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It makes it hard to follow directions and instructions because they require holding multiple steps in mind. It can lead to losing important items and missing deadlines

We have a hard time prioritizing, and having a “good” memory involves paying attention to what is important. One study required children to remember specific words from a list. These were the “important” or priority words. Those with ADHD remembered the same number of words as those without the condition, but they were less likely to recall the important words.1

working memory is the ability to manipulate that information

People with ADHD sometimes interrupt others because they are afraid of forgetting what they want to say

Attention and memory are connected.

ADHD makes it hard to control one’s attention. Experts note that having problems with “source discrimination3" and “selective attention” lead to being “overwhelmed by unimportant stimuli.4"

In other words, we experience an information overload and do not know what to remember. It goes back to the test with the ADHD children who recalled the same number of words as their peers but not the “right” words.

On average, it was low, but when looked at individually, it showed that each ADHD child alternately processed problems quickly and slowly, though often as accurately as the other children.5

The cerebrum has two halves, or hemispheres, that are further divided into four regions, or lobes. The frontal lobes, located behind the forehead, are involved with speech, thought, learning, emotion, and movement.

Behind them are the parietal lobes, which process sensory information such as touch, temperature, and pain.

At the rear of the brain are the occipital lobes, dealing with vision

Lastly, there are the temporal lobes, near the temples, which are involved with hearing and memory.

The second-largest part of the brain is the cerebellum, which sits beneath the back of the cerebrum.

diencephalon, located in the core of the brain. A complex of structures roughly the size of an apricot, its two major sections are the thalamus and hypothalamus

The brain is extremely sensitive and delicate, and so it requires maximum protection, which is provided by the hard bone of the skull and three tough membranes called meninges.

Want more proof that the brain is extraordinary? Look no further than the blood-brain barrier.

This led scientists to learn that the brain has an ingenious, protective layer. Called the blood-brain barrier, it’s made up of special, tightly bound cells that together function as a kind of semi-permeable gate throughout most of the organ. It keeps the brain environment safe and stable by preventing some toxins, pathogens, and other harmful substances from entering the brain through the bloodstream, while simultaneously allowing oxygen and vital nutrients to pass through.

One in five Americans suffers from some form of neurological damage, a wide-ranging list that includes stroke, epilepsy, and cerebral palsy, as well as dementia.

Alzheimer’s disease, which is characterized in part by a gradual progression of short-term memory loss, disorientation, and mood swings, is the most common cause of dementia. It is the sixth leading cause of death in the United States

50 million people suffer from Alzheimer’s or some form of dementia. While there are a handful of drugs available to mitigate Alzheimer’s symptoms, there is no cure.

Unfortunately, negative attitudes toward people who suffer from mental illness are widespread. The stigma attached to mental illness can create feelings of shame, embarrassment, and rejection, causing many people to suffer in silence.

In the United States, where anxiety disorders are the most common forms of mental illness, only about 40 percent of sufferers receive treatment. Anxiety disorders often stem from abnormalities in the brain’s hippocampus and prefrontal cortex.

Attention-deficit/hyperactivity disorder, or ADHD, is a mental health condition that also affects adults but is far more often diagnosed in children.

ADHD is characterized by hyperactivity and an inability to stay focused.

Depression is another common mental health condition. It is the leading cause of disability worldwide and is often accompanied by anxiety. Depression can be marked by an array of symptoms, including persistent sadness, irritability, and changes in appetite.

The good news is that in general, anxiety and depression are highly treatable through various medications—which help the brain use certain chemicals more efficiently—and through forms of therapy

“There are 12 tasks,” he said. “They’re all visuospatial. The role of attention in working memory almost always has a spatial dimension. When you’re paying attention—even when you’re paying attention to me talking here in this café—there’s a spatial component. When there’s a loud noise, you might shift your attention to where it’s coming from. Being able to maintain your spatial focus on me is important for you right now. Even though it’s words coming from me, there’s an important component of space. So if you can improve the stability of that spatial aspect, you will be better at visuospatial tasks and be better at keeping your focus on me rather than on that noise over there.”

Where Cogmed beats all other forms of cognitive training is in the number of published, randomized clinical trials demonstrating its benefits and the number of trials still under way, led by independent researchers at leading institutions without any commercial connection to the company.

“If Cogmed was a drug, everyone would call this study groundbreaking.”

Many questions remain. But there is no going back to the notion that working memory capacity is fixed.”

“[Adderall] makes me so happy I can be at a family function or out socializing and not get too distracted by other events/conversations around me. I can hear them, but am not taken in by them.”

