ADHD 2.0 : New Science and Essential Strategies for Thriving with Distraction—From Childhood Through Adulthoodby Edward M. Hallowell, John J. Ratey
A step-by-step guide that provides new science and essential strategies to help you, or someone you care about, fully understand ADHD. The focus is on recognizing your strengths, knowing who you are, and loving that so you can better your life. Following the approach that knowledge is power, you can learn to manage the uniquely powerful asset and gift that is ADHD.
A Spectrum of Traits
“Who are we, the people who have ADHD?”
Many people do not fully understand the complexity, power, and magnitude of ADHD or the advances in understanding and treatments. The misconceptions that ADHD is just a child’s condition, a drug company fabrication, laziness, or a rare condition are extremely damaging.
While the condition does bring pain and suffering to many, it also brings out unique talents such as creativity, artistic flair, ingenuity, and iterative thinking. Therefore, ADHD is not entirely a disorder or an asset. It is an array of traits specific to a unique kind of mind. If managed with understanding, ADHD can be a one-of-a-kind gift and asset.
There are several universal qualities that people with ADHD tend to share: distractibility, impulsivity, and hyperactivity are the classic descriptors. This can be extended to include risk-taking behavior, irrational thinking, extreme optimism, intolerance of boredom, creativity, and brooding nature.
Many of these tendencies can contradict each other: a lack of focus combined with the ability to super-focus, lack of direction combined with an entrepreneurial approach, and a tendency to procrastinate blended with the ability to complete a week’s work in two hours!
Here are the main tell-tale signs of ADHD:
Trouble organizing and planning
High creativity and imagination
Poor time management and procrastination
Strong-willed and stubborn
Restlessness or daydreaming often
A unique and active sense of humor
Trouble sharing despite a desire to make friends
High sensitivity to criticism or rejection
Impulsiveness and impatience
A desire for life changes
Addictions and compulsive behaviors
Metaphorical lightning rod and weather-vane – Lightning rod for whatever can go wrong, but this can lead the person with ADHD to receive ideas, energies, and premonitions that lead to success. Internal weather-vane gives the ability to sense a shift in mood or energy, which is useful in identifying risks and opportunities.
Tendency to externalize or blame others
- Negative self-image
A similar condition to ADHD is known as VAST: The Variable Attention Stimulus Trait. This refers to ADHD-like symptoms caused by the conditions of modern life. Technology and the Internet force our brains to process much more data than ever in human history. Our brains are essentially no different though, so to deal with this information overload and faster pace, we have developed new (often antisocial) habits to cope.
Whether you have ADHD or the environmentally induced VAST, you need to detoxify the label and focus on the positives.
Actions to take
Understanding the Demon of the Mind
“Regardless of the trait, condition, disorder, or disease, nature versus nurture always comes down to both”
Advances in brain science have enabled a better understanding of brain function and its nervous system. This enables an appreciation of the genetics behind brain function and epigenetics (the impact of the environment upon the expression of genes).
For example, you may have genes that predispose you to depression, but as you had loving parents and a nurturing school environment, these genes never surfaced. If you had unloving parents, zero nurturing, and suffered trauma or abuse, then these genes are far more likely to be expressed. Nature and nurture are, therefore, both components of any traits, conditions, disorders, or diseases you may experience.
One of the major discoveries in neuroscience in the past generation is neuroplasticity: the brain’s ability to change over the course of a lifetime. Teaching an old dog new tricks is not an impossibility! What you do, who you love, where you live, what you eat, your pets, if you laugh a lot, among a million other experiences, changes who you are.
These advances in science help us understand the tension and contradiction that lie at the core of ADHD and VAST. It explains what is happening in our brains that leads to creativity, entrepreneurialism, and dynamism, as well as irrational brooding, worrying, ruminating, and self-destructive behaviors. If you understand the science, you can circumvent the negatives and make the best use of the positives - your talents.
When you are engaged in a task, various groups of neurons combine to light up your brain: this is known as the task-positive network (TPN). The TPN gets you going, immersed, and focused on a task. You do not wonder whether you are happy or not, you may get frustrated, but you can get over this and stay on track. This is known as the‘Angel’ mindset. Conversely, you can get trapped in the TPN with the inability to disengage, and this hyper-focused state is one that people with ADHD can fall into.
