Psychoeducation
The following short videos explain more about the neurological processes associated with ADHD.
Psychoeducation Videos
Further Reading on Psychoeducation
Distraction
Distractibility in ADHD is primarily triggered by external stimuli – noises, movement, external visual sensations. The cause of this is in the interaction of two attention networks in the brain: a ventral frontoparietal network driven by and responding to sudden stimuli in a reflexive manner (“bottom-up”) and a dorsal frontoparietal network consciously controlling attention in a goal-directed way (“top-down”) (Corbetta & Shulman, 2002). A meta-analysis found reduced activation in both these networks in children with ADHD (Cortese et al., 2012). One study of 7 to 11-year-olds showed: when irrelevant sounds were to be ignored in a targeted way, the corresponding brain activity was measurably weaker than in children without ADHD; thus, it is more difficult to suppress background noises (Fu et al., 2022). Another study of 9 to 12-year-olds also found reduced activation in the parietal lobe, a brain area important for the processing of visual stimuli, when ignoring visual distractors (Booth et al., 2005).
In the VR scene, there are constant new external stimuli that may distract you from working on the actual task.
Memory
Working memory – the capacity to retain information in your head for a short time and to work with it – is primarily controlled by the prefrontal cortex (PFC). It keeps a focus on relevant information while at the same time controlling how to respond to it, depending on what is required for a given task (D’Esposito & Postle, 2015). A study of 362 children showed significantly reduced activation in the left inferior frontal cortex (inferior frontal gyrus), an area associated with attention control, in children with ADHD during a working memory task (Li et al., 2023). This makes it more difficult to retain and process several items of information at the same time. A meta-analysis of 26 studies confirms this at the behavioural level: there are significant deficits in both verbal and spatial working memory, irrespective of intelligence (Martinussen et al., 2005). The PFC is also dependent on the neurotransmitters dopamine and noradrenaline for stabilising information against disruptive stimuli (Clark & Noudoost, 2014).
In the VR scene, you need to retain several items of information in your memory while new ones are constantly added. Disruptive stimuli make it more difficult to retain information.
Daydreaming
Daydreaming differs from distractibility by external stimuli: here, it is internal stimuli, self-referential thoughts, that distract. This is due to the default mode network (DMN), a brain network activated primarily when the brain is not engaged in a goal-directed task (Raichle et al., 2001). The DMN has some overlap with the limbic system, a network of deep brain structures (including the hippocampus and amygdala) that stores memories and processes positive and negative emotions. The hippocampus, in particular, is part of both systems. Emotional evaluation in the amygdala and memory checks in the hippocampus converge in the nucleus accumbens, the so-called reward centre, part of the basal ganglia. There, along with dopaminergic signals, these inputs are “converted” into a reward and thus the motivation to act (Rajmohan & Mohandas, 2007). A study of 7 to 10-year-olds found alterations in connectivity between limbic areas and the prefrontal cortex in ADHD (Fateh et al., 2023). In addition, an experimental study of 7 to 12-year-olds showed: when children with ADHD were encouraged to engage in self-referential thinking, their attention was significantly more impaired afterwards than in children without ADHD (Merrill et al., 2022).
In the VR scene, perception slips away into an inner, dream-like state, with the outside world temporarily fading into the background.
Hyperactivity
Motor restlessness in ADHD is closely linked to the basal ganglia. These deep brain structures control movements. The putamen plays a crucial part in this. It regulates movement and is strongly influenced by the neurotransmitter dopamine (Rocha et al., 2023). Impulse control is also closely connected to these dopaminergic circuits (Dalley & Robbins, 2017). A study of 6 to 12-year-old boys showed: an altered activation pattern in the putamen was directly correlated with the ability to sit still (Teicher et al., 2000). In addition, a longitudinal study of 270 children found an early-onset, stable surface reduction in the dorsal striatum – the area of the basal ganglia that includes the putamen – that persisted from childhood into adolescence (Shaw et al., 2014). A finding relevant to day-to-day school life is that, in an attention task, the performance of children with ADHD improved significantly when they were doing some light exercise, which was accompanied by increased prefrontal activity. In children without ADHD this made no difference (Hoy et al., 2024).
Thus, it is often only movement that brings about the brain activity required for attention – including in the VR scene.
Dr. phil. Theda Heinks
Neuropsychologist (FSP) and certified ADHD coach
Booth, J. R., Burman, D. D., Meyer, J. R., Lei, Z., Trommer, B. L., Davenport, N. D., Li, W., Parrish, T. B., Gitelman, D. R., & Mesulam, M. M. (2005). Larger deficits in brain networks for response inhibition than for visual selective attention in attention deficit hyperactivity disorder (ADHD). Journal of Child Psychology and Psychiatry, 46(1), 94–111.
