ADHD 2.0: New Science and Essential Strategies for Thriving with Distraction
"However ubiquitous the term, one thing remains very much and frustratingly the same: Most people, even now, don’t understand the power, magnitude, and complexity of this condition. Nor do they know the tremendous advances in understanding and treatment that have been made in recent years."
estimated that 5% of the population has ADHD
"Still others—even less charitably—think ADHD is a fancy term for laziness and that people who “have it” need some good old-fashioned discipline! In fact, “laziness” is a word about as far from accurate as it could be. The mind of someone with ADHD is in fact constantly at work. Our productivity may not always show it, but this is not because of a lack of intent or energy!"
"The psychologist Russell Barkley, one of the top authorities in the field, sums up the danger in stark statistics: Compared to other killers from a public health standpoint, ADHD is bad. Smoking, for example, reduces life expectancy by 2.4 years, and if you smoke more than 20 cigarettes a day you’re down about 6.5 years. For diabetes and obesity it’s a couple of years. For elevated blood cholesterol, it’s 9 months. ADHD is worse than the top 5 killers in the U.S. combined."
ADHD takes off 13 years from your life on average.
"Yes, ADHD is a powerful force of pain and needless suffering in too many lives. But if mastered, it brings out talents you can neither teach nor buy. It is often the lifeblood of creativity and artistic talents. It is a driver of ingenuity and iterative thinking. It can be your special strength or your child’s, even a bona fide superpower. If you really understand it and make it your own, ADHD can become the springboard to success beyond what you ever imagined and can be the key that unlocks your potential. As we’ve said, we see this in our practices every day."
"We often explain ADHD to children using a very simple analogy that certainly resonates with adults, too: A person with ADHD has the power of a Ferrari engine but with bicycle-strength brakes. It’s the mismatch of engine power to braking capability that causes the problems. Strengthening one’s brakes is the name of the game."
"Having ADHD doesn’t mean you’re crazy, so admittedly “lunatic” may be too strong a word. But risk taking and irrational thinking go hand in hand with ADHD behavior. We like irrational. We’re at home in uncertainty. We’re at ease where others are anxious. We’re relaxed not knowing where we are or what direction we’re headed in. A common lament we hear from parents of teens with ADHD makes the point: “What was he thinking? He must have lost his mind!”"
"People with ADHD are lovers in the sense that they tend to have unbridled optimism. We never met a deal we didn’t like, an opportunity we didn’t want to pursue, a chance we didn’t want to take. We get carried away. We see limitless possibilities where others see just the limits. The lover has trouble holding back, and not holding back is a major part of what it means to have ADHD."
"Being a poet might best be defined with another trio of descriptors: creative, dreamy, and sometimes brooding. “Creativity,” as we use the term in connection with ADHD, designates an innate ability, desire, and irrepressible urge to plunge one’s imagination regularly and deeply into life—into a project, an idea, a piece of music, a sandcastle. Indeed, people with ADHD feel an abiding need—an omnipresent itch—to create something. It’s with us all the time, this unnamed appetite, whether we understand what it is or not; the act of creation offers the magnet’s north pole to our south and clicks us together. It captivates us, plants us in the present, and sets us transfixed within the creative act, whatever it might happen to be."
"Like all three characters—the lunatic, the lover, and the poet—we have a pronounced intolerance of boredom; boredom is our kryptonite. The second that we experience boredom—which you might think of as a lack of stimulation—we reflexively, instantaneously, automatically and without conscious thought seek stimulation. We don’t care what it is, we just have to address the mental emergency—the brain pain—that boredom sets off."
"Before you get divorced, it would be marriage-saving if someone could explain to you both that walking past the trash, like hundreds of other acts of seemingly selfish disregard for others, stems not from selfishness or another character defect but from a neurological condition that renders attention inconsistent and immediate memory so porous that a task can be forgotten in a heartbeat. What compounds these problems, and makes some people doubt the validity of the diagnosis, is that these same people can hyperfocus, deliver a brilliant presentation on time, and be super-reliable when they are stimulated."
"Strong will, stubbornness, refusal of help. It can seem stunningly stupid, but many people with ADHD, especially men, state outright, “I’d rather fail doing it my way than succeed with help.”"
"Generosity. As painful as the distortions we carry around can be, we also carry around a pocketful of miracles, a positive energy that comes and goes. But when it comes, we are the most generous people you’ll ever find, the most optimistic, the most enthusiastic. Yes, ironically, although we tend to reject help from others (see above!), we are the ones who offer the shirt off our back to the person who needs it, whether we know them or not."
