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A rant about useless advice like "Just focus harder!" and how to actually be helpful instead

Originally posted in response to "how to train dogs while having ADHD", thought it might be of interest here too.

In a very simplified manner, typical animal brain pathways work like this:

(predictor of reinforcement) stimulus dopamine spike, resulting in activation/motivation of movement reinforcement

The primary reinforcer triggers a dopamine burst depending on expected size of reinforcement, which affects how much the stimulus is predicted to be worth causing a dopamine spike next time. A lack of dopamine spike from a stimulus instead inhibits movement, since that would lead to a non-reinforced action.

Dopamine is also triggered in other types of neurons by aversive events, and by alerting signals that the organism needs to pay attention to to figure out whether it's something good or bad that then requires being acted on.

In all of these cases, although dopamine is involved in the actual end result of obtaining the reinforcer, its more global role is earlier in the seeking/motivational systems which help to organise the brain's activity towards or away from specific cues that it determines.

One of the key components in ADHD is issues with insufficient dopamine - either not enough of it is released, or it is re-uptaken by the releasing neurons too quickly, or the receptors are less sensitive to it, etc. This does not mean that people with ADHD just find things less rewarding, because the timing of pauses within the dopamine reward burst are also important in characterising it as a reinforcement response. What it instead means is that there is a general flattening of background dopamine in the earlier motivational aspects of the neurons related to the individual spikes:

(predictor of reinforcement) stimulus insufficient dopamine spike -> brain continues in "seeking system" mode, searching for a stimulus that will provide a stronger spike worth responding to

environmental cues that should be focused on to engage with are often not sufficiently stimulating to an ADHD brain to do so, reulting in the brain continuing to search the environment for more stimuli to latch onto - this is seen externally as lack of focus, but also things like working memory issues, problems in processing speech (particularly in distracting environments with lots of competing stimuli)
"hyperfocus" is nothing more than finally finding something sufficiently dopamine-motivating to engage with, and environmental stimuli that should also result in a new dopamine spike large enough to shift that attention away failing to do so
just because you know you want to do something or that it's going to have a good result doesn't mean you've got enough of a dopamine spike to trigger you into action, compared to a non-ADHD person who thinks of wanting to do something and then somehow miraculously spontaneously does it at will
short-term reinforcement boosts motivational dopamine spikes more than temporally distant reinforcement. ADHD people have a moderate tendency to favour small immediate rewards over large delayed rewards.
this is why it's much easier for ADHD people to get unhelpfully stuck into video games, or doing fun "easier" tasks like brainstorming ideas than actually implementing them - the former has a much higher reinforcement history relative to aversive history compared to the tasks we know we "should" be doing and have previously failed at like daily chores, so we're more likely to get a sufficient dopamine spike to repeat them again in future
adrenaline increases brain arousal, which is why it can suddenly feel easier for an ADHD person to finally get started on a task the night before when the external deadline is looming, and why a self-imposed prior deadline to allocate extra time doesn't trigger the adrenaline required to start as much - you know you can move your own deadline which is the much easier response to the stimulus to choose
ADHD people often report being successful as paramedics or emergency room healthcare staff - while for most people increased stress tips them into over-arousal and impedes function, for ADHD the stress is more likely to bring you to the optimum point of the inverted-U function curve where you can continually activate motion
unmedicated ADHD people are more likely to engage in risk-seeking behaviour, and to succumb to addictions or binge-eating disorders - activities which are more likely to satisfy the seeking systems in the brain, where for non-ADHD people more of that need is naturally sufficiently met by less risky daily activities
lack of reinforcement still impedes activity just as much or more; avoidance of in-the-moment situational aversives is not inhibited, but distant far-off aversives such as failure to meet future deadlines does not have as much of an impact on promoting avoidance behaviour now as it should

All of this is to say that statements like "make a schedule and stick to it" or "just focus" are based on a fundamental misunderstanding of both how ADHD works and how to be a good animal trainer, in this case for the human animal learner. Prior to diagnosis, even if picked up on as children, it is almost guaranteed that the person will already have learned experiences of failing to activate for regular daily tasks, such as paying attention to instructions, remembering instructions long enough to do them or prior to a competing stimulus taking over, taking action on reminders, selecting the appropriate one out of a variety of competing stimuli and so on. There is a persistent lack of reinforcement for the correct behaviours, because the correct behaviours are not occurring - instead there is regular accidental practising of incorrect behaviours, together with external aversives (Why did you forget your hat at school? You still haven't tied your shoes, now we're late for the bus! How did you not realise you needed this signed until the day after it was due?). This is where classical conditioning comes in - the aversives are applied both externally, and also then internally in the form of guilt and self-judgement at being unable to take the correct action, and this conditions the entire situation around organisation, planning, and doing the thing that you know you "should" be doing to be aversive in and of itself. Thinking that you should do something, or being told you should do something that you know you have previously failed at like "make a schedule" is inherently aversive and generates an avoidance response to the situation itself, and makes it less likely that the ADHD person will have an activating dopamine spike (this is the root cause of most procrastination). This is why, although medication helps greatly with getting functional expected levels of dopamine in place in response to stimuli, you still often need to do additional work to unlearn your prior aversive experiences that are also inhibiting your ability to take action by replacing them with very positively reinforcing ones.

You shouldn't set up a dog for failure in training, and you shouldn't set up an ADHD person for failure either. Everything needs to be re-imagined and reframed to become as close to error-free learning as possible. This is why schemes like "Unfuck Your Habitat" tend to be easier to maintain, because they are correctly structured. Instead of presupposing an entire nebulous regime or change in habits that needs to be implemented in its entirety and then stuck to, which is more likely to fail and then generate internal guilt about the situation, it's better to present individual components that are so small that they are minimally aversive to consider, frame them as optional suggestions to look forward to rather than a chore/habit that must be done, and to challenge yourself to do just one, give yourself positive reinforcement, and then to do just another one if you're up for it (and you probably will be when it's sliced down that small!). This is a version of the problem of lumping when shaping behaviours, and instead the good trainer learns how to split/slice them down and to reinforce at every step to progressively build them up into something bigger. Keep self-training sessions short, and repeat in the moment only once you have self-monitored that you are still motivated and eager to keep going, just like you would continuously monitor a dog's behaviour to see if they're still motivated to continue a shaping session or if you need to give them a break before they get tired/frustrated and behaviour starts breaking down. Assistance needs to be given to the ADHD person to restructure their environment to make sure tools required for a task are at hand and the right decision is easy in the moment, rather than asking them to muster up sufficient motivation to figure out everything about the situation themselves in advance and also then do the required task in one go. Yes, this is what good quality targeted therapy/ADHD coaching is for, to teach us to rewire our own brains by training ourselves using the most efficient error-free force-free learning methods until it becomes second-hand - by contrast simplistic statements like "you just need to focus" drags you out of that beneficial improvement mindset and back into the mire of "well why CAN'T I just focus, what is wrong with me" which is what needed to be unlearned in the first place.