Rebuild What Matters

The TPN, the DMN, and the ADHD Brain: What to Do When They Won't Take Turns

That’s a whole lot of initials. TPN stands for the task-positive network and DMN stands for the default mode network. Both of these networks operate throughout different brain regions, in both hemispheres, and in a neurotypical brain, they take turns. The TPN is responsible for helping people start and complete tasks and the DMN is responsible for the ability to think imaginatively and creatively. A bit more background on the DMN: it consists of two halves, the front part which is called the medial prefrontal cortex and the back half of the network which is called the posterior cingulate. The front half of the DMN allows individuals to contemplate, imagine, and plan for the future. The back half of the DMN is responsible for facilitating personal history and autobiographical memory, meaning it permits individuals to reflect on the past and draw conclusions from it. 

Knowing about these two networks in the brain is important for people with ADHD because it will help make sense of a lot of things and empower different desired outcomes. Knowledge is a powerful antidote to shame. Therefore, psychoeducation is an important component in the treatment of ADHD. 

As mentioned above, in a neurotypical brain the TPN and the DMN act like a seesaw and they take turns being active. When the TPN is activated and a task is being done, the DMN sits idly and does not interrupt and distract from the task. For a person with ADHD, there are two people on one side of the seesaw. Dr. Ned Halloway, a Board-Certified Psychiatrist and ADHD expert, describes ADHD as having a Ferrari engine for a brain with the brakes (impulse control) equivalent to the brakes of a bicycle. We can envision the feeling that comes with not being able to slow down in time. Another supportive analogy equates the DMN to a hangry toddler who refused an afternoon nap: it’s negative, gloomy, disruptive, and sometimes inconsolable over the slightest infraction. 

The DMN, particularly in the back half of it, is where people who are brilliantly creative and imaginative, and often diagnosable with ADHD, get trapped. Read: where gloomy, negative, and self-critical rumination abounds plentifully. Because the DMN competes with the TPN in a neurodivergent brain, instead of taking turns, it is so much more difficult to create and sustain focus, task-orientation, clarity, encouragement/motivation, and contentment. Another purpose and goal of any effective ADHD treatment is to help slide the DMN to its side of the seesaw, restore functionality, and allow the TPN to also engage. At this point, productivity is NOT the goal. Helping the DMN sit on its side of the seesaw, without interfering, while the TPN pushes off the ground is the goal. One could say the goal is to get off the ground at this point in the treatment protocol. 

Two ways to “get off the ground” when stuck in DMN:

  1. Distract yourself by doing something externally 

    a. do 5 jumping jacks, 

    b. draw 3 circles on the back of a receipt with your non-dominant hand,

    c.  practice square breathing, 

    d. tie your shoes

2. Focus on a single task, gradually increasing attention span

a. read 1 page of a book,

b. brush teeth,

c. put a dirty dish/mug in sink,

d. hang up/fold 1 piece of clothing,

e. draft part of an e-mail


Remember, the goal isn’t productivity right now. That will come!




For further reading:

ADHD 2.0: New Science and Essential Strategies for Thriving with Distraction - from Childhood Through Adulthood by Edward M, Hallowell. M.D., and John J. Ratey, M.D.


Feeling Connected Matters: Ways to Build a Satisfied Life

Connection is an important piece when we look at overall mental health. Its presence is more meaningful than money, status, or success in terms of warding off symptoms of depression, low self-esteem, low self-compassion, and shame. I think why so many of us feel disconnected is because connection requires effort, vulnerability, and consistency. It’s not enough to show up to a workout class, church, book club, run club, monthly brunch gathering, Mahjong group, or any other positive social group if showing up is all that really occurs. Connecting and feeling connected (connection) are two different things - the first requires physical and mental effort and the second requires those as well as emotional effort. In order to feel connected and experience connection, people have to be willing to be vulnerable and share their genuine thoughts, feelings, ideas, struggles, and successes with others in order to be known. Realistically, this could be with 2-3 other people, but even one other person would be a great start. 

There is a whole plethora of people who are comfortable with listening to others and are excellent at offering the non-judgmental spaces, the connected feeling, yet have a harder time being on the receiving end. If this resonates, this is a challenge to find some balance in this dynamic. Talk about that good thing that happened the other day, the thing you’re proud of, and that thing that ruined your day while continuing to hold that space for others. 