If your mind wanders from the task or you experience anger or dismay while completing and after finishing the task, then the brain goes into the default mode network (DMN). The DMN facilitates expansive, imaginative, and creative thinking. The back half of the DMN enables you to draw on previous experiences, and the front part allows you to look toward the future and new approaches. In DMN mode, you may daydream and make interesting connections.
When you get caught in the DMN and lost in the moment, this can seriously affect your schoolwork, job, relationships, and wellbeing. If you have ADHD or VAST, this can result in a battle in terms of getting stuck in one area of the brain and being two steps behind other people. You could also experience pirouette syndrome (circling back to check something constantly) or catastrophic (extremely negative) thinking.
The DMN and TPN are the yin and yang of the brain. Both help and hold us back, and one isn’t any better than the other. However, in the ADHD or VAST brain, the DMN can be considered a bit of a ‘Demon’ because of the capacity for intractable rumination. Highly imaginative, creative people, including those with ADHD or VAST, can get stuck in the DMN and develop extremely negative, gloomy, and self-critical thoughts. They have stored a memory bank of their worst moments and are prone to negativity.
In a neurotypical brain, when the TPN is turned on, and you are on task, the DMN is turned off. In the ADHD brain, studies show that the TPN and DMN are competing, and it is difficult to switch between them. There is no synchrony between the front and back regions of the DMN either.
This is reflected when your creative side starts to develop something beautiful, then your depressive side determines it is ugly. Many of the greatest scientists, inventors, and performers have struggled with these ‘glitchy’ connections: creating great works, then languishing in despair and often seeking relief in self-destructive behaviors.
Now you understand more about ‘glitchy’ connections and faulty switches in the ADHD brain, you can start to recognize when you or your loved one is stuck and which part of the brain is taking hold. In this way, you can outsmart the ‘Demon’ via distraction and spend more time in the TPN, where you are focused on your task.
Actions to take
The Cerebellum Connection
“Our understanding of the cerebellum took a revolutionary step forward, with big (though unexpected) implications for ADHD”
Another important brain-related development, with huge implications for people with ADHD or VAST symptoms, is our understanding of the area in the brain called the cerebellum. Located at the base and back of your brain, these two small lobes operate like a gyroscope to coordinate your balance and physical movements. These components are commonly referred to as the vestibulocerebellar system, or more simply, VCS.
Consider riding a bike. You probably had trouble finding your balance and coordinating your muscle movements the first time you tried. Gradually, you made minor corrections to maintain balance, and soon you were cycling away. Your VCS was connecting with your motor neurons, which then becomes an automatic, ingrained process that you will never forget.
Of course, there are cases of malfunctions in the cerebellum. If your spatial judgment is impaired, you are demonstrating dysmetria (literally meaning ‘wrong length’) which is usually caused by an injury (stroke, brain injury, infection, etc.). Other physical symptoms of cerebellar dysfunction can include poor balance, staggering or impaired gait.
Research studies completed by Prof. Jeremy Schmahmann identified that a dysfunction of the cerebellum could also affect our emotional equilibrium. While the cerebellum can regulate your balance, gait, and movement, it can also regulate speed, capacity, consistency, and appropriateness of cognition and emotional processes. These findings were subsequently identified as a neurological syndrome called Cerebellar Cognitive Affective Syndrome (CCAS).
The symptoms of CCAS include problems with executive function, linguistic processing, spatial cognition, and affective (emotional) regulation. Extremely similar cognitive issues to ADHD! The central challenge of ADHD is gaining better control over the metaphorical Ferrari brain (improving the brakes!) in terms of both speed and emotion.
If research shows that cerebellar injuries can lead to a loss of control in your thinking, feeling, and behavior, it is not a big leap to think that if you strengthen the cerebellum, you will enhance control over your thoughts and emotions, while not losing your talents.
