This is so funny cause it’s such a coincidence that I got the idea to write this on the eve of the anniversary of the unluckiest day in the life of Phineas Gage; September the 13th.
The year was 1848 (I just had to 🤣). A 25 year old gentleman named Phineas Gage was impaled by a large iron rod through his skull while working on the railway. He miraculously survived the ordeal and was fully “functional” save for his prefrontal cortex which was irreparably damaged. The doctor treating him commented that while he had retained his intellectual faculties, his ability to control his impulses were gone. He was described as being “fitful, irreverant, indulgent and impatient of restraint”.
If you have ADHD and found that the description hit a little too close to home, let me tell you why.
The core pathology of ADHD involves the prefrontal cortex and while our prefrontal cortices are not completely damaged, we are unable to regulate its functions at will. This essentially makes us, just like Phineas Gage, appear like we are people who have no willpower.
What is willpower? ( source: Americal Psychological Association)
- The ability to self effortfully regulate the self
- The ability to ignore short term desires in favour of a long term gain.
- The ability to override an unwanted thought, feeling or impulse
Willpower and the Prefrontal Cortex
The prefrontal cortex is the area of the brain responsible for our executive functions (I have written about this before). It helps us kick start and follow through on a task, holding us back from reacting to every impulse or temptation and reminds us that we need to ignore distractions in order to focus on the bigger picture.
Willpower and Executive Functions
This is where the hot and cold EFs play a role (read here). The cold EFs are the rational part of the brain that reminds you of the goal while the hot EFs are the emotional and impulsive part which reacts to triggers.
When you look at desserts, your hot EFs jump into action telling you to do it. The cold EFs would then remind you that you shouldn’t because you’ve already had a piece of cake earlier. So the two parts of the EF will battle it out to determine the outcome.
Willpower and ADHD
So where does this leave people with ADHD who have deficits in both hot and cold EFs? It’s a tough one but there are a few things you could try depending on your resources and support.
- Medications to power the prefrontal cortex
Stimulant meds work by increasing dopamine to certain areas of the brain, including the prefrontal cortex. It doesn’t work for everyone but this is one of the options you have to boost the function of these areas
- Outsource the cold EFs to someone else
For those who don’t feel any improvements with meds, try getting help. This of course depends on family/friends support and sometimes money. Find a coach, get a PA, ask a friend or family member to help body double or monitor your progress. If you have poor family support and struggle financially, reach out to the many ADHD communities online. There are many who are willing to help. Especially in body doubling, because it benefits both people. Probably should mention ahead that I don’t like the idea of body doubling so please refrain from asking me…hahaha. Sorry, I like working alone.
- Practice mindfulness
This is also a little difficult especially when you’re burned out and at your wits end but it does help to take a minute to pause before making decisions. Before taking meds I used to be unable to practice this because you really need your cold EFs for this.
Notice that all the “solutions” I offered up there comes with some form of caveat? I’m not being negative but just being realistic. If it was so easy, I’m sure most of you (me included) won’t struggle with our ADHD.
All self help strategies involve heavy use of executive functions that we can’t easily regulate, but there are always ways to hack it. So don’t feel bad if you bought a self help book and failed to practice it. It’s not you. That book was written for neurotypicals and would require some tweaking for it to work for us.
The online ADHD community is full of hacks for people at all levels of resources. Just keep looking for what fits you. It’s out there somewhere.
These Are the Contents of My Head 