ADHD 2.0 : New Science and Essential Strategies for Thriving with Distraction—From Childhood Through Adulthood

by Edward M. Hallowell

We also know that ADHD can crop up for the first time in adulthood. This often happens when the demands of life exceed the person’s ability to deal with them. Classic examples are when a woman has her first baby or when a student starts medical school. In both instances the organizational demands of daily life skyrocket and the person shows the symptoms of ADHD that he or she had been able to compensate for in the past. It is then that ADHD can and should be diagnosed.

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!

ADHD can be a scourge, an unremitting, lifelong ordeal, the reason a brilliant person never finds success but rather limps through life in frustration, shame, and failure, amid catcalls to try harder, get with the program, grow up, or in some other way reform. It can lead to suicide, addictions of all kinds, felonious acts (the prisons are full of people with undiagnosed ADHD), dangerously violent behavior, and a shorter life.

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. Having ADHD costs a person nearly thirteen years of life, on average. Barkley adds, And that’s on top of all the findings of a greater risk for accidental injury and suicide….About two-thirds of people with ADHD have a life expectancy reduced by up to 21 years.

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.

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.

If you know who you are, it becomes easier to like who you are.

We are the kid who gets daily lectures on how we’re squandering our talent, wasting the golden opportunity that our innate ability gives us to do well, and failing to make good use of all that our parents have provided. We are also sometimes the talented executive who keeps falling short due to missed deadlines, forgotten obligations, social faux pas, and blown opportunities. Too often we are the addicts, the misfits, the unemployed, and the criminals who are just one diagnosis and treatment plan away from turning it all around.

We are also imaginative and dynamic teachers, preachers, circus clowns, and stand-up comics, Navy SEALs or Army Rangers, inventors, tinkerers, and trend setters. Among us there are self-made millionaires and billionaires; Pulitzer and Nobel prize winners; Academy, Tony, Emmy, and Grammy award winners; topflight trial attorneys, brain surgeons, traders on the commodities exchange, and investment bankers. And we are often entrepreneurs. We are entrepreneurs ourselves, and the great majority of the adult patients we see for ADHD are or aspire to be entrepreneurs too. The owner and operator of an entrepreneurial support company called Strategic Coach, a man named Dan Sullivan (who also has ADHD!), estimates that at least 50 percent of his clients have ADHD as well.

“ADHD” is a term that describes a way of being in the world. It is neither entirely a disorder nor entirely an asset. It is an array of traits specific to a unique kind of mind. It can become a distinct advantage or an abiding curse, depending on how a person manages it.

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.

Being a poet might best be defined with another trio of descriptors: creative, dreamy, and sometimes brooding.

We’ve got an overabundance of attention, more attention than we can cope with; our constant challenge is to control it.

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. Like mental EMTs, we swing into action. We might pick a fight to create a bit of stimulation; we might go shopping online with manic abandon; we might rob a bank; we might snort cocaine—or we might invent the best widget the world has ever seen or come up with the solution to what’s keeping our business from taking off.

it helps to think of ADHD as a complex set of contradictory or paradoxical tendencies: a lack of focus combined with an ability to superfocus; a lack of direction combined with highly directed entrepreneurialism; a tendency to procrastinate combined with a knack for getting a week’s worth of work done in two hours; impulsive, wrongheaded decision making combined with inventive, out-of-the-blue problem solving; interpersonal cluelessness combined with uncanny intuition and empathy; the list goes on.

Unexplained underachievement. The person is simply not doing as well as innate talent and brainpower warrant. There’s no obvious explanation, like poor eyesight, serious physical illness, or cognitive impairment due to head injury, say.

High degree of creativity and imagination. People with ADHD—at any age—often possess intellectual effervescence. Unfortunately, this natural sparkle can be snuffed out by years of criticism, reprimands, redirection, lack of appreciation, and repeated disappointments, frustrations, and outright failures.

Our truncated sense of time leads to all manner of fights, failures, job losses, disappointed friends, and failed romances, but at the same time to an uncanny ability to work brilliantly under extreme pressure, as well as to be wonderfully, infuriatingly oblivious to the time pressures that stress most people to the max.

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. It’s why so many of us excel in sales. We can be charismatic, infectiously funny, persuasive, and just what you need if you’re feeling low.

it is really just the undiagnosed and untreated ADHD that is causing the problems. This is why we call ADHD such a “good news” diagnosis: Once you know you have it, and you find the right help, life can only get better, often much better.

“recognition-sensitive euphoria,” or RSE, which refers to our enhanced ability to make constructive use of praise, affirmation, and encouragement. As much as we can get down in the dumps over a minute criticism, we can fly high and put to great use even small bits of encouragement or recognition.

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.

Uncannily accurate intuition, coupled with a tendency to overlook the obvious and ignore major data.

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. The upside of this symptom is that if you find the right creative outlet—start a business, write a book, build a house, plant a garden—you can scratch the itch that way, rather than develop a bad habit or an outright addiction.

the internal, inborn weather vane leads the person with ADHD to be the first to sense a shift in mood or energy in the group, the class, the family, the organization, the town, the country. Before others catch on, the person with ADHD is telling others to watch out, there’s an ill wind brewing; or to get ready, a big opportunity is just around the corner. Like the lightning rod, the weather vane effect can’t be explained on any scientific basis we know of, but we see it in our patients, of all ages, all the time.