Connection (feeling connected) and living a satisfied life are related. The authors of the book Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder define a connected life as including the following points of connection: “family, friends and community, school or work, activities, the arts, groups, teams and organizations, pets, nature, ideas and information, the spiritual world, the past, and yourself.” The book goes on to note that people with ADD/ADHD have a harder time feeling comfortable with themselves, so it is more effective to focus on building and deepening connections externally in this subset population, especially at the beginning stages. 

Identifying individual strengths and talents is often difficult for people with ADD/ADHD, usually due to low self-esteem, and that is why connection is important. This is where a good balance of community (points of connection) can help identify and nurture positive attributes and skill set which by default will increase self-esteem and further talent discovery and creativity. It creates a generous cycle that bolsters mental health and satisfaction with life. 

Connection is vulnerable and also satisfying. Try it sometime. 


Further reading:

Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder by Edward M. Hallowell, M.D., and John J. Ratey, M.D. (2005) 


ADHD & Rejection Sensitive Dysphoria

“The worst thing of this ADD thing, or whatever you doctors call it, doesn’t make it into the medical books. I’ve read descriptions online. They make it sound like a shopping list of symptoms, you know, forgetful, disorganized, can’t be on time, so on, so on, blah, blah, blah. The people who write that don’t know the real hell of having whatever this thing truly is. I never have a moment’s peace. It’s like I have a radar, always on the alert for: What have I done wrong lately? Who’s mad at me? What disaster is going to hit out of the bleeping clear blue sky? That’s what most people don’t get. 

…

What this man, let’s call him Mark, struggles with is common in the world of ADHD. And Mark is quite right, it is not considered part of the textbook definition of ADHD. Yet Mark’s suffering may be the most painful part of ADHD, the ongoing insecurity, the all but perpetual feeling of shame, of being on the outs with the world.

There’s a devilish catch here. If you do have ADHD, you are indeed prone to make mistakes. There are many good parts to ADHD, but making careless mistakes is one of the leading bad parts. If you make mistakes over and over again you will get called out over and over again, and if this goes on long enough you develop a syndrome not unlike PTSD. As one of my adult patients put it to me, “Each day when I wake up my first thought is, ‘How will I screw up today?’”

William Dodson, M.D., an experienced and skilled clinician who runs an ADHD center in Colorado, calls this problem “rejection sensitive dysphoria.” Dysphoria basically means feeling bad. Dodson points out that many people with ADHD are inordinately sensitive to what they perceive to be rejection, so sensitive that any rejection can send them into a state of dysphoria, which is far too clinical and too mild a term for the intense feeling of misery that overcomes them at these moments.” (Halloway & Ratey, 2005.)

This excerpt is out of the book titled Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder by M.Ds., Edward Hallowell and John Ratey. It captures what a lot of people with ADHD struggle with: rejection, whether real or perceived but most often perceived. The emotional pain that follows after feeling rejected leads to any of the above coping mechanisms: people-pleasing, numbing behaviors (substance use), acts of self-sabotage, avoidance, perfectionism, outbursts (anger or tears) and as a result may set the stage for low self-esteem/confidence and onset of severe depression within this community. 

Finding ways to balance out RSD, or rejection sensitive dysphoria, is pivotal to achieving mental well-being. Some cognitive approaches include becoming curious about the part of the brain that is spiraling into a story of “I don’t matter, everyone hates me, and she’s mad at me.” I have found that people with ADHD are quite funny and have a sense of humor that can absolutely support the development of curiosity toward the perception of being rejected. This internal dialogue can sound something like, “Hey RSD, WTF? Not today.”

A behavioral approach can include exercising, spending time with friends/family/dog, or watching a favorite movie or TV show. Engaging in some of these more helpful approaches offers the person experiencing RSD a fair opportunity to experience a more connected life. 

In closing, connection is a necessary component of treating ADHD. It’s important to a client’s healing journey that they work with a competent mental health team (psychiatrists, therapists, coach) whom they also feel seen, understood, and cared for by. The same goes for a client’s personal relationships too: these relationships need to be rooted in empathy, compassion, structure/boundaries, and delight. 



Further reading:

Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder by Edward M. Hallowell, M.D., and John J. Ratey, M.D. (2005)