One way to improve your vestibular health and increase cerebellar strength is by working on your balance. Balancing and coordination exercises that stimulate the cerebellum and vestibular system have been around for some time in the treatment of ADHD and many people report vast improvement in their symptoms. Your exercises should increase in difficulty, work the vestibular system hard and form part of a wider ADHD treatment plan.
Actions to take
The Healing Power of Connection
“But there is an equally clear antidote. Connection, positive connection, which at its most distilled is called love, has incredible healing power.”
A landmark study at the Kaiser Pemanente HMO asked 17K subjects ten probing questions about incidents of emotional or physical trauma or abuse (as witness or victim), exposure to drug or alcohol use, and familial mental health. Two-thirds reported one experience on what became the Adverse Childhood Experience Scale (ACEs), still used as a standard screening tool in many medical practices.
ACEs scores run higher in families with ADHD, but the antidote for this is positive connection or love.
Creating comfortable, positively connected environments is important for people of all ages, particularly those who have ADHD. Many children in the classroom with ADHD and adults in the adult world with ADHD feel dislocated due to the loss of psychosocial integration. This lack of connection simply because they are different, leads people with ADHD to feel misunderstood, alienated, left out, and on the outside looking in.
What we need is an increase in psychosocial integration so this warm and wonderful force becomes the lifeblood of all families, schools, and organizations. You should tap into the power of connection as much as possible as it is a powerful tool for overcoming the major learning disability of fear. Creating a connected life is key to pretty much everything good in life, and, for the most part, it is free.
Actions to take
Find Your Right Difficult
“Once we find an outlet for our creativity that is a Goldilocks kind of just right, once we find a project to sink our teeth into, then presto! we light up like a Christmas tree.”
Most people with ADHD or VAST are naturally creative people with a drive to build, develop or create something different. If you don’t have a creative outlet, you can quickly become unmotivated and depressed. Equally, if you put all their energy toward something beneath your creative abilities, you will lose interest very quickly. However, if you can find a channel for your creativity that fits just right, the stars align!
ADHD and VAST are unique in behavioral science in terms of their matched opposite characteristics (an upside and a perceived downside). Not recognizing this uniqueness is the key reason that strengths associated with ADHD/VAST are ignored, with doctors focusing more on pathology and problem behaviors.
People with ADHD or VAST may be bad at some things, but they can be exceptionally good at one or two other activities. You should focus on unwrapping your gifts and identifying your superpowers. It may take some trial and error, or it may happen like a lightning strike out of the blue, but with concerted effort, you will find your unique superpower.
Assessing strengths is a key way to finding the right challenge. Focusing on talents, goals, achievements, challenges, and how people could support you better is vital information you can use to create better learning or working environment.
A challenge to this process is that people with ADHD tend to like problems and need the difficult as easy is boring! However, this tendency to never give up can be a self-defeating narrative if the challenge does not make you productive, happy, or improve your life.
To compound this problem, people with ADHD or VAST tendencies usually reject help. The upside is nonconformity and an aversion to hypocrisy, but the downside can be very counterproductive. Rejecting help and taking the approach that you would rather fail than accept help can negatively impact your education, career, health, and relationships. You can spend years pursuing the impossible, so finding the ‘right difficult’ is so important!
Actions to take
Create Stellar Environments
“What constitutes the best environment, or what we call a stellar environment, for a person who has attention issues? How much difference does creating such an environment make?”
Environment matters a great deal. Research shows that our environment (including diet, exposure to toxins, stress, and other factors) changes how our genes are expressed. How you live determines whether you get a disease that you are genetically predisposed to, so your environment is a powerful tonic.
Most adults never discover they have ADHD until their environment changes dramatically. Life-changing events, such as becoming a parent or starting university, drastically change your environment. Eventually, productivity and equanimity return, but sometimes this can also highlight underlying ADHD.
There are elements in your environment that you cannot control, but there are things you can absolutely control, including attention issues, connection, exercise, and stress reduction. Further, there are five other areas to focus on:
Daily Structure – Structure is one of the best and most important ways to establish a stellar environment. Develop a schedule and to-do list that works for you. If you are a parent of a child with ADHD or VAST tendencies, once you have developed a great structure and routine, help them keep them on track. Ensure you include unstructured and uninhibited play, reward tasks, and control screen times (try to delay access to electronic devices as much as possible).
