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Dull Repetitive Assignments

Rewards like sex, money, drugs and novel situations all cause the release of dopamine in the reward circuit of the brain, a region buried deep beneath the cortex. Aside from generating a sense of pleasure, this dopamine signal tells your brain something like, “Pay attention, this is an important experience that is worth remembering.”

The more novel and unpredictable the experience, the greater the activity in your reward center. But what is stimulating to one person may be dull — or even unbearably exciting — to another. There is great variability in the sensitivity of this reward circuit.

Clinicians have long known this to be the case, and everyday experience bears it out. Think of the adrenaline junkies who bungee jump without breaking a sweat and contrast them with the anxious spectators for whom the act evokes nothing but terror and dread.

Dr. Nora D. Volkow, a scientist who directs the National Institute on Drug Abuse, has studied the dopamine reward pathway in people with A.D.H.D. Using a PET scan, she and her colleagues compared the number of dopamine receptors in this brain region in a group of unmedicated adults with A.D.H.D. with a group of healthy controls. What she found was striking. The adults with A.D.H.D. had significantly fewer D2 and D3 receptors (two specific subtypes of dopamine receptors) in their reward circuits than did healthy controls. Furthermore, the lower the level of dopamine receptors was, the greater the subjects’ symptoms of inattention. Studies in children showed similar changes in dopamine function as well.

These findings suggest that people with A.D.H.D are walking around with reward circuits that are less sensitive at baseline than those of the rest of us. Having a sluggish reward circuit makes normally interesting activities seem dull and would explain, in part, why people with A.D.H.D. find repetitive and routine tasks unrewarding and even painfully boring.

Psychostimulants like Adderall and Ritalin help by blocking the transport of dopamine back into neurons, thus increasing its level in the brain.

Another patient of mine, a 28-year-old man, was having a lot of trouble at his desk job in an advertising firm. Having to sit at a desk for long hours and focus his attention on one task was nearly impossible. He would multitask, listening to music and texting, while “working” to prevent activities from becoming routine.

Eventually he quit his job and threw himself into a start-up company, which has him on the road in constantly changing environments. He is much happier and — little surprise — has lost his symptoms of A.D.H.D.

My patient “treated” his A.D.H.D simply by changing the conditions of his work environment from one that was highly routine to one that was varied and unpredictable. All of a sudden, his greatest liabilities — his impatience, short attention span and restlessness — became assets. And this, I think, gets to the heart of what is happening in A.D.H.D.

Consider that humans evolved over millions of years as nomadic hunter-gatherers. It was not until we invented agriculture, about 10,000 years ago, that we settled down and started living more sedentary — and boring — lives. As hunters, we had to adapt to an ever-changing environment where the dangers were as unpredictable as our next meal. In such a context, having a rapidly shifting but intense attention span and a taste for novelty would have proved highly advantageous in locating and securing rewards — like a mate and a nice chunk of mastodon. In short, having the profile of what we now call A.D.H.D. would have made you a Paleolithic success story.

In fact, there is modern evidence to support this hypothesis. There is a tribe in Kenya called the Ariaal, who were traditionally nomadic animal herders. More recently, a subgroup split off and settled in one location, where they practice agriculture. Dan T. A. Eisenberg, an anthropologist at the University of Washington, examined the frequency of a genetic variant of the dopamine type-four receptor called DRD4 7R in the nomadic and settler groups of the Ariaal. This genetic variant makes the dopamine receptor less responsive than normal and is specifically linked with A.D.H.D. Dr. Eisenberg discovered that the nomadic men who had the DRD4 7R variant were better nourished than the nomadic men who lacked it. Strikingly, the reverse was true for the Ariaal who had settled: Those with this genetic variant were significantly more underweight than those without it.

So if you are nomadic, having a gene that promotes A.D.H.D.-like behavior is clearly advantageous (you are better nourished), but the same trait is a disadvantage if you live in a settled context. It’s not hard to see why. Nomadic Ariaal, with short attention spans and novelty-seeking tendencies, are probably going to have an easier time making the most of a dynamic environment, including getting more to eat. But this same brief attention span would not be very useful among the settled, who have to focus on activities that call for sustained focus, like going to school, growing crops and selling goods.

