Understanding Brain Fog in Adults with ADHD

Health Writer
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Brain fog - you know, that feeling that you have cobwebs in your brain; where it is hard to think clearly. You feel like you are walking around in a fog and it takes you a while to process what is going on around you. You might find it difficult to concentrate, but not because you are distracted - it is more because your thoughts simply won’t come together. You might feel like you are moving inside a dream. When you are forced to concentrate, you find it exhausting. Some people describe it simply as a “fuzzy” brain.

If this description sounds a bit like how you feel, Russell Barkley and other researcher have a name for it - Concentration Deficit Disorder (CDD). In the past it has also been referred to as Sluggish Cognitive Tempo (SCT) but Barkley feels this term is derogatory and offensive and prefers the term CDD. He sees this as a “second attention disorder that is distinct from yet overlaps with ADHD.”

Although there is no official diagnosis of CDD, researchers have attributed the following symptoms to it:

  • Excessive daydreaming
  • Trouble staying alert or awake in boring situations
  • Easily confused
  • Stares a lot
  • Spacey, feeling like “in a fog” or mind continually wandering
  • Lethargic, more tired than others
  • Underactive (hypoactive)
  • Slow moving or sluggish
  • Doesn’t process questions or explanations accurately or as quickly as others
  • Apathetic or withdrawn
  • Lost in thoughts
  • Slow to complete tasks
  • Lacks initiative or effort fades

In the past, this type of diagnosis was often given to people who have trouble focusing or paying attention but did not exhibit any hyperactivity or impulsivity. Many would be considered hypoactive. While it sounds similar to Inattentive type ADHD, Barkley believes there are some differences but while there is so overlap (daydreaming, lost in thoughts, slow to complete tasks, lack of initiative), he believes this is a separate attention disorder - related yet distinct. As with ADHD, however, the symptoms do not correlate with a lower cognitive function or intelligence. Because it is distinct from ADHD, however, it is possible to have both ADHD and CDD, for example, Barkley indicates that 54 percent of those diagnosed with ADHD, Predominantly Inattentive Type, also have CDD. .

Because there is no official diagnosis, there is no official diagnostic criteria for CDD. Barkley suggests that if a child exhibits 3 of the 12 symptoms listed, with a degree of impairment from the symptoms, then this might be cause for diagnosis. For adults, this would be 5 of 9 symptoms.

Unfortunately, the lack of research into CDD means there isn’t much available information on what treatments work best, especially in adults.

The research has shown that stimulant medications do not seem to a significant improvement in symptoms in children with CDD.

It is not known if cognitive behavioral therapy (CBT) will work - it does not have much success with ADHD but since this is distinct from ADHD it might help. However, people with CDD are more likely to have anxiety and/or depression and CBT works well to combat these disorders so could be very helpful for adults with CDD.

Other medications that might help include: atomoxetine (an ADHD medication but works to help reduce anxiety), modafinil (if CDD is a disorder of arousal) or clomipramine or fluvoxamine (if CDD is related to OCD).

If there isn’t any diagnosis or preferred treatment, what are you supposed to do when you are drowning in your mental fog? The following are suggestions from different forums and blogs:

The blog Working with ADHD suggests:

  • Taking a brisk walk, going to the gym or running up and down the steps several times. Make sure you exercise every day.
  • Get a good night’s sleep
  • Drink a glass of water
  • Have a cup of coffee

One of the members of Working with ADHD, Marcia offers what works for her: stand up, shake your arms and “give yourself marching orders.” Say aloud what you need to do, essentially ordering yourself to get it accomplished. Set a time limit, such as, “I will work on this for 30 minutes.” Set a timer and force yourself to do it.

On Reddit, some forum members have suggested:

  • Take 15 minutes to engage in something mentally stimulating that you enjoy.
  • Monitor your sleep habits. Not getting enough sleep can make your brain fog increase but sleeping too much can do the same thing. Try to sleep seven to eight hours a day (or whatever amount you found works best for you), the trick is to be consistent
  • Change your environment. Sometimes a simple relocation will help (that means get off the couch or out of bed) and try completing whatever task in a new environment.
  • Have something to eat. Preferably something healthy but several members did indicate chocolate was a favorite.
  • Write. Keep a diary of what you are thinking when you are in a brain fog. It will help organize your thoughts and force your brain to start working.

For more information:

8 Signs of Inattention in Adults with ADHD

ADHD at Work

Adult ADHD and Disorganization: My Messy House

Strategies for Managing Adult ADHD

Adults with ADHD