Distorted negative self-image. Due to the inability to observe oneself accurately, coupled with the heightened sensitivity to perceived criticism and a record of underachievement, people with ADHD usually have a self-image that is far more negative than is warranted.

We’re starting to understand the genetics behind brain function, as well as the epigenetics, the varying impact of environment upon the expression of genes. For example, it is because of epigenetics that you may have been born with genes that predispose you to depression, but because of loving parents and a nurturing school system, those genes never get expressed.

Thanks to the work of many neuroscientists, we know that what you do, who you love, where you live, what you eat, how much you move, what kind of stress you experience, if you have a pet, whether you laugh a lot—all those and a zillion more bits of experience constantly change who you are in subtle ways. Your brain responds to all these cues in turn.

We can change who we are and where we’re headed. It’s not easy, but it can be done, and done at any age. You’re never too old to find a new life, a new love, a better day. Our brains present us with the opportunity day in and day out. We just have to unwrap the gift.

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. In this state, you don’t consciously know whether you’re happy or not, which is just as good as being happy, if not better, because you’re not wasting any energy in self-assessment. 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.

When you allow your mind to wander from a task, or when you finish the task, or if you pause too long in anger or dismay while doing the task, the TPN in your brain defaults to a different connectome. Not surprisingly—given that we default to this state—this other connectome is called 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. It is in the DMN mode that you can daydream (and miss your exit on the highway) or make interesting connections between concepts (helpful when appreciating riddles or jokes or solving crossword puzzles, or coming up with the Next Big Thing).

But as helpful as the DMN can be (angelic in its own right), it is also a Demon (as its initialism suggests!) for the ADHD or VAST brain because of our capacity for intractable rumination while captive in it.

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.

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. Do a crossword. Work your brain. Read a book. Hell, why not write a book? Sure, dig a hole or fry a few eggs. Or try an exercise that zeroes in on your breathing. Pick a pattern to focus on, for example, 6-3-8-3. Inhale for six beats, hold for three, exhale for eight beats, hold for three; repeat. After a few cycles, you will move out of the DMN. The point is: Focus on anything external to yourself. Activating the TPN will shut down the DMN.

you must not allow yourself to be drawn in, you must quickly do something active, to engage the TPN.

Meditation, exercise, and human connection can also reduce the power of the glitchy switches.

Don’t feed the Demon. Shut off its oxygen by denying it your attention. Do something else that engages your mind. Stay in action!

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. Basically, it’s been shown that you can take your cerebellum to the cerebellar gym and beef it up.

An obvious way to improve vestibular health and possibly increase cerebellar strength is to work on one’s balance. And, in fact, the idea that using balancing exercises can help ADHD (and dyslexia) has been in the air for decades.

Samuel should do the balancing exercises listed below for thirty minutes every day, in any order he wanted. I assured her that he could change them around for variety. If you can, I said, get a wobble board, a board with a rounded bottom so that it’s hard to balance on. Also get an inflatable exercise ball that’s big enough for him to sit on so his legs can’t touch the floor. 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.

Dr. Vivek Murthy, the nineteenth Surgeon General of the United States and author of the book Together: The Healing Power of Connection in a Sometimes Lonely World, named another adverse condition—loneliness—the number one medical problem in the country. In a Harvard Business Review essay, he said: During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness. Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking fifteen cigarettes a day and even greater than that associated with obesity. Loneliness is also associated with a greater risk of cardiovascular disease, dementia, depression, and anxiety. At work, loneliness reduces task performance, limits creativity, and impairs other aspects of executive function such as reasoning and decision making. For our health and our work, it is imperative that we address the loneliness epidemic quickly.

The single most important factor in predicting health, longevity, occupational success, income, leadership ability, and general happiness comes down to one four-letter word. “It’s love,” Vaillant famously stated. “Full stop.”

in order for love to work its most sustaining magic, the individual who is loved must be able to receive the love, to metabolize it, to use Vaillant’s word. Even if you had a loveless childhood and feel empty at age twenty-five, by age seventy-five you can feel fulfilled and content if you’ve learned how to take love in rather than push it away.

We humans ignore connection until we nearly perish due to its absence. We are living in a massive Vitamin Connect deficiency.

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.

get into the habit of giving hellos and nods to people you don’t know. This kind of passing acknowledgment gives a quick dose of Vitamin Connect, and it prods you out of the habit of anonymity most of us slip into.

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.

Join some kind of group that holds meetings—a book club, a lecture series, a knitting circle. Then attend those meetings! The MacArthur Foundation Study on Aging showed this to be one of the two factors most associated with long life (the other is frequency of visits with friends).

Take a daily inventory of gratitude. This sounds corny, but it feels really good. Whether you make a written list or just take the time to go over what you’re grateful for in your mind, you come away feeling lighter and more optimistic.

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!