FOREWORD
The time to view Attention Deficit Hyperactivity Disorder through a new lens is long overdue. Dr. Dale Archer’s The ADHD Advantage redefines all but the most severe cases of ADHD as expectable difference, not medical diagnosis. Hopefully, his work will help reverse the dangerous global trend that seeks to medicalize individual variability and medicate it into oblivion. Dale’s view is quite different. Rather than suppressing ADHD symptoms, he finds the adaptive strengths in them that can be leveraged with awareness and the right set of tools. Pills are not always the answer.
As chair of the task force that produced the fourth edition of the Diagnostic and Statistical Manual, I have been alarmed by the tripling of ADHD rates in just twenty years. It’s not that our kids are getting sicker. Human nature is remarkably constant. Some of the increase may be due to better recognition of real cases, but the evidence is overwhelming that we are in the midst of a fad largely engineered by drug companies’ misleading marketing to doctors, stressed parents and overworked teachers, as well as a quick-fix mentality and insurance demands that a diagnosis be made immediately on a first visit.
We are turning our kids into pill poppers. ADHD is now diagnosed in 11 percent of all children ages four through seventeen and is medicated in 6 percent. It is estimated that 15 percent of all children will get the diagnosis before they reach voting age. And the percentages get really crazy for teenage boys—20 percent are diagnosed and 10 percent are medicated. Remarkably, a child’s date of birth is the best predictor of whether he gets the label. The youngest kid in the class is almost twice as likely as the oldest to be diagnosed with ADHD. Misplaced diagnostic exuberance has turned age-appropriate immaturity into a psychiatric disease—and treats it with a pill, rather than just letting the kid grow up.
The rates of ADHD jumped because of three events during the late 1990s. First, new and very expensive ADHD drugs came on the market. This provided the means and motive for aggressive marketing. Twenty years ago, sales of ADHD drugs in the United States totaled a modest $40 million; now they have soared to an obscene $9 billion. Most of this money would be better spent to improve schools by reducing class size and adding gym periods so that fidgety kids could blow off steam.
Second, drug companies were allowed for the first time to engage in direct-to-consumer advertising. Ads peddling the ADHD illness to sell the profitable pill soon dominated TV, the Internet and print media. The misleading message was that ADHD is common, underdiagnosed, the cause of all school and behavioral problems, the result of a chemical imbalance and easily treatable with a pill. The marketing was mostly aimed at primary care doctors, who now prescribe the bulk of psychiatric medicines. They usually write quick and unnecessary prescriptions after a very brief visit, being forced into a premature diagnosis in order to get paid. Kids are hard to diagnose and change a lot from visit to visit without intervention—especially since they are often first seen on their worst day. Medication should be a last resort used only for the clearest, most impairing, most pervasive and most persistent disorders. Instead, the medicines are often passed out like candy.
Third, the first report from a multicenter study suggested that medication was superior to psychotherapy in treating ADHD. Subsequent follow-up studies failed to support the long-term effectiveness of medication, but these did not receive very much attention.
It is easy to overdiagnose and overtreat ADHD. It is defined by nonspecific symptoms and behaviors that are widely distributed in the general population: poor concentration, distractibility, impulsivity and hyperactivity. At the poles, the diagnosis is easily made. At one pole, the kid who presents with classic early-onset, severe ADHD is unmistakable. At the other are the kids who clearly do not have ADHD. But in between (at an arbitrary, flexible, fuzzy and heavily populated boundary), it is tough to distinguish clinical ADHD from normal kids who are no more than frisky and difficult to manage. Dale’s ADHD continuum describes this in detail—a new way of looking at symptoms that no longer warrants the immediate reflex of a prescription.
Overdiagnosis and loose prescription habits have fostered a thriving secondary market for pills originally intended for ADHD but instead illegally diverted for recreational use and/or performance enhancement. Remarkably, one-third of college students now use stimulants, as do one in ten high school students. Stimulant overdoses have quadrupled in recent years. And more than 10,000 two- and three-year-olds are already on stimulants. Things have gotten so out of hand that two federal agencies are now tussling over control of stimulant distribution: the Drug Enforcement Agency has clamped down on the production of stimulants, causing the Federal Drug Administration to express concern that not enough pills are available for legitimate use.