“Since being on Adderall, I have been insanely productive… I have paid all my outstanding bills and parking tickets (and even renewed my car's registration before it was due). I'm not late for things anymore… I have not spent a single day lying around my house doing nothing in the past few months. I have a budget, and a scheduler that I actually use.”

When she asked me why I needed it, I replied just as the college kids had on 60 Minutes: “For focus.”  

Did it make me smarter? No. Did it make me a faster writer? Yes. Previously, when I’d sit down at my desk, I felt adrift at sea. It was as though my MacBook and research materials, piled high, swayed from left to right and then back again. It was dizzying; I just couldn’t get a grip.

My metaphoric double vision snapped to mono and I could see and think as clearly as if I’d stepped out of a fog. I’d never had such concentration and it showed in the number of well-written pages I produced daily

But with Adderall, I had knowledge aplenty and knew that once I stopped it, my depression would quickly lift. I also know that not everyone has that kind of previous experience or perspective, which is when folks get into deep trouble.

“Under medical supervision, stimulant medications are considered safe.” I’d add, as the Nature authors did, especially for “mentally competent adults.”

a newly emerging model of how the brain focuses attention on a particular task, using neurons in the thalamic reticular nucleus as a switchboard to control the amount of information the brain receives, limiting and filtering out sensory information that we don't want to pay attention to

People need to be able to focus on one thing and suppress other distractions to perform everyday functions such as driving, talking on the phone, and socializing

sets the stage for ever more detailed studies on the complex behavior involved in how the mammalian brain pays attention to what's important, and especially how those neural circuits are broken in cases of attention-deficit diseases, such as ADHD, autism, and schizophrenia

its individual neurons as possible regulators of the brain's ability to multitask

The test, they say, was designed to gauge how well the area of the brain known to control higher behavioral functions, the prefrontal cortex, could direct the focus on one sense over another

researchers distracted the mice with opposing stimuli: If the mouse was expecting a flash of light to guide it to the milk reward, the researchers distracted it with a sound, and vice versa. Distracting the mice decreased their ability to collect the food reward to 70 percent from nearly 90 percent, even if the distracting stimulus was removed later

found that inactivating the prefrontal cortex region of the brain, which is believed responsible for decision-making in complex behaviors, disrupted TRN neural signaling and reduced mice to only random success in obtaining a milk reward when presented with specifically cued light or sound signals

Inactivating the TRN, while leaving the cortical regions intact, also diminished success with obtaining the prompted food reward

prefrontal cortex is essential to performing such behavioral tasks

this part of the brain "stores the knowledge ultimately communicated to the TRN to control how much visual or auditory sensory information is suppressed or not, and how the brain ultimately multitasks

Dwell on those positive thoughts for a little bit. Then extend that same feeling toward yourself. Ruminate on that for a little while. Then expand that feeling out to others. Maybe think of someone you aren't as close to and think tenderly about them.

You also become more accepting of your own failings. That's what a 2014 study in the journal Social Cognitive and Affective Neuroscience found. In this experiment, there were three small groups of women who were subjected to videos of distressing images. One group got empathy training. Another got compassion training.

The people with the compassion training still felt these negative emotions, like those with empathy training did, but the part of their brain connected with reward and positive effect also lit up.

Compassion prompts your brain to have a wider sense of what's going on and it gives you access to more ideas on how to act. When your brain feels threatened like it does with pain, even someone else's, it focuses on the pain only to make it go away, and shuts down those other avenues that incentivize you to help.

Soldiers who took compassion training recovered faster from stressful situations, such as basic training. Their heart and breathing rates return to normal much quicker than those soldiers who don't get the training.

School children who did a short eight-week compassion training program functioned better overall, a study showed. After the training, even students who struggled with mental challenges such as ADHD had better attendance and behavior records, and their grades improved.

"Developing compassion, sets a foundation for the stability of the mind," Jha said. "And developing intrinsic compassion, a concern for the suffering of others and for oneself, that can be very powerful ... for all involved."

‘Where are you, Sue?’ I was brought up short. I tried to picture my own body and where it really was, but my prefrontal cortex was deactivated as the brain hovered on the edge of sleep (Muzur et al 2002). With my TPJ disturbed it was impossible to combine a body schema with vestibular and sensory input to give a firm sense of an embodied self (Blanke et al 2002).

The roofs, gutters and chimneys I saw were just as I imagined them, not as they were. So were the cities, lakes, oceans and islands I saw. I laughed at the vivid ‘star-shaped island with a hundred trees’, believing it was a thought-form in the astral plane (Besent 1896, Findlay 1931) because that was the only theory I knew.