You may wonder what accounts for the recent explosive increase in the rates of A.D.H.D. diagnosis and its treatment through medication. The lifetime prevalence in children has increased to 11 percent in 2011 from 7.8 percent in 2003 — a whopping 41 percent increase — according to the Centers for Disease Control and Prevention. And 6.1 percent of young people were taking some A.D.H.D. medication in 2011, a 28 percent increase since 2007. Most alarmingly, more than 10,000 toddlers at ages 2 and 3 were found to be taking these drugs, far outside any established pediatric guidelines.

Some of the rising prevalence of A.D.H.D. is doubtless driven by the pharmaceutical industry, whose profitable drugs are the mainstay of treatment. Others blame burdensome levels of homework, but the data show otherwise. Studies consistently show that the number of hours of homework for high school students has remained steady for the past 30 years.

I think another social factor that, in part, may be driving the “epidemic” of A.D.H.D. has gone unnoticed: the increasingly stark contrast between the regimented and demanding school environment and the highly stimulating digital world, where young people spend their time outside school. Digital life, with its vivid gaming and exciting social media, is a world of immediate gratification where practically any desire or fantasy can be realized in the blink of an eye. By comparison, school would seem even duller to a novelty-seeking kid living in the early 21st century than in previous decades, and the comparatively boring school environment might accentuate students’ inattentive behavior, making their teachers more likely to see it and driving up the number of diagnoses.

Not all the news is so bad. Curiously, the prevalence of adult A.D.H.D. is only 3 to 5 percent, a fraction of what it is in young people. This suggests that a substantial number of people simply “grow out” of it. How does that happen?

Perhaps one explanation is that adults have far more freedom to choose the environment in which they live and the kind of work they do so that it better matches their cognitive style and reward preferences. If you were a restless kid who couldn’t sit still in school, you might choose to be an entrepreneur or carpenter, but you would be unlikely to become an accountant. But what is happening at the level of the brain that may explain this spontaneous “recovery”?

To try to answer that question, Aaron T. Mattfeld, a neuroscientist at the Massachusetts Institute of Technology, now at Florida International University in Miami, compared the brain function with resting-state M.R.I.s of three groups of adults: those whose childhood A.D.H.D persisted into adulthood; those whose had remitted; and a control group who never had a diagnosis of it. Normally, when someone is unfocused and at rest, there is synchrony of activity in brain regions known as the default mode network, which is typically more active during rest than during performance of a task. (In contrast, these brain regions in people with A.D.H.D. appear functionally disconnected from each other.) Dr. Mattfeld found that adults who had had A.D.H.D as children but no longer had it as adults had a restoration of the normal synchrony pattern, so their brains looked just like those of people who had never had it.

WE don’t yet know whether these brain changes preceded or followed the behavioral improvement, so the exact mechanism of adult recovery is unclear.

But in another measure of brain synchrony, the adults who had recovered looked more like adults with A.D.H.D., the M.I.T. study found.

In people without it, when the default mode network is active, another network, called the task-positive network, is inhibited. When the brain is focusing, the task-positive network takes over and quiets the default mode network. This reciprocal relationship is necessary in order to focus.

Both groups of adult A.D.H.D. patients, including those who had recovered, displayed simultaneous activation of both networks, as if the two regions were out of step, working at cross-purposes. Thus, adults who lost most of their symptoms did not have entirely normal brain activity.

What are the implications of this new research for how we think about and treat kids with A.D.H.D.? Of course, I am not suggesting that we take our kids out of school and head for the savanna. Nor am I saying we that should not use stimulant medications like Adderall and Ritalin, which are safe and effective and very helpful to many kids with A.D.H.D.

But perhaps we can leverage the experience of adults who grew out of their symptoms to help these kids. First, we should do everything we can to help young people with A.D.H.D. select situations — whether schools now or professions later on — that are a better fit for their novelty-seeking behavior, just the way adults seem to self-select jobs in which they are more likely to succeed.

In school, these curious, experience-seeking kids would most likely do better in small classes that emphasize hands-on-learning, self-paced computer assignments and tasks that build specific skills.

This will not eliminate the need for many kids with A.D.H.D. to take psychostimulants. But let’s not rush to medicalize their curiosity, energy and novelty-seeking; in the right environment, these traits are not a disability, and can be a real asset.