What started as a childhood epidemic is now also spreading rapidly to adults. ADHD promises to become a very popular diagnosis in this new market because virtually everyone would like to concentrate better and be less distractible. And the differential diagnosis in adults is particularly difficult because nonspecific ADHD-like symptoms accompany virtually every one of the psychiatric disorders. Far too often, ADHD is becoming a common add-on diagnosis—especially used by clinicians prone to prescribing polypharmacy drug cocktails. Adult ADHD should be diagnosed only when symptoms are clear-cut, definitely impairing and had their onset in early childhood. There is no such thing as late-onset ADHD.
So, how can we sort things out? How can we succeed in reducing the overdiagnosis of ADHD without risking underrecognition and undertreatment? This book is a good place to start by recognizing that the ADHD has inherent strengths that, until now, have rarely been discussed. Dale has identified and explored several key advantages, including resilience, an ability to be calm in a crisis, a propensity for multitasking and a penchant for nonlinear thinking. He discusses new research and gives dozens of real-life examples of how these strengths play out in the day-to-day lives of people who have attained a level of personal and professional success in multiple fields, whether they are CEOs, teachers, truck drivers or small-town doctors. In addition, he highlights two fields in which those with ADHD appear to excel: athletics and entrepreneurship.
His takeaway is that by trying to suppress and medicate ADHD out of existence, we risk suppressing the gifts that are part of the package. Dale offers an array of useful and insightful alternatives for leveraging these strengths without the aid of a pill. Overmedicating, he argues, could dim the light that could be the next great business leader, explorer or innovator.
Parents are the first line of protection against the glut of medicating. Increasing physical activity can help fidgety kids. Enroll them in a team sport, swimming, yoga, martial arts, dance or tumbling—anything to let the kid blow off steam and acquire discipline. This book lays out a host of pragmatic options for both children and adults to improve education, career and relationships. Not every difference is a sign of dysfunction. Kids differ in the pace of their development. Immaturity is not a disease. Medications can be helpful, sometimes essential, for clear-cut and severe cases when all else has failed, but only as a last resort, not as a careless panacea.
We don’t help our kids by giving them an inaccurate ADHD diagnosis and prescribing unnecessary medication. We help our kids by loving them, accepting them and helping them to find and use their strengths.
—Allen Frances, MD
Chair of the DSM-IV Task Force
Author of Saving Normal
AUTHOR’S NOTE
To respect the privacy of a few individuals mentioned in this book, names and identifying details have been changed. First and last names are used for those who were willing to be fully identified.
INTRODUCTION
What do David Neeleman, founder of JetBlue; John Chambers, CEO of Cisco; and business mogul Sir Richard Branson have in common? They, along with the singer Pink, Ty Pennington, Adam Levine and countless other high-profile achievers have publicly embraced their diagnosis of ADHD, and for good reason. For many, this trait is a blessing, not a curse.
It’s time to dispel the widespread misperception that this is only an affliction in need of a fix. Even its name—Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder—features a double whammy of negative connotations from those two D-words, implying that someone who possesses its typical characteristics is both broken and deficient. But this loaded term is a complete misnomer, because ADHD is not a minus. Leveraged and understood, it can be a huge plus! Just consider what David Neeleman has to say about the most overly diagnosed and medicated condition in mental health:
If someone told me you could be normal or you could continue to have your ADD, I would take ADD. . . . I can distill complicated facts and come up with simple solutions. I can look out on an industry with all kinds of problems and say, “How can I do this better?”
He goes on to state that if there was a pill he could take to make it go away, he’d refuse to take it, and he’s absolutely right. Far from being a group of symptoms that need to be medicated and managed, the most common features are, in fact, strengths that some of the world’s most accomplished people have leveraged to attain new heights in their chosen fields.