I was too tired to do more than glimpse this new vastness. In exhaustion, I seemed to face a choice, to stay in this marvelous, right-seeming, perfect state, or return to ordinary life. The choice made itself and the struggle began. After more than two hours of serious disturbance, this brain took some time to reinstate both body schema and self-image and even then confused my own body with others. When I opened my eyes I felt and saw greyish body-shapes around the others as well as myself; displaced body schemas that gradually faded until I was (more or less) back to normal. Yet nothing was ever quite the same again.”

But that’s the joy of doing science at all. I have not, in these posts, covered the tunnel experience, the silver cord and several other features more commonly found during near-death experiences, but I may return to them in future. For now I hope you have enjoyed this series of OBE stories.

“It is hard to look at increasing trends in media consumption of all types, media multitasking and rates of ADHD in young people and not conclude that there is a decrease in their attention span,

Emerging research suggests that watching short, fast-paced videos makes it harder for kids to sustain activities that don’t offer instant—and constant—gratification.

One of the few studies specifically examining TikTok-related effects on the brain focused on Douyin, the TikTok equivalent in China, made by the same Chinese parent company, ByteDance Ltd. It found that the personalized videos the app’s recommendation engine shows users activate the reward centers of the brain, as compared with the general-interest videos shown to new users.

Brain scans of Chinese college students showed that areas involved in addiction were highly activated in those who watched personalized videos.

It also found some people have trouble controlling when to stop watching.

attention. “If kids’ brains become accustomed to constant changes, the brain finds it difficult to adapt to a nondigital activity where things don’t move quite as fast,”

A TikTok spokeswoman said the company wants younger teens to develop positive digital habits early on, and that it recently made some changes aimed at curbing extensive app usage. For example, TikTok won’t allow users ages 13 to 15 to receive push notifications after 9 p.m. TikTok also periodically reminds users to take a break to go outside or grab a snack.

Kids have a hard time pulling away from videos on YouTube, too, and Google has made several changes to help limit its use, including turning off autoplay by default on accounts of people under 18.

When kids do things that require prolonged focus, such as reading or solving math problems, they’re using directed attention

This function starts in the prefrontal cortex, the part of the brain responsible for decision making and impulse control.

“Directed attention is the ability to inhibit distractions and sustain attention and to shift attention appropriately. It requires higher-order skills like planning and prioritizing,”

Kids generally have a harder time doing this—and putting down their videogame controllers—because the prefrontal cortex isn’t fully developed until age 25.

“We speculate that individuals with lower self-control ability have more difficulty shifting attention away from favorite video stimulation,

“In the short-form snackable world, you’re getting quick hit after quick hit, and as soon as it’s over, you have to make a choice,” said Mass General’s Dr. Marci, who wrote the new book “Rewired: Protecting Your Brain in the Digital Age.” The more developed the prefrontal cortex, the better the choices.

Dopamine is a neurotransmitter that gets released in the brain when it’s expecting a reward. A flood of dopamine reinforces cravings for something enjoyable, whether it’s a tasty meal, a drug or a funny TikTok video.

“TikTok is a dopamine machine,” said John Hutton, a pediatrician and director of the Reading & Literacy Discovery Center at Cincinnati Children’s Hospital. “If you want kids to pay attention, they need to practice paying attention.”

Researchers are just beginning to conduct long-term studies on digital media’s effects on kids’ brains. The National Institutes of Health is funding a study of nearly 12,000 adolescents as they grow into adulthood to examine the impact that many childhood experiences—from social media to smoking—have on cognitive development.

she predicts they will find that when brains repeatedly process rapid, rewarding content, their ability to process less-rapid, less-rewarding things “may change or be harmed.”

“It’s like we’ve made kids live in a candy store and then we tell them to ignore all that candy and eat a plate of vegetables,”

“We have an endless flow of immediate pleasures that’s unprecedented in human history.”

Parents and kids can take steps to boost attention, but it takes effort

Swap screen time for real time. Exercise and free play are among the best ways to build attention during childhood,

“Depriving kids of tech doesn’t work, but simultaneously reducing it and building up other things, like playing outside, does,”

Practice restraint.

“When you practice stopping, it strengthens those connections in the brain to allow you to stop again next time.”

Use tech’s own tools. TikTok has a screen-time management setting that allows users to cap their app usage.

Ensure good sleep. Teens are suffering from a sleep deficit.

The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.

Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier.