Greetings my friend!
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Where has the time gone!? It's nearly April!

What makes us feel urgency? How do we anticipate the future? How do we motivate ourselves to do the things that will benefit us in the future (but not now)? How do we decide which of those things will be most important? How do we focus on those things and avoid distraction?

This list of questions sounds a lot like the list of executive functioning skills from my second newsletter. What ties them all together? Dopamine.

We hear a lot about dopamine, but often that information is simplified and meme-ified. It’s actually a lot more complicated, but within that complication is an opportunity.

Understanding our brain helps us to better understand our behavior and to work with our biology, rather than against it.

Here is a great quick primer on dopamine from How to ADHD: How Dopamine Affects Learning and Motivation in ADHD Brains​

Dopamine is a neurotransmitter (chemical messenger) involved in:

• Focusing attention
• Maintaining and updating working memory
• Making decisions
• Learning
• Motivation
• Emotion regulation
• Task switching
• Time perception
• Movement

We can think of dopamine as similar to how insulin is a chemical messenger that helps regulate blood sugar, which in turn ensures that our cells have sufficient glucose to use as energy. In a healthy person, insulin levels go up and down in response to our food intake and our energy needs. It works as a balanced system.

Dopamine function is also a balanced system, when it’s working optimally. Taken as a whole, the dopamine system helps us plan and act outward on the world to obtain resources that we want and need to survive and thrive. Each of these dopamine functions is not separate. They are intertwined and they reinforce each other.

Dopamine is involved in wanting, in deciding if a goal is worthwhile given the cost, in planning how to achieve the goal, in feeling the future benefit, in persisting to work until completion, in feeling satisfaction at gaining a reward, and keeping track of what we did to succeed so we can repeat it.

It’s important to note that “cost” here refers to our body’s reserves of energy and effort. It is the brain’s job to conserve energy, and only exert effort when the rewards are substantial enough. Effort can be physical, but it can also be mental. The classic Stroop Task is a great demonstration of mental effort. In this task, you must name the ink color of a list of words. When you view the two lines of text below, avoid reading the word, and instead focus on saying the color of the typeface.

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Green Blue Orange Yellow Purple Red

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Green Blue Orange Yellow Purple Red

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Notice how you have to slow down on the second line. Inhibiting your automatic impulse to read the word and instead identifying the non-matching ink color takes extra mental effort. The feeling of mental effort is intricately tied to dopamine.

Moment to moment, our level of dopamine is fluctuating in different parts of our brain. The level of dopamine impacts how we feel about our tasks, how hard they look, and whether they feel worth the effort.

Researchers have found that a subcortical structure called the striatum works in concert with the prefrontal cortex to assess these cost/benefit choices. Using dopamine as its measure, the striatum tries to conserve mental and physical effort and maximize benefit. The posterior region of the striatum is responsible for basic voluntary motor decisions, such as “Should I move my arm or not?” And as we trace the striatum forward toward the prefrontal cortex, the decisions get more abstract. — Should I pick this raspberry from this bush? Should I leave this bush for another bush with more raspberries? Should I walk to another patch of raspberries? Should I hike an hour for more raspberries if it’s getting dark? Should I transplant raspberries nearer to my home? Should I cross-breed plants that produce bigger berries with plants that produce sweeter berries? When should I start studying for my genetics exam? Should I patent the raspberry genome?

Dopamine is engaged in the cost/benefit choices and the feeling of mental effort, but it doesn’t stop there. When we decide that the goal is worth pursuing, dopamine activates all the focus and pursuit functions.

For example, let’s say that on my walk home from work I noticed a flower shop, and it popped into my head that my partner would really appreciate receiving a bouquet of flowers. However, this flower shop was on the other side of a busy street, so I have to weigh the benefits (my partner would be delighted with my surprise) against the efforts to get the flowers (their monetary cost and the inconvenience of getting across the street to purchase them).

The dopamine system would be involved in many ways in this scenario.