Those with ADHD are life’s entrepreneurs, CEOs, leaders, explorers, champion athletes and out-of-the-box thinkers, with extraordinary abilities to work under pressure, rebound from crises, multitask and conceive of ideas outside the restrictions of linear thinking. While people with ADHD can have trouble focusing on any one task, if something piques their interest they can become hyperfocused, able to carry an idea or task through to new heights of achievement. They are also an overwhelmingly positive bunch, possessing an innate resilience, high energy and a sense of humor that allows them to get past the many challenges of day-to-day living, and to keep on trying.
Look closely at many of the world’s most cutting-edge CEOs, those who have created new products, transformed their industry landscapes and founded their own businesses from scratch, and chances are you’ll find they possess a greater or lesser degree of the ADHD trait. These are the people who push the boundaries of what’s possible and refuse to accept the restrictions of the status quo, and that is a good thing.
Simply put, ADHD can be best understood as a brain with a very low boredom threshold. (Yes, this is greatly simplified; I wish it were so easy.) People who have it chafe against the mundane and routine, and yet they excel in chaotic situations. Centuries ago, they would have been the restless ones in the village during times of plenty. But when famine or catastrophe struck, they were the fearless leaders who found new lands or new ways of surviving. A research study found high populations of those with the genetic background for ADHD in far-flung places like Siberia, Tierra del Fuego and Australia, prompting scientists to refer to the dopamine transporter gene associated with ADHD as the “explorer gene,” something we’ll be exploring in more detail in Chapter Four.
Now, I can’t say for certain that this set of genes led the dawn of civilization, but there is no question they gave our adaptable and risk-taking ADHD forebears an evolutionary advantage. This genetic trait still exists in our species for a reason. Impulsivity, for example, which gets a bad rap today, could mean the difference between life and death in times of grave danger, when there is no time to waste analyzing a decision. Think about it. Our ADHD forebears were the prehistoric survivors who could calmly make a split-second decision to jump off a cliff to save themselves from a charging saber-toothed tiger. Jumping off a cliff may look crazy. But in fact, this impulsive act, or what some might call a gut instinct, is a split-second calculation based on the odds of survival. After all, a possible broken limb is better than being mauled to death. That quick reaction may be your only real chance of survival.
Today, in these turbulent times of economic, social and technological transition, the ADHD adventurer’s moment has come again, and you will meet many who are finding new frontiers as they travel, explore and discover.
These next pages will challenge the standard view that individuals must suppress their adventurous natures and attempt to squeeze into our ever-narrowing definition of what is defined as normal by focusing on the many positives of a condition that, for many, has contributed to the unique position they hold in the world today. We need to recognize, embrace and skillfully use the best of this ADHD trait, not manage or stifle or “normalize” the very qualities that could define our next generation’s leaders.
This book explodes the myth that ADHD is a problem that needs to be fixed. Of course, many do struggle with the “symptoms,” and need treatment. Yes, there is a flip side to some of these strengths in the absence of self-awareness and the use of certain strategies to overcome the weaknesses. But for too long, educators and mental health experts have been overdiagnosing and overprescribing to the detriment of our nation’s children. It’s a fact that’s only just beginning to get recognition from former proponents of stimulant use among members of the medical community.
In the spring of 2014, Dr. Keith Conners, who was among the first physicians to legitimize ADHD as a diagnosis, called our surging diagnosis and prescription rates “a national disaster of dangerous proportions.”
ADHD diagnoses have been climbing exponentially. Statistics vary depending on which study you cite, but in the United States the National Center for Health Statistics reports that 6.4 million American kids (11 percent) ages three through seventeen have been diagnosed. Even more disturbing is the number of children now on medication for ADHD: 3.5 million; up from 600,000 in 1990, according to the Centers for Disease Control and Prevention (CDC).
“The numbers make it look like an epidemic,” Dr. Conners told the New York Times. “Well, it’s not. It’s preposterous. This is a concoction to justify the giving out of medications at unprecedented and unjustifiable levels.”
“Honor dies where conflict of interest lies,” says Dr. Allen Frances, a professor emeritus at Duke University and the former chairman of the DSM-IV Task Force (DSM referring to Diagnostic and Statistical Manual of Mental Disorders, which you will be hearing more about in the coming pages). Dr. Frances, one of the most respected experts in this field, has expressed his outrage at how closely tied the so-called thought leaders in ADHD are to Big Pharma, and has become an outspoken critic of this trend to overdiagnose and medicate even toddlers, which he aptly calls “reckless.”
Interestingly, the state-by-state variability ranges from 5.6 percent in Nevada to 15.6 percent in North Carolina. What does that say about the validity of a diagnosis? Why do three times more kids in North Carolina have ADHD than in Nevada? Is it the water, or is the desert a cure? Even more stark is the comparison with the United Kingdom, where the average diagnosis rate is less than 2 percent. Or France, where the percentage of kids diagnosed and medicated for ADHD is less than 0.5 percent!
This profound discrepancy is fueled by Big Pharma, overworked teachers, psychiatrists, stressed-out parents, a pop-a-pill mentality and our microwave culture. In a highly competitive environment where it pays to conform and be “normal,” there’s an unhealthy tendency for parents, doctors and educators to identify something as a problem in the hopes of finding a cure.
ADHD wasn’t even recognized as a condition until 1980, much less treated, but it’s since become one of the most searched terms on the Internet, more than sex and death (but, interestingly, below Twitter, Facebook and Google). When college students are abusing drugs like Ritalin to ace tests and one of the hottest stories in sports involves suspensions of NFL players doping with stimulants, and kids in middle school aren’t allowed in class unless they take their medication, something is seriously wrong.
It’s time to say the pendulum has swung too far and must head the other way. Look, I’m not suggesting that in severe cases treatment for ADHD is not indicated, but do more than one in ten kids really merit the diagnosis? What’s needed is a drastic shift in the way we diagnose, view and handle what is more of a distinctive personality type than a debilitating psychological condition. We need to understand that ADHD isn’t just something that flicks on and off like a switch. It exists along a continuum, on a scale from 1 to 10, and only a few with the diagnosis have symptoms that are severe enough to merit the highest ratings of 9, 10 or 10+ and hence require medication, but as a last resort—not first. For most, all it takes is awareness and a few simple adjustments to leverage this trait into your greatest strength.
I am going to give you the tools and information to turn back this tide. As parents, children, teens and adults with ADHD, you deserve a brand-new perspective about this diagnosis, as well as a range of prescriptions (not pills) to help you or your loved one identify the many strengths of this trait. By the end of this book, you will be able to develop a life’s path that fits, and enhance the best of ADHD to maximize potential in school, career, relationships and life.
Part I will define ADHD, its history, genetics and pathology, put it into historical context and speculate on the many extraordinary figures throughout the ages, such as Christopher Columbus, Leonardo da Vinci, Mozart, Eleanor Roosevelt, Virginia Woolf and Benjamin Franklin, who probably had this trait in abundance. It will examine the effect an ADHD diagnosis has on a child, and propose innovative and practical ways to harness their potential with descriptions of progressive academic programs that could serve as a blueprint for educators and parents.
There will also be a quiz to help you determine where you, or your child, sit on the ADHD continuum, and data that describes how ADHD typically manifests according to age group.
This section will also discuss when treatment may be needed and those last-resort instances when it’s appropriate to medicate, with strong caveats about the potential side effects, the tendency to overmedicate and the abuse of these stimulant drugs. It will also offer some alternative methods that, instead of suppressing the strengths, improve the focus and calm necessary to maximize them—including, but not limited to, mindfulness practice, strategies on how to study, how to kick into hyperfocus mode and the beneficial effects of exercise. Diet will also be addressed, but not in a way most would expect. You are not necessarily what you eat!
Part II will focus on the many advantages of ADHD, using success stories from all walks of life, from real people with everyday jobs all the way to high-profile celebrities, doctors, lawyers, athletes, CEOs and entrepreneurs—to highlight these strengths. Conversations with everyone from small-business owners to business moguls will illuminate how nonlinear thinking can spawn entire industries, and a low boredom threshold can lead to multiple interconnected businesses that make up a multibillion-dollar commercial empire.
It’s worth noting here that the vast majority of people interviewed for this book were more than happy to be on the record and share their stories with the world. This is striking, because for most books in the mental health field it’s almost impossible to reveal identities due to stigma. The interviewees’ eagerness to fully participate shows that a positive shift in perceptions has begun, helped in part by the high-profile celebrities, athletes and businesspeople who have publicly embraced their diagnoses. The New York Times has also done some stellar reporting over the past two years, putting misunderstandings about ADHD and its overmedication in the spotlight. The Times’ coverage has doubtless helped to raise awareness and change attitudes toward the diagnosis. But make no mistake, the stigma still exists, and can affect perceptions in certain career fields, which is why a small handful of our interview subjects requested anonymity.
Part III will illustrate how these strengths can be leveraged in entrepreneurship, athletics and relationships. It will end with the best advice gleaned from the scores of successful ADHDers on the best way to find your fit. Because, more than most people, those with ADHD must have passion to be truly engaged and stimulated by their life’s work.
Because there is no one-size-fits-all tool for a trait that has many individual variables, we have laced this book with dozens of inspirational stories. Men and women of all ages and backgrounds have experiences and insights to share, from Christopher Lauer, the young German politician who stands on the podium and, with little to no preparation, gives some of the most rousing speeches of any Berlin public figure, to fashion designer Kelly Dooley, the consummate multitasker whose brand has become a cult favorite among celebrities. You will meet business moguls and athletes, like NFL quarterback Dave Krieg, one of the most prolific passers in NFL history. And middle school teachers, like Tichelle Harris, who switched from a career in banking to teach and transform the lives of underserved kids, doing all that she can to inspire other young ADHDers like herself, who might not otherwise get the mentoring they need inside the public education system.
Each of these ADHDers has a life and career story as unique as their fingerprints, having carved out jobs and businesses for themselves that are as fascinating as they are unconventional and unexpected. But the one thing they all have in common is a tool kit with specific and practical tips. In their self-awareness, developed through life experience, research or with the support of understanding and educated family members and partners, they have come up with ways that work for them to manage their time, recharge, refocus and follow through. Their particular tools may not work for everyone, but they will inspire you to assemble your own kit to better leverage the strengths of the ADHD trait.
Entrepreneur Shane Jordan, for example, who owns a thriving chain of computer repair shops, talks about how the singular focus of riding his motorbike or landing a plane—his two favorite hobbies—creates a stillness and calm in his mind that’s as good as a week’s vacation on a beach for someone without ADHD. Trade show and real estate CEO Kenneth “Bucky” Buckman shares how he manages his high energy by listening to his body, which shuts down every six months or so and forces him to rest, so that he can power up again for the next business challenge. Home decorating start-up owner Anita Erickson filters out the distraction of all the thoughts running through her brain by writing them down on lists. The simple act of writing it down helps her to mentally de-clutter, so that she can focus on the main priorities of her day.
Where applicable, we will include these takeaways, to help those with the diagnosis, as well as their family members, spouses, teachers and peers, better leverage their strengths. Specific and practical information will be offered, in quick bullet points, at the end of the relevant chapters, the better to suit fast minds eager to get to the point!
But by far the most important takeaway from the book is that there is a vast world of possibility out there for people with the ADHD trait. The key to a successful life because of, not in spite of, ADHD is acceptance. Be proud of who you are and recognize that your unique combination of genetics, brain chemistry and personality could land you in the pages of history. No, your brain does not work like a “normal” brain. So what? It’s a matter of leveraging its characteristics as strengths, choosing the right career and education path and maintaining an awareness of what works, without struggling to try to fit into a box that teachers, family, peers and the rest of society call “normal.” ADHD is not a disorder; it’s a difference that, in the right context and with a set of customized tools, can help you or your child become one of life’s explorers, leaders, inventors or entrepreneurs. This trait is precisely what can give you the edge. It’s your distinct advantage, so go ahead, embrace it!
