ADHD & How Anyone Can Improve Their Focus | Huberman Lab Podcast #37
发布时间 2021-09-13 12:00:32 来源
Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today we are going to talk all about attention deficit hyperactivity disorder or ADHD. We are also going to talk about normal levels of focus. What are normal levels of focus and how all of us, whether or not we have ADHD or not, can improve our ability to focus, our ability to rule out distraction, turns out those are two separate things, as well as remember information better.
欢迎来到Huberman实验室播客，在这里我们讨论科学和基于科学的日常生活工具。我是Andrew Huberman，斯坦福医学院的神经生物学和眼科学教授。今天，我们将全面探讨注意力缺陷多动障碍（ADHD）。我们还会聊到正常的专注水平是什么，以及不论是否患有ADHD，我们每个人如何提高自己的专注能力和排除干扰的能力。事实证明，这两者是分开的事情，同时还会谈到如何更好地记忆信息。
We are also going to talk about how we can learn to relax while focusing, which turns out to be a critical component of learning new information and for coming up with new creative ideas. So whether or not you have ADHD or know someone who does, or if you're somebody who feels that they do not have ADHD, but would simply like to improve their ability to focus or to be more creative. This episode is definitely for you as well. We are going to talk about drug-based tools that are out there.
我们还会讨论如何在专注的同时学习放松，这实际上是学习新信息和产生创意的关键要素。因此，无论你是否有多动症（ADHD），或者认识有多动症的人，甚至如果你认为自己没有多动症，但只是想提高专注能力或变得更有创意，这一集对你来说同样适用。我们还会探讨现有的一些药物工具。
We are going to talk about behavioral tools. We will talk about the role of diet and supplementation. And we will talk about new emerging brain-machine interface devices, things like transcranial magnetic stimulation. If you don't know what that is, don't worry. I will explain it to you. These are non-invasive methods for rewiring your brain in order to make focusing more natural for you. And to teach you how to increase your depth of focus.
我们将讨论行为工具。我们还会谈到饮食和补充剂的作用。同时，我们将探讨一些新兴的脑机接口设备，比如经颅磁刺激。如果你对此不了解，不必担心，我会向你解释。这些都是非侵入性的方法，用于重新调整你的大脑，使注意力集中变得更加自然，并教你如何提高注意力的深度。
Now just a quick reminder that anytime we discuss a psychiatric disorder, it's important that we remember that all of us have the temptation to self-diagnose or to diagnose others. So as I list off some of the symptomology of ADHD, some of that symptomology might resonate with you. You might think, oh, maybe I have ADHD or you might decide that someone you know definitely has ADHD. However, it is very important that you don't self-diagnose or diagnose somebody else.
现在请稍微提醒一下，每当我们讨论精神疾病时，记住我们都有自我诊断或诊断他人的倾向是很重要的。当我列出多动症（ADHD）的一些症状时，其中一些可能会让你感到共鸣。你可能会想，哦，也许我有多动症，或者你可能觉得你认识的人肯定有多动症。然而，非常重要的是，你不要自我诊断或给别人下诊断。
The clear and real diagnosis of ADHD really should be carried out by a psychiatrist, a physician, or a very well-trained clinical psychologist. There are clear criteria for what constitutes full-blown ADHD. However, many of us have constellations of symptoms that make us somewhat like somebody with ADHD. And if you're struggling with focus nowadays as a lot of people are, because of stress, because of smartphone use, which turns out can induce adult ADHD. We'll talk about that.
真正明确的多动症（ADHD）诊断应该由精神科医生、医生或非常有经验的临床心理学家来进行。对于确诊多动症，有明确的标准。然而，我们中的很多人都有一些症状，这些症状让我们看起来有点像多动症患者。如果你现在难以集中注意力，这可能是由于压力或者智能手机使用导致的。这些因素可能会引发成人多动症。我们将详细讨论这个问题。
Well, then pay attention to the symptomology. You may actually require professional treatment. You might not. Equally important is to remember that some of the terms that we cover, like impulse control and attention and concentration, are somewhat subjective and they can change over time. Sometimes we have a better level of attention than others. Maybe it depends on how we slept or other events going on in our life. Or something that we're entirely unaware of.
好的，那就要注意症状。你可能真的需要专业治疗，也可能不需要。 同样重要的是记住，我们讨论的一些术语，比如冲动控制、注意力和集中力，是比较主观的，并且可能随着时间而改变。有时候我们的注意力水平比其他时候要好，可能这取决于我们的睡眠质量或生活中发生的其他事情，或者是一些我们完全没有意识到的因素。
The important thing to remember is that we can all improve our attentional capacity. We can all rewire the circuits that make heightened levels of focus more accessible to us. We can do that through multiple types of interventions and we are going to cover all those interventions today. Before we march into the material, I'd like to remind that this podcast is separate from my teaching and research roles at Stanford.
重要的是要记住，我们都可以提升自己的注意力容量。我们可以通过多种方式重新连接大脑，让我们更容易集中精力。今天我们将讨论所有这些方法。在开始讨论之前，我想提醒大家，这个播客与我在斯坦福的教学和研究工作是分开的。
It is however part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Roka. Roka makes eyeglasses and sunglasses that are of the utmost quality. I've spent a lifetime working on the visual system and I can tell you that there are many features built into our visual system that allows us to see things clearly, whether or not we are in shade or bright sunlight, etc.
然而，我的愿望和努力之一是为大众提供免费的科学和科学相关工具的信息。为了实现这个目标，我想感谢今天播客的赞助商。我们第一个赞助商是Roka。Roka制造的眼镜和太阳镜质量非常高。我一生都致力于研究视觉系统，可以告诉你，我们的视觉系统有很多功能可以让我们无论在阴影下还是在明亮阳光中都能清楚地看到事物。
A lot of sunglasses have the problem that you have to constantly take them off and put them back on again because of changes in background luminance as we call it. Roka sunglasses have solved this problem. It doesn't matter if you're standing in tree shade or a bright light or what have you, you can always see things with perfect clarity. And that shows that they really understand the way that the visual system works and their eyeglasses are built accordingly.
许多太阳镜都有一个问题，那就是由于背景光线变化，我们不得不不断地摘下和重新戴上。Roka太阳镜解决了这个问题。无论你是在树荫下还是在强光下，你总能清晰地看到事物。这说明他们真的了解视觉系统的工作原理，并且他们的眼镜也是根据这一点设计的。
I wear readers at night, so I wear eyeglasses to read at night or when I drive at night and their readers and eyeglasses are terrific as well. One thing I like so much about their eyeglasses and their sunglasses is that despite being, quote unquote, performance glasses, meaning you can wear them all running or swimming or biking, they don't fall off your face, even if you get sweaty, they're very lightweight. You don't even notice that they're on, is that the aesthetic is really good. A lot of performance glasses, they look kind of ridiculous frankly. They make people look like cyborgs, but their aesthetics are terrific. They have a lot of different styles you can select from. The company was founded by two all American swimmers from Stanford and everything about their sunglasses and eyeglasses were designed with optical clarity and performance in mind.
我晚上戴老花镜，所以我晚上读书或开车时会戴眼镜。他们的老花镜和普通眼镜都非常棒。我非常喜欢他们的眼镜和太阳镜的一点是，尽管这些眼镜是所谓的“高性能眼镜”，也就是说可以在跑步、游泳或骑自行车时佩戴，但即使出汗，也不会从脸上掉下来，而且非常轻，几乎察觉不到它们的存在。更棒的是它们的外观设计非常好看。很多高性能眼镜看起来有点夸张，让人好像变成了机器人，但他们的设计确实不错。他们提供多种不同款式可供选择。这家公司是由两位曾是斯坦福大学的美国游泳健将创立的，他们的太阳镜和眼镜设计都以光学清晰度和性能为宗旨。
If you'd like to try Roka, you can go to roka.com. That's roka.com and enter the code Huberman to save 20% off your first order. Today's episode is also brought to us by Bel Campo. Bel Campo is a regenerative farm in northern California that raises organic grass fed and finished certified humane meat. I tend to eat meat about once a day. So typically, I'll fast until about noon or one and then my lunch consists of a small piece of steak or chicken and some salad and then I tend to eat my carbohydrates in the evening before I go to sleep. Sometimes and especially lately, I'm eating my protein earlier in the day because I'm playing around with some of the findings related to protein intake early in the day. But regardless, I'm eating meat about once a day. For me, it's extremely important that any meat that I consume come from humane raised animals and that the meat be of the very highest quality.
如果你想尝试Roka产品，可以访问roka.com。只需输入代码Huberman，你的首次订单即可享受20%的折扣。今天的节目还由Bel Campo赞助。Bel Campo是一家位于北加州的可再生农场，饲养有机草饲并经过认证的人道处理的优质肉类。我通常每天吃一次肉。一般情况下，我会空腹到中午或下午一点，然后我的午餐通常包括一小块牛排或鸡肉和一些沙拉，晚饭前我通常会吃一些碳水化合物。最近，有时我会在一天的早些时候摄入蛋白质，因为我正在试验关于早期蛋白质摄入的一些研究结果。但无论如何，我每天大约会吃一次肉。对我来说，肉类要来自人道饲养的动物，并且肉质必须是最高品质的，这一点非常重要。
So with Bel Campo meats, the animals graze on open pastures and seasonal grasses, which results in meats that's much higher in nutrients and healthy fats, including omega-3s, which I've talked a lot about on this podcast, the importance of omega-3s for heart health, for brain health, for mood, etc. Personally, I love their ribeye steaks, their New York steaks, their chicken is terrific, and I also like the organic meatballs. All the all meat is organic and grass-fed and grass-finished. If you'd like to try Bel Campo, first time customers can get 20% off by going to Bel Campo.com slash Huberman and using the code Huberman at checkout.
贝尔坎波肉类的动物在开放的牧场和季节性草地上放牧，这使得肉类中含有更多的营养和健康脂肪，包括omega-3。我在这个播客中已经多次谈到omega-3对心脏健康、大脑健康和情绪的重要性。我个人非常喜欢他们的肋眼牛排、纽约牛排，他们的鸡肉也很棒，我还喜欢他们的有机肉丸。所有的肉类都是有机的，并且是草饲和草完成的。如果你想试试贝尔坎波的产品，新客户可以通过访问BelCampo.com/HuBerman并在结账时使用代码Huberman享受八折优惠。
Today's episode is also brought to us by Helix Sleep. Helix Sleep makes mattresses and pillows that are absolutely second to none. I started sleeping on a Helix mattress about eight, nine months ago, and I've never slept better in my life. If you go to the Helix site, they have a short two-minute night quiz. That quiz asks you questions like, do you sleep on your back, do you sleep on your side, do you sleep on your stomach, do you tend to run hot or cold in the middle of the night? Maybe you don't know. They actually have an option to select, I don't know. Helix will match you to a mattress that's specific to your sleep needs.
今天的节目由Helix Sleep赞助。Helix Sleep生产的床垫和枕头都是顶级的。大约八九个月前，我开始使用Helix的床垫，睡眠质量从未像现在这样好。你可以访问Helix的网站，进行一个简短的两分钟夜间问卷调查。调查会问你一些问题，比如你是仰睡、侧睡还是趴睡，你晚上是否容易觉得热或冷。如果你不确定，他们也有一个“不知道”选项。Helix会根据你的睡眠需求，为你匹配一款专属床垫。
It turns out to be really important. Some people have the tendency to run hot and sleep on their stomach. Other people lie on their back and they're waking up cold in the middle of the night. You really need a mattress that's matched to your sleep needs. I did that and I matched to the dusk mattress, dusk, and it turns out to be perfect for me and my sleep needs. As well, their pillows are really terrific. If you're interested in upgrading your mattress, go to helixleep.com slash huberman. Take their two-minute sleep quiz and they'll match you to a customized mattress. You'll get up to $200 off any of their mattresses and you'll get two free pillows with your order.
这真的很重要。有些人容易体温过高，喜欢趴着睡；而另一些人则仰卧，但半夜会感到寒冷。你确实需要一个与自己的睡眠需求相匹配的床垫。我找到了适合我的黄昏床垫，发现它完全符合我的睡眠需求。此外，他们的枕头也非常好。如果你有兴趣升级床垫，可以访问helixsleep.com/huberman，参加他们的两分钟睡眠测验，他们会为你匹配一个个性化的床垫。你还能享受最高200美元的优惠，并在下单时获得两个免费枕头。
They have a 10-year warranty. You have to try it out for a hundred nights risk-free. It's more than three months. If you don't like it, they'll pick it up for you and they'll take it away and you get all your money back. If you're interested, go to helixleep.com slash huberman for up to $200 off your mattress and two free pillows. Let's talk about ADHD, attention deficit hyperactivity disorder. Let's also talk about focus and attention and everybody's ability to focus and attend, not just people with ADHD. We are also going to talk about tools that would allow anyone, whether or not they have ADHD or not, to enhance their level of concentration and focus.
他们提供10年保修期。你可以无风险试用一百晚，这比三个月还长。如果你不满意，他们会来你家取走产品，并全额退款。如果你感兴趣，可以访问helixsleep.com/huberman购买，最高可享受200美元的床垫优惠，还能免费获得两个枕头。现在让我们来聊聊注意力缺陷多动障碍（ADHD）。同时也谈谈注意力和专注力，以及每个人提升专注和注意力的能力，而不仅仅是那些患有ADHD的人。我们还将讨论一些工具，可以帮助任何人，无论是否有ADHD，提升他们的专注力和注意力水平。
ADHD used to be called ADD, attention deficit disorder. We have record of ADD in the medical literature dating back to as early as 1904. Now there's nothing special about 1904. That's just the first time that it showed up in the standard medical literature. We have to believe that ADD, which we now call ADHD, existed before 1904 and probably long before 1904. Why? Well, because it has a strong genetic component. If you have a close relative that has ADHD, there's a much higher probability that you will have ADHD and that probability goes up depending on how closely related to that person you happen to be.
ADHD曾经被称为ADD，即注意力缺陷障碍。在医学文献中，我们可以追溯到最早在1904年就有关于ADD的记录。1904年并不是特别的年份，只是ADD第一次出现在标准医学文献中。我们有理由相信，ADD，也就是现在称为ADHD的症状，早在1904年之前就已经存在，并且可能存在了很长时间。为什么这么说呢？因为它有很强的遗传因素。如果你的近亲有ADHD，那么你患ADHD的概率会大大增加，而且这种概率随着你和那位近亲关系的亲密程度而提高。
So for instance, if you're an identical twin and your twin has ADHD, there's a very high concordance as we say, a very high probability that you will have ADHD, up to 75% chance. If you have a fraternal twin with ADHD, that number goes down a bit in the 50 to 60% range and so on. If you have a parent with ADHD, that number ranges anywhere from 10 to 25% likelihood that you will have ADHD if you have two parents and so on and so on. So there's a genetic component. That genetic component, it turns out, relates directly to how specific neural circuits in the brain wire up, the chemicals they use and the way they use those chemicals, a topic that we are going to discuss in depth today.
例如，如果你有一个孪生的同卵双胞胎兄弟或姐妹，并且他们患有多动症（ADHD），那么你有很高的可能性也会患有多动症，概率高达75%。如果你的双胞胎兄弟或姐妹是异卵双胞胎而且有多动症，那么这个概率会降低一些，大约在50%到60%之间。如果你有一个患有多动症的父母，那么你有10%到25%的可能性也会患上多动症。如果你两个父母都有多动症，概率还会有所不同。由此可见，多动症有一定的遗传因素。这个遗传因素与大脑中特定神经回路的形成、使用的化学物质及其运作方式直接相关，这是我们今天将深入讨论的话题。
Now, if you have a close relative with ADHD, that does not mean that you are faded to have ADHD. And if you happen to have ADHD, there are ways to overcome those symptoms of lack of attention in impulsivity and so on. Another important point about ADHD is that it has nothing to do with intelligence. Whether or not we're talking about intelligence measured by a standard IQ test, a rather controversial issue, as many of you probably know, there are lots of forms of intelligence that a standard IQ test just wouldn't pick up, emotional intelligence, musical intelligence, spatial intelligence, all sorts of intelligences.
现在，如果你的近亲有多动症（ADHD），这并不意味着你注定也会有多动症。而即使你有多动症，也有方法可以克服注意力缺陷、冲动等症状。关于多动症的另一个重要点是，它与智力无关。无论我们是否在谈论通过标准智商测试测量的智力，正如许多人可能知道的那样，这确实是一个有争议的问题，因为有许多种智力是标准智商测试无法涵盖的，比如情绪智力、音乐智力、空间智力等等。
None of them are related to ADHD. Being very high functioning doesn't make you more likely to have ADHD and being ADHD doesn't necessarily mean that you have a low IQ. So there are people with ADHD, you have low IQs, people with ADHD with high IQs, people with ADHD with high emotional IQ or with low IQ in the emotional scale. It's all over the place. The important point is that your ability to attend and focus does not relate to how smart you are or your IQ of any type, not just a standard IQ. The renaming of ADD to ADHD took place in the mid to late 1980s.
他们都与多动症（ADHD）无关。高功能表现并不意味着你更有可能患有多动症，而患有多动症也不一定说明你的智商低。因此，有些多动症患者智商较低，而有些则智商较高；有些多动症患者情商高，而有些则情商低。这种情况多种多样。关键是，你的注意力和专注力与你的智力水平或任何类型的智商无关，不仅仅是标准智商。注意力缺陷障碍（ADD）被重新命名为注意力缺陷多动障碍（ADHD）是在20世纪80年代中后期。
When the psychiatric community and the psychological community started taking better notice of the fact that so-called hyperactive kids also had attentional issues. This might seem obvious, but there's been extensive and ongoing revision of the criteria for designating a psychiatric disorder. This is still an ongoing process, even today. In the mid-80s, we started hearing about ADHD and then gradually that term ADD has been dropped away. However, just the renaming of ADD to ADHD has led to much better diagnosis and detection of ADHD. So right now, the current estimates are that about one in 10 children and probably more have ADHD.
当精神病学界和心理学界开始更好地注意到所谓的多动症儿童也存在注意力问题时，这个问题才开始受到重视。虽然这听起来很明显，但为诊断精神疾病制定的标准一直在不断修订。这一过程甚至在今天仍在继续。上世纪80年代中期，我们开始听说注意力缺陷多动障碍（ADHD），而以前指的注意力缺陷障碍（ADD）这一术语逐渐被淘汰。然而，单是将ADD重命名为ADHD就已经大大改善了ADHD的诊断和检测。目前的估计是，大约每10个儿童中就有1个，甚至更多的儿童患有ADHD。
The current estimates are anywhere from 10% to as high as 12%. Now, fortunately, about half of those will resolve with proper treatment, but the other half typically don't. The other thing that we are seeing a lot nowadays is increased levels of ADHD in adults. And there's some question as to whether or not those adults had ADHD that went undetected during their childhood or whether or not ADHD is now cropping up in adulthood due to the way that we are interacting with the world.
目前的估计大约在10%到12%之间。幸运的是，其中大约一半通过适当的治疗可以康复，但另一半通常不会。我们现在还发现，成人中的多动症（ADHD）数量有所增加。有一种说法认为，这些成年人可能在童年时就有未被发现的多动症，也有人认为由于我们现在与世界互动的方式，成人时期才出现了多动症。
In particular, smart phone use, the combination of email, text, real world interactions, multiple apps and streams of media and social media all coming in at once, trying to manage life, all of the things that are going on are creating kind of cloud of pulls on our attention. And so there is this question to whether or not we are creating ADHD in adults that never had ADHD prior to being an adult. So let's talk about attention. And first, let's just define what we mean by attention. Out there in the scientific literature and discussions about ADHD, we will hear things like attention and focus and concentration and impulse control.
特别是智能手机的使用，把电子邮件、短信、现实世界的互动、多个应用程序、各种媒体和社交媒体流都结合在一起，同时涌入并试图管理生活，这些正在造成一种对我们注意力的干扰。因此，问题在于我们是否在成年人中创造了以前从未有过的注意力缺陷多动症（ADHD）。那么，就让我们来讨论一下注意力。首先，需要明确我们所说的注意力是什么意思。在科学文献和关于ADHD的讨论中，我们会听到注意力、专注力、集中力和冲动控制等词汇。
For sake of today's discussion, attention, focus and concentration are essentially the same thing. We could split hairs and the scientific literature does split hairs about these. But if we want to understand the biology and we want to have a straightforward conversation about ADHD, if I say attention or focus, I'm basically referring to the same thing, unless I specify otherwise. Okay. So people with ADHD have trouble holding their attention. What is attention? Well, attention is perception. It's how we are perceiving the sensory world.
为了今天的讨论，我们可以将注意力、专注和集中视为同一概念。虽然在科学文献中，这些术语可能会被详细区分，但为了更好地理解生物学，并进行关于注意缺陷多动障碍（ADHD）的简单讨论，如果我提到“注意力”或“专注”，基本上是在说同一件事情，除非我特别说明。这么说吧，患有ADHD的人在保持注意力方面有困难。什么是注意力呢？注意力其实就是感知，它是我们感知外界感官世界的方式。
So just a little bit of neurobiology 101, we are sensing things all the time. There's information coming into our nervous system all the time. For instance, right now, you're hearing sound waves. You are seeing things. You are sensing things against your skin, but you are only paying attention to some of those. And the ones that you're paying attention to are your perceptions. So if you hear my voice, you are perceiving my voice. You are not paying attention to your other senses at the moment. Okay. You might even be outside in a breeze. And until I said that, you might not be perceiving that breeze, but your body was sensing it all along.
这是一点神经生物学的基础知识：我们的身体一直在感知各种事物。信息不断进入我们的神经系统。比如，现在你正在听到声波，看见东西，感受到皮肤上的接触，但你只会注意其中的一部分。而你注意到的，就是你的感知。如果你听到我的声音，那就是你在感知我的声音，而此刻你没有在注意其他的感觉。好比说，你可能正在外面吹着微风，但在我提到之前，你可能没有注意到那阵微风，但你的身体其实一直在感知它。
So attention and focus are more or less the same thing. But impulse control is something separate. Because impulse control requires pushing out or putting the blinders on to sensory events in our environment. It means lack of perception. Impulse control is about limiting our perception. People with ADHD have poor attention and they have high levels of impulsivity. They are easily distractable. But the way that shows up is very surprising. You might think that people with ADHD just simply can't attend to anything. They really can't focus even if they really want to. But that's simply not the case.
注意力和专注力基本上是差不多的概念，但冲动控制则是另外一回事。冲动控制需要我们对环境中的感官刺激进行过滤，或是自动屏蔽掉。这意味着减少感知。冲动控制就是要限制我们的感知。患有注意力缺陷多动障碍（ADHD）的人通常注意力不集中，并且冲动性强，容易分心。但这一点的表现方式常常让人惊讶。人们可能会认为患有ADHD的人无法专注于任何事物，即使他们真的很想专注也做不到。但事实并非如此。
People with ADHD, yes, they are distractable. Yes, they are impulsive. Yes, they are easily annoyed by things happening in the room. They sometimes have a high level of emotionality as well, not always, but often. However, people with ADHD can have a hyper focus and incredible ability to focus on things that they really enjoy or are intrigued by. Now this is a very important point because typically we think of somebody with ADHD as being really wild and hyperactive or having no ability whatsoever to sit still and attend.
患有注意力缺陷多动障碍（ADHD）的人，确实容易分心，行为冲动，并且对周围发生的事情容易感到恼火。他们有时还表现出极强的情绪反应，虽然不是总如此，但经常会出现。然而，患有ADHD的人在他们真正感兴趣或感到好奇的事情上可以表现出超强的专注力。这个特点很重要，因为我们通常认为ADHD患者非常活跃，静不下来，或者完全没有能力坐着专心。
And while that phenotype, as we call it, that contour of behavior and cognition can exist. Many people, if not all people with ADHD, if you give them something they really love, like the child loves video games or if a child loves to draw or if an adult loves a particular type of movie or a person very much, they will obtain laser focus without any effort. So that tells us that people with ADHD have the capacity to attend, but they can't engage that attention for things that they don't really, really want to do.
虽然这种我们称之为“表型”的行为和认知特征是存在的，但很多患有多动症（ADHD）的人，如果给他们一些他们真正热爱的东西，比如孩子喜欢电子游戏或绘画，或者成年人特别喜欢某种电影或某个人，他们就会毫不费力地集中注意力。这告诉我们，患有多动症的人是有能力集中注意力的，只是他们无法在自己不真正想做的事情上投入注意力。
And as we all know, much of life, whether or not you're a child or an adult, involves doing a lot of things that we don't want to do. Much of our schooling involves doing things that we would prefer not to do and sort of forcing ourselves to do it to attend, even though we are not super interested in what we are attending to. There are a couple other things that people with ADHD display quite often. One is challenges with time perception. Time perception is a fascinating aspect of how our brain works.
正如我们所知，无论是作为孩子还是成年人，生活中很大一部分时间都要做我们不愿意做的事情。在我们的教育过程中，我们常常得做一些自己不太想做的事情，需要强迫自己去参与，即便我们对所参与的内容并不十分感兴趣。有几点是注意缺陷多动障碍（ADHD）患者经常表现出来的。其中之一就是对时间感知的挑战。时间感知是一种大脑运作的奇妙表现。
And later we're going to talk about time perception and how you can actually get better at time perception. It's very likely that right now you are doing things that get in the way of optimal time perception. And I will tell you how to adjust your ability to measure time with your brain. People with ADHD often run late. They often procrastinate. But what's interesting and surprising is that if they are given a deadline, they actually can perceive time very well.