Nutrition – How you fuel your body really matters. For the ADHD brain, the best option is to stick to whole foods (whole grain, fresh foods), fruits, vegetables, healthy oils, fats, and good protein (unprocessed meats, fish, nuts, and eggs). Drink lots of water and tea, and have coffee in moderation.
Avoid sugar (including fruit juice), and processed and junk foods! Some people find that eliminating dairy or gluten helps, so it is worth trying. Vitamin and mineral supplements are valuable too, particularly vitamin B complex, C and D, magnesium, calcium, and zinc.
Sleep – Stimulation seekers who have ADHD or VAST can be resistant to going to bed at a decent time. Your brain will not function well if you do not get enough sleep. How much sleep is enough? The amount it takes to wake up without an alarm clock is your physiological requirement for sleep. Sleep apnea is a disorder that can cause a syndrome that looks like ADHD. You can get this checked out at a sleep lab in most hospitals.
Positivity – Populate your world with positivity. While you can’t control other people’s actions or outlooks, you can control who you allow into your world and spend time with. If you have a child with ADHD, this means choosing the right school and/or advocating for them at school. For an adult, this may mean seeking a new job if your current role doesn’t surround you with positive understanding. This extends to your friends and partner in terms of choosing to spend your time with positive people.
Accept and Find the Right Help – Never worry alone. If demands exceed your ability to meet them, your need to get help in the right places from the right people. Most people understand that asking for help is not a sign of weakness, but the social limitations of ADHD/VAST can be painful and disabling.
A key tool to overcome these limitations is social coaching. This teaches you how to read a social scene and understand your behavior rather than just try to change it. You’ll gain an understanding of what is happening in a social situation and learn accordingly. In the long term, this teaches you how to handle social interactions and enjoy them.
Actions to take
Move to Focus, Move to Motivate: The Power of Exercise
“Have a big paper due or presentation to give? Need to study for an important test? Here’s a pro tip: Take a run around the block, go up and down the stairs in your house, just do something to get yourself moving.”
Exercise is one of the most powerful, non-medical tools available. Apart from the obvious health benefits, it improves mood and motivation, reduces anxiety, regulates emotions, and maintains focus. The benefits of getting your heart rate up are many, and one of the most important is the release of a protein called ‘brain-derived neurotrophic factor.’
This protein creates a fertile environment for growth, and more exercise leads to an increase in nerve cells being used. This, in turn, boosts dopamine and norepinephrine, which regulate the attention system. Research has shown that one of the gene differences in people with ADHD is a lack of dopamine and norepinephrine, so exercise corrects this deficit without the need for medication. This can be achieved by completing a moderate exercise for 20-30 minutes. In the classroom, this can extend to brain breaks and typical outdoor breaks.
Time-in is another concept used in school classrooms. Rather than having a time-out, students are encouraged to complete a physical activity to restore emotional regulation. This can include riding a stationary bike, bouncing on a trampoline, or sending a child on an errand to deliver a message. When a child is focused on exercise and play, sensory and emotional issues almost disappear.
Balance and coordination training is a great transformative tool for kids and adults with ADHD, and it’s never too early to start. Martial arts are a great fitness practice, combining balance and coordination, focus and discipline, and the ability to master your emotions.
Yoga is another great way to strengthen your balance and focus. Yoga focuses on your body, breathing, aligned posture, and increasing heart rates (depending on the type of yoga being completed). Recent studies in Taiwan showed significant improvements in accuracy and reaction times in subjects who had completed yoga over two months.
Meditation is less physically challenging but shows powerful results in terms of tackling the DMN (default mode network). Mindfulness meditation decreases negative activity in the DMN and improves learning, memory, and emotional regulation. Breathing exercises are an important part of meditation and strengthen connections to the task-positive network (TPN).
Remembering how good you feel after completing an exercise session is a huge motivator!
Actions to take
Medication: The Most Powerful Tool Everyone Fears
“Unfortunately, from Adderall to Zenzedi, the medications prescribed for ADHD have entered the realm of hot-button issues, and in that realm reason disappears.”