Continue reading the main story
Correction: November 16, 2014

An opinion essay on Nov. 2 about the treatment of attention deficit hyperactivity disorder omitted an attribution for part of the description of an M.I.T. study comparing patterns of brain activity in adults who had recovered from childhood A.D.H.D. and adults who had not. The description of one finding — about the similarity of the two groups on one measure of brain synchrony — came from a news release from the McGovern Institute for Brain Research at M.I.T.

Motivation can be tough. Even when you want to do something – like exercising regularly, eating right or keeping a journal – it’s easy to find your enthusiasm slackening off.

But motivation gets really tough when the task at hand is downright boring.

I

don’t know exactly what your most-dreaded things are, but maybe they look something like this:

  • Repetitive, boring data entry or copy-and-pasting tasks on the computer
  • Housework – laundry, cleaning, cooking, tidying, washing dishes…
  • Sorting and filing papers
  • Delivering leaflets door-to-door

They’re tasks that are repetitive, unchallenging and uncreative. There might be relatively little reward or recognition for completing them. No wonder you put them off, or struggle to focus when you’re tackling them.

The problem is, you can’t simply ditch these tasks. For whatever reason, they need to be done. So here’s how to stay motivated (and sane!) while you’re tackling them:

#1: Remind Yourself WHY
Whatever the task at hand, there’s a why behind it. Sometimes, focusing on the why can help you feel more motivated to do a good job – even though the work itself is boring. Your why might be:

  • An end result that benefits you – e.g. a clean, tidy house that you can relax in
  • An end result that helps someone else – e.g. a happy client
  • Saves you doing more work in the future
  • Doing good in the world – helping charity or a political/religious organization that you support
  • Your paycheck – an important motivator for many of us!

#2: Think How Good You’ll Feel When You’re Done
Chances are, you might have been dreading this tedious task for a while. Maybe you’ve been putting it off for days, weeks or even months. It’s been hanging over you.

Think about how great you’ll feel once you’re done with it. You’ll have it off your mind, you’ll have a sense of accomplishment, and you’ll be able to get on with the rest of your life without dreading this one thing.

The faster you get on with the task, the sooner you can enjoy the benefits of having finished. Yes, I know that’s obvious – but we sometimes need to remind ourselves of it.

#3: Work in Short Bursts
You know what happens when you try to concentrate on something for hours on end … your attention wanders. Perhaps you manage 20 minutes or so, but then you’re onto Twitter, and you click on a link, and you end up reading web comics. Or you flick the television on and get drawn in.

By working in short bursts, you help yourself stay on task. If you spend 15 minutes cleaning the kitchen or 30 minutes entering data, before taking a break, it’s much easier to focus – you know the end is in sight!

#4: Crank the Music
I find that music distracts me from my more intense, creative work – but it’s ideal for boring tasks. You’ll probably want to choose something with a fast tempo and a bit of energy to it – maybe rock music, or whatever works for you.

If you’re not a music fan, or if you’re working in an environment where loud music isn’t appropriate, try audio books. Try LibriVox for classic books, read by volunteers – they’re free.

#5: Use Your Task as a Breather
This might sound odd – but you can actually use those dull tasks as a welcome break in the day. Sure, two hours of cleaning or data entry might drive you nuts, but spending 15 or 20 minutes doing something unchallenging can give you a chance to unwind, in between more intense tasks.

You’ll find that it helps to pay attention to the times of day when you’re most creative – and the times when you’re feeling a definite slump. Use dull tasks to fill your “slump” times, and keep your most important work for your best hours.

#6: Work With a Partner
You might not always have this option, but when you do, it’s often a great way to improve a dull task. Find someone else to work with. That might mean:

  • Doing the housework with your partner or kids
  • Asking a colleague to help you out at work
  • Getting a friend to come over and clear out the garage with you

…and so on. It’s motivating to have someone else along because you’ll be sharing the work (so it’ll get done faster), you’ll have someone to talk to, and you won’t want to slack off because you’ll be letting them down. Of course, you’ll probably need to return the favor in future…

What hideously boring tasks are festering on your to-do list? What could you do to make them a little more bearable?

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Ali Luke

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