"Exquisite sensitivity to criticism or rejection. William Dodson, one of the smartest clinicians ever to write about ADHD, made famous the term “rejection-sensitive dysphoria,” or RSD, which describes a tendency on the part of people who have ADHD to overreact precipitously and disastrously to even the slightest perceived put-down, dis, or vaguely negative remark."
"An itch to change the conditions of life. As you get older, this tends to manifest as a general dissatisfaction with ordinary life leading to a need to improve upon it, augment it, supercharge it, ratchet it up several notches. This “itch” can lead to major achievements and creations, or it can lead to addictions of all kinds as well as a host of other dangerous behaviors. Often it leads to both."
"Susceptibility to addictions and compulsive behaviors of all kinds. From drugs and alcohol, to gambling, shopping, spending, sex, food, exercise, and screens, we who have ADHD are five to ten times more likely than the person who does not have ADHD to develop a problem in this domain. This stems from the “itch” mentioned earlier and the need to juice up reality."
"If one parent has ADHD, the risk is one in three that a given child will have ADHD. If both parents have ADHD, the risk is two in three for a given child. However, those are just averages. In Dr. Hallowell’s family, for example, he has ADHD, his wife does not, but all three of their children have it."
"The connectome that lights up when you’re engaged in a task is called the task-positive network, or TPN. Aptly named, the TPN gets you down to work. You’re deliberately doing something and you are intent on it, unaware of much beyond the bounds of what you’re doing."
"You may become frustrated with what you’re doing and have moments of anger or dismay, but if you stay in the task, in the TPN, those moments will pass, and the TPN, buoyant connectome that it is, will carry you along. When you’re thinking with the TPN, you’re in the Angel mindset. But you can also get trapped in the TPN, doing a task from which you cannot disengage. This is the hyperfocused state that people with ADHD can fall into."
"the default mode network (DMN). The DMN allows for expansive, imaginative, and creative thinking. The back half of the DMN—called the posterior cingulate—facilitates your autobiographic memory, your personal history. This allows you to think back, draw upon, and pick apart the past. The front part, the medial prefrontal cortex, is the opposite. It enables you to look forward and to think about, imagine, and plan for the future."
"To paraphrase Gabrieli, the problem when ADHD enters in is twofold. The first is what’s called the anticorrelation property of the two networks. Imagine a seesaw. In a neurotypical brain, when the TPN is turned on and you’re on task, the DMN is turned off. But in the ADHD brain, the fMRI shows that when the TPN is turned on, the DMN is turned on as well, trying to muscle its way in and pull you into its grasp, thereby distracting you. In ADHD, therefore, the DMN competes with the TPN, which in most people it does not do."
"When the DMN rules, it demands more. This hunger can be satisfied through artistic achievement or through entrepreneurial wheeling and dealing or, maybe best of all, through love. But if and when these efforts don’t pay off—the novel you’re writing doesn’t resonate with readers, the deal falls through, the relationship ends—you have to start the search again for how you will bring ordinary life sufficiently alive to satisfy the hunger of your imagination."
"As a practical matter, this means that the minute you start to ruminate and slip into brooding negativity, look elsewhere. Do anything. Walk around. Yell. Dance a jig. Dice celery. Play the piano. Feed your dog. Sing “Row, Row, Row Your Boat” while standing on one leg. Tie your shoes. Whistle “Dixie.” Blow your nose. Jump rope. Bark like a dog, howl like a wolf, call a radio show and vent like a maniac."
"The point is: Focus on anything external to yourself. Activating the TPN will shut down the DMN. It’s difficult to do because the DMN is seductive and the negative messages it is feeding you are captivating and convincing, borne out of your past experiences, but you must not allow yourself to be drawn in, you must quickly do something active, to engage the TPN."
Movement and balance
"The paper was called Dysmetria of Thought. In it—as might be expected from this paper’s title—he suggested that dysfunction of the cerebellum could cause us to lose not only our physical balance, but also our emotional equilibrium. In other words, just as the cerebellum had long been known to act as a kind of gyroscope or balancer of gait and movement, he explained, “so does it regulate the speed, capacity, consistency, and appropriateness of cognition and emotional processes.”"
"If Schmahmann’s research proves that cerebellar injuries of all kinds can lead to the loss of control of the oscillation dampener (the brakes), it’s not a big leap to postulate that by beefing up or returning the cerebellum to top working order, you might beef up your braking power, enhancing control over thought and emotion without losing any talents or capabilities in the process."
