Patients who exhibit ADD symptoms suffer from an underactive prefrontal cortex, the brain region behind the forehead. The prefrontal cortex is the executive center of the brain. It provides top-down management to every other brain region. In fact, the prefrontal cortex distinguishes us from other mammals in that, when functioning properly, it prevents us from acting solely on our emotions.
The prefrontal cortex modulates the high and low feelings produced in our emotional center so we don’t live on an emotional roller coaster, over-reacting to negative or positive events on an hourly basis. The prefrontal cortex is also responsible for assisting our ability to formulate a plan of action and for enhancing our ability to execute the plan. Patients suffering from an underactive prefrontal cortex are master procrastinators; they always wait until they are “down to the wire” before they begin working on a project. Normally, the prefrontal cortex filters extraneous stimuli protecting the rest of the brain from being distracted with things that are not a priority at the moment. Patients with an underactive prefrontal cortex have great difficulty with prioritization of tasks.
Other functions performed by the prefrontal cortex include braking brain activity so we don’t think too fast, turning the brain off at night so we can sleep and providing impulse control so we don’t jump in first, and think about the consequences of our actions later. When the prefrontal cortex is underactive it cannot perform well at any of these functions. They often feel they cannot turn their brain off at night.
Many say, “My body wakes up at 7 a.m. but my brain wakes up at 9 a.m.” ADHD patients experience “brain fog in the morning.” They often self medicate this brain fog with nicotine and coffee. Nicotine is stronger than cocaine and heroin in ability to stimulate a surge of dopamine from brain cell storage units. Most ADD patients inherit an underactive prefrontal cortex from one of their parents. Some ADD patients acquire an underactive prefrontal cortex from brain trauma and some from neurotoxicity, the excessive accumulation of neurotoxins in the brain. The prefrontal cortex is the most sensitive brain region to toxins.