Clark, K. L., & Noudoost, B. (2014). The role of prefrontal catecholamines in attention and working memory. Frontiers in Neural Circuits, 8, Article 33. https://doi.org/10.3389/fncir.2014.00033
Corbetta, M., & Shulman, G. L. (2002). Control of goal-directed and stimulus-driven attention in the brain. Nature Reviews Neuroscience, 3(3), 201–215. https://doi.org/10.1038/nrn755
Cortese, S., Kelly, C., Chabernaud, C., Proal, E., Di Martino, A., Milham, M. P., & Castellanos, F. X. (2012). Toward systems neuroscience of ADHD: A meta-analysis of 55 fMRI studies. American Journal of Psychiatry, 169(10), 1038–1055. https://doi.org/10.1176/appi.ajp.2012.11101521
Dalley, J. W., & Robbins, T. W. (2017). Fractionating impulsivity: Neuropsychiatric implications. Nature Reviews Neuroscience, 18(3), 158–171. https://doi.org/10.1038/nrn.2017.8
D’Esposito, M., & Postle, B. R. (2015). The cognitive neuroscience of working memory. Annual Review of Psychology, 66, 115–142. https://doi.org/10.1146/annurev-psych-010814-015031
Fateh, A. A., Huang, W., Hassan, M., Zhuang, Y., Lin, J., Luo, Y., Yang, B., & Zeng, H. (2023). Default mode network connectivity and social dysfunction in children with Attention Deficit/Hyperactivity Disorder. International Journal of Clinical and Health Psychology, 23(4), Article 100393. https://doi.org/10.1016/j.ijchp.2023.100393
Fu, T., Li, B., Yin, W., Huang, S., Liu, H., Song, Y., Li, X., Shang, H., Zhou, Y., Cheng, D., Cao, L., & Dang, C.-P. (2022). Sound localization and auditory selective attention in school-aged children with ADHD. Frontiers in Neuroscience, 16, Article 1051585. https://doi.org/10.3389/fnins.2022.1051585
Hoy, B.-A., Bi, M., Lam, M., Krishnasamy, G., Abdalmalak, A., & Fenesi, B. (2024). Hyperactivity in ADHD: Friend or foe? Brain Sciences, 14(7), Article 719. https://doi.org/10.3390/brainsci14070719
Li, X., Motwani, C., Cao, M., Martin, E., & Halperin, J. M. (2023). Working memory-related neurofunctional correlates associated with the frontal lobe in children with familial vs. non-familial attention deficit/hyperactivity disorder. Brain Sciences, 13(10), Article 1469. https://doi.org/10.3390/brainsci13101469
Martinussen, R., Hayden, J., Hogg-Johnson, S., & Tannock, R. (2005). A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 44(4), 377–384. https://doi.org/10.1097/01.chi.0000153228.72591.73
Merrill, B. M., Raiker, J. S., Mattfeld, A. T., Macphee, F. L., Ramos, M. C., Zhao, X., Altszuler, A. R., Schooler, J. W., Coxe, S., Gnagy, E. M., Greiner, A. R., Coles, E. K., & Pelham, W. E., Jr. (2022). Mind-wandering and childhood ADHD: Experimental manipulations across laboratory and naturalistic settings. Research on Child and Adolescent Psychopathology, 50(9), 1139–1149. https://doi.org/10.1007/s10802-022-00912-6
Raichle, M. E., MacLeod, A. M., Snyder, A. Z., Powers, W. J., Gusnard, D. A., & Shulman, G. L. (2001). A default mode of brain function. Proceedings of the National Academy of Sciences, 98(2), 676–682. https://doi.org/10.1073/pnas.98.2.676
Rajmohan, V., & Mohandas, E. (2007). The limbic system. Indian Journal of Psychiatry, 49(2), 132–139. https://doi.org/10.4103/0019-5545.33264
Rocha, G. S., Freire, M. A. M., Britto, A. M., Paiva, K. M., Oliveira, R. F., Fonseca, I. A. T., Araújo, D. P., Oliveira, L. C., Guzen, F. P., Morais, P. L. A. G., & Cavalcanti, J. R. L. P. (2023). Basal ganglia for beginners: The basic concepts you need to know and their role in movement control. Frontiers in Systems Neuroscience, 17, Article 1242929. https://doi.org/10.3389/fnsys.2023.1242929
Shaw, P., De Rossi, P., Watson, B., Wharton, A., Greenstein, D., Raznahan, A., Sharp, W., Lerch, J. P., & Chakravarty, M. M. (2014). Mapping the development of the basal ganglia in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(7), 780–789. https://doi.org/10.1016/j.jaac.2014.05.003
Teicher, M. H., Anderson, C. M., Polcari, A., Glod, C. A., Maas, L. C., & Renshaw, P. F. (2000). Functional deficits in basal ganglia of children with attention-deficit/hyperactivity disorder shown with functional magnetic resonance imaging relaxometry. Nature Medicine, 6(4), 470–473. https://doi.org/10.1038/74737