"Based on Schmahmann’s research, and based on the findings from other MRI studies that show that the central strip down the midline of the cerebellum—called the vermis—is ever so slightly smaller in people who have ADHD than in people who do not,*1 it makes sense to think that stimulating and challenging the cerebellum/VCS, the way lifting a weight stimulates and challenges a muscle, might help reduce the negative symptoms of ADHD. Among all the regions of the brain, the cerebellum is the most plastic, the most changeable of all, able to promote the growth of existing neurons, making them look, on scans, bushier, with more interconnecting branches, like full treetops."
"Regardless of the specifics, the exercises increase in difficulty as the subject progresses through the program, which typically takes three to six months. But, no pain, no gain! And the gain is clear. These exercises, if done faithfully, do indeed work the vestibular system hard, and many report subsequent improvements in the symptoms of ADHD."
Lily and Sam
"But I had to ask myself whether I could devise a treatment plan that Lily could implement simply by following my suggestions via email. She did not have easy access to a psychiatrist, so there’d be no doctor in China involved, which meant we could not use medication. You make do with what you’ve got. We were blessed to have email, which afforded speedy communication, as well as a massively motivated, intelligent mom, not to mention, as it turned out, a massively motivated, intelligent little boy."
"Human connection and warmth. I asked Lily to hug Samuel a lot, in the morning and in the evening, and tell him how much she loved him. I stressed the importance of touch. Because he got so many reprimands at school, he needed to get lots of love at home. I also told her to ask the school to stop hitting him. If they were willing to put an end to corporal punishment, I was sure that Samuel would progress much more rapidly. My humble suggestion to the school was “Try treating him with kindness and warmth.”"
"Stand on one leg for one minute or until he falls over. Stand on one leg with eyes closed for one minute or until he falls over. Take off socks and then put on socks without sitting down. Stand on wobble board for as long as he can, up to five minutes, then do it with eyes closed. Sit on exercise ball with feet off the floor for as long as he can, up to five minutes, then do it with eyes closed. Put five playing cards on the floor. Standing on one leg, bend over and pick up one card at a time. Do a low plank hold (elbows down on the ground, feet extended behind) for up to three minutes. Learn to juggle balls, and then spend three to five minutes juggling."
"hear Lily tell it, Samuel started to improve within a matter of weeks—noticeably so. He was doing better in school—more focused, less disruptive of his classes, more successful with homework and class participation. The news of his transformation seemed to spread, she said, like juicy gossip. Parents wanted to know what was going on with Samuel. Why were his scores going up so much? They asked Lily what she was doing differently. No more yelling, no more hitting, she explained. Many were surprised that Lily’s husband was going along with this plan, but no one seemed to be arguing with the results: Samuel’s better behavior and greater happiness. Lily reported that others seemed impressed. All of this happened in a few short weeks, and it continued for months."
"Creating comfortable, positively connected environments is the most important step in helping people of all ages get the most out of life in general; the lack of connection particularly hurts people who have ADHD."
"We know all too well that you sink without enough connection, no matter how unsinkable you may think you are. Too many people don’t tap into the power of connection nearly as much as they should because they claim to be too busy for connection, or they trivialize its power. But the deeper reason that some people avoid connection is that they fear it. They fear it because they’ve connected before and been hurt in a way they never want to be hurt again."
"Make a point of having meals with your family—family dinners have been proven to work wonders, even to improve SAT scores—and have meals with other people you know. It’s wonderful to introduce children to people from out of town, even from out of the country, and make dinner a big deal where people meet to eat and greet. The more you do this, the more meals turn into events that take on meaning beyond merely a chance to refuel."
"Unless you or someone in your family is allergic, or your physical layout makes it impossible, get a pet! We are biased toward man’s best friend—dogs—because of their companionability and their obvious, freely given love for their owners. But a cat, guinea pig, parrot, hamster, ferret, turtle, fish, or even a snake provides both a focus of our love and a sense of it in return. Pets give us “the other vitamin C” as no other being can."
"Keep up with at least two good friends regularly. This is even better than going to the gym every day! One way to do this is to have a standing lunch date or a time reserved for a catch-up phone call every week. Soon you will really look forward to this regular shot in the arm of love and familiarity."
"Reserve at least a half hour of uninterrupted one-on-one time with your child every week, no agenda, doing whatever your child wants as long as it’s safe, legal, and not too expensive. Child psychiatrist Dr. Peter Metz calls this “special time,” and he says it works magic on the parent-child relationship and for a child’s sense of belonging and love."
"Clear yourself of pent-up anger and resentment—that is, practice forgiveness of others and of yourself. Do this as often as you fill up your car with gas. There is no one way to do this; you’ll have to find a way that works for you. One example: You say to yourself, He was a son of a bitch, but I am not going to waste one more second of my precious life being angry at him. Forgiveness does not mean that you condone the deed, just that you renounce the hold that anger has over you."