接下来我们将讨论时间感知以及如何提高时间感知能力。目前很可能你在做的事情会阻碍你对时间的最佳感知。我会告诉你如何调整大脑对时间的测量能力。患有多动症的人经常会迟到和拖延。但有趣且令人惊讶的是，如果给他们设定一个截止日期，他们实际上能很好地感知时间。
And they often can focus very well if the consequences of not completing a task or not attending are severe enough. It's a little bit like the way that people with ADHD can really focus if they like something. Well, if they're scared enough about the consequences of not attending, oftentimes not always, but oftentimes they can attend. If they're not really concerned about a deadline or a consequence, well, then they tend to lose track of time and they tend to underestimate how long things will take.
他们常常能够很好地集中注意力，只要不完成任务或不参与活动的后果足够严重。这有点像患有多动症的人如果对某件事情感兴趣，就能非常专注。如果他们对不参与的后果感到足够害怕，通常情况下（虽不是总是），他们就能集中注意力。如果他们对截止日期或后果不是特别在意，那么他们往往会失去时间概念，低估事情所需的时间。
Now many people do that, not just people with ADHD, but people with ADHD have challenges understanding how to line up the activities of their day in order to meet particular deadlines, even if it's just a simple thing like finishing one set of tasks before lunch. Oftentimes they will remember that lunch starts at noon, but somehow they aren't able to fill the intervening time in a way that's productive. And they can obsess about the upcoming deadline, we will talk about how to remedy this.
现在，许多人都会这样做，不仅仅是注意力缺陷多动障碍（ADHD）患者。但是，患有ADHD的人在安排日常活动以满足特定截止日期方面面临困难，即使只是像在午餐前完成一系列任务这样简单的事情。通常，他们会记得中午12点午餐开始，但却无法以有效的方式利用中间的时间。他们可能会对即将到来的截止日期感到焦虑。我们会讨论如何解决这个问题。
In addition, their spatial organization skills are often subpar, not always, but often you will find that somebody with ADHD uses what's called the pile system in order to organize things. They will take many belongings and this could be in the kitchen or in their bedroom or in their office or in any space and they will start piling things up according to a categorization system that makes sense to them and only them. It doesn't really have any logical framework.
此外，他们的空间组织能力往往较差，虽然不是总是如此，但通常你会发现有注意力缺陷多动障碍（ADHD）的人会使用所谓的“堆放系统”来整理东西。他们会把许多物品堆放在一起，比如在厨房、卧室或办公室，按照只有他们自己才明白的分类方法进行整理。这种方法并不遵循任何逻辑框架。
Now many people use the pile system and if you use the pile system that doesn't mean that you have ADHD, in fact, if you're unpacking a house or you've moved recently or you've received a lot of presence recently, the pile system makes perfect sense to organize your space. But people with ADHD tend to organize things according to the pile system all the time and that pile system doesn't work for them. So that's the key distinction that they use a filing system and it's not really files. They're piling things up in a way that makes sense to them, but then it doesn't work for them in terms of what tasks they actually need to perform. They can't find things or if anyone moves one thing, then it's very disruptive to their overall plan because their overall plan doesn't really work in the first place. So that's a common phenotype as we call it. A phenotype, by the way, is just an expression of a particular set of underlying genetic or psychological components.
现在很多人会使用堆叠整理法。如果你使用这种方法，并不意味着你有多动症（ADHD）。事实上，如果你正在整理刚买的房子，或是最近搬家了，又或者是最近收到了很多礼物，用堆叠整理法来安排空间确实是合情合理的。但有多动症的人往往总是使用堆叠整理法，而这种方法对他们并不奏效。关键在于，他们实际上是在用堆叠代替文件整理。他们按照自己的逻辑堆放东西，但这种方法并不能帮助他们完成实际需要做的任务。他们常会找不到东西，如果有人挪动了某件东西，就会打乱他们的整体计划，因为他们的计划本身并不合理。这种行为是一种我们称为表型的常见现象。顺便提一下，表型指的是一组潜在的遗传或心理成分的具体表现。
So we see the phenotype. So a phenotype would be brown hair and green eyes. For me, a phenotype could also be that somebody uses the piling system. The other thing that people with ADHD have real trouble with is so called working memory. Now you might think that people with ADHD would have really poor memories, but in fact that's not the case. People with ADHD often can have a terrific memory for past events that can remember upcoming events quite well. Their memory is clearly working. However, one aspect of memory in particular that we call working memory is often disrupted. Working memory is the ability to keep specific information online to recycle it in your brain over and over again so that you can use it in the immediate or short term.
所以我们看到的是表型。表型可能是棕色的头发和绿色的眼睛。而在我看来，表型还可以指某人使用一种整理系统。另一个是注意力缺陷多动障碍（ADHD）患者在所谓的工作记忆方面往往遇到很大的困难。你可能会认为ADHD患者的记忆力会非常差，但事实并非如此。ADHD患者往往对过去的事件有非常好的记忆，而且可以很好地记住即将发生的事件。他们的记忆显然是有效的。然而，特别是我们称之为工作记忆的一个记忆方面常常会受到干扰。工作记忆是指能够在大脑中循环利用特定信息的能力，以便即时或短期使用这些信息。
A good example of this would be you meet somebody, they tell you their name, they give you their phone number verbally and you have to walk back to your phone and enter it into your phone. People without ADHD might have to put some effort into it. It might feel like a bit of a struggle, but typically they would be able to recite that phone number in their mind over and over and then put it into their phone. People with ADHD tend to lose the ability or lack the ability to remember things that they just need to keep online for anywhere from 10 seconds to a minute or two. A string of numbers like 643781, for most people would be pretty easy. 643781, 643781, you could probably remember that a minute from now without writing it down. But if you add one more number to that 6437813, it gets tougher. There's a reason why phone numbers typically have seven digits in them. Of course, there's an area code, but remembering information that strings out longer than seven numbers or a sentence or two, that's challenging for most people.
一个很好的例子是，当你遇到一个人，他们告诉你他们的名字，并口头告诉你他们的电话号码，而你需要走回到手机旁把号码输入进去。没有多动症（ADHD）的人可能需要花一些精力来完成这个任务，可能会觉得有点困难，但通常他们能够在脑海中反复默念这个电话号码，然后输入到手机里。而有多动症（ADHD）的人往往会失去或缺乏记住短时间内需要记住的信息的能力，持续时间从10秒到一两分钟不等。对于大多数人来说，像643781这样的一串数字相对比较容易记住。643781，643781，你可能在一分钟后仍能记住这个数字，而不需要写下来。但如果你再加一个数字，变成6437813，就变得难一些。这就是为什么电话号码通常由七位数字组成。当然，还有区号，但要记住超过七位数字或一两句话的信息，对大多数人来说都是有挑战的。
People with ADHD have severe challenges, even with much smaller batches of information over even much smaller batches of time. Deficits in working memory are also something that we see in people who have frontotemporal dementia, so damage to the frontal lobes, or age-related cognitive decline. And so it will come as no surprise that later when we discuss treatments, supplements, and other tools for ADHD, that many of those treatments, supplements, and tools for ADHD are similar to the ones that work for age-related cognitive decline. Okay, so we've more or less established the kind of menu of items that people with ADHD tend to have, some have all of them, some have just a subset of them. Their severity can range from very intense to mild, but in general, it's challenges with attention and focus, challenges with impulse control. They get annoyed easily.
患有多动症（ADHD）的人即便在处理相对较少的信息和使用较短的时间时，也会面临严重的挑战。工作记忆的缺陷也在患有额颞叶痴呆（frontotemporal dementia）的人中常见，这通常是由额叶损伤或年龄相关的认知衰退引起的。所以，当我们谈论多动症的治疗、补充剂以及其他工具时，它们与用于年龄相关认知衰退的治疗、补充剂和方法有很多相似之处，这一点并不令人惊讶。
我们已经大致了解了多动症患者可能遇到的问题清单，其中一些人全部出现，而另一些人可能只是遇到部分问题。这些问题的严重程度可以从非常严重到轻微不等，但总体来说，主要表现为注意力和专注力方面的挑战，以及冲动控制的困难，他们容易感到烦躁。
They have kind of an impulsivity. They can't stay on task. Time perception can be off. They use the piling system or a system that doesn't work well for them in order to organize their things in physical space. And they have a hard time with anything that's mundane that they're not really interested in. But again, I just want to highlight that people with ADHD are able to obtain heightened levels of focus, even hyper-focus, for things that are exciting to them, and that they really want to engage in. So now you have the contour of what ADHD is. And if you're somebody who doesn't have ADHD, you should also be asking yourself which aspects of ADHD are similar to things have experienced before. Because what we know about the healthy brain is that there's also a range of abilities to focus.
他们有点冲动，难以专注于任务。时间感可能偏差。他们会使用堆放物品或对他们来说效果不佳的系统来整理自己的物品。同时，他们对无聊且自己不感兴趣的事情感到困难。但我想强调的是，对于那些让他们感到兴奋并真正感兴趣的事情，患有多动症（ADHD）的人能够达到高度集中的状态，甚至是过度集中。因此，现在你对ADHD有了一个初步的了解。如果你不是ADHD患者，也应该反思一下，ADHD的哪些特征与你以前的经历类似。因为我们知道，健康的大脑在专注能力上也有一定的范围。
Some people focus very well on any task. You give them a task. They can just laser in on that task. Other people, they have to kind of fight an internal battle. They have to convince themselves that it's important or interesting. They have to kind of incentivize themselves internally. Other people doesn't matter. They could be bored to tears with the information, but they can do it just because they are, quote, unquote, very disciplined people. We tend to admire those people, but as you'll see a little bit later, it's not clear that that's the best way to run your attentional system. There might be something to this business of having heightened levels of attention for the things that you are most interested or excited by.
有些人能很好地专注于任何任务。你给他们一个任务，他们就能全心投入。而有些人则需要与内心斗争，必须说服自己事情的重要性或趣味性，并给自己一些内在激励。还有一些人不在乎内容再无聊，他们也能完成，因为他们所谓的非常自律。我们倾向于钦佩这些人，但之后你会看到，这种方式是否是管理注意力系统的最佳方式尚不明确。也许专注在最让你感兴趣或激动的事情上会有某种优势。
So let's drill into this issue of why people with ADHD actually can focus very intensely on things that they enjoy and are curious about. Now, enjoyment and curiosity are psychological terms. They're not even really psychological terms. They're just the way that we describe our human experience of liking things, wanting to know more about them. But from a neurobiological perspective, they have a very clear identity and signature. And that's dopamine. Dopamine is released from neurons. It's what we call a neuromodulator. And as a neuromodulator, it changes the activity of the circuits in the brain such that certain circuits are more active than others.
那么，让我们深入探讨一下为什么患有多动症(ADHD)的人实际上可以非常专注于他们喜欢和好奇的事物。现在，“喜欢”和“好奇”是心理学术语。其实，它们甚至不完全是心理学术语，仅仅是我们用来描述人类体验中的喜欢某物、想知道更多信息的方式。但从神经生物学的角度来看，它们有着非常明确的标识和特征，那就是多巴胺。多巴胺由神经元释放，是一种我们称之为神经调节剂的物质。作为一种神经调节剂，它改变大脑中不同回路的活动，使得某些回路比其他回路更活跃。
And in particular, dopamine creates a heightened state of focus. It tends to contract our visual world and it tends to make us pay attention to things that are outside and beyond the confines of our skin. That's what we call exteroception. Dopamine also tends to put us in a state of motivation and wanting things outside the confines of our skin. So whether or not we're pursuing something physical in our world or whether or not we're pursuing information in our outside world, dopamine is largely responsible for our ability and our drive to do that. But dopamine as a neuromodulator is also involved in changing the way that we perceive the world.
多巴胺能够增强我们的专注力。它会使我们更集中注意力，缩小我们的视觉范围，并促使我们关注皮肤之外的事物，这就是我们所说的外部感知。多巴胺也会让我们处于一种积极状态，渴望获得皮肤之外的东西。因此，无论我们追求的是物质上的目标，还是外界的信息，多巴胺都是我们具备这种能力和推动力的重要因素。此外，作为一种神经调节物质，多巴胺还参与改变我们感知世界的方式。
So as I mentioned earlier, you have all these senses coming in and you can only perceive some of them because you're only paying attention to some of them. Dopamine when it's released in our brain tends to turn on areas of our brain that narrow our visual focus and our auditory focus. So it creates a cone of auditory attention that's very narrow, it creates a tunnel of visual attention that's very narrow. Whereas when we have less dopamine, we tend to view the entire world. We tend to see the whole scene that we are in. We tend to hear everything all at once.
正如我之前提到的，我们有许多感官信息输入，但我们只能感知其中的一部分，因为我们只关注其中的一些。当大脑释放多巴胺时，它会激活大脑中某些区域，使我们的视觉和听觉注意力变得集中。这会形成一个很窄的听觉注意焦点和一个很窄的视觉注意焦点。而当我们的多巴胺水平较低时，我们倾向于关注整个世界，可以看到我们所处场景的全貌，并能同时听到所有声音。
So as I describe this, hopefully you're already starting to see and understand how having dopamine release can allow a person, whether or not they have ADHD or not, to direct their attention to particular things in their environment. So now what we're doing is we're moving away from attention as this vague ambiguous term and we're giving it a neurochemical identity, dopamine, and we are giving it a neural circuit identity. And just to put a little bit of flavor and detail on which neural circuits those are, I want to discuss two general types of neural circuits that dopamine tends to enhance.
在我描述的过程中，我希望你已经开始了解和理解，多巴胺的释放是如何使人们，无论他们是否有多动症，能够将注意力集中在环境中特定事物上的。因此，我们逐渐将注意力从一个模糊的概念，赋予了一种神经化学的身份，即多巴胺，并且也赋予了一种神经回路的身份。为了更具体地说明这些神经回路，我想讨论一下多巴胺通常增强的两类神经回路。
So let's talk neural circuits. And for those of you that love hearing neuroscience nomenclature, you're going to eat this part up. And for those of you that don't like a lot of names of brain areas, I invite you to tune out or just try and grab the top contour of this. I will describe it in pretty general terms, but I will give some detail because I know there are some of you out there who really want to dig deeper into what the exact structures and connectivity is are. Okay. So there are two main types of circuits that we need to think about with respect to ADHD, attention and dopamine.
那么，我们来聊聊神经回路吧。对于那些喜欢神经科学术语的人来说，你会非常享受这一部分。而对于不喜欢脑区名称太多的人，我建议你可以选择忽略这些细节，或者试着抓住整体的轮廓。我会用比较通俗的语言来描述，但是也会提供一些细节，因为我知道有些人想深入了解具体的结构和连接。那么，关于多动症、注意力和多巴胺，我们需要考虑两种主要的回路类型。
The first one is called the default mode network. The default mode network is the network of brain areas in your brain and my brain and in everybody's brain that is active when we're not doing anything when we're just sitting there idle at rest. Now it's very hard to not think about anything, but when you're not engaged in any type of specific task, so you're not driving, you're not playing a video game, you're not trying to study, you're not trying to listen, you're just sitting there letting your brain kind of go wherever it wants to go, your default mode network underlies that state of mind.
第一个被称为默认模式网络。默认模式网络是你的大脑、我的大脑以及每个人的大脑中活跃的一组脑区，这些脑区在我们不做任何事情时，例如只是静坐休息时，会变得活跃。不去想任何事情是很难的，但当你没有专注于任何特定任务的时候，比如没有在开车、玩电子游戏、学习或听东西，只是坐在那里让大脑自由遐想时，默认模式网络就在支持这种心理状态。
The other set of circuits that we're going to think about and talk about with respect to ADHD are the task networks, the networks of the brain that make you goal-oriented or that are at least trying to make you goal-oriented. And those are a completely different set of brain areas. However, the default mode network and these task networks are communicating with one another and they're doing that in very interesting ways. So first I want to describe how these two sets of brain areas, the default mode network and the task networks normally interact.
我们接下来要探讨与多动症（ADHD）相关的另一组脑回路是任务网络。这些是使大脑具有目标导向的一组网络，或者至少是试图让你具有目标导向的网络。这些网络涉及完全不同的一组脑区域。然而，默认模式网络与这些任务网络正在相互沟通，并且它们的沟通方式非常有趣。首先，我想介绍一下这两组脑区域——默认模式网络和任务网络——通常是如何互动的。
Okay. So little bit of naming here, again, feel free to ignore it if you don't want this level of detail, but the default mode network includes an area called the Dorsal Lateral Prefrontal Cortex. Frontal Cortex, no surprises in the front and you have a Dorsal the top and side lateral part, Dorsal Lateral Prefrontal Cortex. You got one on each side of your brain, right? And then you have a brain area called the posterior single at Cortex and then you have an area called the lateral parietal lobe. Again, you don't need to remember these names, these are three brain areas that normally are synchronized in their activity. So when one of these areas is active in a typical person, the other areas would be active as well. So it's a little bit like a symphony or a band, like a three piece band. It's like drums, guitar, and bass. They're playing together.
好的，这里有点术语上的说明，如果你不需要这些细节，可以忽略，不过，默认模式网络包含一个叫做背外侧前额叶皮层的区域。前额叶皮层位于大脑的前部，背外侧部分位于顶部和侧面，也就是背外侧前额叶皮层。大脑的两侧各有一个这样的区域。另外，还有一个叫做后扣带回皮层的脑区，以及一个叫做外侧顶叶的区域。你不需要记住这些名称，这三个大脑区域通常是同步活动的。也就是说，当其中一个区域在一个典型的人脑中活跃时，其他区域也会同时活跃。这有点像一个交响乐团或者一个三人乐队，像是鼓、吉他和贝斯一起演奏。
Okay. That's how it is in a typical person in a person with ADHD or even a person who has subclinical ADHD or in any human being who hasn't slept well, what you find is the default mode network is not synchronized. These brain areas are just not playing well together. Now, the task networks include a different set of structures. It still involves the prefrontal Cortex, but it's a different part of the prefrontal Cortex. Okay. Tends to be the medial prefrontal Cortex. And there are some other brain areas that the medial prefrontal Cortex is communicating to all the time, mainly to suppress impulses. It's shutting down the desire to stand up or to scratch the side of your cheek or your nose if you're trying not to do that. Anytime you're restricting your behavior, these task directed networks are very active.
好的。在一个典型的人、一个患有多动症（ADHD）的人、甚至是一个有轻微多动症症状的人，或者任何一个没有睡好觉的人身上，你会发现默认模式网络（DMN）是不同步的。这些大脑区域并不能很好地协调工作。任务网络则涉及不同的结构。它仍然包括前额叶皮层，但涉及的是前额叶皮层的不同部分，通常是内侧前额叶皮层。内侧前额叶皮层会一直与其他一些大脑区域进行沟通，主要是为了抑制冲动。比如，当你试图不站起来或者不抓挠脸颊或鼻子时，它会关闭这些冲动。任何时候，只要你在约束自己的行为，这些任务导向的网络就会非常活跃。
Okay. Now normally in a person without ADHD, the task networks and the default mode networks are going in kind of seesaw fashion. They are actually what we call anti correlated. So it's not just that they are not correlated. They are actually opposing one another. They are anti correlated. In a person with ADHD, the default mode networks and the task networks are actually more coordinated. That might come as surprising. I think that we all have this tendency to kind of jump to conclusion and assume that somebody who doesn't have an easy time paying attention or has ADHD, that their brain must be completely incoherent. That's not working well because everything is out of whack.
好的。通常情况下，在没有注意力缺陷多动障碍（ADHD）的人中，任务网络和默认模式网络以一种类似跷跷板的方式运作。它们实际上是互相关联的，我们称之为“负相关”。这不仅仅是说它们没有关联，而是它们彼此对立。在患有ADHD的人中，默认模式网络和任务网络实际上更加协调。这可能会让人感到意外。我们往往倾向于快速下结论，认为那些注意力难以集中的人或者患有ADHD的人，他们的大脑一定是完全不协调的，运作不良，一切都乱套了。
But there's something interesting about people with ADHD whereby the task networks and the default mode networks are actually working together in a way that's correlated and that is what's abnormal. So this would be like the guitar, bass and the drums playing together in a way where the bass isn't keeping the back beat and the drums aren't keeping the back beat. That they're playing together. They're all playing the melodies and harmonies in a way that just doesn't sound right. That's what's going on in the brain of somebody with ADHD. And we can now confidently say based on brain imaging studies that when somebody gets better when they're treated for ADHD or when they age out of ADHD as sometimes is the case, that the default mode networks and the task networks tend to become anti correlated again.
患有注意力缺陷多动障碍（ADHD）的人有一个有趣的现象：他们的大脑中任务网络和默认模式网络以一种相关的方式同时工作，这是不正常的情况。这就像吉他、贝斯和鼓在一起演奏，但贝斯和鼓没有保持节拍的稳定，而是一起演奏旋律和和声，听起来不太对劲。这就是ADHD患者大脑中发生的事情。现在我们可以根据脑成像研究自信地说，当ADHD患者经过治疗有所改善，或者在成长过程中症状减轻时，默认模式网络和任务网络往往会再次变得相互抗衡。
So that's the underlying neurobiology. But you'll notice that I didn't mention dopamine at all. What dopamine is doing in this context is dopamine is acting like a conductor. Dopamine is saying if this circuit should be active, then that circuit should be active. It should be default mode network and then when the default mode network is not active, then it should be the task network. So it's really acting as a conductor saying, you go now you go now you go now you go now you go and in ADHD, there's something about the dopamine system that is not allowing it to conduct these networks and make sure that they stay what, you know, the engineers are physicists or mathematicians would say out of phase to be anti correlated.
这就是潜在的神经生物学基础。不过，你会注意到，我并没有提到多巴胺。在这个背景下，多巴胺的作用就像一个指挥家。多巴胺在协调各个脑回路的活动：如果这个回路应该活跃，那么那个回路也应该活跃。比如默认模式网络活跃时，那么当它不活跃时就应该是任务网络活跃。所以，多巴胺实际上是以一种指挥的方式运作，像是在说：现在该你了，现在该你了。而在注意力缺陷多动障碍（ADHD）中，多巴胺系统似乎出了问题，无法有效地指挥这些网络，确保它们保持，工程师、物理学家或数学家所说的“反相关”状态。
Okay. Out of phase and anti correlate essentially the same thing at least for purposes of this discussion. So that raises two questions. Could it be that dopamine is not at sufficiently high levels or could it be that dopamine is just doing it all wrong? In other words, is there no conductor or is the conductor playing with like little tiny toothpicks? And so the instruments can't see what they're supposed to do. They can't get the instruction because it's just not loud enough so to speak or could it be that the information is getting out but the information that's getting out is wrong. The conductor is there but the conductor isn't very good at conducting.
好的。在这个讨论中，"不同步"和"反相关"可以看作基本上是同一种情况。这就引出了两个问题：是否可能是因为多巴胺水平不够高，或者是多巴胺根本在发挥错误的作用呢？换句话说，是不是根本没有指挥，或者是指挥在用小牙签来指挥？因此，乐器看不到它们应该怎么做。它们无法接收到指示，因为音量不够大，或者可能是信息传递出去了，但传递的信息是错误的。虽然有指挥，但指挥能力并不好。
Now we can gain insight into how this system works and fails and how to treat it by looking at some of the current and previous treatments for ADHD as well as some of the recreational drugs that people with ADHD tend to pursue and like. Now I'm certainly not a proponent of people with ADHD taking drugs recreationally. That's not what this is about. But if you look at their drug seeking behavior and you couple that drug seeking behavior to their desire to remedy their attention deficit, you start gaining some really interesting insight into how dopamine is regulating these circuits in normal circumstances and in people with ADHD.
现在，我们可以通过研究当前和过去对多动症（ADHD）的治疗方法以及一些多动症患者常追求和喜好的娱乐性药物，来深入了解这个系统是如何运作及失效的，并如何对其进行治疗。当然，我并不提倡多动症患者娱乐性地使用药物，这不是重点。但如果你观察他们寻求药物的行为，并将这种行为与他们想要改善注意力缺陷的愿望相结合，你会开始获得一些非常有趣的见解，了解多巴胺在正常情况下和多动症患者中是如何调节这些回路的。
So what exactly is going on with the dopamine system in people with ADHD? And what's going on with the dopamine system in people that have terrific levels of attention for any task? Well, in the year 2015 an important paper came out, the first author is Spencer and it came out in a journal called biological psychiatry and it formalized this so-called low dopamine hypothesis of ADHD. The idea that dopamine was somehow involved or not at the appropriate levels in people with ADHD had been around for a pretty long time.
那么，对于多动症（ADHD）患者来说，他们的多巴胺系统到底发生了什么变化？而那些在任何任务中都能保持极高注意力的人，他们的多巴胺系统又是怎样的呢？在2015年，一篇重要的论文发表在《生物精神病学》杂志上，第一作者是斯宾塞。这篇论文正式提出了所谓的“低多巴胺假说”，即认为多巴胺水平在多动症患者中并不适当的想法。这种观点，即多巴胺在多动症患者中以某种方式发生作用或水平不适当，已经存在很长时间了。
But a formal proposition of the low dopamine hypothesis led to some really important experiments and understanding of what goes wrong in ADHD. It turns out that if dopamine levels are too low in particular circuits in the brain, that it leads to unnecessary firing of neurons in the brain that are unrelated to the task that one is trying to do and that is unrelated to the information that one is trying to focus on. So if you think back before you've got this default mode network and a task related network and they need to be in this kind of concert of anti-correlation and in ADHD, they're firing together.
