do (no task) and their minds wandered. The DMN network stretches from the frontal lobes (planning) back into more posterior brain cortical areas that may represent objects or actions. It is said that the DMN is active when one is thinking about themselves or others and it creates a coherent internal narrative about the self. By improving the functioning of the DMN and better integrating it with another network (task positive) the hope is that it could help reduce mind wandering and distractibility in ADHD patients. With meditation, the DMN activity is reduced which promotes increased focus and stronger functional connectivity of brain regions involved in cognition and self monitoring.
MBCT can be especially beneficial for adolescents and adults because if they can pinpoint certain behaviors to their condition they may find it easier to change their reaction to a response. Behavioral interventions seen in CBT are designed to help the patient develop skills such as planning, time management, and problem solving while during cognitive methods patients learn to identify and modify their problematic thinking patterns. Mindfulness and meditation can improve neuropsychological deficits in ADHD by strengthening function of brain regions which underlie the deficits. As mentioned above, people with ADHD often struggle with mind wandering, distractibility, and emotional dysregulation which mindfulness meditation could help seriously reduce. Instead of immediately acting on temporary emotional states the ADHD patient can observe their emotional states as temporary events that will pass which can improve their emotional regulation. This brain-network interaction is more and more common as clinical neuroscientists continue to develop their research with modern brain activity scanners.
Attention: Mindfulness training can have an impact especially because it is affordable, easily implemented, and sustainable over time. Research has focused on the Posner model of attention, which consists of three components: alerting, orienting, and monitoring. Each of these systems is supported by distinct brain networks that MT can positively influence. The alerting network, primarily supported by the reticular activating system, modulates alertness and prepares the brain to respond to new information by maintaining a state of readiness and sustained focus. Someone with ADHD may improve their ability to sustain their attention for extended periods of time with practice maintaining awareness of present-moment experiences/perceptions. The orienting network which is responsible for selecting relevant info from the environment is supported by the parietal lobe (and sensory lobes in vision, audition, etc.) and enables rapid attention shifts. This allows one to focus on key stimuli and adapt when conditions inevitably change.
Specifically through concentrative practices like breath focused meditation, a person with ADHD can improve their ability to swiftly redirect attention to the task intended. This would effectively reduce distractibility and the person with ADHD would become more responsive to important cues in their environment instead of responding to irrelevant cues leading them to pursue a different task. The conflict monitoring network regulates attention by prioritizing competing stimuli. The system involves the anterior cingulate cortex. This system is essential for managing impulses and controlling behavior because it allows people to anticipate their future actions by weighing competing demands on attention. During tasks that require self regulation, this ability is crucial and through mindfulness training one can strengthen this network by improving their ability to recognize distractions (or impulsive thoughts) without immediately reacting. Again, this would allow the ADHD person to respond deliberately rather than react immediately.
Memory
Working memory is the small amount of information the brain relies on while completing cognitive tasks that can be accessed quickly and efficiently. It is essential in carrying out daily tasks. Working memory deficits are linked to emotional processing, social skills, lack of focus, hyperactivity, and impulsivity in the ADHD person. Research is still investigating the effects of ADHD on short and longer term memory, but currently ADHD is shown to hinder the encoding of memory which could make it more difficult to retrieve the info in the future.
Episodic memory, which is the ability to recall past events and the specific context in which they took place, in the ADHD person is also impaired. Episodic memory is a form of long term memory that allows humans to guide their current and anticipated future behavior. It influences what information is placed into working memory and allows one to use the knowledge from the past and apply it to current and future tasks.
In a study from 2016 a multimethod approach to the investigation between mindfulness and episodic memory performance found that individuals who had practiced mindfulness performed better on tasks that required episodic memory recall. It can be assumed that mindfulness enhances memory retention by improving attention during the encoding of relevant information by reducing mind wandering/distractions. Recent neuroimaging studies have demonstrated that experienced meditators have increased levels of gray matter specifically in the hippocampus and right anterior insula. The hippocampus is known to be involved in learning, memory, and the modulation of emotional control while the insula plays a role in awareness which are important in the process of mindfulness training. Neuroplasticity can directly result from mindfulness training which has been shown from task specific increases in brain gray matter from the acquisition of abstract information, motor skills, aerobic training, and cognitive skills. Differences in regional gray matter are associated with performance abilities which suggests the increase in gray matter corresponds to improved functioning in relevant areas.