Over the long term, finding the right school, job, teacher, mentor, or partner as well as developing positive connections to people, activities, and purpose matter most. However, in the short term, medication can help you. Ensuring the right medication and following the guidelines associated with that medication is important.
Another common question is whether to try non-pharmaceutical treatments before taking any medication. This does have merit, and approaches like cerebellar stimulation techniques will produce positive results over time. However, if a medication can deliver these results quicker, then it may be a better option.
No one should be forced to take medication. The medication works better if you or your loved one want to take it. This proven phenomenon is known as the placebo effect, where your mind enhances the efficacy of any intervention (medication, surgery, exercise, for example.) Consider how much better you do on a job you really want to do and how much better you take care of something you really wanted, like a house, pet or car.
Analyzing the risk versus benefit of the medication is a good place to start. You need to learn as much as you can about the disorder, whether you have thoroughly explored non-medical treatments, and how much the disorder negatively impacts you and your loved ones.
If the answer to these questions leads you to go down the route of medication, you then need to fully understand the pharmaceutical options for you or your loved one. There is no one-size-fits-all ADHD medication, so be patient with your healthcare provider until you can identify a formula that works.
Stimulants are the ADHD drug of choice, with few side effects and a 70% to 80% efficacy rate. They can be split into two main categories: methylphenidate type (more effective in kids and teens) and amphetamine-type (slightly more effective in adults). Stimulants increase dopamine and norepinephrine, which stimulate the brain’s brakes and enable more control as well as improve motivation, information processing, awareness, and executive function.
Stimulant-like drugs are another option. They increase dopamine and norepinephrine, are not addictive, and are a good alternative for people who have side effects from stimulants. However, they are slower acting and can have common side effects, like insomnia, nausea, headache, agitation, dry mouth, and constipation.
Outliers to stimulant and stimulant-like medication include blood pressure medicines that can be used alone or in combination with stimulants. They calm agitation, aggression, and emotional hypersensitivity as well as improve focus and attention. However, they can cause a significant drop in blood pressure, and stopping this medication abruptly can cause a considerable rise in blood pressure and pulse.
Blood pressure medication has gained importance due to a new disorder: rejection-sensitive dysphoria (RSD). RSD is extreme emotional pain experienced due to the perception, real or imagined, that a person has been rejected, ridiculed, or criticized. Rejection sensitivity is often part of ADHD, where people dwell on the slights of normal life and amplify their effects. This can lead to misreading cues, withdrawal from daily life, or aggressive outbursts.
While there are concerns about medication addiction, research shows that taking a stimulant or stimulant-like drug earlier in life actually helps to prevent addiction later in life. Since most addictions begin between the ages of 13 and 23, and people with ADHD are more prone to addiction, it makes sense to start medication before 13.
Another new approach is genetic testing to aid the selection of medication. These tests are still in development and are expensive, but they can provide valuable information about how rapidly you will metabolize a medication. This can help in terms of dosing and avoiding any negative reactions to the medication, so it is an option you can consider.
Actions to take
Putting It All Together: Find Your Feel and Make It Real
“ADHD and VAST have brought such shame and pain to so many who don’t deserve it that we’re passionate about using what we know and doing all that we can to end that shame and pain.”
ADHD has been misunderstood for a very long time. This led to punishing children for what they could not control and the waste of talent across generations of adults. Finally, the world is catching on that the issue isn’t laziness, disrespect, or self-indulgence. It is due to neural functioning being slightly but meaningfully different from ‘neurotypicals’ in the population.
Connecting with others, identifying your strengths, not focusing on weaknesses, establishing structure in your environment, getting exercise, and taking medication help address these glitches and imbalances. The world is also starting to see the amazing potential of people with this condition, including creativity, entrepreneurial spirit, and energy.
Every person has their own style of living life and their own feel of doing what they do. You need to personalize the techniques provided in the previous chapters to find the approach that feels right for you. There is no one right way, but remember that no brain is the best, and each of us has a magnificent lifelong chance to find our brain’s special way.