ADHD seems to manifest internally as an inability to go from 'wanting to want something' to 'wanting' it. Decisions don't turn into impulses to act, but non since deliberate drives generate their own impulses, behavior becomes hedonically opportunistic.
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The inability to act on one's decisions leads to a frustration of anticipated reward, until no more reward is anticipated and the individual becomes depressed. The depression (and underlying ADHD problem) may not manifest in an environment where decisions are hedonically driven.
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Methylphenidate binds to the noradrenalin receptor which has been hypothesized to increase the gain (think logistic regression) of neurons, making neural representations more binary and hence better separable.
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