The misnomer of attention-deficit hyperactivity disorder.

ABSTRACT

We propose that attention-deficit disorder represents an inefficiency of an integrated system designed to allocate working memory to designated tasks rather than the absence or dysfunction of a particular form of attention. A significant portion of this inefficiency in the allocation of working memory represents poor engagement of the reward circuit with distinct circuits of learning and performance that control instrumental conditioning (learning). Efficient attention requires the interaction of these circuits. For a significant percentage of individuals who present with attention-deficit disorder, their problems represent the engagement, or lack thereof, of the motivational and reward circuit as opposed to problems, or disorders of attention traditionally defined as problems with orienting, focusing, and sustaining. We demonstrate that there is an integrated system of working-memory allocation that responds by recruiting relevant aspects of both cortex and subcortex to the demands of the task being encountered. In this model, attention is viewed as a gating function determined by novelty, flight-or-fight response, and reward history/valence affecting motivation. We view the traditional models of attention, rather than describe specific types of attention per se, as representing the description of the behavioral output of this integrated orienting and engagement system designed to allocate working memory to task-specific stimuli.