但有关低多巴胺假说的正式提议引发了一些重要的实验和对注意缺陷多动障碍（ADHD）的理解。研究发现，如果大脑中某些回路的多巴胺水平过低，就会导致不必要的神经元活动。这些活动与人们正在尝试完成的任务或想要专注的信息无关。回想一下，当你的大脑中有预设模式网络和任务相关网络时，它们应该反相关地协调工作，但在ADHD中，它们却同时活跃。
Well, the problem seems to be that when dopamine is low, certain neurons are firing when they shouldn't be. This is like a band, right? We'll go back to our band that's a guitar base and a person playing the drums and it's as if one of those or several of those instruments are playing notes when they shouldn't be playing, right? The pauses in music are just as important as the actual playing of notes. When dopamine is too low, neurons fire more than they should in these networks that govern attention.
问题似乎在于，当多巴胺水平较低时，一些神经元在不该活动的时候却开始活动。这就像一个乐队，对吧？我们可以把它比作一个有吉他和鼓手的乐队，好比说其中一个或几个乐器在不该演奏的时候开始演奏。音乐中的停顿和演奏音符同样重要。当多巴胺过低时，在控制注意力的神经网络中，神经元的活动比预期的更多。
This is the so-called low dopamine hypothesis. And if you start looking anecdotally at what people with ADHD have done for decades, not just recently since the low dopamine hypothesis has been proposed, but what they were doing in the 1950s and then the 1940s and the 1960s, what you find is that they tend to use recreational drugs or they tend to indulge in non-drug stimulants. So things like drinking six cups of coffee or quadruple espresso or when it was more prominent, smoking a half a pack of cigarettes and drinking four cups of coffee a day.
这就是所谓的低多巴胺假说。如果你从过去几十年中，特别是早在提出低多巴胺假说之前，就开始观察患有多动症的人，你会发现他们倾向于使用娱乐性药物或非药物的刺激物。在20世纪50年代、40年代和60年代，他们常常会喝六杯咖啡或四倍浓缩咖啡，或者在过去香烟普遍的时候，每天抽半包烟并喝四杯咖啡。
Or if the person had access to it, using cocaine as a recreational drug or amphetamine as a recreational drug, all of those substances that I just described, in particular cocaine and amphetamine, but also coffee and cigarettes, increased levels of multiple neurotransmitters, but all have the quality of increasing levels of dopamine in the brain and in particular, in the regions of the brain that regulate attention and these task-related and default mode networks.
如果一个人能够接触到这些物质，比如将可卡因或安非他命当作娱乐性毒品来使用，那么这些物质，包括咖啡和香烟，都会提高多种神经递质的水平。其中尤其是可卡因和安非他命，会在大脑中增加多巴胺的水平，特别是在那些负责调节注意力、任务相关网络和默认模式网络的区域。
Now young children, fortunately, don't have access to those kinds of stimulants, most of the time, and those stimulants all have high potential for abuse in adults. So we will talk about the potential for abuse in a few minutes, but if you look at children, even very young children with ADHD, they show things like preference for sugary foods, which also act as dopamine-inducing stimulants. Now of course, once they get access to soda pop and coffee and tea, they start to indulge in those more than other people.
现在，幸运的是，大多数情况下，幼儿接触不到那些类型的刺激物。而这些刺激物在成年人中具有高度的滥用潜力。我们稍后会讨论滥用的可能性，但如果你观察孩子们，甚至是非常小的患有多动症的孩子，他们会表现出对甜食的偏好，因为甜食也起到类似于刺激多巴胺的作用。当然，一旦他们可以接触到汽水、咖啡和茶，他们就会比其他人更容易沉迷于这些东西。
For a long time, it was thought that children with ADHD consumed too many sugary foods or drank too much soda or adults with ADHD would take recreational drugs like methamphetamine or cocaine or would drink coffee to excess or smoke cigarettes to excess because they had poor levels of attention and because they couldn't make good decisions, they were too impulsive and so forth.
长时间以来，人们认为患有注意力缺陷多动症（ADHD）的儿童摄入了过多的糖分或饮用了太多的汽水，而患有ADHD的成年人则可能会滥用像冰毒或可卡因之类的娱乐性毒品，或者过量饮用咖啡或抽烟。这些行为被认为是由于他们注意力水平较低、无法做出良好决策且过于冲动等原因造成的。
And while that certainly could be the case, knowing what we now know about dopamine and the fact that having enough dopamine is required in order to coordinate these neural circuits that allow for focus and quality decision-making, an equally valid idea is that these children and these adults are actually trying to self-medicate by pursuing these compounds. Things like cocaine lead to huge increases in dopamine. Well, what happens when somebody with ADHD takes that drug?
虽然这确实有可能，但根据我们现在对多巴胺的了解，以及我们知道多巴胺水平充足是协调这些允许专注和高质量决策的神经回路所必需的，另一种同样合理的想法是，这些儿童和成人实际上是在通过追求这些化合物来尝试自我药疗。像可卡因这样的东西会导致多巴胺的大幅增加。那么，当一个有多动症的人服用这种药物时，会发生什么呢？
It turns out they actually obtain heightened levels of focus. Their ability to focus on things other than things they absolutely care intensely about goes up. Likewise, children who consume anything that increases their levels of dopamine, if those children have ADHD, they tend to be calmer. They tend to be able to focus more. Now, this is very different than children who do not have ADHD. When they consume too much sugar, they tend to become super hyperactive. When they consume any kind of stimulant, they tend to go wild and run around like crazy.
事实证明，他们实际上可以获得更高水平的专注力。他们在关注那些不那么关心的事情时，专注力反而提升了。同样地，如果患有多动症的儿童摄入增加多巴胺的物质，他们往往会变得更冷静，注意力更集中。 这与没有多动症的儿童非常不同。这些儿童摄入过多糖分时，往往会变得极度活跃。而当他们摄入任何刺激性物质时，往往会兴奋得满屋子乱跑。
Actually, I have an anecdote about this just to illustrate it. I have a friend. He has two children that are now in their teens and 20s, but when they were little, one time I brought them some chocolate, just as a gift when I showed up at their house. Within 30 minutes, the kids were running around like crazy. They were pretty high energy kids, but they were going bonkers. That's actually when the mother, my friend at the time, unfortunately, still now, looked at the chocolate and realized that it was chocolate with espresso beans. It was like dark chocolate espresso beans. I was really at fault there.
其实，我有一个小故事可以说明这个问题。我有一个朋友，他有两个孩子，现在分别是十几岁和二十多岁。当他们还是小孩子的时候，有一次我去他们家时，带了一些巧克力作为礼物。半小时之内，这两个孩子就开始疯狂地跑来跑去。本来他们就是精力充沛的孩子，但那次真是失控了。实际上，那时孩子的妈妈，也就是我的朋友，才注意到我带去的巧克力是夹杂了浓缩咖啡豆的黑巧克力。这确实是我的失误。
You don't want to give kids dark chocolate with espresso beans, but what you're really seeing that hyperactivity, that is dopamine. It's the sugar combined with the caffeine, in this case, combined with a few other compounds that exist in chocolate that really increase our levels of alertness and our tendency to want to move around a lot. Dopamine and low levels of dopamine apparently are what's wrong in people with ADHD. That dopamine hypothesis is what led to the idea that treating people, children and adults included with dopamine-nergic compounds would somehow increase their ability to focus.
你不应该给孩子吃带有浓缩咖啡豆的黑巧克力，因为你真正看到的那种过度活跃是由于多巴胺的作用。这是糖与咖啡因的结合，再加上巧克力中存在的一些其他化合物，实际上这些成分增加了我们的警觉性以及想要活动的倾向。据说，注意力缺陷多动症（ADHD）患者通常是因为体内多巴胺水平低。这种多巴胺假说引发了一个想法，即通过给予多巴胺能化合物，可能会提高患有ADHD的儿童和成人的专注能力。
If you look at the major drugs that were developed and now marketed by pharmaceutical companies for the treatment of ADHD, those drugs have names like Ritalin, nowadays, it's typically things like Adderall, Modaphanil, and some of the other derivatives, they all serve to increase levels of dopamine, in particular dopamine in the networks that control task-directed behavior and that coordinate the default mode network and these task-related networks. So many of you have probably heard of Ritalin. Ritalin is a prescription stimulant that is prescribed for ADHD, as well as for narcolepsy.
如果你看看那些由制药公司研发并现已上市用于治疗多动症（ADHD）的主要药物，这些药物的名字比如利他林（Ritalin），还有现在经常用的药物如阿德拉尔（Adderall）、莫达非尼（Modaphanil）以及一些其他衍生药物，它们都能提高多巴胺水平，尤其是在控制任务导向行为以及协调默认模式网络和这些任务相关网络的多巴胺水平。许多人可能都听说过利他林。利他林是一种处方兴奋剂，通常用于治疗多动症和发作性嗜睡病。
Narcolepsy is a condition in which people tend to fall asleep during the daytime. Quite a lot, excessive daytime sleepiness, not due to lack of sleep at night. But also tend to fall asleep when they get excited. If they're really emotionally excited or about to eat or any other kind of activity that would normally get somebody really aroused and alert, people with narcolepsy tend to fall asleep or they tend to become what's called cataplectic. They tend to just sort of go limp in the muscles. So it's this invasion of sleep into the daytime. It's dysregulated by emotion.
嗜睡症是一种使人白天容易入睡的疾病。这种情况并不是因为晚上缺乏睡眠，而是白天过度的困倦。另外，当患者感到情绪激动时，也倾向于入睡。比如，当他们非常兴奋、即将进食或从事任何正常情况下会让人清醒的活动时，他们容易入睡或出现所谓猝倒现象，肌肉变得松弛无力。也就是说，嗜睡在白天不合时宜地出现，并受情绪影响。
You can imagine why a stimulant, something that would wake you up, make you very alert, focused and motivated would be a good treatment for narcolepsy. Adderol also is used to treat ADHD and to treat narcolepsy. Things like Modaphanil also used to treat ADHD and narcolepsy. So you're sensing a theme here. So what are the differences and similarities between these drugs? And what can that tell us about ADHD? Well, Ritalin was one of the first generation drugs that was prescribed for ADHD in order to deal head on with this dopamine hypothesis.
你可以想象为什么兴奋剂，即能让你清醒、注意力集中、精力充沛的东西，会是治疗嗜睡症的良好选择。Adderall 也被用于治疗多动症（ADHD）和嗜睡症。类似于莫达非尼（Modafinil）这样的药物也用于治疗 ADHD 和嗜睡症。你可能已经发现了其中的共同点。那么，这些药物之间有什么异同呢？这又能告诉我们关于 ADHD 的什么信息呢？瑞他林（Ritalin）是最早用于治疗 ADHD 的药物之一，它的作用是直接应对多巴胺假说。
This idea that in ADHD dopamine levels are too low. Nowadays, Adderol is the more typically prescribed drug for ADHD. That has to do with some of the so-called pharma kinetics, the rate at which those drugs enter the system and how long they last in the system. So for instance, Ritalin was a drug that was packaged into various time-release formulas, whereas initially Adderol was only released in a form that had a very short life. So meaning that it wasn't in the bloodstream very long and didn't affect the brain for very long.
在多动症（ADHD）中，有一种观点认为多巴胺水平过低。如今，Adderall 是更常被用于治疗多动症的药物。这与一些被称为药代动力学的因素有关，即这些药物进入身体的速度及其在体内维持的时间。例如，利他林（Ritalin）曾被做成多种缓释配方，而最初的 Adderall 则只以短效形式存在，这意味着它在血液中停留的时间不长，对大脑的影响也较短。
And so the dosages could be controlled in a more typical way without going into a lot of tangential detail. As you all know, at different times of day, you tend to be more or less alert. So a long sustained release drug, while that might sound like a really terrific thing, if that drug is having an effect of making you more alert and it's released across very many hours of your day, there might be periods of your day when you feel too alert, periods of your day when you feel just right and periods of your day when you wished that you were more alert.
因此，药物剂量可以通过一种更常规的方式进行控制，而不需要涉及太多无关细节。正如你们所知道的，在一天中的不同时间，你的警觉性会有所不同。因此，长效缓释药物虽然听起来很棒，但如果这种药物的效果是让你更警觉，并且在一天的很多小时内持续释放，那么可能会导致你在一天中有时感到过于警觉，有时恰到好处，而有时又希望自己能更警觉。
These are some of the pharmacokinetics, kinetics, meaning movement of the different compounds within the bloodstream and brain that could, you could imagine in a very real way would impact whether not someone would feel really good on one of these drugs or whether or not they would feel too anxious or too sleepy and so on. Let's take a step back for a second and just ask what are these drugs? We know they increased dopamine, but what are they really?
以下是一些药代动力学的内容。药代动力学指的是不同化合物在血液和大脑中的移动方式，这会直接影响一个人服用这些药物后的感受，比如是否会感到非常好，或者是否会感到过于焦虑或困倦等。在深入了解之前，我们先退一步思考，这些药物是什么？我们知道它们会增加多巴胺，但它们究竟是什么呢？
Well, Ritalin, also called methylphenidate, is very similar to emphetamine, speed, or what's typically called speed in the street drug nomenclature. Adderol, which goes by various other names, okay? So Adderol, Adderol XR, my DAS, my Diasis, things like that. Adderol is basically a combination of emphetamine and Dextro-emphetamine.
利他林，也被称为甲基苯丙胺，与安非他命或街头俗称的“冰毒”非常相似。还有一种叫阿德拉尔的药物，有很多不同的名字，比如阿德拉尔、阿德拉尔XR等。阿德拉尔主要是由安非他命和右旋安非他命组合而成的。
Now, some of you probably realize this that Adderol is emphetamine, but I'm guessing that there are a good number of you out there, perhaps even parents and kids that don't realize that these drugs like cocaine and emphetamine, methamphetamine, which are incredibly dangerous and incredibly habit forming and have high potential for abuse. Well, the pharmaceutical versions of those are exactly what are used to treat ADHD.
现在，你们中的一些人可能已经意识到 Adderall 是一种安非他命，但我猜测，可能有很多人，甚至包括家长和孩子，并不知道这些药物，比如可卡因、安非他命和甲基苯丙胺，是非常危险、极易上瘾并且滥用潜力极高的。事实上，那些用于治疗 ADHD（注意力缺陷多动障碍）的药物正是这些药物的药用版本。
Now, they're not exactly like cocaine or methamphetamine, but they are structurally and chemically very similar and their net effect in the brain and body is essentially the same, which is to increase dopamine, primarily, but also to increase levels of a neuromodulator called epinephrine or norepinephrine, also called noradrenaline and adrenaline, those names are the same.
现在，它们并不完全像可卡因或甲基苯丙胺，但在结构和化学性质上非常相似，其在大脑和身体中的净效应基本相同，主要是增加多巴胺水平，同时也增加一种叫做肾上腺素或去甲肾上腺素的神经调节物的水平，后者也被称为去甲肾上腺素和肾上腺素，这些名称是一样的。
And to some extent, to increase levels of serotonin in the brain and blood, but not so much serotonin, that's just kind of a small smidgen of effect, okay? So dopamine way up, norepinephrine and adrenaline way up, so that's motivation, drive, focus, and energy. And to some extent, a little bit of serotonin, which is really more about feeling calm and relaxed.
在一定程度上，可以增加大脑和血液中的血清素水平，但血清素的提升幅度不大，这只是一个很小的效果，好吗？多巴胺大幅提升，去甲肾上腺素和肾上腺素也大幅提升，所以这与动机、驱动力、专注力和精力有关。而在一定程度上，少量的血清素则更关乎于感到平静和放松。
And you could imagine why that would be a good balancing effect for dopamine and norepinephrine. So what I'm essentially saying is that the drugs that are used to treat ADHD are stimulants and they look very much like, in fact, nearly identical to some of the so-called street drugs stimulants that we all hear are so terrible.
你可以想象为什么这对多巴胺和去甲肾上腺素会有很好的平衡作用。基本上，我想表达的是，用于治疗多动症的药物是兴奋剂，它们与我们常听说的那些所谓“很糟糕”的街头兴奋剂非常相似，实际上几乎是一模一样的。
However, I do want to emphasize that at the appropriate dosages and working with a quality psychiatrist or neurologist or family physician does have to be a board certified MD that prescribes these things. Many people with ADHD achieve excellent relief with these drugs, not all of them, but many of them do, especially if these treatments are started early in life.
然而，我想强调的是，在合适的剂量下，并与具备资质的精神科医生、神经科医生或家庭医生合作——这些医生必须是持有认证的医学博士才能开具这些药物。许多患有 ADHD（注意力缺陷多动症）的人在使用这些药物后能获得很好的缓解效果，虽然并不是所有人都有这种效果，但许多人确实可以，特别是如果这些治疗在他们年轻时就开始。
So now knowing what these drugs are, I want to raise the question of why prescribe these drugs. I mean, everyone has to make a decision for themselves or for their child as to whether or not they're going to take these things or not. I also want to acknowledge that many people out there, many, many people out there are taking these drugs even though they have not been clinically diagnosed with ADHD.
翻译为中文：
现在知道这些药物是什么了，我想提出一个问题：为什么要开这些药物呢？我的意思是，每个人或他们的孩子都需要自己决定是否服用这些药物。我还想提到，外面有很多人，即使没有被临床诊断为多动症（ADHD），也在服用这些药物。
And when I say these drugs, I'm specifically referring to riddling an aderol and modaphanil, but more typically it's aderol. People using cocaine and anaphenamine for recreational purposes, that's a completely different beast and it is indeed a beast and it's something that I strongly discourage.
当我提到这些药物时，我具体指的是利他林、阿得拉尔和莫达非尼，但更常见的是阿得拉尔。人们用可卡因和安非他命来娱乐，这是完全不同的情况，这确实是一种“野兽”，我强烈反对这种行为。
However, I'm aware that up to 25% of college students and perhaps as many as 35% of all individuals between the ages of 17 and 30 are taking aderol on a regular or semi-regular basis in order to work, in order to study and in order to function and focus in their daily life, even though they have not been diagnosed with ADHD.
然而，我了解到多达25%的大学生，可能还有多达35%的17到30岁人群，虽然没有被诊断出患有多动症（ADHD），但为了工作、学习或者在日常生活中运作并保持专注，都会定期或不定期地服用阿得拉尔（Adderall）。
There's a whole black market for this. They're getting it from people with prescriptions. I'm not here to pass judgment. I just want to emphasize how these drugs work. Some of the things that they do to enhance cognition and focus that actually serve the brain well in certain individuals and how they can be very detrimental in other individuals.
这方面有一个庞大的黑市。他们是通过有处方的人获得这些药物的。我不是来评判的，我只是想强调这些药物的作用。在某些人群中，它们确实可以提高认知能力和专注力，对大脑有益，但在另一些人群中则可能非常有害。
I sort of blew right past it, but the fact that in upwards of 25% of young people are taking things like aderol despite not having a clinical diagnosis of ADHD, well that's a ridiculously high number. A few years ago, it was estimated that aderol use and riddling use without diagnosis of ADHD was second in incident only to cannabis.
我之前有点忽略了这一点，不过事实上，现在有超过25%的年轻人虽然没有被诊断为多动症（ADHD），却在使用类似于阿得拉（Adderall）这样的药物，这是一个非常惊人的数字。几年前，据估计，没有ADHD诊断却使用阿得拉或利他林（Ritalin）的情况，在发生率上仅次于大麻的使用。
But actually now, the consumption of aderol without prescription is higher than the consumption of cannabis in that age group. What that means is that there's a lot of stimulant use in that age group. There are a lot of adults also using and abusing stimulants in order to gain focus.
事实上，现在没有处方而消费阿得洛（Adderall）的情况在那个年龄段比大麻的消费还多。这意味着该年龄段有大量使用兴奋剂的情况。很多成年人也在使用和滥用兴奋剂来提高注意力。
We could have a whole discussion about whether or not life is becoming more demanding, whether or not the need for focus is excessive. That's why people are doing that. Frankly, it's an interesting discussion, but it's not one that would deliver us to any answers.
我们可以全面讨论生活是否变得更加紧张，以及人们是否需要过度专注。这就是为什么人们会这样做。坦率地说，这是一个有趣的讨论，但无法带给我们任何答案。
Rather, I'd like to focus on the ways that people now and people have always been self-medicating to increase focus. Caffeine, which I indulge some, I don't think to access, has long been used as a stimulant to increase dopamine, increase norupinephrine, increase focus and energy.
相反，我想关注一下古今中外的人们是如何通过自我用药来提高专注力的。咖啡因，我自己也会适量摄入，我不认为这是过度的，一直以来被用作一种刺激物，可以提高多巴胺和去甲肾上腺素的水平，从而增强专注力和精力。
In addition to that, it works through the so-called cyclic AMP, phosphodiesterase pathway. Remember, anytime you see you hear an ASE, that's an enzyme. Phosphodiesterase is involved in the conversion of things like cyclic AMP into energy for cells and so forth. Basically, coffee gives you energy. It makes you feel good. It increases focus because of the circuits that it engages in the brain. People have been taking caffeine and continue to take caffeine for ages.
此外，它通过所谓的环磷酸腺苷（cyclic AMP）和磷酸二酯酶途径发挥作用。记住，每当你看到“ASE”结尾的词，那就是一种酶。磷酸二酯酶参与了将环磷酸腺苷等物质转化为细胞能量的过程。简单来说，咖啡能给你提供能量，让你感觉良好，并通过在大脑中激活特定的神经回路来提高集中力。人们很久以来一直在摄取咖啡因，并将继续这样做。
People also used to smoke cigarettes nicotine in order to gain focus. Nowadays, that's less common because of the concerns, quite valid concerns about lung cancer from smoking, but there's a lot of vaping out there. There are a lot of people now consuming nicotine, which is the active substance in cigarettes and in most nicotine vapes that stimulates the brain to be more focused and more alert. The idea of taking stimulants of consuming things or smoking things in order to increase alertness is not a new idea.
过去，人们常常通过吸烟来摄取尼古丁，以提高注意力。如今，由于对吸烟导致肺癌的担忧，这种做法变得不那么常见了。这种担忧是相当合理的。然而，现在有很多人通过电子烟摄取尼古丁。尼古丁是香烟和大多数尼古丁电子烟中的活性成分，它可以刺激大脑，提高注意力和警觉性。通过摄入或吸食某些东西来提高警觉性和集中注意力的想法并不新鲜。
It's just that in ADHD, it's surprising that these things would work. If the problem is attention deficit hyperactivity disorder, what we're really talking about here or children that are prescribed a drug that ought to be a stimulant, it ought to make them hyperactive and rather than doing that, it actually somehow serves to calm them a bit or at least allow them to focus. Here's the reason. Children have a brain that's very plastic, meaning it can remodel itself in change in response to experience very, very quickly compared to adults.
只是对于多动症（ADHD）来说，这些方法的效果让人感到惊讶。如果问题是注意缺陷多动障碍，我们实际上讨论的是孩子们被开了一种应该是兴奋剂的药物，这种药物本应让他们更加活跃，但实际上却能够让他们稍微平静下来，或者至少帮助他们集中注意力。这是原因所在：孩子们的大脑具有很强的可塑性，与成年人相比，能够非常迅速地根据经验进行自我重塑和改变。
Taking stimulants as a child, if you are a child diagnosed with ADHD, allows that four brain task-related network to come online, to be active at the appropriate times. Because those children are young, it allows those children to learn what focus is and to sort of follow or enter that tunnel of focus. By taking a drug, it's creating focus artificially. It's not creating focus because they're super interested in something. It's chemically inducing a state of focus.
如果一个被诊断患有多动症（ADHD）的儿童服用兴奋剂，这可以让大脑中的四个与任务相关的网络适时启动和活跃起来。由于这些孩子年龄较小，这帮助他们学习如何集中注意力，并学会进入或保持专注的状态。通过服用药物，他们的注意力是被人为地提升的，这并不是因为他们对某件事情特别感兴趣，而是通过化学方式诱导出一种专注的状态。
Let's face it, a lot of childhood and school and becoming a functional adult is about learning how to focus even though you don't want to do something. In fact, when I was in college, I had this little trick that may or may not work for some of you, which is if I couldn't focus on the material I was trying to learn, I would dilute myself into thinking that it was the most interesting thing in the world. I would just kind of lie to myself and tell myself, okay, this I won't mention the subjects. I absolutely love this.
面对现实吧，很多童年、上学的经历，以及成长为一个能够正常运作的成年人，都是在学习如何集中注意力，即使你不想做某件事情。实际上，当我在上大学时，我有一个小诀窍，这个方法对你们中的一些人可能有效，也可能无效。当我无法专注于我正在学习的内容时，我会让自己相信这件事是世界上最有趣的。我会对自己撒个小谎，告诉自己：“好吧，这个科目我不会提，我非常喜欢这个。”
I would just tell myself that I loved it. I noticed that just that selective or deliberate engagement of that desire to know circuit, whatever that is in my brain, no doubt involves dopamine, allowed me to focus and remember the information. And somewhat surprisingly, or perhaps not surprisingly, I would often fall in love with the information. I find that that was my favorite class. It was what I wanted to learn the most. That's one way you can do it artificially, but kids with ADHD, they can't do that.
