Stimulants as State Regulators

Question / Claim

Prescription stimulants improve performance by regulating arousal and reward salience rather than enhancing attention networks.

Key Assumptions

• Attention networks (DAN, VAN, FPN) are not the main drivers of real-world task performance.(medium confidence)
• Arousal and perceived reward value are prerequisite conditions for effective attention.(high confidence)
• Many ADHD symptoms reflect motivational and state-regulation deficits rather than core attentional impairment.(medium confidence)
• Subjective and behavioral improvements in attention can occur without structural changes in attention networks.(high confidence)

Evidence & Observations

• Large-scale resting-state fMRI analysis (ABCD Study, n≈11,875) shows stimulants alter somatomotor and salience/parietal memory connectivity, not attention networks.(citation)
• Precision imaging drug trial in healthy adults replicated stimulant-related connectivity changes linked to arousal.(citation)
• Stimulant-related connectivity patterns strongly resemble those associated with longer sleep duration and independent arousal biomarkers (EEG, respiration, norepinephrine transporter PET).(citation)
• Personal and clinical observations consistently report improved focus, reduced distractibility, and greater task persistence under stimulant medication.(personal)
• Behavioral improvements (reaction time, persistence, grades in ADHD or sleep-deprived children) occur despite no detectable changes in attention-network connectivity.(citation)

Open Uncertainties

• Whether long-term stimulant use can safely substitute for chronic sleep deprivation without developmental costs.
• How these findings should reshape ADHD diagnostic criteria and clinical language.
• Whether task-based fMRI under high motivational manipulation would reveal secondary attention-network effects.

Current Position