Jelle Bruineberg

Project title

Rethinking ADHD: from executive control to a disorder of salience

What is your project about?

The aim of this project is to rethink the theoretical assumptions underpinning Attention-deficit/hyperactivity disorder (ADHD) is typically thought of as a disorder of executive control: an inability to control where attention is directed. But directly controlling one’s attention is difficult for everyone. Moreover, in situations that capture their interests, people with ADHD can focus for particularly long periods of time.    

The core idea to be pursued is that ADHD might be better understood as a difference in the way the world draws your attention. Everyday attention is then not so much a tug-of-war between controlling your attention and being distracted, but a balancing act between sticking to the task at hand and remaining open to other things that might also be relevant. My hypothesis is that a salience-based account of ADHD can make better sense of the paradoxical aspects of ADHD and lead to a better understanding of the disorder.

How did you become interested in your particular field of research?

I wrote my dissertation on the philosophy and cognitive science of skilled action: the kinds of things we do without thinking about them. The guiding idea here was that in skilled action we are drawn to those opportunities for action that are relevant to pursue in a specific situation. Towards the end of my PhD, I started to realize that what was true of skilled action might also hold for distraction: we are just being drawn to act and attend to things that are not the most relevant. Pursuing this line further has led to a number of paradoxical insights, for example that having full control over our attention would not be very useful, because we would miss loads of things that are actually relevant.

What are the scientific challenges and perspectives in your project?

ADHD is a tricky concept. Where to draw the line between normal and pathological distractibility? To what extent is the rise in ADHD diagnoses a consequence of changed environments, changed brains, or changed expectations about what kinds of behavior are acceptable? Moreover, scientific descriptions of ADHD loop back in the way people understand their own distractedness. All of this can make ADHD a bit of a moving target.    

I try to deal with these challenges by taking an indirect route: we first need to better understand attention before we can attempt to understand ADHD. And to better understand attention, we need to realize that everyday life is not neatly divided up in terms of tasks and distractors. Once we have a better understanding of attention as sensitivity to what is relevant, it will become easier to understand what is going wrong in ADHD.

What is your estimate of the impact, which your project may have to society in the long term?

Theoretical debates about attention might seem inconsequential for the treatment and lived experience of those diagnosed with ADHD (of whom there are many in countries like Denmark).  But theoretical frameworks do play a role in the self-understanding of people with ADHD, and expectations about what kind of control over attention is “normal” likely loop back into the way people make sense of their own symptoms.    

A better theoretical grasp on attention and accepting that a certain amount of distraction is the price to pay for remaining open to things that might turn out to be relevant, might eventually lead to better diagnosis and treatment of ADHD as well as a different understanding of what it means to be diagnosed with ADHD.

Which impact do you expect the Sapere Aude programme will have on your career as a researcher?

Receiving the Sapere Aude grant feels like a major breakthrough: it is my first successful grant in Denmark. More than expected, it provides me with a sense of belonging in the Danish research environment. No doubt it will extend my network and put me on the map of Danish academia. The Sapere Aude grant is also the first grant in which I get to build a small research group. For someone like me who likes to collaborate this is very exciting, and I am really looking forward to working with the PhD student and the post-doc.

Although I have worked on salience, attention and distraction, ADHD always felt like too “big” of a topic to work on. The Sapere Aude grant provides me with the critical mass required for developing a new perspective on ADHD and to take on board the wealth of pre-existing research on the topic. In this way, the Sapere Aude grant will help me to develop my research in directions that would not have been within reach otherwise.