我会告诉自己我喜欢它。我发现，只要选择性地或有意地激活大脑中的求知回路（无疑涉及多巴胺），我就能专注并记住信息。有趣的是，或者并不令人意外的是，我常常会爱上这些信息。我发现那是我最喜欢的课程，也是我最想学习的内容。这是一种可以人为制造的方式，但患有多动症的孩子却无法做到这一点。
They're told to sit still and they end up getting up 11 times. They're told that they can't speak out in class or that they have to remain in their seats for 10 minutes and they just, despite their best effort, they simply cannot do it. They're highly distractible. So what are we to make of this whole picture that we need more dopamine, but these kids with ADHD, they're getting their dopamine by way of a drug, which is for all the world and phetamines, right? It's speed. That's really what it is.
他们被告知要坐好不动，但最终他们会起身11次。他们被告知不能在课堂上大声说话，或者必须保持坐在座位上10分钟，但是尽管他们尽了最大的努力，他们就是做不到。他们很容易分心。那么我们该如何理解这个现象呢? 我们需要更多的多巴胺，但患有多动症的孩子通过一种实际上是苯丙胺的药物来获得多巴胺，对吧？这就是“兴奋剂”，实际上就是这样。
What are the long-term consequences? What are the short-term consequences? And what should we make of people taking these drugs without a clinical need? What are the consequences there? Well, in order to get to some of those answers, I went to one of my colleagues. This is a colleague that I've actually known for a very long time. I was their teaching assistant when they were an undergraduate. They went on to get an MD, a medical degree, as well as a PhD.
长期后果是什么？短期后果又是什么？对于那些没有临床需要却服用这些药物的人，我们应该怎么看？这些有什么后果？为了找到这些问题的答案，我去咨询了一位同事。这位同事我认识很久了。我曾在他们本科时担任过他们的助教。后来，他们取得了医学博士（MD）和哲学博士（PhD）学位。
And I've become a pediatric neurologist that specializes in the treatment of epilepsy and ADHD in kids of all ages, from age three to 21. That's the age range, pretty broad age range, and has extensive knowledge in this. And what makes them particularly interesting for sake of this discussion is that they have a child, a young boy who's now showing signs of ADHD, and they are on the threshold of trying to decide whether or not they will prescribe adderol, or something similar.
我是一名儿科神经科医生，专门治疗不同年龄段儿童的癫痫和多动症，年龄范围从3岁到21岁，这是一个非常广泛的年龄段，并且在这个领域拥有丰富的知识。对于这次讨论来说，让我特别感兴趣的是，我自己有一个小男孩，现在表现出多动症的迹象，而我正面临一个重要的决策：是否要给他开阿得拉（Adderall）或类似的药物。
So we had a discussion about this. And prior to learning that their child may have ADHD, I asked the following questions. First of all, I asked, what do you think about giving young kids amphetamine? And their answer was, you know, on the face of it, it seems crazy, but provided that the lowest possible dose is used and that that dosage is modulated as they grow older and develop those powers of attention, their observation was that they've seen more kids benefit than not benefit from that.
我们就这个问题进行了讨论。在得知他们的孩子可能有多动症之前，我问了以下几个问题。首先，我问他们对给小孩子服用安非他命有什么看法。他们的回答是，从表面上看，这似乎很疯狂，但如果使用尽可能低的剂量，并随着他们年龄增长和注意力能力的发展调整剂量，他们观察到受益的孩子比没有受益的孩子更多。
Now, I'm certainly not saying what people should do. You obviously have to go to a doctor because as I always say, I'm not a doctor. I don't prescribe anything. I'm a professor. So I profess things. And here I'm professing that you talk to your doctor if you're considering giving riddle in or adderol or any type of stimulant to your child, of course, what could be more important than the health of your child? But it's a very interesting answer because typically we hear, yes, Medicaid or don't Medicaid. Rarely do we hear that the medication should be adjusted across the lifespan in any particular kind of way.
现在，我当然不是在告诉人们应该做什么。显然，你需要去看医生，因为我总是说，我不是医生。我不开任何处方。我是一个教授，所以我传授知识。在这里，我建议如果你考虑给孩子服用Ritalin、Adderall或其他任何类型的兴奋剂，你应该咨询医生。当然，还有什么比孩子的健康更重要呢？这确实是一个非常有趣的答案，因为我们通常听到的是要么同意用药，要么反对用药。很少有人提到应该在人的一生中以某种特定方式调整药物。
Now the fact that this person, this now friend of mine and colleague of mine, has so much expertise in the way that the brain works and is considering putting their child on such medication, I said, you know, why wouldn't you wait until your kid reaches puberty? I mean, we know that in boys and in girls, there are increases in testosterone and estrogen during puberty that dramatically change the way that the body appears, but also that dramatically changed the way that the brain functions.
现在，这个人——他已经是我的朋友和同事——对大脑运作有很高的专业知识，并且正在考虑让他们的孩子服用这种药物，我就问，为什么不等到你孩子青春期时再考虑呢？因为我们知道，在青春期，男孩和女孩体内的睾酮和雌激素水平会上升，这不仅会显著改变身体的外貌，也会极大地改变大脑的功能。
In particular, we know this that puberty triggers the activation of so-called fronto-temporal, task-related executive functioning. That's just fancy science speak for being able to focus, being able to direct your attention, being able to control your impulses. Look at a small child, or look at a puppy, and then look at an older child, or look at a dog, very different levels, patterns of spontaneous behavior. Young children move around a lot. They're, I don't want to say shifty because that makes it sound like they're up to something bad, which they might be, but they don't have to be up to something bad. They fidget a lot.
特别是我们知道，青春期会激活所谓的额颞区，与任务相关的执行功能。这其实是一个比较复杂的说法，简单来说，就是指在青春期，我们开始能够更好地集中注意力、引导自己的注意力并控制冲动。观察一下小孩子或者小狗，再看看大一点的孩子或者成年狗，它们的自发行为水平和模式是很不同的。小孩子常常活动不停，我不太想用“坐立不安”这个词，因为它似乎意味着他们在做坏事（虽然他们可能真在这样），但也未必。他们经常动来动去。
So to puppies, everything's a stimulus as animals and humans get older, they learn how to control their behavior and sit still, listen and focus, even if they don't want to. So giving a drug that allows a child to access that stillness early on, it's thought will allow them to maintain that ability as time goes on. But I decided to push a little bit further. I said, well, why would you do it now as opposed to during puberty or after puberty?
对小狗来说，一切都是刺激物。随着动物和人类逐渐长大，他们学会如何控制自己的行为，能够坐定、倾听和集中注意力，即使他们并不想这样。而有些人认为，如果给孩子服用能够帮助他们提早获得这种安静能力的药物，在时间推移中，他们就会继续保持这种能力。但我决定再深入探讨一下。我问：为什么要现在使用这些药物，而不是在青春期期间或之后使用呢？
And their answer was very specific and I think very important. What they said was, look, neuroplasticity is greatest in childhood and tapers off after about age 25, but neuroplasticity from age three until age 12 or 13 is exceedingly high. And they're right. When you sit back and you look at the literature on neuroplasticity, you'd say childhood plasticity and young adult plasticity is much greater than adult plasticity, but that early childhood plasticity is far in a way, the period in which you can reshape the brain at an accelerated rate.
他们的回答非常具体，我认为这非常重要。 他们说，神经可塑性在儿童期最为显著，并在大约25岁后逐渐减少，但从三岁到十二、十三岁时，神经可塑性非常高。他们说得对。当你回顾有关神经可塑性的文献时，会发现儿童期和青年期的神经可塑性远远高于成年期的神经可塑性，而幼儿期的神经可塑性更是一个能够加速重塑大脑的时期。
So this lines up really well with the clinical literature, not surprisingly, they're a clinician, that early treatment is key. If you have the opportunity to work with a quality physician and treat these things early, these drugs can allow these frontal circuits, these task related circuits to achieve their appropriate levels of functioning and for kids to learn how to focus in a variety of different contexts. Now, is that the only thing that they should be doing? Of course not.
这与临床文献相当一致，不出所料，他们是一位临床医生，早期治疗是关键。如果有机会与一位优秀的医生合作并及早治疗这些问题，这些药物可以帮助大脑前部的神经回路和与任务相关的回路达到正常的功能水平，从而让孩子们在不同的环境中学会如何专注。当然，这并不是他们应该做的唯一事情。
So the next question I asked was, what should we make of all this diet-related stuff? Right? I've heard before that the so-called elimination diet or ingesting no sugars or no dairy or no gluten that all of these things have been purported to improve symptoms of ADHD. And people and parents with ADHD go to fanatic lengths to try and find the exact foods that are causing problems.
所以接下来的问题是，我们应该如何看待所有这些与饮食相关的内容，对吧？我以前听说过所谓的消除饮食法，比如不摄入糖、乳制品或麸质，据说所有这些方法都可以改善多动症的症状。患有多动症的人和父母会不遗余力地尝试找出究竟是哪些食物在引起问题。
And the exact foods that the kids can eat in order to try and get their brain wired up right and correctly. And to avoid lifelong ADHD. And their answer was really interesting. But before I tell you their answer, I want to tell you the studies and the data related to this question of whether or not food and the constellation of foods that want to avoid and willy has anything to do with our levels of attention.
孩子们可以吃哪些特定的食物，以帮助他们的大脑正常发育，并避免终身患上注意力缺陷多动障碍（ADHD）。他们的答案非常有趣。但在告诉你他们的结论之前，我想先分享一些与这个问题有关的研究和数据：饮食以及需要避免的食物是否与我们的注意力水平有关。
And in particular, whether or not that can be used as a leverage point to treat ADHD. So you can imagine the challenges of exploring the role of diet and nutrition in any study, but especially in a study on ADHD. Why? Well, because as I mentioned before, children with ADHD and it turns out adults with ADHD tend to pursue sugary foods or any types of food that increase their levels of dopamine. They are naturally drawn to those foods, whether or not they realize it or not, presumably as a way to try and treat their lack of focus and impulsivity.
特别是，探讨这是否可以作为治疗多动症的一个着力点。你可以想象，在任何研究中探索饮食和营养的作用都充满挑战，尤其是在多动症研究中。这是为什么呢？正如我之前提到的，多动症儿童和成年人往往会偏好含糖食品或任何能提高多巴胺水平的食物。他们自然会被这些食物吸引，无论他们是否意识到这点，这可能是试图改善他们注意力不集中和冲动行为的一种方式。
So in this study that I'm about to share with you, there was no drug treatment. It was just a study manipulating diet and involved 100 children 50 in the so-called elimination diet group, the special diet where certain foods were eliminated and 50 in the so-called control group. However, being a well-designed, randomized controlled trial, the study also included a crossover, meaning where the kids would serve as their own control or control group at a certain portion of the studies. They would be in one group where they eliminated certain foods and then after a period of time in the study, they would swap to the other group. This is a powerful way to design a study for reasons that you can imagine because you start to eliminate changes and effects due to individual differences. In any case, 100 children total, 50 in each group at any one period in time and the effects that they observe were extremely dramatic.
在这个我即将与您分享的研究中，没有使用药物治疗。研究仅通过调整饮食进行，并包含了100名儿童，其中50名儿童属于所谓的“消除饮食组”，即通过去除某些食物而形成的特殊饮食组，而另外50名儿童则属于“对照组”。这是一个设计良好的随机对照试验，还采用了交叉设计，这意味着在研究的某些阶段，孩子们会作为自己的对照组。具体来说，他们会先被分配到一个组，去除某些食物，经过一段时间后再互换组别。这种设计方式非常有力，因为它可以消除由个体差异引起的变化和效果。总之，研究总共涉及100名儿童，每个组任何时段都有50名，研究观察到的效果非常显著。
In the world of statistics and analysis of scientific data, we talk about p-values, probability values. What's the likelihood that something could happen according to chance? And typically the cutoff would be something like p less than 0.05. That's less than 0.05 chance essentially of the effect being due to chance. However, in this study, every single one of the effects is p less than 0.001, very, very infinitesimally small probability that the effect observed could be due to chance. So what were these effects? These effects were enhanced ability to focus, less impulsivity, even less tendency to move when trying to sit still. So everything from mental focus to the ability to control their bodies improved when they were in the elimination diet group.
在统计学和科学数据分析领域，我们经常讨论p值，也叫概率值。这是指某件事情发生是由于偶然的可能性有多大。通常情况下，p值小于0.05被认为是一个阈值，这意味着某个效果由偶然因素造成的可能性小于5%。然而，在这项研究中，所有观察到的效果的p值都小于0.001，这意味着这些效果由偶然因素造成的概率极其微小。那么，这些效果是什么呢？这些效果包括提高注意力、减少冲动，甚至在尽量保持静止时减少身体移动。也就是说，当处于消除饮食组时，从精神专注能力到身体控制能力都有所改善。
What was eliminated? Well, the elimination diet in this particular study was a so-called oligo antigenic diet. It was a diet in which each kid took a test to determine which foods they had antibodies for, meaning that they were mildly allergic to. Now, in this study, it was very important that the kids not be extremely allergic to any food, because as I mentioned before, they actually served as a control at one point in the study where they were eating all sorts of foods, including foods that they had mild allergies to. So basically what this study said was that eliminating foods to which children have allergies can dramatically improve their symptoms of ADHD.
消除的是什么？在这项特定的研究中，消除饮食是一种所谓的低抗原性饮食。每个孩子通过测试来确定对哪些食物有抗体，也就是说他们对这些食物有轻微的过敏反应。在这项研究中，非常重要的一点是，这些孩子不能对任何食物有严重过敏，因为正如我之前提到的，他们在研究的某个阶段实际上是作为对照组，食用了各种食物，包括那些他们有轻微过敏的食物。总的来说，这项研究表明，消除孩子过敏的食物可以显著改善他们的多动症（ADHD）症状。
And this study, not surprisingly, because it was published in such a high quality journal, Lancet, etc., large number of subjects, set the world on fire. People were extremely excited about these results because here in the absence of any drug treatment, there was a significant improvement in ADHD symptoms observed and then came the criticisms. So many papers were published after this, specifically dealing with reanalysis of these data. And I want to be fair in saying that the data in the paper look good, but there are criticisms of the overall structural design in the study. I don't want to go into all the details exactly because it gets really nuanced about some of the statistics in the way that one examines these types of data. But there was skepticism, and in science, skepticism is healthy, especially when making decisions about whether or not to treat or feed children one food or another or give them one drug or another.
这项研究发表在《柳叶刀》等高质量期刊上，有大量的受试者参与，因此毫不意外地引起了全球轰动。人们对这一结果感到非常兴奋，因为即使在没有任何药物治疗的情况下，研究还是观察到了注意力缺陷多动障碍（ADHD）症状的显著改善。然而，也随之而来了一些批评。之后发表了很多关于重分析这些数据的论文。我要公平地说，论文中的数据看起来不错，但对研究总体结构设计存在一些批评。我不想详细探讨所有细节，因为涉及到一些统计分析的复杂问题，但的确存在质疑。在科学研究中，质疑是健康的，尤其是在决定是否让孩子接受某种食物或药物时。
Now I want to return to the story of my friend who is a pediatric neurologist and treats ADHD and has a child who is on the precipice of perhaps starting to take drugs for the treatment of ADHD. I asked the simple question, do you see an effective diet, meaning when parents control the diet of their children, does it make a positive or negative or no difference in terms of the way that the kids respond to ADHD drugs like riddle in an aderal or whether or not it can help them avoid treating with those drugs entirely. And her response was very straightforward. She said elimination of simple sugars has a dramatic and positive effect. She's observed that over and over and over again in many dozens, if not hundreds of patients.
现在我想回到我那位朋友的故事，她是一名儿科神经科医生，专门治疗多动症（ADHD），并且她的孩子可能正处于即将开始服用治疗多动症药物的边缘。我问了一个简单的问题，就是当家长控制孩子的饮食时，是否会对孩子对待多动症药物如利他林（Ritalin）和阿得拉尔（Adderall）的反应产生积极、消极或没有影响，亦或者是否可以帮助他们完全避免使用这些药物进行治疗。她的回答非常直接。她说，消除简单糖分的摄入会带来显著且积极的效果。她已经在几十甚至上百位患者身上多次观察到了这一点。
Okay. Now that's not a peer reviewed study. That's a statement that I'm conveying to you anecdotally, but it's a highly, highly informed one. I said, what about these elimination diets? She said, and I found other sources to support this, that these only go into genetic diets are controversial. There are many people who really believe in identifying all the things that you're allergic to and making sure that you and especially your kids avoid those foods. However, there's another camp that's starting to emerge in the peer reviewed scientific literature showing that when kids are not exposed to certain foods, in particular nuts and things of that sort, they develop allergies to those foods.
好的。这不是一项经过同行评审的研究，而是我通过个人观察传达给你的信息，但这是基于高度专业知识的。关于那些消除类饮食，我问她，她说（并且我找到了其他来源支持这一点），这些只针对遗传性的饮食是有争议的。有很多人相信应该找出所有让你过敏的食物，并确保你和尤其是你的孩子避免这些食物。然而，另一种观点正在同行评审的科学文献中出现，表明如果孩子不接触某些食物，特别是坚果类食物，他们反而会对这些食物产生过敏。
And then when exposed to them later, they cause real problems. So there's a whole galaxy of discussion and controversy and outright fighting about allergies and kids and whether or not the oligo antigenic diet is the appropriate one. However, out of the four neurologists and psychiatrists that I spoke to about ADHD and preparation for this, every single one said children with ADHD as much as possible should be encouraged to avoid high sugar and simple sugar foods of most kinds. And if they can find particular foods that exacerbate those symptoms, obviously eliminating those foods is beneficial. And the foods that exacerbate their symptoms change over time. So I don't like giving a complicated answer, but I also don't like giving an incomplete answer. What this tells me is that children, especially young children who have ADHD should probably not eat much sugar in particular, simple sugars.
翻译成中文，尽量易读:
"然后，当他们后来接触这些物质时，会引发真正的问题。因此，关于过敏和儿童，以及寡抗原饮食是否适宜，有大量的讨论、争议，甚至是不停的争吵。然而，在我与四位专注于多动症领域的神经科医生和精神科医生交流后，他们都一致认为，尽量鼓励多动症儿童避免摄入高糖和大部分的单糖食物。如果能找到特定加重症状的食物，显然避免这些食物是有好处的。而且，这些加重症状的食物会随着时间改变。所以，我不喜欢给出复杂的答案，但我也不喜欢给出不完整的答案。总结来说，多动症儿童，尤其是小孩子，可能应该尽量少吃糖，特别是简单糖。"
In addition to that, exploring whether or not they have existing allergies to foods they already consume might be a good idea. At least that's what this paper, the Pelsar et al. Lancet paper seems to speak to. And I should mention that that paper was published in 2011. Since then, there have been many dozens of studies exploring the same thing as well as meta-analyses of all those data. And it does appear that diet can have a highly significant role in eliminating or at least reducing the symptoms of ADHD so much so that some of the children are able to not take medication at all or eventually wean themselves off medication as young adults and as adults.
此外，探讨他们是否对已经食用的食物存在过敏问题可能是个好主意。至少在Pelsar等人在《柳叶刀》期刊上发表的论文中是这样提到的。需要注意的是，这篇论文于2011年发表。从那时起，已有几十项研究探讨了同样的问题，并对所有这些数据进行了荟萃分析。研究结果表明，饮食确实可以在消除或至少减少多动症（ADHD）症状方面起到非常重要的作用，以至于一些孩子可以完全不需要服药，或者逐渐在年轻成人甚至成人阶段停药。
One interesting question is whether or not adults should modify their diet in order to increase their levels of focus if they're already having normal levels of focus but would like more or would like to reduce existing adult ADHD. That's an interesting and even more controversial topic. It brings us right into the realm of what are called omega-3 fatty acids. I've talked many times on this podcast about the known benefits of omega-3 fatty acids in particular getting one gram, 1000 milligrams or more, even as much as 2000 milligrams each day of the so-called EPA component of omega-3 fatty acids known to have antidepressant effects, mood elevating effects known to have important effects protecting the cardiovascular system.
一个有趣的问题是，成年人是否应该为了增加注意力，而调整他们的饮食，尽管他们的注意力水平已经正常，但想进一步提高，或者希望减少现有的成人多动症。这是一个有趣且更具争议性的话题。它让我们进入了欧米伽-3脂肪酸的领域。我在这个播客中多次谈到欧米伽-3脂肪酸的已知益处，特别是每天摄取一克（1000毫克）或更多，甚至高达2000毫克的所谓EPA成分，这种成分已知具有抗抑郁效果、提升情绪效果，并对心血管系统有重要的保护作用。
I think it's now clear that the immune system also benefits that omega-3 fatty acids that include a gram or more of EPAs are very beneficial. Typically that's done through fish oil. Liquid fish oil is going to be the most cost efficient but they're capsule forms for those of you that don't like fish oil. You can ingest this through other means you can get from certain algi or krill etc. You have to make it compatible with your particular diet whether or not you're vegan or vegetarian or omnivore etc.
我认为现在已经很清楚，免疫系统也能从含有1克或更多EPA的欧米伽-3脂肪酸中获益。通常，这通过鱼油来实现。液态鱼油是最具成本效益的选择，但对于不喜欢鱼油的人来说，还有胶囊形式。你也可以通过其他来源摄取，例如某些藻类或磷虾等。你需要根据自己的饮食习惯进行调整，无论你是素食主义者、纯素食主义者还是杂食者等。
Omega-3s have been shown to have all these positive health benefits. Do they have positive effects on focus and attention? And the answer is you can find studies that support that statement and the effects are significant but the effects are modest. You can also find studies that show no effect. However, much like with omega-3s and antidepressants whereby ingestion of omega-3 fatty acids of a gram or more of EPA per day allows people with major depression to get away with taking lower doses of antidepressant medication. It does seem that ingestion of omega-3 fatty acids in adults that include EPAs of a thousand milligrams or more can allow adults with ADHD or mild attention deficit issues to function well on lower doses of medication and in rare cases to eliminate medication entirely.
Omega-3 脂肪酸被证实具有多种健康益处。它们对专注力和注意力有正面影响吗？答案是，你可以找到支持这种说法的研究，这些研究表明效果显著但比较温和。同时，你也能找到没有效果的研究。然而，就像 Omega-3 和抗抑郁药一样，每天摄入一克或以上的 EPA 型 Omega-3 脂肪酸可以让患有严重抑郁症的人减少抗抑郁药的用量。看起来，成年人每天摄入一千毫克或以上的 EPA 型 Omega-3 脂肪酸，可以让有 ADHD 或轻度注意力缺陷问题的成年人在减少药物剂量的情况下表现良好，甚至在少数情况下完全不需要用药物。
So what this says is once again that the omega-3 fatty acids are beneficial. Will they cure or eliminate ADHD? I think it's safe to say no. They are playing a supportive or what we call a modulatory role. Just like good sleep plays a supportive and modulatory role for essentially everything. Your immune system, your ability to think, your ability to regulate your emotion, it's modulating that process. This component of modulation is extremely important to highlight and I think I want to spend a moment on it because this is especially important in the context of ADHD and all the information that's out there.
这段话的意思是，omega-3脂肪酸是有益的。它们能治愈或消除多动症（ADHD）吗？我觉得可以肯定地说，不会。它们起到的是一种支持或调节的作用。就像良好的睡眠对几乎所有事情都起着支持和调节的作用一样，包括你的免疫系统、思考能力和情绪调节等。这种调节作用的成分非常重要，我想特别强调这一点，因为在ADHD及相关信息的背景下，它尤为重要。
There are biological processes that are mediated by particular compounds like dopamine. So for instance, the ability to feel motivated to attend to focus is mediated by the circuits in the brain that release dopamine. However, attention is also modulated by how rested you are. If you want to eliminate your ability to think well at all, just stay up for two nights and don't sleep at all. If you do that, you will have modulated the circuits in your brain that respond to various things and you will be highly distractible, you will be highly emotional, you will feel like garbage. But that doesn't mean that sleep mediates focus and attention. It modulates it indirectly.
有些生物过程是由特定化合物介导的，比如多巴胺。例如，感受到动力和专注的能力是由大脑中释放多巴胺的回路介导的。然而，注意力也会受到你休息程度的影响。如果你想完全毁掉自己的思考能力，只需连续两晚不睡觉。如果你这样做，你会改变大脑中对各种事物反应的回路，你会变得非常容易分心，情绪不稳，感觉很糟。不过，这并不意味着睡眠直接介导专注和注意力，它只是间接地调节它。
Likewise, I think these are mega-threesome fatty acids. In particular, the EPA's which are so beneficial for mood and apparently also for attention, they don't directly mediate attention and mood. What they do is they modulate those circuits. They make dopamine more available. They make whatever dopamine is available more likely to bind to the various receptors that are present on neurons and so forth. I think this is very important because likewise, diet and any discussion about nutrition has to include this framework of is the diet, the elimination diet or whether or not it's some other diet or esoteric diet, ketogenic diet, is it modulating or mediating a process?
同样，我认为这些是重要的三联不饱和脂肪酸，特别是EPA，它对情绪非常有益，并且据说对注意力也有帮助。尽管它们并不直接影响注意力和情绪，但它们通过调节相关的神经回路来发挥作用。EPA能够增加多巴胺的可用性，使得现有的多巴胺更容易结合到神经元上的不同受体上。我认为这是非常重要的，因为在谈论饮食和营养时，也要考虑饮食是否在调节或介导某一过程，无论是消除饮食、其他饮食、特殊饮食还是生酮饮食。
Most likely, in the context of ADHD, it's modulating that process. If the ADHD is mild or if it's caught early enough or if it's in conjunction with pharmacology, with a prescription treatment, well, then it might help guide the child or adult to a better place of being able to focus. But it's not going to be the switch that flips everything. Now, that does not mean that consuming the wrong foods, sugary foods or foods that you happen to be allergic to is a good idea. It will still be detrimental. I hope that conceptual framework helps because if you go online, if you're somebody with ADHD or not, you're going to be bombarded with the ADHD diet, the only go into genetic diet, the elimination, this supplement, that EPA.