"Make a point of paying compliments. This may feel awkward, but how much do you love it when someone notices and comments on something good about you? Give that kindness back and you will likewise feel good!"
"Engage in some kind of spiritual practice, whether as an individual or in a group. It doesn’t have to be organized religion, just some framework for entertaining and sharing the Big Questions, Ideas, Uncertainties, Possibilities, and Hopes. Finding the right group is key, but once you do find such a connection, it will reach into, enlighten, and warm many areas of your life."
"Never worry alone. This one is key. Of course, choose with care the people you worry with. But when you worry with the right person, worry quickly turns into a chance to problem-solve and sometimes even a chance to laugh—releasing your worries—together."
"Connect with your personal vision of greatness and try to hold it in your consciousness every day as a guide and inspiration. One way to do this is to identify one living person you admire, then allow that admiration to lift you up."
"Be on the lookout for any charismatic mentor. Many studies show that charismatic mentors—not grades, study habits, where they go to school, or IQ—make the biggest difference in kids with ADHD and VAST. If they can find a teacher, coach, family friend, or anyone else who understands and inspires them, then the sky truly is the limit."
"Of course, it’s true that most people who have ADHD or VAST are really bad at quite a few things (in which their noses get rubbed all the time), but usually they are, or could be, truly exceptional at one or two other activities. Toward that end, we take a strength-based approach to treating people in our practices. As we like to say, we do not treat disabilities, we help people unwrap their gifts. More exuberantly: We help identify superpowers!"
"People with ADHD and VAST need a challenge. As we’ve said, boredom is our kryptonite. The trick, though, is not just to find a challenge—after all, digging a hole and filling it up is a challenge—but to find the right challenge. We call that the right difficult. One proactive way to pinpoint your right difficult is to develop a practical inventory of your strengths—what you are good at."
"What three or four things are you best at doing? What three or four things do you like doing the most? What three or four activities or achievements have brought you the most praise in your life? What are your three or four most cherished goals? What three or four things would you most like to get better at? What do others praise you for but you take for granted? What, if anything, is easy for you but hard for others? What do you spend a lot of time doing that you are really bad at? What could your teacher or supervisor do so that your time could be spent more productively? If you weren’t afraid of getting in trouble, what would you tell your teacher or supervisor that he or she doesn’t understand about you?"
"Most of the time these children have files full of negative comments or failures. It’s good to get positives into the record. It’s also essential that the teacher know what your child’s interests are—from dinosaurs to planets to sports to horses to videogames—so that he or she can come up with side projects to keep your child interested. This can be crucial, because a major reason kids with attention issues do poorly in school is that they feel bored, which in turn leads the teacher to believe they don’t care about schoolwork."
"As one patient—let’s call him Jon—put it: What drives me is, unfortunately, not what makes me happy. A way to explain it is that the way my brain works is such that I constantly need to be working on impossibly difficult projects. If I’m not doing that, I get bored and restless. I told my wife that if you stuck me on a beach for a week and forced me to relax, and took away my iPhone and my pen and paper, after thirty minutes I’d start writing to-do lists and business ideas using my own blood. But that is not what makes me “happy” because such work is hard and stressful. So it’s sort of a catch-22. Either I’m doing what drives me, which is intense problem solving every second I am awake, or I’m bored/anxious/don’t know what to do with myself."
"Greg: I don’t know, but it does. Doc, we had this exact same discussion when you brought up the subject of trying medication. I just want to do this on my own. I want to live my life my way, on my terms."
"Dr. Hallowell: But I want to help you see how self-defeating that approach is. Especially in today’s world. No one is independent. No one is self-sufficient. We all depend on one another. The realistic goal in life is not to be independent, but to be effectively interdependent. In other words, you have to be able to give as well as get. That’s how successful people operate. Why waste your time doing what you’re bad at? Hire someone else to do that so you can do what you’re good at."
structure and environment
"Indeed, structure is more likely something that you resist. Being free and a nonconformist is, after all, in our bones. But there is almost no more important and helpful lifestyle hack for us than engineering structure. Structure provides the walls of the bobsled run. Without it you careen off into disaster. Neglect it at your peril!"
"Let’s start with the proverbial low-hanging fruit: having a schedule and a to-do list. Creating structure with these two age-old strategies will help you plan, prioritize, be on time more often, and procrastinate less. Just the simple act of sitting down to write or type out a schedule or to-do list will help, because any and every time you itemize the tasks on your plate, you are neurologically reinforcing their importance."