• Motivation: Thinking of my partner thanking me for my thoughtfulness will trigger release of dopamine. I want to get those flowers!
• Weighing the costs and benefits: Research shows that higher levels of dopamine promote the choice of “high reward, high effort” tasks over “low reward, low effort” tasks.
• Working memory: Increased dopamine improves the stability of our working memory, and makes it easier to juggle and update information. I consider questions like: Does she like flowers? Can I afford flowers? Do I have time to stop?
• Planning: I decide that obtaining flowers is NOT worth the risk of stepping out into traffic. Instead, I make a plan to get across the street by backtracking to the previous intersection with a traffic light.
• Task persistence: Even as I walk in the opposite direction from my goal, and as I stand at the red light, dopamine helps me maintain my motivation.
• Reinforcement: When the light turns green and I can cross, I am rewarded by a jolt of dopamine.
• Attention: Dopamine helps me stay focused and avoid daydreaming as I cross the intersection.
• Task switching: If, while I was waiting at the red light, I saw the “Closed” sign appear in the flower shop window, dopamine would help me have the cognitive flexibility to change my plan and not cross the street. But let’s say the shop remained open and I bought the flowers, so we can continue our example.
• Reward based learning: When I arrive at home and present the bouquet to my partner and I see her eyes light up, I am again rewarded by a jolt of dopamine. The dopamine helps strengthen my mental representation of all the behaviors that I just completed so that the whole scenario will be more memorable and I’ll be more likely to repeat it.
• Alternate ending: I arrive home with the flowers and I’m puzzled because my partner seems frustrated. Her eyes do not light up. She says she loves the flowers, but she had really needed me to pick up her important package at the UPS store as I had previously agreed. I always walk past it on my route home, but because I had crossed the street and was focused on the flowers, UPS had completely slipped my mind. In this case, my dopamine levels drop, and I experience regret. I am less likely to repeat my quest for flowers.

At every step in my journey, dopamine was helping me access the mental resources I needed to choose, pursue and achieve my goal. However, in my alternate ending I introduced a plot twist: I have ADHD. In my spontaneous and well-intended effort to get flowers, I forgot the important task I had already agreed to do on my way home. When I weighed the costs and benefits of the idea and brought all the relevant information into my working memory, I missed a crucial detail.

In the ADHD brain, we have less available dopamine. One well-supported explanation is that we have an overabundance of reuptake transporter molecules that sweep up the dopamine after it has been released. Normally, reuptake occurs after a neurotransmitter has done its job. For ADHDers, dopamine is vacuumed away too quickly, so it is a challenge for us to fully access our cognitive resources, even when we want to. It is as if the choice of “high reward, high effort” tasks over “low reward, low effort” tasks is a faulty switch that keeps slipping to “low” and powering down the focus and pursuit functions too soon.

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For ADHDers, our ability to start and continue an important (but perhaps boring) task is like releasing a ball on a pinball table. Because we have limited dopamine available, the ball is in perpetual danger of rolling into the trough, ending our play. Keeping the ball in motion (working on our task) feels effortful and challenging, and often frustrating.

In contrast, a neurotypical brain often has enough dopamine to continue a task once it has started, like this serene forest xylophone. There is a plan and a path, and gravity keeps it all going until it’s done. (Yes, for any neurotypicals reading, I know this is probably an exaggeration.)

If we looked at this comparison and took it to mean only that gravity is constantly working against ADHDers, it could be pretty bleak and depressing. But a pinball table isn’t just an empty table. It has lights, sounds, flippers, bumpers, springs, and obstacles, and also possibility of a high score. A good pinball table is built for dopamine production. It succeeds at keeping us engaged in the otherwise monotonous task of keeping an anonymous ball from rolling into a nondescript hole.

Accept that the table is tilted.

When we treat ourselves as if we should behave and get things done like neurotypical folks, we get surprised and disappointed when the ball rolls backward instead of forwards. I think our alternative is to start building our own personalized pinball table. We don’t have to expect that our brain will act like the serene forest xylophone.

When we know that our dopamine will be limited and will need to be replenished, we can begin to imagine how we might do that. What dopamine supports can we put in place, in the form of medication and otherwise? And how can we reduce the load we put on our cognitive functions so that more working memory, attention, flexibility and persistence will be available for the task at hand?

Knowing that all of these functions are connected, we can see that making many small adjustments can have a cumulative effect. Yes, you might have only one item on your shopping list, and you are capable of keeping it in your memory, but you don’t have to. You can let that working memory be free for something else, and this benefits your resilience overall.

What would it mean to put the quarter in our pinball table? When we are low on dopamine, we focus on costs, not benefits. This means it’s hard to get started on a task. If we increase dopamine, we can see benefits more clearly. It’s not a sign of weakness that we need extra support or fun to get going on a project. Our table is tilted. We need the big flashing display to show us the grand prize and tell us a story of how we can get there. Furthermore, sometimes it is okay and necessary to let the ball rest in the trough, because we know we have another quarter when we need it.

I’ve been reading a book called The Extended Mind: The Power of Thinking Outside the Brain, by Annie Murphy Paul. The premise of the book is that our mind is not just the wet-ware in our skull. It extends through our whole body and beyond to our natural and built environments, and to the people who live and think alongside us. As ADHDers, we need to think of our dopamine system as a brain-plus system. It’s about how we add in our supports.

And now, before I venture into a new topic, I must find a stopping point even though there still so much more to say!

This month's newsletter has taken extra time to write because I'm still in research mode. I'm discovering new information and reading new studies. I wish I could share it all with you!

How will you design your pinball table? What are the most fun, dopamine-inducing elements?

Until next time!

Warmly,

Randy