在 ADHD（注意力缺陷多动障碍）的情况下，很可能是对该过程进行调节。如果 ADHD 症状较轻，或者在早期就被发现，或者结合药物治疗，那么这种方法可能有助于儿童或成人更好地集中注意力。但它不会是彻底解决问题的开关。这并不意味着食用错误的食物、含糖食物或自己过敏的食物是个好主意，这些仍然会对健康产生不良影响。希望这个概念框架能对你有所帮助，因为如果你上网搜索，无论你是否有 ADHD，你都会被 ADHD 饮食、遗传性饮食、排除性饮食、各种补充剂和 EPA 产品的信息轰炸。
I think it's very important to understand whether or not you're talking about something mediating a process or modulating a process. Now, drugs like riddle and drugs like Adderall, they are tapping into the circuitries and the neurochemistries that mediate attention and focus. They are not the only alternatives or the only choices, rather, for treatment of these circuits and enhancement of the circuits for focus. I'm going to talk about other alternatives and some behavioral alternatives that are not very well known, but are very, very effective in a few minutes. But I really want to make this clear distinction between modulation and mediation because it's vital for anyone that's trying to modulate or mediate anything within their own brain.
我认为，理解你是在谈论某种事物在“调节”一个过程还是“介导”一个过程，这一点非常重要。像Ritalin（利他林）和Adderall（安非他命）这样的药物，它们影响的是参与注意力和集中力形成的神经线路和神经化学。这些药物并不是治疗这些神经线路和增强集中力的唯一选择。接下来我会讨论其他一些替代方案，包括一些不太为人知但效果非常显著的行为替代方案。但是，我要特别强调调节和介导之间的区别，因为对于任何想要调节或介导自己大脑功能的人来说，这都是至关重要的。
If any of you are interested in this oligo-antigenic diet as it relates to ADHD and you want to explore a more recent study besides that classic 2011 Lancet study that's rather controversial. There's a paper that was published in Frontiers in Psychiatry just last year, 2020. The title of the paper is oligo-antigenic diet improves children's ADHD rating scale scores reliably in added video rating. The added video rating is just that they're using an additional measure of focus and attention. Again, that's Frontiers in Psychiatry 2020. I'll put a link to it in the caption. That's a more recent study for you to peruse.
如果你们中的任何人对与多动症（ADHD）相关的寡抗原饮食感兴趣，并希望探索一项较新的研究，而不是那篇相对有争议的2011年《柳叶刀》经典研究，可以看看发表在《精神病学前沿》杂志上的一篇文章。这篇论文是在2020年发表的，题目是“寡抗原饮食可靠改善儿童多动症评分，在添加视频评分中表现明显。”这里的“添加视频评分”是指他们使用额外的方式来评估注意力和专注力。再次强调，这篇文章发表于2020年的《精神病学前沿》。我会在说明中附上链接，以便你查阅。
We've talked about the neural circuits of focus and the chemistry of focus. We haven't talked yet about what would make us better at focusing and what focusing better really is. Let's take a step back and think about how we focus and how to get better at focus. I'm going to share with you a tool for which there are terrific research data that will allow you in a single session to enhance your ability to focus in theory forever. What I'm about to read you is from an excellent book that I recommend if any of you are interested in neuroscience and things like meditation and default mode networks and things of that sort. The book is called Altered Traits.
我们已经讨论了专注的神经回路和专注的化学反应。但是，我们还没有讨论过如何提高我们的专注能力，以及提升专注力真正意味着什么。让我们退一步，思考一下我们是如何专注的，以及如何提升我们的专注能力。我将与您分享一个工具，其出色的研究数据显示，这可以让您在一次练习中，理论上永久提高您的专注能力。接下来我要朗读的内容来自一本非常优秀的书，如果你们对神经科学、冥想、默认模式网络等感兴趣，我强烈推荐这本书。书名是《改变特质》。
Science reveals how meditation changes your mind, brain, and body. No, I'm not going to try and convince you to meditate. I'm going to share with you a small passage in the book that relates some research data related to focus that are very important. If you want to meditate, that's your choice. That's a separate matter. This is a book by Daniel Goldman and Richard Davidson. I should just mention that Goldman is a well-known author. He's written books on emotional intelligence and so forth. Richard Davidson is also a PhD. He's a professor of psychology and psychiatry.
科学揭示了冥想是如何改变你的思维、大脑和身体的。 不，我不会试图说服你去冥想。我只是想和你分享一本书中的一小段，它涉及到一些关于注意力的研究数据，这些数据非常重要。如果你想冥想，那是你的选择，那是另外一回事。这本书是由丹尼尔·戈尔曼和理查德·戴维森合著的。我还要提到的是，戈尔曼是一位知名作家，曾撰写关于情商等方面的书籍。理查德·戴维森也是一位博士，他是一位心理学和精神病学的教授。
He's at a University of Wisconsin-Madison. It's done terrific work on brain states and modulation of brain states and so forth. What we're about to talk about is when attention works and when attention falters and what we are specifically going to talk about are what are called attentional blinks. Not actual eye blinks. We're going to talk about that in a few minutes, but we're going to talk about attentional blinks. I'm paraphrasing here because Goldman and Davidson wrote about this so beautifully. I'd rather paraphrase from them than try and just make up a new way to say it that is less interesting or less good, but I want to credit them.
他是在威斯康星大学麦迪逊分校。他们在研究大脑状态和调节大脑状态方面做了出色的工作。我们即将讨论的是注意力何时起作用以及何时减弱，特别要谈的是所谓的“注意力丧失”（注意力“眨眼”现象），而不是实际的眼睛眨眼。我们将在几分钟内详细谈论这个问题。我在这里做一个简单的转述，因为Goldman和Davidson对这一现象的描述非常精彩。我更愿意从他们的观点出发，而不是编造一种不那么有趣或精彩的说法，但我想对他们表示感谢。
Attentional blinks are really easy to understand if you think about a where's Waldo task. This task where's Waldo where there are a bunch of people and objects and things in a picture and somewhere in there is Waldo with the striped hat and the glasses and skinny dude and you have to find Waldo. It's a visual search and it's visual search for an object that has distinct features but is embedded in this ocean of other things that could easily be confused as Waldo. You tend to look, look, look, look, look, and then you find Waldo. Kids can do this. They enjoy doing this. Adults may or may not enjoy it, but they can do it too. They find Waldo.
注意力瞬脱就像“在哪儿找沃尔多”的游戏一样，特别容易理解。在这个任务中，你会看到一幅图画，上面有许多人、物体和各种物品，其中沃尔多戴着条纹帽子、眼镜，是个瘦瘦的人，而你的任务就是找到沃尔多。这是一次视觉搜索，需要在一片类似的事物中寻找具有独特特征的目标物（沃尔多）。在搜索的过程中，你可能不断地找啊找，最后终于找到沃尔多。孩子们很喜欢做这样的找图游戏，他们乐在其中。而成年人可能对这种游戏感觉不同，但他们同样能找到沃尔多。
When you find Waldo or when you search for a target in some other visual search task, at that moment your nervous system celebrates a little bit and it celebrates through the release of neurochemicals that make you feel good. You found it and you pause. Now the pause is interesting because when you pause, what we know from many experiments is that in that moment of pause and mild celebration, however mild, you are not able to see another Waldo sitting right next to it. So what this means is in attending to something, in searching and in identifying a visual target, your attention blinked. It shut off for a second.
当你找到瓦尔多，或是在其他视觉搜索任务中寻找目标时，你的神经系统会小小地庆祝一下，这种庆祝通过释放让你感觉良好的神经化学物质来实现。你找到了它，然后停顿下来。这个停顿很有趣，因为我们知道，从许多实验中得知，在这个短暂的停顿和轻微的庆祝时刻中，即使很轻微，你无法看到紧挨着的另一个瓦尔多。也就是说，在专注于某个事物、进行搜索以及确认视觉目标时，你的注意力短暂地"眨了眼"。它关闭了一秒钟。
And there's a more formal and more laboratory type way that we look at this. The more typical way to do this is to give someone a string of letters or a string of numbers. And beforehand you tell them, be on the lookout for the letters R and Z. Okay, you're just going to watch this string of numbers go by and there will be a letter R in there and there will be a letter Z in there and try and spot them both. And what you find is when you present that string of numbers and then they see the R, they see the R, they register it consciously and they tend to miss the Z just like in the Waldo type example. Now of course the numbers are going by pretty quickly but they can spot the R. They could also spot the Z if you told them beforehand just spot the Z.
这里有一种更正式、更实验室化的方法来研究这个问题。更典型的方法是给某人一串字母或数字，同时提前告诉他们要注意字母R和Z。你让他们看着这串快速闪过的数字，其中会出现字母R和字母Z，让他们试着找出来。结果是，当数字串出现时，他们看到R并能意识到它的存在，但往往会错过Z，这就像在"Waldo"游戏示例中一样。当然，数字流得非常快，但他们能够发现R。如果事先只告诉他们找出Z，他们也可以发现Z。
And the numbers are moving through at the same rate in both conditions. So what that means is that in every case, you are capable of seeing the R or the Z. It's when you try and see both that seeing the first one prevents you from seeing the second one. It's what we call an attentional blink. We do this all the time and people with ADHD tend to have many more attentional blinks than people that don't. And this is true for children and for adults. This is an important point. So important that I want to emphasize it twice in case you intentionally blinked. If you see something that you're looking for or you're very interested in something, you are definitely missing other information.
在这两种条件下，数字以相同的速度移动。这意味着在每种情况下，你都能看到字母R或Z。当你试图同时看到两个字母时，看到第一个字母会阻碍你看到第二个字母。这种现象被称为注意力瞬脱。我们常常会出现这种情况，而有注意力缺陷多动障碍（ADHD）的人比没有这种障碍的人更频繁地经历注意力瞬脱。这对于儿童和成人都是如此。这个点非常重要，重要到我想再强调一遍，以防你在注意的时候错过了其它信息。如果你看到你正在寻找的东西，或者对某件事非常感兴趣，那你肯定会错过其他信息。
In part because you're over focusing on something and this leads to a very interesting hypothesis about what might go wrong in ADHD where we've always thought that they cannot focus and yet we know they can focus on things they care very much about. Well, maybe just maybe they are experiencing more attentional blinks than people who do not have ADHD. And indeed there are data now to support the possibility that that's actually what's happening. And that should be exciting to anyone that has ADHD. It should also be exciting to anyone that cares about increasing their focus and their ability to attend.
这可能是因为你过于关注某件事，这引出了一个非常有趣的假设，即在我们一直认为注意力缺陷多动障碍（ADHD）患者无法集中注意力的情况下，可能会出现的问题。然而，我们也知道，他们能够专注于自己非常关心的事情。那么，也许他们经历了比没有ADHD的人更多的“注意力闪烁”。实际上，现在有数据支持这种可能性。这对于有ADHD的人来说应该是令人兴奋的消息，对于那些希望提高自己专注力的人来说也值得关注。
What there's a saying is that these circuits that underlie focus and our ability to attend and our ability to eliminate distraction. They aren't just failing to focus. That's just a semantic way of describing the outcome. They are over focusing on certain things and thereby missing other things. And so our distractibility or the distractibility of somebody with ADHD could exist because they are over focusing on certain elements and they are therefore missing other elements that they should be attending to.
有一种说法是，这些脑回路支撑了我们的专注能力、注意力以及排除干扰的能力。它们并不是简单的无法集中注意力，这只是对结果的描述。从本质上讲，它们是过度专注于某些事物，从而忽略了其他事物。因此，我们的注意力分散，或者说多动症患者的注意力分散，可能是因为他们对某些元素过于专注，从而忽视了他们本应注意的其他元素。
So what they really need is this property that we call open monitoring. Now open monitoring is something that's described in the book that I just referred to and that typically is associated with people who have done a lot of meditation. So called the positive meditation or if spent a lot of time learning how to do what's called open gaze visual analysis and open gaze thinking. But there's a simpler version of this that allows us to bypass all that. First of all, your visual system has two modes of processing. It can be highly focused on soda straw view. So looking for the R in this string of numbers and the example that I just gave. Or if you're very excited about something you're in that soda straw view of the world and you're missing other things. Okay, that's high levels of attention.
他们真正需要的是一种被称为“开放监控”的特性。开放监控在我刚提到的那本书中有所描述，它通常与那些经验丰富的冥想者有关，也就是所谓的正念冥想，或者花大量时间学习所谓的“开放凝视”视觉分析和思考的人有关。但有一种更简单的方法可以让我们绕过这些。首先，你的视觉系统有两种处理模式：一种是高度集中的模式，就像从一个吸管里看东西一样。在我刚刚举的例子中，就是在一串数字中寻找字母“R”。如果你对某件事特别感兴趣，你就进入了这种吸管视角中，从而忽略了其他事物。这就是高度注意力集中的状态。
However, there's also a property of your visual system that allows you to dilate your gaze to be in so called panoramic vision. Panoramic vision is something you can do right now no matter where you are and I can do it right now. You won't know that I'm doing it. But even though I'm still looking directly at you, I'm consciously dilating my gaze so that I can see the ceiling, the floor and the walls all around me.
然而，你的视觉系统还有一种功能，可以让你的视野扩展至所谓的全景视觉。无论你身处何地，你现在就可以做到这一点，我也可以。你不会知道我正在这么做。不过，即使我仍在直视着你，我也在有意识地扩展视线，以便我能够看到周围的天花板、地板和墙壁。
That panoramic vision is actually mediated by a separate stream or set of neural circuits going from the eye into the brain. And it's a stream or set of circuits that isn't just wide angle view. It also is better at processing things in time. Its frame rate is higher. So you've seen slow motion video and you've seen standard video. Slow motion video gives you that slow motion. Look because it's a higher frame rate. You're thin slicing time. Okay. You can use panoramic vision to access the state that we call open monitoring. When people do that, they are able to attend to and recognize multiple targets within this string of numbers. They can see the R and they can see the Z and they can see additional things.
这种全景视觉实际上是通过一组独立的神经通路，从眼睛传递到大脑的。这种神经通路不仅仅用于广角视野，它在处理时间上的能力也更强，就像帧率更高的视频一样。你看过慢动作视频和普通视频，慢动作视频之所以显得慢，是因为它有更高的帧率，使得时间被细化了。同样，你可以利用全景视觉进入一种我们称之为"开放性监测"的状态。在这种状态下，人们能够注意和识别数字串中的多个目标，他们可以看到字母R，也可以看到字母Z，甚至还能看到更多的东西。
So this is something that can be trained up and people can practice whether or not they have ADHD or not. What it involves is learning how to dilate your gaze consciously. That's actually quite easy for most people. Whether or not you wear directive lenses or contacts or not, you can consciously go into open gaze and then you can contract your field of view as well. There have also been studies done where people were taught to think in a particular way for a very short period of time and that forever changed their ability to limit or reduce the number of these attentional blanks.
所以，这是一种可以通过训练来掌握的技巧，无论人们是否患有多动症。这个技巧包括学习如何有意识地放宽你的视野。实际上，对于大多数人来说，这并不难。不论你是否佩戴矫正眼镜或隐形眼镜，你都可以有意识地进入开放视野，然后也可以收缩你的视野范围。还有一些研究表明，人们可以在很短的时间内学习一种特定的思维方式，并永久性地改变他们减少这些注意力空白的能力。
There are now published accounts in the literature of a simple practice done for about 15 minutes where subjects were asked to just sit quietly, eyes closed and do what is sort of akin to meditation but to not direct their mind into any particular state or place. But simply to think about their breathing and to focus on their so-called interoception, focus on how their body feels, their mind drifted to bring it back. Okay. So it's basically meditation for about 15 minutes. That might not seem like a significant or unusual practice or that it would have any impact at all but remarkably just doing that once for 17 minutes significantly reduced the number of attentional blanks that people would carry out.
有文献记载了一种简单的练习，要求参与者静坐大约15分钟，闭上眼睛，进行类似冥想的活动，但不需要特意引导思绪进入某个特定状态或地方。只需专注于自己的呼吸，关注所谓的内感受，注意身体的感觉，并在思绪飘散时将注意力拉回来。可以说这基本上是15分钟的冥想。这个练习看似平常，似乎没什么特别之处，也不像会产生多大影响，但令人惊讶的是，只需进行17分钟，就能显著减少人们注意力涣散的次数。
In other words, their focus got better in a near permanent way without any additional training. There's something about that practice of reducing the amount of visual information coming in and learning to pay attention to one's internal state, what we call interoception, that allow them an awareness such that when they needed to look for visual targets, when they need to focus on multiple things in sequence, they didn't experience the same number of attentional blanks.
换句话说，他们的专注力得到了几乎永久性的提升，而且不需要额外的训练。这种通过减少外部视觉信息的输入，转而关注自身内在状态的练习，也就是我们所说的“内感知”，使他们获得了一种意识。这种意识让他们在需要寻找视觉目标或连续专注于多件事情时，不再像以前那样常常走神。
And I should mention not incidentally as people age and their working memory gets worse and their ability to focus gets worse, the number of attentional blanks that they carry out goes up. And there are now studies exploring whether or not the simple meditation like practice of 15 to 20 minutes or so of sitting and just quietly resting and paying attention to one's breathing and internal state can also offset some of that age-related what is called cognitive decline.
随着年龄的增长，人的工作记忆和注意力会变差，这时他们出现注意力空白的次数会增加。我应该顺便提一下，现在有研究正在探索一种简单的冥想练习，看看这种方法是否能缓解一些与年龄相关的所谓认知退化。这种练习通常就是坐下来安静地休息15到20分钟，专注于自己的呼吸和内在状态。
So what these data tell me is that regardless of whether or not you're a child or you're an adult, whether or not you have ADHD or not, whether or not you're experiencing age-related cognitive decline or you would simply like to avoid age-related cognitive decline. A simple practice of taking 17 minutes, sitting and paying attention to your internal state, just interrecepting, registering your breathing, registering the contact of your skin with whatever surface you're on can forever rewire your brain to be able to attend better and possibly even offset some of that age-related attentional drift.
这些数据告诉我，无论你是孩子还是成年人，无论你是否有多动症，无论你是否面临与年龄相关的认知衰退，或者只是想避免这样的衰退。一个简单的方法就是花17分钟坐下来，专注于你的内在状态，只需关注内心，留意自己的呼吸，感受皮肤与所接触表面的接触。这种练习可以永远重塑你的大脑，使其更好地专注，甚至可能抵消一些年龄相关的注意力下降。
Now, I don't expect anyone to start meditating regularly. I don't expect anyone to do anything they don't want to do, but I think most of us could handle one meditation session of 17 minutes or so. And so if ever there was a tool that stood to rewire our attentional circuitry in a powerful way, this seems to be it. And in addition, the ability to engage in panoramic vision to dilate our gaze, this so-called open monitoring that allows the brain to function in a way that it can detect more information faster, that's a powerful tool as well. And the beauty of that tool is that it works the first time and it works every time.
现在，我并不指望任何人开始定期冥想。我也不希望任何人去做他们不想做的事情，但我认为大多数人都能坚持一次大约17分钟的冥想。因此，如果有一种工具可以以强大的方式重塑我们的注意力回路，这就是其中之一。此外，进行泛视觉观察以扩展我们的视野，这种所谓的开放监控能够让大脑以更快的速度检测更多的信息，这也是一种强有力的工具。而这种工具的妙处在于，第一次使用就有效，而且每次都有效。
Now, how exactly it works is a little bit unclear. Is it, for instance, orchestrating this synchrony or asynchrony between the default mode network and the task-related networks? We don't know. Those studies have not yet been carried out. Nonetheless, the effects are significant, they are long-lasting, and they appear to exist after just one session of this quiet 17-minute interoception, which to me makes it seem like a very worthwhile thing to do for everybody.
现在，它具体是如何运作的，还有些不清楚。例如，它是如何在默认模式网络和任务相关网络之间协调同步或异步？我们还不知道，因为相关研究尚未完成。尽管如此，其效果显著且持久，只需一次安静的17分钟内感session后便会出现。在我看来，这对每个人来说，都是非常值得一试的事情。
So we just talked about attentional blinks, which are essentially blinks of thinking. It's your mind shutting off for a moment and missing information. Now let's talk about actual blinks, the sort that you do with your eyelids. This might come across as somewhat obvious, but you can do fast, what are called spontaneous blinks, and they are always coordinated between the two eyes, or you can do long blinks, like when you go to sleep at night, you do one very long blink, and I'm not being facetious.
我们刚刚谈到了注意力瞬间丧失，基本上就是思维上的"眨眼"。这指的是你的大脑短暂"关闭"，因此错过了一些信息。现在，让我们来谈谈真正的眨眼，也就是你用眼睑做的动作。这可能听起来显而易见，但你可以快速眨眼，通常称为自发性眨眼，而且总是两只眼睛协调一致地进行。或者，你也可以做较长时间的眨眼，比如在晚上睡觉时，你会有一个非常长的眨眼，这一点我并不是在开玩笑。
When you go to sleep at night, you are shutting your eyelids, and you are limiting the amount of information coming in, and your perception of time starts to drift as you go into sleep. Your perception of time changes from very fast at one moment to very slow, meaning the frame rate at which you are analyzing information, dreaming, etc. is variable when you are in sleep. Sometimes it's very fast, meaning you experience things in slow motion.
当你在晚上入睡时，你闭上眼睑，减少外界信息的进入，你对时间的感知开始漂移。你的时间感知从很快变得很慢，这意味着当你进入睡眠状态时，你分析信息和做梦的速度是可变的。有时信息处理速度很快，这让你感觉事情像是慢动作一样。
Sometimes it's very fast. In waking, too, your experience of time can sometimes be very fast, sometimes be very slow. Typically, the more alert you are, the higher the frame rate, your thin slicing, your experience. You've probably had this happen if you're ever very stressed and you're waiting for something, or somebody, it seems like it takes forever because your frame rate is higher, you're analyzing time more finally. Conversely, if you are very relaxed or even sleepy, you wake up and you have to think about all the things you have to do it, it will seem like the world is going by very, very fast and that you are moving very slow.
有时候，时间过得很快。在清醒时，时间的流逝也会有快有慢。通常来说，你越是警觉，感知的“帧速率”就越高，你的经验和分析也会更细致。你可能经历过这样的情况：当你非常焦虑地等某件事情或某个人时，时间似乎过得特别慢，因为你的帧速率变高了，时间被更多地分割和分析。相反，如果你很放松或有些困倦，当你醒来需要思考今天要做的事情时，世界似乎在飞速流逝，而你却觉得自己行动缓慢。
Time is going at the same rate, but your perception of time is what's changed. Believe it or not, your perception of time is also changed on a rapid basis, moment to moment basis, by how often you blink. This is a well-established literature in the world of neuroscience that unlike the literature and claims about blinking and sociopathy, which have no basis, the science of blinking as it relates to time perception has some very good data to support it.
时间的流逝速度并没有改变，但你的时间感却发生了变化。相信与否，你对时间的感知会因为你眨眼的频率而快速变化，这种变化是瞬时的。在神经科学领域，有确凿的研究支持这种观点，与有关眨眼与反社会行为（即冷酷无情）的说法没有科学依据不同，关于眨眼与时间感知之间关系的研究有着很好的数据支持。
I want to just emphasize one study in particular, which is quite appropriately titled Time Dislates after spontaneous blinking. This is a paper that was published in current biology, the first author is Terrohn T-E-R-H-U-N-E. It's a wonderful paper. They examine the relationship between fluctuations in timing and blinking and to make a long story short, what they found is that right after blinks, we reset our perception of time.
我想特别强调一项研究，这项研究的标题十分贴切，叫做《自发眨眼后的时间膨胀》。这篇论文发表在《当代生物学》杂志上，第一作者是Terrohn（T-E-R-H-U-N-E）。这是一篇出色的论文。研究人员研究了时间波动与眨眼之间的关系。简而言之，他们发现，在我们眨眼之后，我们会重置对时间的感知。
Okay? So blinks in that sense are a little bit like the curtain coming down on a scene between scenes in a play or takes in a movie. You know, when they clap the clap thing, they start it take, you know, what do they say? Action. And then at the end, they do the thing and they click it down and they say, it's a take. That's one take. When you blink, it's a take.
好的？在这个意义上，眨眼就像戏剧中场景与场景之间的幕布落下，或者电影里拍摄时的镜头切换。你知道，当他们拍摄时，会用场记板来标记开始，他们会说“开始”，然后在结束时再标记一下，说“这一条录好了”。当你眨眼时，就像完成了一个镜头。
Okay? Now what's interesting and will immediately make sense to you as to why this is important is that the rate of blinking is controlled by dopamine. So what this means is that dopamine is controlling attention, blinks relate to attention and focus. And therefore the dopamine and blinking system is one way that you constantly modulate and update your perception of time.
好的。现在，接下来这一点有趣且重要，一旦我说出来你就能立刻明白：眨眼的频率是由多巴胺控制的。这意味着多巴胺在控制注意力，而眨眼与注意力和集中力有关。因此，多巴胺和眨眼系统是你不断调整和更新时间感知的一种方式。
Unfortunately, it's also one that you can control. So the basic takeaway of this study was that blinking controls time perception, but also that levels of dopamine can alter your sense of time and stay with me here and that blinking and dopamine are inextricably linked. They are working together to control your attention.