"Instead, start small: Pick one or two regularly scheduled commitments or expected tasks and set up a structure to help you follow through. Experiment with what works for you until you hit on it. With every appointment kept or chore completed, you’ll get a little hit of self-satisfaction, and probably a lot of positive feedback from the people around you, too. That kind of feedback reward also reinforces your desire to get more of it and will help motivate your continued attention to that schedule and list."
"And a note of encouragement: Rewards work much better for the ADHD mind than do consequences. So whether you’re an adult working on structure for yourself or a parent maintaining it for a child, build little rewards into the systems you contrive."
"You have the most control over your home environment. Strive for your home to be a safe haven and happy place—for you and/or for your child. Key elements include: Playful attitude. Permission for everyone to be real and genuine. Enough structure, schedule, and rules to avoid confusion and chaos. Meals together daily, with whoever lives in the home; food can bring us together."
"Drink lots of water. Or tea. We also love coffee, as caffeine is the best over-the-counter focus medication that there is. Just drink it in moderation and watch for side effects: elevated heart rate, irregular heartbeat, lots of trips to the bathroom (it’s a laxative and a diuretic), insomnia, agitation, and irritability. These are all signs you’ve drunk too much coffee!"
"There are some supplements everyone can agree to recommend: a multivitamin; vitamin D; magnesium; B complex; vitamin C (ascorbic acid, as well as Connect!); calcium; zinc."
"For our purposes, the main application of cannabinoids so far appears to be in treating the anxiety that so often accompanies both ADHD and VAST. Perhaps by interacting with the gabaminergic system, CBD can relieve anxiety. Don’t be put off by the big word. GABA is just a molecule, a neurotransmitter that drugs like the benzodiazepines (Valium, Xanax, Klonopin, and others) and alcohol promote. In the right doses it can be calming."
"How much sleep is enough? The amount of sleep it takes for you to wake up without an alarm clock. That’s your physiological requirement for sleep. Try to get that much and your brain will repay you; your body will as well."
"We don’t have statistics to back this up, but our anecdotal evidence is overwhelming: People with ADHD and VAST often make the mistake of falling for train wrecks. That’s because helping and saving people in distress is highly stimulating. Our advice: Try to fall for a stable person who is also stimulating. They really do exist."
"When you exercise, the clunky connectomes in the default mode network become smoother, allowing for easier and more complete transitions into the task-positive network, where we access our frontal cortex. Remember, the frontal cortex is the CEO of the brain. When you get yourself moving, this area is “sparked,” turning your attention system on and allowing you to stay focused and on task."
"The team looked at more than seven hundred individuals from eight countries. After doing just twenty to thirty minutes of moderately paced exercise, those subjects experienced an increased reaction speed and precision of response, helping them to “switch gears” to focus with greater strength and accuracy. Additionally, 65 percent of the people significantly improved their planning and organization skills; this, after just a single episode of exercising for twenty to thirty minutes."
"But there is another now proven way to motivate yourself to stick with your exercise: Imagine or recall how good it feels after you’re finished. A recent study led by Dr. Michelle Segar at the University of Michigan showed that for adults, the best long-term (defined as more than one year) motivator for exercising was stress reduction and a feeling of well-being."
"Dr. Ratey suggested Lucy try jumping rope vigorously for five minutes before starting on her math. It clicked! Feeling less anxious, and with her brain turned on, she no longer felt as daunted by the math problems. Years later, buoyed by her success, Lucy kept at this practice in both college and nursing school. When she felt overwhelmed or frustrated with organic chemistry, physics, or an anatomy lab, she’d jump rope, which had become her “conditioned motivator.” She knew that doing so would instantly reduce her stress, make her feel better, and get her brain back on track."
"People who disparage the use of medication or slander those of us who prescribe it have probably never heard the stories of abject human suffering in people of all ages that we hear every day, either in person or from people writing to us from around the world. Nor have they heard a mother or a newly treated adult cry over the amazing benefits the medication has led to in just a matter of days, ending years of needless suffering. To deplore the use of a tool that can not only relieve suffering but actually turn it into success, health, and joy, well, that’s just plain ignorant, as well as cruel to the people whom it scares away from ever trying medication."
"Not to belabor the obvious, but this is a point most people overlook. It’s really a fundamental principle of a happy and successful life. We do better when we are involved with activities and people we want to be involved with. We do worse, far worse, when forced or coerced. Like doing the right thing for the wrong reason, even the best medication will not work as well as it could if you do not want to take it. So wait as long as it takes for you or your child not only to get comfortable but to want to take medication before you start it."