不幸的是，这也是你能够控制的功能。所以，这项研究的基本结论是，眨眼会影响时间感知，此外，多巴胺水平也会改变你的时间感，并且眨眼与多巴胺之间有着不可分割的联系。它们共同作用于控制你的注意力。
When dopamine levels go up, people tend to overestimate how long something lasted. Why? Because they are processing time more finely. It's slow motion mode. When dopamine levels are lower, they tend to underestimate time intervals. Let's remember back to the very beginning of the episode, what's going on in people with ADHD. They are not good at managing their time. They tend to run late or they are disorganized. They are not just disorganized in space, meaning in the physical space around them, they are disorganized in time. Their dopamine is low. We know that as well. And so they are underestimating time intervals. And so it makes perfect sense that they would be late. It makes perfect sense that they would lose track of time or the ability to focus.
当多巴胺水平升高时，人们往往会高估某件事情持续了多久。为什么呢？因为他们在更细致地感知时间，就像慢动作模式。当多巴胺水平较低时，人们常常低估时间间隔。让我们回想一下这段情节的开头，这种情况在患有多动症（ADHD）的人身上是怎样的呢？他们不善于管理自己的时间，常常迟到或是显得杂乱无章。他们不仅在空间上，也就是他们周围的物理空间上显得杂乱，在时间上的表现同样如此。他们的多巴胺水平是低的，我们也知道这一点。因此，他们会低估时间间隔。因此，他们迟到是很合理的，他们失去时间感或失去专注能力也是很合理的。
This is really exciting because what it means is that children with ADHD, adults with ADHD, or people with normal levels of focus that want to improve their ability to focus, can do so through a training that involves learning how often to blink and when and how to keep their visual focus on a given target. And it turns out this study has actually been done. There's a study again. I'll link to this study entitled Improvement of Attention in Elementary School Students through Fixation Focus Training Activity. I won't go through all the details, but what they found was a short period of focusing on a visual target allowed these school children to greatly enhance their ability to focus on other types of information.
这真的很令人兴奋，因为这意味着患有多动症的儿童和成人，或者那些想要提高专注能力的普通人，都可以通过一种训练来实现。这种训练包括学习如何控制眨眼的频率、何时眨眼，以及如何将视觉专注力保持在特定目标上。事实证明，已经有这样的研究进行过。有一项研究名为《通过凝视焦点训练活动改善小学生的注意力》，我会提供该研究的链接。我不会详细介绍所有细节，但研究发现，短时间专注于一个视觉目标能够显著提升这些小学生在其他类型信息上的专注能力。
And a significant component of the effect was due to the way that they were controlling the shutters on their eyes, their eyelids, and controlling their blinks. So what they did in the study is that they had these kids focus their visual attention on some object that was relatively close, like their hand, for a minute or so, which actually takes some effort if you try and do that. They were allowed to blink. However, it's known from other work that if people can consciously override the desire to blink, at least to the point where they feel like they have to or else their eyes would dry out, that actually can increase attention even further.
在这项研究中，一个显著的影响因素是他们如何控制眼睛上的“百叶窗”，也就是他们的眼睑，以及他们如何控制眨眼。在实验中，研究人员让这些孩子把视觉注意力集中在一个相对较近的物体上，比如他们的手，持续大约一分钟左右。如果你试图这样做，会发现这其实需要一些努力。虽然他们被允许眨眼，但其他研究表明，如果人们能有意识地克制住眨眼的欲望，至少到他们觉得必须眨眼否则眼睛会干的地步，这实际上可以进一步提高注意力。
And they had conditions where they would look at a point further across the room and even further across the room. It only took a few minutes each day to do this 30 seconds in one condition or maybe a minute and then at another station of looking a little bit further out and a little bit further out. However, there was an important feature of this study that is definitely worth mentioning, which is before they did this visual focus task or training, they did a series of physical movements with the kids so that the kids could sort of eliminate or move out some of their desire to move and would thereby enhance their ability to sit still.
他们有一些条件是让孩子们注视房间更远处的一个点，甚至是更远的地方。每天只需要几分钟，可能是30秒到一分钟的时间，在不同的点上注视得更远。然而，这个研究有一个非常重要的特点值得一提，那就是在进行这个视觉专注训练之前，他们让孩子们做了一系列的身体运动，这样孩子们可以消耗掉一些想要活动的精力，从而提高他们静坐的能力。
Now, it's long been known that kids need a recess. They need time to run around and play and roll around, do whatever it is that they do in order to be able to sit still at all. Adults probably need this too, frankly, but kids need it more because the circuits in the brain that control reflexive movements and as we say, kind of rhythmic, unrelating behavior and things like that, that's an active suppression. And kids have less of that circuitry built up until they hit about age 15 or 16. So they have the kids move around a bit and then do this focus training.
众所周知，孩子们需要休息时间。他们需要时间跑跑跳跳、玩耍翻滚，做各种活动，以便能安静地坐下。坦白说，大人可能也需要这样，但孩子更需要，因为大脑中控制反射性运动和一些我们称之为有节奏的、不相关行为的回路，是通过积极抑制来实现的。而孩子们在15或16岁之前，这些回路还没有完全建立。因此，让孩子们先活动一会儿，再进行专注力的训练是很有必要的。
That brings me to another treatment that's actively used nowadays in schools for kids with ADHD, but also starting to be used by many kids and by parents in order to keep their kids focusing and not going crazy in the car or not acting out in general. And that's the prevalence of these so-called fidgetter toys or things that kids can do actively and repetitively in order to move out some of their underlying reverberatory activity in their nervous system. So what you will find is that some kids with ADHD are now given a rubber band on their desk, literally a rubber band that's attached to their desk and they're able to pull on it, even snap it against the desk.
这让我想到了另一种目前在学校广泛使用的治疗方法，主要针对患有注意力缺陷多动障碍（ADHD）的孩子。这种方法如今也开始被许多孩子和家长使用，以帮助孩子集中注意力，并避免在车上或日常行为中失控。这就是所谓的"解压玩具"的流行，孩子们可以通过这些玩具进行活动和重复动作，从而释放他们神经系统中的一些多余活动。于是，有些有注意力缺陷多动障碍的孩子会在他们的课桌上放一个橡皮筋，他们可以拉动橡皮筋，甚至用它弹击桌子。
If I had done that when I was a kid, I think my teachers were throwing me out of class, but I think it's great that they're allowing them to do this now as a way of moving some of their physical energy out or engage their physical energy, rather as opposed to trying to sit statue still all the time and attend. And it turns out that does enhance these children's ability to focus mentally when they have some physical activity to attend to. And it turns out it also can work for adults. I'll share with you a related anecdote because it illustrates the underlying mechanism. I've had the great privilege of being able to do a number of surgeries, brain surgeries during my career.
如果我小时候那样做，我想我的老师会把我赶出课堂。不过，我觉得现在允许孩子们这样做非常好，因为这让他们能够释放或利用多余的体力，而不是一直像个雕像一样静坐。这实际上有助于提高孩子们的注意力，因为他们有一些身体活动可以参与。事实证明，这对成年人也有类似的效果。我给你分享一个相关的轶事，因为它很好地解释了这个背后的机制。在我的职业生涯中，我有幸参与过多次脑外科手术。
So one thing you find when you do brain surgeries is that the brain's pretty small, regardless of the species that you're working on and you're in there and you're trying to do something very specific. And the more you try and hold your hands really steady, the more they want to shake. All right, so it's not natural for any of our limbs to sit perfectly still. Depending on how much coffee you've had, how well rested you are, and your sort of baseline level of autonomic arousal, some of you may find that you can hold out your hand to absolutely rock solid. Others will shake a little bit more. Doesn't mean you're nervous if you're shaking, doesn't mean you're calm, if you're still. What it relates to is the amount of what we call pre-motor activity, the number of commands to move that are being sent through the system.
当你进行脑外科手术时，你会发现，不管是对哪种生物进行手术，大脑其实都很小，而且你需要在里面完成非常精细的操作。你越是尽力让手保持稳定，它们就越容易颤抖。事实上，我们的四肢保持绝对静止并不自然。手是否稳定取决于你喝了多少咖啡、休息得如何以及你自身的自主神经兴奋程度等因素。有些人可能发现自己的手可以保持绝对稳定，而有些人手可能会稍微颤抖一点。这并不意味着颤抖时你就很紧张，或者静止时你就很冷静。这与我们所谓的“预动作活动”有关，即发送到系统中的移动命令的数量。
And that's what I mean by reverberatory activity. And it does seem that kids with ADHD and adults with ADHD have a lot of reverberatory activity in their nervous system. And so that's that constant desire to move. It's hard for them to sit still. And therefore, it's hard for them to attend to harness their attention. When you do a surgery and you find that your hands are shaking, what you learn from your mentors, which I did, and what works extremely well, whether or not you're doing a surgery or not, is that you simply tap your foot or you bounce your knee a little bit, which you might think would make your handshake even more.
这就是我所说的回响活动。似乎患有多动症的孩子和成年人在他们的神经系统中有很多回响活动。因此，他们总是渴望移动，很难静坐不动，因此很难集中注意力。当你做手术时，如果发现手在颤抖，你可以从导师那里学到一点技巧，我就是从他们那里学到的，而且这在无论是否在做手术时都非常有效。那就是轻轻地跺脚或者稍微晃动膝盖，尽管你可能会觉得这样做会让手抖得更厉害。
But provided that it's subtle, what it does is it actually shuttles some of the activity from those pre-motor circuits to elsewhere in the body. And then you're able to sit much more still with your hand. You're able to perform the surgery with much more precision. You are able to write with much better hand writing. And for those of you who engage in public speaking, if you're ever too nervous, that's why pacing while you public speak helps if you're nervous. That's why bouncing your knee behind the podium works as well. That's why nodding your head and gesticulating can help. It's not a matter of quote unquote moving energy out of the body. That doesn't actually happen.
只要这种方式足够微妙，它实际上会将一些活动从大脑的运动前区转移到身体的其他地方。这样一来，你的手能够更加静止地放着，因此更精准地进行手术，写字也更加工整。对于那些需要进行公开演讲的人，如果你感到紧张，走来走去会有所帮助。这也是为什么在讲台后面抖腿有效，点头和做手势也有帮助。这并不是所谓的将“能量”从身体中移出去，实际上并不会发生这种事。
What it is is you're engaging those pre-motor circuits that are sending through commands. It's like trying to stuff a bunch of stuff through a funnel. And it creates this tension. So you're giving it an outlet for the neural circuitry to be able to move something so that you can keep other components of your body and your mental attention engaged and locked on to something. What we call focus. One thing related to this whole business of blinking and focus and training yourself to focus and not blinking, etc. is that most all of the drugs, riddle in adderol and recreational drugs that increase dopamine, even coffee and tea and other forms of caffeine, they tend to make us blink less.
这段话的意思是：当你使用那些负责动作准备的脑回路时，就像是试图通过一个漏斗塞进很多东西一样，会产生一种紧张感。通过给这些神经回路一个出口，让它们能够移动某些东西，你就可以让身体的其他部分以及注意力保持专注，这就是所谓的“专注”。提到的关于眨眼、专注和训练专注力的问题，很重要的一点是，大多数药物，比如利他林（Ritalin）、阿得拉（Adderall），以及增加多巴胺的休闲药物，甚至咖啡、茶和其他形式的咖啡因，往往都会让我们减少眨眼。
And when we get tired, we tend to blink more. Now, this is sort of a duh, but being wide eyed with excitement or fear or with your eyes barely being able to keep them open, now it should make perfect sense that these shutters on the front of your eyes, they aren't just there for winking and they aren't just there for cosmetic purposes. They are there to regulate the amount of information going into your nervous system and they're there to regulate how long you are bringing information into your nervous system and in what bins, how widely or finally you are binning time is set by how often you blink and how widely or specifically you are grabbing attention from the visual world is set by whether or not you're viewing things very specifically like across here through a soda straw view like this or whether or not you're in this panoramic sort of whole environment mode, this kind of fisheye lens or wide angle lens mode.
当我们疲惫时，我们往往会更多地眨眼。这听起来有点理所当然，但无论是因兴奋或恐惧睁大双眼，还是因困倦难以睁开眼睛，都应该很清楚一个道理：我们眼前的这些“快门”不仅仅是用来眨眼或者装饰的。它们的作用是调节进入你神经系统的信息量，以及控制你将信息输入神经系统的时间长短。你眨眼的频率决定了时间被划分得多宽泛或多精细，而你对视觉信息的关注程度是由你是通过一种狭窄的，如通过吸管般的视野专注地观看，还是以全景模式、广角镜头方式浏览整个环境所决定的。
And in fairness to the pharmacology and the circuitry, while dopamine and heightened levels of alertness and excitement tend to make us blink less and attend more, there's actually a study that's looked at the other neurochemical systems and drugs and how those relate to blinking and so this will all be obvious by the title of the paper I'm about to share with you. This is a paper entitled Decrease Spontaneous Eye Blink Rates in Chronic Cannabis Users. Evidence for Strietal Canabinoid Dopamine Interactions. Okay, I'm not going to go into all the details here, but one thing that is somewhat surprising is that many people with ADHD use or abuse, cannabis.
为了公平对待药理学和神经电路，尽管多巴胺和高水平的警觉性和兴奋感通常会让我们更少眨眼、更专注，但实际上有一项研究考察了其他神经化学系统和药物，以及它们与眨眼的关系。我将要与您分享的论文标题可以对此做出解释。这篇论文的标题是《慢性大麻使用者自发眨眼率下降：纹状体大麻素-多巴胺相互作用的证据》。我不会详细介绍其中所有细节，但令人有些惊讶的是，许多注意力缺陷多动障碍 (ADHD) 患者会使用或滥用大麻。
You might think, well, why would they do that? Because I thought that a increase in dopamine is actually what's going to lead to heightened levels of attention and that's what these people and children crave. Well, it turns out that cannabis also increases dopamine transmission in the brain, but because of the other chemicals it increases, namely serotonin and some components of the cannabinoid and opioid system, it creates that kind of alert but mellow feel. Again, here I'm not a proponent of this. I personally am not a THC or cannabis user. It's just not my thing. Obviously, it's illegal some places and so you have to determine that for yourself. It does have medical purposes and some places it is legal, but THC increases dopamine and increases neurochemicals that can also create a state of calm.
你可能会想，为什么他们会这样做？因为我认为多巴胺的增加实际上会导致更高水平的注意力，而这正是这些人和儿童所渴求的。事实证明，大麻也能增加大脑中的多巴胺传递，但由于它还增加了其他化学物质，特别是血清素以及一些与大麻素和阿片系统相关的成分，它创造了一种既警觉又平和的感觉。我要再次声明，我并不是在倡导使用大麻。我个人不是THC或大麻的使用者，这不是我的爱好。显然，在一些地方这是非法的，所以你需要自行决定。大麻确实有医疗用途，在某些地方是合法的，但THC不仅增加多巴胺，还能增加其他神经化学物质，从而创造出一种平静的状态。
It's that middle ground and this paper has a beautiful demonstration whereby not just while people are using cannabis, but depending on how long they've been using cannabis across their lifespan, the rates of eye blinking change. So if you look at the number of years that people have been using cannabis on a regular basis either daily or up to excuse me, weekly or up to daily, what you find is that for people that have not been using cannabis at all or have only been using it for about two years, their rates of eye blink are much higher than people who have been using it chronically for 10 years. In other words, people who be using cannabis for 10 years don't blink very often at all.
这篇文章展示了一个很好的例子，说明了在大麻使用者中，不仅在使用大麻时，眼睛眨动的频率会发生变化，而且这种变化还与他们使用大麻的时间长短有关。也就是说，如果你观察那些定期使用大麻的人，比如每周使用或者每天使用，并且已经持续了多年的用户，可以发现那些没有使用过大麻或仅使用过大约两年的人，眼睛眨动的频率要比那些长期使用了10年的人高得多。换句话说，使用大麻达10年的人，眨眼的频率非常低。
Now, cannabis has well known effects in depleting memory, but it does seem to engage the focus and blinking system in a way that increases focus. So basically what I'm saying is marijuana seems to increase people's focus, but then they can't remember what they were focusing on. Something I'd like to discuss just briefly is the so-called interceptive awareness that's present in people with ADHD, both children and adults. Interoceptive awareness is one sense of one's own internal state, heartbeat, breathing, contact of skin with a given surface, et cetera.
现在，大麻对记忆力削弱的影响是众所周知的，但它似乎会以某种方式影响注意力和眨眼系统，从而提高专注力。基本上，我想表达的是，大麻似乎能提高人们的专注力，但随后他们可能记不住自己专注的内容。我想简要讨论一下在患有多动症（ADHD）的人群中普遍存在的内感知觉，这包括儿童和成年人。内感知觉是对自身内部状态的一种感知，比如心跳、呼吸、皮肤与某个表面的接触等。
For a long time, there was this hypothesis, this idea that people with ADHD were just not in touch with how they felt. That somehow they weren't registering all the stuff that was going on inside them, changes in heart rate and so forth. And so they were behaving in a way that was dysregulated or appeared dysregulated. And that if they could just learn to attend to their internal state better, that somehow they would function better in the world. Now, before we described a process, literally a 17-minute interoceptive exercise that does seem to lead to improvements in one's ability to focus for a longer period of time. However, it's very unlikely that that was due to increasing interoceptive awareness per se.
长期以来，有一种假设或观点认为，多动症患者与自己的情感不够接触。他们似乎无法察觉自己内心发生的事情，比如心率变化等。因此，他们的行为显得不稳定或看起来不够稳定。如果他们能够更好地关注自己的内在状态，他们在现实世界中的表现可能会更好。我们之前介绍过一种过程，就是一个持续 17 分钟的内感知练习，似乎能够改善人们更长时间集中注意力的能力。然而，这种效果很可能并不是单纯由于内感知意识提高所致。
It probably wasn't because people gaining much heightened or improved ability to understand what's going on internally. In fact, you can imagine how that might actually prevent one's ability to pay attention to things in the outside world. So while there is benefit to just sitting there and being in stillness, as they say, or focusing on one's breathing and internal state for sake of then accessing information in the external world, a really nice study called interoceptive awareness in attention, deprecit, hyperactivity disorder, explored whether or not interoceptive awareness was different in people with ADHD or did not have ADHD.
这可能不是因为人们在理解自己内心状态方面有了显著的提升或改善。实际上，可以想象，这种内心的关注可能会干扰人们注意外界事物的能力。所以，虽然“静坐”或专注于呼吸和内在状态有其好处，以便随后更好地获取外界信息，但有一项非常有趣的研究《注意力缺陷多动障碍中的内感知觉意识》探讨了有无ADHD的人在内感知觉意识方面是否存在差异。
And the findings were essentially that there's no difference, that people with ADHD, children and adults, they are aware of what's going on inside them, just as much as anyone else is. And the typical measure of interoceptive awareness is one's ability to count their own heartbeats. This is actually challenging for some individuals and very easy for other individuals, regardless of their attentional capacity. Some people just can really feel their heart beat without taking their pulse. Other people cannot. And these studies are pretty straightforward to do. You ask people to sit there and to count their heartbeats and then you are monitoring their heartbeats and you get to gauge how accurate they are.
研究结果基本上表明，没有区别。患有多动症的儿童和成人，对自己内在情况的感知能力与其他人一样。通常衡量内感知能力的方法是看一个人能否数出自己的心跳。这对于一些人来说很有挑战性，而对于其他人来说则非常容易，且与他们的注意力水平无关。有些人不必摸脉搏就能清晰地感觉到自己的心跳，而另一些人则无法做到。这类研究相对简单：让参与者坐着数自己的心跳，同时研究者监测他们的心跳，来评估他们的准确性。
So it's important to understand that people with ADHD are in touch with how they feel. It's really a question of whether or not they can take the demands that are placed upon them and enter a cognitive state, a mental state that allows them to access the information they need to access. In other words, whether or not they can focus. But it is absolutely wrong to think that the child that's getting up 11 times during a short six, you know, six minute interaction at the table or whether or not a child who somehow has to venture off every moment or a coworker of yours who's an adult who's constantly fidgeting or moving things around that somehow they are unaware that they are oblivious. They're not oblivious to how they feel. Chances are they are very challenged in the situations that they're in and they're doing everything they can to try and regulate their attention.
因此，理解多动症(ADHD)患者其实非常了解自己的感受是很重要的。不过，真正的问题在于他们是否能应对工作和生活的各种要求，并进入一种认知状态，这种状态可以帮助他们获取所需的信息。换句话说，就是他们是否能集中注意力。但认为那些在短短六分钟的餐桌互动中站起11次的孩子，或者每时每刻都得走开一下的孩子，或者某个成天手脚不停、不断调动东西的同事，这些人是对周围状况一无所知、无动于衷的想法是完全错误的。实际上，他们对自己的感受很清楚，而他们很可能在面临的状况中感到非常困难，并竭尽全力尝试调节自己的注意力。
So I think it's an important study to highlight because it really underscores the fact that something else is going on and that something else has everything to do with this ability to coordinate these task-directed networks and to coordinate that in the proper way with that default mode network. And that is a process as you now know that's regulated exquisitely by certain neurochemicals and in particular the neurochemicals dopamine, norepinephrine and serotonin. And a fourth one I'd like to throw into the mix which is acetylcholine which is very vital for cognitive focus.
我认为这是一个值得关注的重要研究，因为它强调了背后另有因素在发挥作用。这个因素主要涉及到如何协调这些任务导向的神经网络，并恰当地与默认模式网络进行协调。这一过程是由某些神经化学物质精细调控的，特别是多巴胺、去甲肾上腺素和血清素。此外，我还想提到一种对认知专注至关重要的神经化学物质，那就是乙酰胆碱。
So now I want to switch back to talking about some of the drugs that are typically used to access those systems prescription drugs. And I want to talk about some of the new and emerging non-prescription approaches to increasing the levels of dopamine acetylcholine and serotonin in the brain using various supplement type compounds because several of them are showing really remarkable efficacy in excellent peer reviewed studies. So before moving to some of the newer atypical compounds and things sold over the counter, I'd like to just briefly return to the classic drugs that are used to treat ADHD. These are the ones I mentioned earlier, methylphenidate, also called ridolin, modaphanil, armodaphanil is another one and aderol. Again, all of these work by increasing levels of dopamine and norepinephrine.
现在，我想回到讨论一些通常用于影响这些系统的处方药物。我还想谈谈一些新兴的非处方方法，如何通过使用各种补充剂来提高大脑中多巴胺、乙酰胆碱和血清素的水平，因为有些补充剂在经过严格的同行评审研究中显示出非常显著的效果。在深入探讨一些更新的非典型化合物和非处方药物之前，我想简要回顾一下用于治疗多动症的经典药物，这些药物包括我之前提到的利他林（或称哌甲酯）、莫达非尼、右旋莫达非尼以及阿德拉。这些药物通过提高多巴胺和去甲肾上腺素的水平来起作用。
Typically they are taken early in pill form or sometimes in capsule form. The dosages that are appropriate vary according to severity of the condition for a given person and the age of the person. This is a complicated landscape for each individual. They have to figure out the pharmacology that's best for them. Some individuals are even layering long or time to release ridolin with aderol and smaller doses. It can get quite complex or it can be quite straightforward. If you are really interested in these drugs and how they work and you'd like to get a glance at a table of all the results from all the studies of which there are now hundreds.
通常，这些药物早期会以药片或胶囊的形式服用。适合的剂量会根据每个人病情的严重程度和年龄而有所不同。每个人的情况都很复杂，他们需要找出最适合自己的药物。有些人甚至会将长效或缓释的利他林与小剂量的阿得拉尔结合使用。这一过程可能会相当复杂，也可能相对简单。如果你对这些药物及其运作方式很感兴趣，并且想查看所有研究结果的表格，现在已经有数百项相关研究了。
There's an excellent review about these drugs and their use and their comparison to similarly structured drugs, in particular MDMA and cocaine and amphetamine, meaning street amphetamine, to really illustrate the similarities of action and some of the problems associated with long-term use. I don't expect you to read this article in full. I'm here so that you don't have to go read these articles, but in case you want a ton of information, the paper is Esposito at all, frontiers in biosciences. It's an excellent, excellent review of the entire literature. It is quite long. I can put a link to that study in our caption.
这些药物及其使用、以及与结构相似的药物特别是MDMA、可卡因和街头安非他明的对比，有一篇非常好的综述文章。这篇文章很好地说明了这些药物作用的相似性以及长期使用所带来的一些问题。我并不期望你完整阅读这篇文章。我在这里是为了让你不必去读这些文章，但如果你想获取大量信息，可以参考Esposito等人在《生物科学前沿》上的论文。这是一篇非常好的文献综述，篇幅相当长。我可以在我们的说明中加上这篇研究的链接。
It essentially describes all the studies that have been done peer-reviewed and published and it refers to these drugs in an interesting way. It doesn't just refer these drugs as for treatment of ADHD. It actually refers to them using language that ordinarily I'm not very fond of, but I'll agree to here, which is so-called smart drugs or neutropics. It also covers caffeine, which again, as I mentioned earlier, increases dopamine, norupinephrine, and to some extent serotonin. What I like about this review so much is that in putting these drugs of abuse, methamphetamine and cocaine right alongside these drugs like Ritalin and Adderall and also caffeine, we start to realize that the distinction between drugs of abuse and the distinction between drugs of treatment is actually very fine and sometimes even a blurry line.
这段话大致描述了所有经过同行评审并发表的研究，并以一种有趣的方式提到了这些药物。它不仅仅是将这些药物视为治疗注意力缺陷多动障碍（ADHD）的药物。实际上，文中采用了我平时不太喜欢但在这里勉强同意的词汇，即所谓的“聪明药”或“益智药”。文章还提到了咖啡因，我之前提到过，咖啡因能增加多巴胺、去甲肾上腺素以及在某种程度上增加血清素。我非常喜欢这篇综述的一点在于，它将滥用药物如甲基苯丙胺和可卡因与像利他林（Ritalin）、阿得拉（Adderall）以及咖啡因一起讨论，我们开始意识到滥用药和治疗药之间的区别实际上很微妙，有时甚至是模糊不清的。
In thinking about whether or not one wants to use these prescription, I want to emphasize prescription, not drugs of abuse, but prescription drugs for treatment of one's own potential capacity. I think it is important to understand the extent to which they all carry more or less the same side effects. The one exception being caffeine. Caffeine side effects can be anxiety. If you ingest too much of it insomnia, if you drink it too late in the day, but typically it will not cause the major side effects of the other drugs such as hyperpensity for addiction and abuse and methamphetamines of any kind as well as cocaine can cause sexual side effects because they're vasoconstrictors. Men have trouble achieving erection. There can often be the intense desire or libido for sex, but an inability to actually perform. That's an issue with any kind of stimulant. These drugs are not without their consequences.
在考虑是否使用这些处方药时，我想强调的是处方药，而不是滥用的药物，而是用于提升自身潜力的处方药。我认为重要的是要了解它们大多具有相似的副作用。唯一的例外是咖啡因。咖啡因的副作用可能包括焦虑，如果摄入过多可能导致失眠，尤其是如果在一天较晚时饮用。然而，通常情况下，它不会像其他药物那样引发重大副作用，例如上瘾和药物滥用的风险。甲基苯丙胺以及可卡因等药物因收缩血管可能导致性方面的副作用，男性可能会遇到勃起困难的问题。可能会有强烈的性欲，但却难以实际完成。这是任何类型兴奋剂都会面临的问题。这些药物并非没有后果。
In addition, and here I'd lump caffeine back into the mix. In addition, they almost all carry cardiac effects. They increase heart rate, but they also have effects on constriction of blood vessels and arteries and veins and so forth in ways that can create cardiovascular problems. Caffeine is a bit of a complicated one. I talked about this on a podcast long ago, but I'll just remind you that it turns out that if you are caffeine adapted, in other words, if you are used to drinking caffeine, then the ingestion of caffeine most often will cause vasodilation to actually allow more blood flow through. However, if you are not caffeine adapted, it will cause vasoconstriction due to an increased stress response. If you're familiar with caffeine, caffeine can actually have a little bit more of a relaxation response. If you drink enough of it, it will make you amped up.
此外，这里我要把咖啡因也算进去。几乎所有这些物质都会影响心脏健康。它们可以增加心率，还会导致血管、动脉和静脉的收缩，从而可能引发心血管问题。咖啡因比较复杂一些。我很久以前在播客里讨论过这个问题，但我想提醒你们，如果你已经适应了咖啡因的摄入，换句话说，如果你习惯喝咖啡，那么摄入咖啡因通常会导致血管扩张，从而促进血液流动。然而，如果你没有适应咖啡因，它反而会导致血管收缩，因为压力反应增加。如果你对咖啡因比较熟悉，它实际上可以引起一定程度的放松反应。但是，如果喝得多了，还是会让人兴奋起来。
These other drugs almost always lead to vasoconstriction, increased heart rate, dilation of the pupils, less blinking, heightened levels of attention, which looks very much like stress. At its extremes, it looks very much like the effects of street drugs, like cocaine and emphetamine. Because of the large amounts of dopamine that released in the brain, people tend to crave that state over and over and yet with each subsequent use, are able to get less and less of that euphoric feeling or that really, really focused feeling. One thing that's being explored quite extensively now in the treatment of ADHD are drug schedules. Whether or not people should take Adderall every day or every other day, whether or not they should take it only every once in a while.
这些药物几乎总是导致血管收缩、心率加快、瞳孔扩大、眨眼减少、注意力水平提升，这些症状看起来和压力非常相似。在极端情况下，它们的效果和街头毒品如可卡因和安非他明非常相像。由于大脑中释放的大量多巴胺，人们往往反复渴望那种状态，但是随着每次使用，他们能获得的愉悦感或极度专注感却越来越少。目前在治疗注意力缺陷多动症（ADHD）方面，人们正在广泛研究药物使用的时间表，比如人们是否应该每天或隔天服用Adderall，或者仅在偶尔的时候服用。
Whether or not young children can take it just a few times and engage in behavioral training of the sort that I talked about before, where they're doing maybe it's a 17 minute meditation type exercise, but more likely it would be the movement followed by the visual focusing because that's only done for 20 or 30 or 60 seconds. Why would you do that? Well, in a chemically enhanced state, your brain is more plastic. The circuits are able to modify and learn better. That's the optimal time to engage in focus in a very deliberate way. So just taking a drug and expecting focus to just work at any point and being able to turn focus on and off at will, that's an unrealistic expectation.
年轻儿童是否可以仅仅进行几次这样的行为训练呢？我之前提到过的那种训练，可能是一个17分钟的冥想练习，但更有可能是运动后跟随的视觉聚焦，因为这部分只需要20、30或60秒。为什么要这样做呢？在化学因素增强的状态下，大脑的可塑性更强，神经回路能更好地调整和学习。这是以非常有意识的方式进行专注训练的最佳时机。所以，仅仅服用药物并期望随时能专注，或者可以随意打开和关闭专注，这是一种不切实际的期望。
Right? More likely, the best use of things like Adderall, Modaphanil, Armodaphanil and Rillin is going to be to combine those treatments with behavioral exercises that actively engage the very circuits that you're trying to train up and enhance and then perhaps, I want to highlight perhaps, tapering off those drugs so that then one can use those circuits without any need for chemical intervention. So despite any controversy that might be out there, I think it's fair to say that the consumption of omega-3 fatty acids can positively modulate the systems for attention and focus. So then the question becomes how much EPA, how much DHA does that differ for what's helpful for depression, etc.
好的？更有可能的是，像Adderall、Modafinil、Armodafinil和Ritalin这样的药物最佳使用方式是结合行为训练，这些训练会积极锻炼并增强你想要提升的脑部回路。然后，或许，更强调一下“或许”，逐渐减少这些药物的使用，以便在没有化学干预的情况下使用这些回路。因此，尽管外界可能存在争议，我认为可以公正地说，摄取omega-3脂肪酸可以积极调节注意力和专注力的系统。那么问题就变成了：多少EPA和DHA对抑郁症等有益是不同的吗？
And actually, it does differ. In reviewing the studies for this, it appears that a threshold level of 300 milligrams of DHA turns out to be an important inflection point. So typically, fish oils or other sources of omega-3s will have DHA and EPA and typically it's the EPA that's harder to get at sufficient levels, meaning you have to take quite a lot of fish oil in order to get above that 1000 milligram or 2000 milligram threshold to improve mood and other functions. But for sake of attention, there are 10 studies that have explored this in detail. And while the EPA component is important, the most convincing studies point to the fact that getting above 300 milligrams per day of DHA is really where you start to see the attentional effects.
实际上，它确实有所不同。在审查相关研究时，我们发现300毫克的DHA是一个重要的转折点。通常，鱼油或其他omega-3的来源中会包含DHA和EPA，而通常较难摄取足够水平的是EPA。也就是说，你需要摄入相当多的鱼油才能达到1000毫克或2000毫克的门槛，以改善情绪和其他功能。关于注意力的研究，有10项详细探讨了这个问题。虽然EPA成分很重要，但最有说服力的研究表明，每天摄入超过300毫克的DHA是注意力效果开始显现的关键点。
Now, fortunately, if you're getting sufficient EPA for sake of mood and other biological functions, almost without question, you're getting 300 milligrams or more of DHA. So that usually checks that box just fine. What's interesting is that there's another compound phosphodiital steering that has been explored for its capacity to improve the symptoms of ADHD. Again, I don't think this is any direct way, but rather in a modulatory way. But it appears that phosphodiital steering taken for two months, for 200 milligrams per day, was able to reduce the symptoms of ADHD in children. It has not been looked at in adults yet, at least as far as I know.
现在，幸运的是，如果你为了情绪和其他生物功能摄入足够的 EPA，几乎可以肯定地说，你会摄入300毫克或更多的 DHA。所以这通常已经足够。而有趣的是，另一种化合物磷脂苷被研究其在改善多动症（ADHD）症状方面的潜力。再强调一下，我不认为这是直接作用，而更像是一种调节方式。但是，研究显示，每天摄入200毫克磷脂苷，持续两个月，可以减轻儿童的多动症症状。至于成年人是否有效，目前还没有相关研究，至少据我所知是这样。
But that this effect was greatly enhanced by the consumption of omega-3 fatty acids. So now we're starting to see synergistic effects of omega-3 fatty acids and phosphodiital steering. Again, that was 200 milligrams per day. This is something that's sold over the counter in capsule form, at least in the US. There were two studies, both were double blind studies. I carried out for anywhere from one to six months on both boys and girls. And it really was boys and girls not men and women. This was kids, age one to six or seven to 12. And it was a fairly large number of subjects. So 147 subjects in one case and 36 and the other.
这说明omega-3脂肪酸的摄入显著增强了这一效果。现在我们开始看到omega-3脂肪酸与磷脂酰弛缓剂的协同作用，同样都是每天摄入200毫克。这种产品在美国至少可以在非处方的胶囊形式购买。有两项研究，都是双盲研究，分别在1到6个月期间针对男孩和女孩进行。确实是男孩和女孩而不是成年人，研究对象是1到6岁或7到12岁的儿童，研究的参与者人数也较多，一项为147名，另一项为36名。
The takeaway is that getting sufficient levels of EPA is in particular this 300 milligram threshold of DHA plus if you are interested in it and it's right for you, 200 milligrams of phosphodiital steering can be an important augment for improving the symptoms of ADHD. You'll also find literature out there and many claims about so-called Ginkgo Bilboa, which has been shown to have minor effects in improving the symptoms of ADHD. Not nearly as effective as Ritalin and Adderall. Ginkgo Bilboa is not appropriate for many people. I am one such person. I don't have ADHD. But when I've taken Ginkgo even at very low doses, I get absolutely splitting headaches.
要点是：获取足够的EPA（特别是DHA达到300毫克的门槛）是很重要的，如果你感兴趣并且适合的话，另外加入200毫克的磷脂酰丝氨酸（磷脂酰谷氨酸）可以显著改善ADHD的症状。此外，你还会发现有一些文献和很多关于银杏叶的说法，虽然研究表明银杏叶对改善ADHD症状有轻微效果，但远不如利他林和阿得拉尔有效。此外，银杏叶并不适合所有人，我本人就是这样。我没有ADHD，可是即使我服用很低剂量的银杏叶，也会感到剧烈头痛。
Some people do not experience those headaches, but it's known to have very potent vasoconstrictive and vasodilating properties that vary depending on when you took the compound. So for those of you that are exploring Ginkgo Bilboa and you will see a lot of claims about Ginkgo Bilboa for attention in ADHD, definitely take the vasodilation, vasoconstriction headache issue into consideration. So I'd like to talk about the drug Modaphanil and the closely related drug are Modaphanil. That's AR Modaphanil. Because Modaphanil and Armodaphanil are gaining popularity out there both for treatment of ADHD and narcolepsy, but also for communities of people that are trying to stay awake long periods of time.
有些人并不会经历头痛的问题，但已经知道它具有非常强的血管收缩和扩张特性，这取决于你何时服用了这种化合物。所以，对于那些正在探索银杏叶提取物的人，你会看到很多关于其用于注意力缺陷多动症（ADHD）的说法，一定要考虑到血管扩张和收缩引发的头痛问题。我想谈谈药物莫达非尼及其相关药物阿莫达非尼，也就是AR莫达非尼。因为莫达非尼和阿莫达非尼越来越流行，不仅用于治疗ADHD和嗜眠症，还被一些需要长时间保持清醒的人群所使用。
So it's actively used in the military by first responders. It's gaining popularity on college campuses and people are using it more and more as an alternative to Adderall and Ridleyne and excessive amounts of coffee. It does increase focus and to a dramatic extent. Modaphanil typically was very expensive. I don't know if it's still this expensive, but when one has a prescription for it, it could still cost as much as $800 or $900 a month. Armodaphanil is a far less expensive version that's chemically slightly different than Modaphanil. Regardless of price, people are taking Modaphanil and Armodaphanil.
它被军队中的急救人员积极使用。这种药在大学校园里越来越受欢迎，人们越来越多地把它作为一种替代选择代替Adderall、Ridleyne和大量咖啡。它确实能显著提高注意力。Modaphanil通常价格非常昂贵。我不确定现在是否仍然这么贵，但即使有处方，也可能每月花费高达$800或$900。Armodaphanil是一种便宜得多的版本，化学成分上与Modaphanil有些不同。无论价格如何，人们都在服用Modaphanil和Armodaphanil。
When I emphasize that unlike Ridleyne and Adderall, Modaphanil and Armodaphanil are weak dopamine reuptake inhibitors and that's how they lead to increases in dopamine. So whereas Ridleyne and Adderall and Fetamine and Cocaine lead to big increases in dopamine also through reuptake mechanisms and so forth. Modaphanil is a weaker dopamine reuptake stimulator. So what that means is that it leaves more dopamine around to be active at the synapse, the gaps between neurons.
当我强调莫达非尼和右旋莫达非尼与利他林和阿得拉相比是弱效的多巴胺再摄取抑制剂时，我是在说明它们如何通过提升多巴胺水平起作用。与此相反，利他林、阿得拉和阿芬他明及可卡因通过再摄取机制等途径导致多巴胺的大量增加。莫达非尼是一种较弱的多巴胺再摄取刺激剂。这意味着它让更多的多巴胺停留在神经元之间的突触，即神经元之间的空隙中发挥作用。
However, it also activates other systems. It acts on theorexan system, which is actually a peptide that we talked about in the episode on hunger, because it regulates hunger and appetite and it regulates sleepiness and feelings of sleepiness. In fact, the, excuse me, a rexan, also called hypocretin system, theorexan hypocretin system, is what's disrupted in narcolepsy. That was the important discovery of my colleagues, Emmanuel Minio and Seiji Nishino at Stanford some years ago. They identified the biological basis of narcolepsy and it's a disruption in the sorexan hypocretin system and Modaphanil is one of the primary treatments for narcolepsy.
然而，它也激活了其他系统。它作用于食欲肽系统，这其实是一种肽，我们在讨论饥饿的那一集中提到过，因为它能够调节饥饿和食欲以及困倦和困意。实际上，这个食欲肽系统，也被称为下丘脑生长素系统，正是嗜睡症中受到干扰的地方。这是我的同事Emmanuel Minio和Seiji Nishino几年前在斯坦福大学的重要发现。他们确定了嗜睡症的生物学基础，即食欲肽系统的紊乱，而莫达非尼是治疗嗜睡症的主要药物之一。
It also has these other effects on the dopamine system and on the norepinephrine system. Even though it doesn't lead to quite as intense levels of dopamine and arousal and focus, it does have the property of raising levels of attention and focus and that's why people are using it. So it's a somewhat milder form of Adderall. Armodafinil for some people works as well as Modafinil and as I mentioned before, it's much lower cost; for other people, it doesn't. I have an experience, meaning I do have an experience that I'll share with you with Armodafinil. A few years ago, I was suffering from jet lag really terribly and I was traveling overseas. I went to a meeting to give a talk. I took half of the prescribed dose of Armodafinil. It was prescribed to me. I took that half dose and I gave my lecture and then I stayed around to answer questions and then four hours later, a friend of mine came up to me and said, you know, you've been talking for four and a half hours and there are only a few people still here.
它还对多巴胺系统和去甲肾上腺素系统有其他影响。虽然它不会导致同样强烈的多巴胺水平以及兴奋和专注，但它确实能够提高注意力和专注力，这就是人们使用它的原因。因此，这是一种相对温和的Adderall替代品。对一些人来说，Armodafinil的效果和Modafinil一样好，而且就像我之前提到的，它的成本更低；但对其他人来说效果可能不如意。我有一段关于使用Armodafinil的经历可以分享给你。几年前，我因严重的时差反应非常痛苦，并且正在海外旅行。我需要去参加一个会议并做演讲。医生给我开了Armodafinil，于是我服用了规定剂量的一半。我服下半剂后进行了演讲，并留下来回答问题。四个小时过去后，我的一个朋友走过来对我说：“你已经讲了四个半小时了，现在这里只剩几个人还在听。”
Luckily there were still a few people; it would be a lot weirder if the room was completely empty, as it wasn't being recorded. So I have firsthand knowledge of the sorts of cognitive effects that it can create. I personally would not want to be in that state for the sake of studying or learning or for doing this podcast, for instance. And I can honestly say that today, all I've ingested is some coffee and some yerba mate tea and some water. I'm not on any of the compounds that I've described during the course of today's episode. You might ask why I took half the recommended dose of Armodafinil. And the reason is that I'm somebody who's fairly hypersensitive to medication of any kind. What you find if you look in the literature is that about 5% of people are hyper-hypersensitive to medication. They require far lower doses of any medication than other people in order to experience the same effects.
幸运的是，房间里还有几个人；如果房间完全空荡荡的，那就显得更奇怪了，因为这一切并没有被录制。因此，我亲身体会到了这种情况下可能产生的认知效应。我个人不希望处于那种状态下去学习或者录制播客之类的事情。今天我只喝了咖啡、云南马黛茶和水。我没有服用我在今天节目中提到的任何化合物。你可能会问我为什么只服用了半剂量的阿尔莫达非尼。原因是我对任何类型的药物都相当敏感。如果你查阅相关文献，会发现大约5%的人对药物特别敏感。这些人所需的药物剂量比其他人大大减少，便能体验到相同的效果。
I'm somebody that I think is sort of modestly hyper, if that sort of oxymoronic statement, but a modest hypersensitivity to medication. So I've almost always been able to get by on taking less of whatever was prescribed for me and feel just fine or in this case, to feel like it was still too much. It turned out that the right dose of Armodafinil for me was 0 milligrams. Now you may notice that I haven't talked much about acetylcholine. Acetylcholine is a neurotransmitter that at the neuron to muscle connections, this is called neuromuscular junctions, is involved in generating muscular contractions of all kinds for all movements. Acetylcholine is also released from two sites in the brain. So a little bit of nomenclature here again, feel free to ignore the nomenclature.
我的体质对药物有点过于敏感，这可能听起来有些矛盾，但我确实对药物的敏感程度比较高。因此，我几乎总是能通过减少药量来获得良好的效果，甚至有时会觉得药量还是太多了。最终，我发现对我来说，合适的阿莫达非尼（Armodafinil）剂量是0毫克。
你可能注意到我没有多提乙酰胆碱。这是因为乙酰胆碱是一种神经递质，它在神经和肌肉连接的地方（称为神经肌肉接点）发挥作用，参与生成各种运动所需的肌肉收缩。乙酰胆碱也从大脑的两个部位释放。如果你对这些术语不感兴趣，可以忽略这些术语。
But there is a collection of neurons in your brainstem that send projections forward, kind of like a sprinkler system that's very diffuse to release acetylcholine and those neurons reside in an area or a structure that's called the pedunculopontine nucleus, the PPN. And then there's a separate collection of neurons in the basal forebrain called unimaginatively nucleus basalis, the nucleus at the base. And they also hose the brain with acetylcholine, but in a much more specific way. So one is sort of like a sprinkler system and the other one is more like a fire hose to a particular location. And those two sources of acetylcholine collaborate to activate particular locations in the brain and really bring about a tremendous degree of focus to whatever is happening at those particular synapses.
在你大脑的脑干中，有一组神经元，它们像喷洒系统一样，向前发送信号，分散地释放乙酰胆碱。这些神经元位于一个叫做脚桥核（PPN）的区域。还有另一组神经元，位于大脑底部的一个结构，叫做基底核。它们也向大脑释放乙酰胆碱，但方式更为精确。所以，一个像是喷洒系统，另一个则像是对特定位置进行精准喷射的水枪。这两种乙酰胆碱来源协同作用，在大脑中特定位置激活神经元连接，使得在这些连接处发生的事情可以得到极大的关注和专注。
So it could be a focus on visual information or auditory information if you're listening closely to what I'm saying right now. You just heard closely step out from the rest of my sentence. No doubt there was acetylcholine released at the sites in your brain where the neurons that represent your recognition of the word closely occurred. Okay. So now you have an example and you have an understanding and hopefully a picture in your mind of how all this is working. Not surprisingly then, drugs that increase cholinergic or acetylcholine transmission will increase focus and cognition. One such compound is so-called alpha GPC, which is a form of choline and increases acetylcholine transmission. Dosages as high as 1200 milligrams per day, which is a very high dosage, spread out; typically it's 300 or 400 milligrams spread out throughout the day, have been shown to offset some of the effects of age-related cognitive decline, improve cognitive functioning in people that don't have age-related cognitive decline.
这段话讨论的是注意力与大脑中乙酰胆碱之间的关系。简单来说，如果你在认真听我现在说的话，你可能特别注意到“closely”这个词，这时你大脑中与识别这个词相关的神经元就会释放乙酰胆碱。因此，增强乙酰胆碱传递的药物能提高集中力和认知能力。例如，α-GPC（一种胆碱形式）能够增加乙酰胆碱的传递。每日剂量高达1200毫克，通常是分成300或400毫克在一天中多次服用。这种补充可以减缓某些与年龄有关的认知衰退效果，也能提高没有认知衰退的人群的认知功能。
That's a very high dose. Typically when people are using alpha GPC to study or to enhance learning of any kind, they will take somewhere between 300 and 600 milligrams. That's more typical. Again, you have to check with your doctor. You have to decide if the safety margins are appropriate for you. Obviously, you'll want to check that out. But alpha GPC is effective in creating more focus by way of this cholinergic system. It stimulates acetylcholine release from both of those locations, the PPN in the back of the brain and nucleus basalis in the front of the brain.
那是一个很高的剂量。通常情况下，人们使用α-GPC来学习或提升任何类型的学习能力时，会服用大约300到600毫克。这是比较典型的剂量。当然，你需要咨询你的医生。你需要决定这个剂量是否在你的安全范围内。显然，你需要仔细检查这个问题。不过，α-GPC确实可以通过胆碱能系统提高专注力。它能促进乙酰胆碱在大脑后部的PPN和前部的基底核的释放。
There are two other over the counter compounds that are in active use out there for treatment of ADHD and in use for simply trying to improve focus. The first one is eltyrosine. It's an amino acid that acts as a precursor to the neuromodulator dopamine. Now knowing everything you know about dopamine attention and the circuits involved, it should come as no surprise as to why people are exploring the use of eltyrosine for that purpose. Eltyrosine does lead to increases in dopamine. They are fairly long lived and eltyrosine can improve one's ability to focus. However, the dosaging can be very tricky to dial in.
有两种非处方药物被广泛用于治疗多动症（ADHD）和提高注意力。第一种是左旋酪氨酸，它是一种氨基酸，作用是多巴胺这种神经调节物质的前体。鉴于我们对多巴胺与注意力及相关神经回路的了解，人们探讨使用左旋酪氨酸来实现这些目标就不足为奇了。左旋酪氨酸确实可以增加体内多巴胺的含量，这种增加效果持续时间较长，并能提高专注能力。然而，用药的剂量调节起来可能会比较困难。
Sometimes it makes people feel too euphoric or too jittery or too alert that they are then unable to focus well. So the dosage ranges are huge. You see evidence for 100 milligrams all the way up to 1200 milligrams. It's something that really should be approached with caution especially for people that have any kind of underlying psychiatric or mood disorder because this regulation of the dopamine system is central to many of the mood disorders such as depression but also especially mania, mania bipolar disorder, schizophrenia, things of that sort.
有时候它可能让人感到过度兴奋、紧张或警觉，从而导致无法集中注意力。因此，剂量范围非常广，从100毫克到1200毫克不等。对于有任何潜在精神或情绪障碍的人来说，这种物质一定要谨慎使用，因为多巴胺系统的调节对许多情绪障碍至关重要，比如抑郁症，尤其是躁狂症、躁郁症、精神分裂症等。
So it's something that really should be approached with caution nonetheless in exploring what's out there and even some studies online that were done either animal studies or human studies. It's clear that eltyrosine is being explored for that purpose as is PEA and phenolethylamine which is essentially PEA but some related compounds. So there's a whole class of dopamine nurgic or dopamine stimulating supplements that people are using to try and get their dopamine levels up and again it's a it's kind of a fine line between too little enough and too much.
因此，在探索现有研究时，确实需要谨慎对待。无论是动物研究还是人类研究，都可以在网上找到一些相关的研究。很明显，l-酪氨酸（eltyrosine）正在被研究用于这个目的，像苯乙胺（PEA）和苯乙胺相关化合物也在被探索。这其实是一大类多巴胺能（dopamine nurgic）或多巴胺刺激补充剂，人们在使用这些补充剂以提高多巴胺水平。不过，使用这些补充剂需要拿捏好分寸，避免过量或不足。
If you want to get the literature on those two compounds there I will refer you to this great website at examin.com just as it sounds and you can put in eltyrosine or PEA and you can get the details on that but I highly recommend also going to their section on ADHD to see how those particular common elements relate specifically to ADHD and cognitive focus.
如果你想查找这两种化合物的相关文献，我推荐你访问一个很棒的网站：examin.com。这个网站的名字就是这样拼写的。在网站上输入“eltyrosine”或“PEA”，你就能找到详细信息。我也强烈建议你查看他们关于多动症（ADHD）的部分，了解这些常见元素如何与多动症和注意力集中相关。
And last but not least in terms of these different compounds I do want to mention the rassetams. These are somewhat esoteric and probably most of you haven't heard about them but some of you probably know a lot about them and they are becoming more popular. They go by names like New Pep and things of that sort. The rassetams are illegal in certain countries. They are gray market in other countries and they are sold over the counter in this country in the US.
最后，我想特别提到不同化合物中的“拉西坦”类。虽然它们有点冷门，可能大多数人都没听说过，但有些人可能对此非常了解，而且它们正变得越来越受欢迎。它们有时会叫做“New Pep”之类的名字。在某些国家，这些化合物是非法的；在其他国家，它们属于灰色市场，而在美国，它们可以在柜台上直接购买。
So they have different margins for safety. You definitely need to consult your doctor especially if you have ADHD but New Pep has been shown when taken you know at 10 milligrams twice daily can be more effective than some of the other rassetams. What is New Pep? New Pep taps into the colonurgic system. The acetylcholine system in ways very similar to alpha GPC but seems to have a slightly higher affinity for some of the receptors involved and can lead to those heightened states of cognitive capacity.
因此，它们的安全边际不同。特别是如果你有多动症，你一定需要咨询医生。不过，据显示，每天两次服用10毫克New Pep可能比其他一些类药物更有效。New Pep是什么？New Pep通过与胆碱能系统互动影响乙酰胆碱系统，其方式与alpha GPC非常相似，但似乎对某些受体有稍高的亲和力，这可能导致认知能力的提高。
And there are these studies one in particular comparative studies of New Pep and rassetam in the treatment of patients with mild cognitive disorders and brain disease of vascular and traumatic origin. That's a mouthful. What this study basically points to is the fact that people who are experiencing some degree of inability to focus due to prior concussion or some vascular event, a stroke or a scheming of any kind because neurons need blood when the blood supply is cut off to neurons or when there's a bleed in the brain.
这段话提到了一项研究，主要比较了New Pep和rassetam在治疗轻度认知障碍以及由血管疾病或创伤性原因导致的脑部疾病患者中的效果。这听起来可能有点复杂。这项研究基本上指出，那些由于先前的脑震荡或某种血管事件（如中风或缺血）导致注意力难以集中的人，他们的神经元需要血液供应。当神经元的血液供应被切断或大脑中出现出血时，就会出现这种情况。
Subsequent to that often there are challenges in maintaining focus. This is very common for people who have done sports where there's a lot of running into each other with your head like rugby, football, hockey and so forth but also people who experience head blows or often overlooked is the fact that most traumatic head injury is not actually from sports even football. It's from things like construction work, from high impact work of that kind.
在那之后，通常会面临保持专注的挑战。这在一些运动员中很常见，比如橄榄球、足球和曲棍球，这些运动中常常会用头互相碰撞。此外，头部受撞击的人也会有这种问题。人们常常忽视的是，大多数严重的头部受伤其实并非来自运动，甚至不是足球。许多是来自建筑工作、或其他高冲击工作的情况。
So there does seem to be some efficacy of New Pep and rassetam and things like it. It's an emerging area and as I mentioned in the US these things are sold over the counter. Again you have to figure out if it's right for you but they are beginning to show some promise and I'm intrigued by them because of the way that they tap into the colonurgic system which is both directly involved in focus and the ability to focus but is also important for things related to age related cognitive decline.
所以，新型Pep和Rassetam之类的东西似乎确实有一些效果。这是一个新兴领域，正如我提到的，在美国这些东西是非处方出售的。你仍然需要考虑它是否适合你，但它们开始显示出一些希望。我对此很感兴趣，因为它们通过作用于胆碱能系统影响注意力的集中能力，而这一系统不仅与集中注意力直接相关，同时也对与年龄相关的认知能力衰退问题很重要。
So a decline in colonurgic transmission or a cedoclin as we call it in the brain is one of the things associated with cognitive decline and it does seem that increasing colonurgic transmission can offset some of that cognitive decline and perhaps even more so in conditions such as vascular damage or concussion to the brain. If you're interested in atypical treatments for ADHD, compounds to improve focus and related themes and you like reading about this stuff, there's an excellent review article that I can refer you to.
因此，大脑中的胆碱能传递减少（我们称之为cedoclin）是与认知能力下降相关的因素之一。据观察，增加胆碱能传递似乎可以抵消某些认知能力的下降，尤其是在大脑血管损伤或脑震荡等情况下效果更为明显。如果您对ADHD（注意缺陷多动障碍）的非典型治疗、提高注意力的化合物和相关主题感兴趣，并且喜欢阅读这方面的内容，我可以为您推荐一篇非常好的综述文章。
It's by on et al. AHN. It was published in 2016 so it's a little bit behind the times although it's surprisingly comprehensive given that which lines up all the various drugs that I've discussed rassetams and adorol and riddlein and various forms of dopaminergic agents and colonurgic agents spells out whether or not they are sold over the counter prior prescription and really lines them up in all their effects, their drawbacks, etc.
这篇文章是由On等人撰写的，发表在2016年，虽然有些过时，但内容相当全面。文章详细列出了我讨论过的各种药物，如拉塞坦类、阿得拉尔、利他林，以及各种形式的多巴胺能和胆碱能制剂。它阐明了这些药物是否可以在柜台购买或需要医生处方，并详细列出了它们的作用效果、缺点等。
I'll refer you to that study. It's available and it's full length form online for free. It's on et al. that the journal is neuroplasticity. Neuroplasticity 2016 should be very easy to find if you put those keywords in and while it is a review, it is a very comprehensive review and if you're really into this stuff and you also want to learn a thing or two about how these things interact with neurofeedback etc.
我会推荐你看那项研究。它可以在网上以完整的形式免费找到。作者中包括“et al.”，发表在《神经可塑性》期刊上。只要在搜索中输入"Neuroplasticity 2016"，应该很容易找到。虽然这是一篇综述，但它非常全面。如果你对这个主题很感兴趣，并且想了解一些关于这些东西如何与神经反馈等相互作用的知识，这篇文章会很有帮助。
There's some information in there as well. I know I've already covered a lot of information but there is one more category of technology for the treatment of ADHD and for enhancement of focus in anyone that I would like to emphasize and that's transcranial magnetic stimulation. Transcranial magnetic stimulation also called TMS is achieving increasing popularity nowadays for the treatment of all sorts of neurologic conditions and psychiatric conditions.
那里也有一些信息。我知道我已经讲了很多信息，但还有一类技术用于治疗多动症和提高注意力，我想特别强调一下，那就是经颅磁刺激。经颅磁刺激，简称TMS，如今在治疗各种神经系统和精神疾病方面越来越受欢迎。
It is a non-invasive tool. It involves taking a coil. It's a device with a coil that's placed over a particular locations in the brain and then sends magnetic stimulation into the brain. It can actually pass through the skull without having to drill through the skull and nowadays can be used to both lower the amount of activity or increase the amount of activity in specific brain areas.
这是一种无创工具。它使用一个线圈设备，将其放置在大脑的特定位置，然后向大脑发送磁刺激。它可以穿透颅骨，而不需要钻开颅骨。如今，这种工具可以用来降低或增加特定大脑区域的活动水平。
Its spatial precision is not remarkable. That doesn't mean it's not of use but it is not a super fine grain tool. It's not a cannon but it's also not a needle. It is somewhere in between. It can direct the activity of particular brain regions at particular depths and as I mentioned it can increase or decrease that activity. For instance, I've had a TMS coil placed on my head not for therapeutic purposes, even it was I wouldn't tell you.
它的空间精度并不显著。这并不意味着它没有用处，只是它不是一个非常精细的工具。它既不是大炮，也不是针，功能介于两者之间。它可以针对特定深度的特定大脑区域进行活动调节，正如我提到的那样，可以增加或减少这些区域的活动。例如，我曾经在头上使用过TMS线圈，但不是出于治疗目的，即便是，我也不会告诉你。
But rather just for, well, I'm a neuroscientist and I worked in a lab with one for entertainment exploratory purposes. Please don't do this at home. It was placed over my motor cortex which generates voluntary action and it was a coil that at that time could only inhibit neurons. And so what I was doing is I was moving objects around on a table just like I am now. It was actually a pencil, not a pen.
只是因为，我是一名神经科学家，我在一个实验室里做过一些探索性和娱乐性质的研究。请不要在家里尝试这个。那时候，我们把一个装置放在我的运动皮层上，这个区域负责产生自愿动作。那个时候使用的线圈只能抑制神经元的活动。所以当时我正在像现在一样在桌子上移动物体，不过移动的其实是一支铅笔，而不是钢笔。
And I was tapping the pencil and then the TMS coil was turned on and for the life of me I could not move that pencil. Okay, because it was inhibiting my upper motor neurons in the portion of my cortex, the control, the voluntary activity. As soon as the coil was turned off, I could return to tapping the pencil again. Nowadays it's possible to stimulate motor cortex or any area of the brain with some degree of precision that could create the impulse to move without actually making the decision to move.
我在敲击铅笔时，TMS线圈被打开了，我竟然完全无法动那支铅笔。原因是它抑制了我大脑皮层中控制自主活动的上位运动神经元。线圈一关掉，我就能够再次敲击铅笔。如今，可以在一定程度上精确地刺激运动皮层或大脑的任何区域，从而产生运动的冲动，而不需要真正做出移动的决定。
So you can literally engage certain neural circuits and therefore behaviors and certain thought and emotional patterns by way of transcranial magnetic stimulation. This has far reaching and vast implications as you can probably imagine. In discussing ADHD with a colleague that uses TMS, what they are doing is they are taking the TMS coil to children and adults that have ADHD and they are using it to stimulate the portions of the prefrontal cortex that we talked about earlier that engage task directed focused states.
通过经颅磁刺激技术，你可以直接激活特定的神经回路，从而影响行为以及某些思维和情感模式。这一点具有广泛而深远的影响，相信你可以想象到。在与使用经颅磁刺激技术（TMS）的同事讨论注意力缺陷多动障碍（ADHD）时，他们所做的是将TMS的线圈应用于患有ADHD的儿童和成年人，并利用它来刺激前额叶皮层中与任务导向和专注状态相关的部分。
So rather than using a drug that generally increases dopamine and some of the other chemicals involved, they are using directed TMS stimulation of these circuits. And fortunately, I was quite relieved to hear this. They are combining that with a focused learning task. So they're literally teaching the brain to learn in a non-invasive way, no drug at all.
所以，他们并没有使用一般性提升多巴胺和其他相关化学物质的药物，而是采用了针对性的经颅磁刺激（TMS）来刺激这些神经回路。我很高兴听到他们这种方法。更棒的是，他们将这种刺激与特定的学习任务结合起来。这实际上是在无创、无药物的情况下，教大脑进行学习。
And right now there are experiments, clinical trials going on comparing TMS of this sort to the drug treatments of the sort that we described earlier that engage these circuits through pharmacologic mechanisms. So very exciting times for TMS, very exciting times for pharmacology related to ADHD and for enhancing focus in general. And when I say very exciting times, I mean no drug is perfect, but the constellation of drugs that's out there is getting much larger. But because they tap into different aspects of their circuitry, I do think that we are well on our way to identifying the ideal combinations of drug treatments, technological treatments and behavioral paradigms for increasing focus in both children and adults with ADHD.
目前，有实验和临床试验正在进行，将这种类型的经颅磁刺激（TMS）与我们之前提到的通过药理机制作用于脑部回路的药物治疗进行比较。这对TMS和与多动症（ADHD）相关的药理学，以及提高注意力的方法而言，是非常令人激动的时期。当我说这些令人激动时，我的意思是虽然没有一种药物是完美的，但市面上的药物选择正在不断增加。由于它们影响脑回路的不同方面，我相信我们正逐步找到最佳的药物治疗、技术手段和行为方案组合，以提高多动症儿童和成人的注意力。
And as a final, final point, I also want to mention something about technologies that are making it harder for all of us to focus regardless of whether or not we have preexisting ADHD or not. You can probably guess where this is going. Everybody nowadays seems to have a smartphone. I'm sure there are a few individuals out there that don't have a smartphone. Nonetheless, most people have them, most kids want one as soon as they can get them. And they are small, they grab our attention entirely, but within that small box of attention, there are millions of attentional windows scrolling by.
最后，我还想提到关于一些技术的问题，这些技术让我们所有人都更难以集中注意力，无论我们是否已经有注意力缺陷多动障碍（ADHD）。你大概能猜到我要说什么。如今每个人似乎都有一部智能手机。我相信还是有一些人没有智能手机。但是，大多数人都有，大多数孩子一有机会就想要一部。智能手机体积虽小，却完全吸引了我们的注意力，在这个小小的注意力框架中，有无数的内容不停地滚动。
Right. So just because it's one device that we look at does not mean that we are focused, we are focused on our phone. But because of the way in which context switches up so fast within the phone, it's thought that the brain is struggling now to leave that rapid turnover of context. Right. Many, many shows, many, many Instagram pages, many, many Twitter feeds, many, many websites. Basically, the whole world, at least in virtual format, is available within that small box. Unlike any other technology humans have ever dealt with before, even though there are trillions, infinite number of bits of information in the actual physical world, your attentional window, that aperture of constriction and dilating that visual window is the way in which you cope with all that overwhelming information. Typically, well, within the phone, your visual aperture is set to a given width.
好的。所以，即便我们只是盯着一个设备看，也不代表我们的注意力全在手机上。但由于手机上信息切换得太快，大脑现在似乎难以适应这种快速变化。对，就是有很多节目，很多Instagram页面，很多Twitter推文，很多网站。基本上，整个世界，至少是在虚拟形式中，都能在那个小盒子里找到。与人类以前接触过的其他技术不同，即使物理世界中有无数多的信息，我们的注意力范围——就像视觉窗口的收缩和扩张——帮助我们应对海量信息。在手机上，你的视觉窗口被设定在一个固定的宽度上。
It's about this big. Typically, the phone seems to be getting bigger, but nonetheless, it's about that big. And within there, your attentional window is grabbing it near infinite number of bits of information, colors, movies. If a picture is worth a thousand words, a movie is worth a billion pictures that brain loves visual motion. And so the question is, does that sort of interaction on a regular basis lead to deficits in the types of attention that we need in order to perform well in work and school relationships, etc. And the short answer is, yes, it does appear so. We are inducing a sort of ADHD.
这大概就是这么大。通常，手机看起来越来越大，但不管怎样，大概就是这个大小。在这么小的屏幕上，你的注意力窗口捕捉到的是几乎无限的信息量，包括颜色和视频。如果一张图片值一千字，那一段视频就值十亿张图片，因为大脑喜欢视觉运动。因此，问题是：这种常规的手机互动是否会导致我们在工作、学习和人际关系中所需的注意力出现缺陷？简单答案是，这确实会发生。我们正在引发一种类似注意力缺陷多动症（ADHD）的情况。
And while the studies on this are ongoing, because prominent use of smartphones really took off right around 2010. And we're only in 2021, long-standing studies take time, which is essentially to say the same thing as long-standing. There are some studies. And one in particular that I'd like to highlight. One was actually carried out pretty early in 2014. This is a study that explored smartphone use at the time they called it mobile phone use, but smartphone use. And in attention, difficulties in attending in 7,102 adolescents. So this is a huge study, a population-based cross-sectional study.
虽然关于这一主题的研究仍在进行中，因为智能手机的大量使用大约是在2010年开始的。现在只是2021年，长时间的研究需要时间，也就是说长期做这样的研究需要时间。不过已经有一些研究存在。其中有一项特别值得关注。其实比较早期的一个研究是在2014年进行的。这个研究探索了智能手机的使用，当时称为手机使用，对7,102名青少年的注意力和注意力困难的影响。所以这是一项大规模的、基于人群的横断面研究。
And you will be probably surprised and somewhat dismayed to hear that in order to avoid this decrease in attentional capacity. Adolescence needed to use their smartphone for less than 60 minutes per day in order to stay focused and centered on their other tasks. Otherwise, they started to really run into significant issues. So 60 minutes is not much. I have a feeling that most young people are using their phone more than 60 minutes per day. I know I am. I think for adults, the number is probably higher. Meaning, if you're an adult, I'm going to just extrapolate from what I read in this study.
为了避免注意力下降，青少年需要每天使用手机不超过60分钟，以便能够专注于其他任务。这一点可能会让你感到惊讶和有些担忧。否则，他们可能会遇到重大的问题。60分钟其实不多，我感觉大多数年轻人每天使用手机的时间都超过了60分钟。我自己也是这样。我认为成年人可能需要更长时间才能受到影响，换句话说，如果你是个成年人，这个时间限制可能会更高。这是我从这项研究中推测出来的。
It seems that probably two hours a day on the phone would be the upper limit beyond which you would probably experience pretty severe attentional deficits. I am a big fan of Cal Newport who wrote the book Deep Work. He's also written the excellent book A World Without Email. I've never met him, but I'm a huge admirer of his work. And I will paraphrase something that he said far more eloquently than I ever could, which is that the brain does not do well with constant context switching. Meaning it can do it, but it diminishes our capacity to do meaningful work of any other kind.
每天花在手机上的时间似乎最多应该限制在两个小时以内，否则你可能会经历严重的注意力缺陷。我是卡尔·纽波特（Cal Newport）的忠实粉丝，他写了《深度工作》这本书。他还写了另一本很棒的书，叫《没有电子邮件的世界》。尽管我从未见过他，但我非常钦佩他的作品。我想要简述一下他曾经比我更优雅表达过的观点：大脑不适应持续的环境切换。这意味着虽然大脑能够做到，但这会降低我们进行任何其他有意义工作的能力。
And so Cal, as I understand, is very, he's a computer science professor at Georgetown, by the way, is very structured and very disciplined in his avoidance of cell phone use. I think we're all striving to do that. I'm not here to tell you what to do, but I think whether or not you have ADHD or not, if you're an adolescent limiting your smartphone use to 60 minutes per day or less. And if you're an adult to two hours per day or less is going to be among the very best ways to maintain, just to maintain your ability to focus at whatever level you can now.
据我了解，Cal 是乔治敦大学的计算机科学教授，他在避免使用手机方面非常有条理和自律。我想我们都在努力做到这一点。我不是来告诉你该怎么做的，但我认为，不论你是否有多动症，如果你是青少年，将你的智能手机使用时间限制在每天不超过60分钟；如果你是成年人，限制在每天不超过两小时，这将是保持你当前专注能力的最佳方法之一。
And as I always say, most of the things that we get recognized for in life, success in life in every endeavor, whether or not it's school, relationships, sport, creative works of any kind are always proportional to the amount of focus that we can bring that activity. It is important to rest, of course, to get proper sleep, but I stand behind that statement. And I leave you with that study about attention and cell phones and how cell phones are indeed eroding our attentional capacities.
正如我常说的，我们在生活中被认可的大多数事情，无论是学校、感情、运动，还是任何种类的创作，其成功程度往往与我们专注于这一活动的程度成正比。当然，休息和充足的睡眠也很重要，但我依然支持这个观点。我也想提醒大家研究表明，手机确实在削弱我们的注意力能力。
So I realize I covered a lot of information about ADHD and the biology of focus and how to get better at focusing. We talked about the behavioral and psychological phenotypes of ADHD. We talked about the underlying neural circuitry. We also talked about the neurochemistry and we talked about the various prescription drug treatments that are aimed at that neurochemistry and aimed at increasing focus in children and adults with ADHD.
我意识到我们讨论了很多关于多动症（ADHD）和注意力生物学以及如何提高注意力的信息。我们谈到了多动症的行为和心理特征，也讨论了其背后的神经系统结构。此外，我们还探讨了多动症的神经化学原理，以及旨在改善这些神经化学情况的处方药物，这些药物的目标是帮助患有多动症的儿童和成人提高注意力。
We also talked about over the counter compounds, the role of particular types of diets and elimination diets. And we talked about interactions between these various features, indicating outcomes for ADHD and enhancing focus in general. We also talked a little bit about emerging neuro technologies and how certain technologies like the smartphone are no doubt hindering our ability to focus and put us at greater risk of developing ADHD at all ages.
我们还讨论了非处方药物、特定饮食类型和排除饮食的作用。我们谈到了这些不同因素之间的相互作用，并指出它们对注意力缺陷多动障碍（ADHD）的影响以及如何提高专注力。我们还简单提到了新兴的神经技术，以及像智能手机这样的技术毫无疑问地阻碍了我们的专注能力，并增加了我们在各个年龄段患上ADHD的风险。
I do acknowledge the irony and somewhat the contradiction of doing a two hour plus episode on ADHD. If indeed people who are watching this have challenges with attention. I want to emphasize that this podcast like all of our podcast episodes are time stamped for a specific reason. They are designed to be digested in whatever batch one chooses. Right. You don't have to watch or listen to the entire thing all at once.
我确实意识到，制作一个超过两个小时的关于 ADHD 的节目有点讽刺和矛盾。毕竟，观看这个节目的观众可能正面临注意力方面的挑战。我想强调的是，这个播客和我们所有的其他节目都有明确的时间标记，这样做是有原因的。它们的设计是让你可以根据自己的情况选择批次来观看或收听。对，你不需要一次性全部看完或听完。
However, if you've gotten to this point in the podcast, I want to thank you. I do hope that you've learned a lot about this condition. I hope you've also learned a lot about your own capacity to focus and things that you can do to enhance your focus. We've even talked about a tool that takes just one 17-minute session to enhance your ability to focus thereafter, presumably forever.
如果你听到播客的这一部分，我想感谢你。我希望你已经学到了很多关于这个状况的知识。我也希望你对自己专注的能力有了更多了解，并知道了可以增强专注力的方法。我们甚至讨论了一种工具，只需一个17分钟的练习，就能永久提升你的注意力。
If you're enjoying this podcast and you're learning from it, please subscribe to our YouTube channel. That really helps us. In addition, in the comment section on YouTube, you can leave a suggestions for future podcast guests and suggestions for future podcast topics that we may have not covered or that you'd like to see covered in the future.
如果你喜欢这个播客并从中学到东西，请订阅我们的YouTube频道。这对我们非常有帮助。另外，在YouTube的评论区，你可以留言建议未来的播客嘉宾或者我们尚未涉及但你希望看到的话题。
In addition, please subscribe to the podcast on Apple and Spotify. And on Apple, you have the opportunity to leave us a comment and up to a five-star review. In addition, please check out the sponsors mentioned at the beginning of the podcast. That's a terrific way to support us.
此外，请在苹果和Spotify上订阅我们的播客。在苹果播客上，您还有机会留下评论并给出最高五颗星的评分。另外，请查看在播客开头提到的赞助商。这也是支持我们的绝佳方式。
And for those of you that would like to support research on stress, neurobiology, and human performance, you can go to hubermanlab.stamford.edu. And there you can make a tax deductible donation for research on neurobiology in my laboratory. In addition, we have a Patreon. It's patreon.com slash Andrew huberman. There, you can support the podcast at any level that you like.
如果您希望支持有关压力、神经生物学和人类表现的研究，您可以访问hubermanlab.stamford.edu。在那里，您可以为我实验室的神经生物学研究捐赠，并享受税收减免。此外，我们还有一个Patreon账号：patreon.com/AndrewHuberman。在那里，您可以用您喜欢的方式支持我们的播客。
During today's episode, we talked a lot about supplement-based compounds. If you're interested in supplements and you want to see the supplements that I personally take, you can go to Thorn. That's THORN, that's THORN, and E slash the letter U slash huberman. And you can see everything that I take and you can get 20% off any of those supplements.
在今天的节目中，我们详细讨论了很多关于补充剂的化合物。如果你对补充剂感兴趣，并想了解我个人在用的补充剂，你可以访问Thorn的网站（网址是 THORN, 然后是 E 斜杠 U 斜杠 huberman）。在那里，你可以看到我所使用的所有补充剂，并享受 20% 的折扣优惠。
Or if you navigate into the Thorn site through that portal, you can get 20% off any of the supplements that Thorn makes. Supplements aren't for everybody. You by no means have to take supplements. But if you are going to take supplements, it's important that you take supplements from a source that's reputable.
或者，如果你通过该门户进入Thorn网站，你可以享受Thorn生产的任何补充剂20%的折扣。补充剂并不是每个人都需要的。完全没有必要强迫自己服用补充剂。但如果您决定要服用补充剂，确保它们来自一个可靠的来源是很重要的。
And which the ingredients are a very high quality and in which the amount of the ingredients that listed on the bottle actually matches what's in the bottle. That's why we partnered with Thorn because they have the highest levels of stringency in terms of quality and specificity of the ingredients.
这些成分的质量非常高，并且瓶子上列出的成分含量实际上与瓶子里的实际含量相符。这就是为什么我们选择与Thorn合作，因为他们在成分的质量和精确性方面拥有最高的严格标准。
And finally, I want to thank you for your time and your attention. And as always, thank you for your interest in science.
最后，我想感谢您花时间和注意力。 一如既往，感谢您对科学的兴趣。