I should know. I am a psychiatrist with ADHD and, no, I have never taken medication for it. Instead, I’ve stayed busy, leveraging my restless nature and innate curiosity to establish a thriving practice, develop multiple successful psychiatric programs and launch several successful businesses and author a New York Times best seller, Better Than Normal.
Interestingly, I did not even realize I was an ADHDer until I wrote the Better Than Normal chapter on ADHD. (Physicians aren’t always the best at self-diagnosis.) The more I delved into the research, the more I recognized myself, and the many ways I had instinctively leveraged the strengths of this trait over the years. The revelation was transformative, and bringing more consciousness to everything I do has greatly enhanced my life. Sure, I need to work around certain aspects of this trait: I’m easily bored, get distracted and linear thinking does not come naturally. But I’ve learned alternative ways of achieving my goals that in the end are so much easier for me, and today I consider the ADHD trait my greatest gift.
PART I
Exploding the Myth
CHAPTER ONE
Born This Way
When Extreme Home Makeover star Ty Pennington was attending grade school in Atlanta, Georgia, his teachers didn’t know what to do with him. It was so bad that, when his mother, who was studying to be a child psychologist, asked the school principal to let her observe the school’s ten “most challenging children” in the classroom, he replied, “Mrs. Pennington, I don’t think you want to see this.”
Within the twenty minutes his mother watched her son from behind the door, Ty tried to climb out the window, swung from the blinds, slapped his classmates on the back of their heads, stripped off most of his clothes and rode his desk around the room as if it were a jeep. It wasn’t that he was trying to be a bully. He just needed an outlet for all his pent-up energy, and the extra attention was an added bonus.
“To call me distracting would be an understatement,” he shared with me. “I got so bored and far behind what was being taught that I found my entertainment by entertaining the class.”
Class Clown
But he suffered for it. Moving from school to school, getting his butt kicked at recess, he gained a reputation for being “a certain type of kid.” He became so well known for his boisterous conduct that by the time he hit middle school, his teachers had him permanently sitting in the hallway. It wasn’t until his family moved to the suburbs and Ty started at a new school where he wasn’t known that his grades started to improve. A new environment and stimuli alleviated his boredom, which in turn helped him focus more. It worked for a while, until the novelty wore off and he began earning the same reputation again.
This was during the seventies, long before ADD or ADHD even existed as a diagnosis, so Ty suffered the pain of not knowing why he was different. He was simply branded a “problem child.” Like a multitude of others, his early school experience was tortuous and demoralizing. The H in his ADHD—Hyperactivity—was especially pronounced. No one, with the exception of his more enlightened mother, believed he would become a success in life. No one else was interested in making sure he got an education. Instead, they put him on antihistamines to keep him drowsy and under control while they focused on teaching the kids in class they deemed “worthy, with a future.”
Ty’s self-esteem took a beating. He was the kid who couldn’t be trusted not to burn down the house if he was left alone. But as he got older, he saw a glimmer of hope. He took up soccer, which channeled all that extra energy and built up his self-confidence.
“All of a sudden it came together and I could read the field. I went from sitting on the bench to scoring hat tricks repeatedly in a game,” he says.
Learning to Learn
After his first year in college, Ty was finally diagnosed with ADHD, and the knowledge that his brain was different from others’ helped him to see that he was not necessarily a bad kid, or less capable than his peers. The diagnosis was a shock at first.
“It was not what I wanted to hear at that age,” he told me. “I was going through a lot, questioning my parents, authority, the meaning of life. . . . And then to find out I had a mental difference. It was rough.”
But his doctor, who also had ADHD, helped Ty to recognize his strengths. This newfound self-awareness was also a relief. He finally understood why he couldn’t retain anything he’d read and the words were just a blur. A visual thinker, he’d draw, and those visual cues would remind him of the answers in class. He’d been sketching some macabre scenes of wagons drawn by rats, carrying giant severed fingers—scenes that had him sent to the therapist’s office. But his therapist told him he had a gift, which gave Ty the courage to work full-time as a carpenter to put himself through art school, where he excelled.
There were a few years of house painting and modeling to pay the bills before he made it in show business and became a household name. Ty was anything but an overnight success. He modeled for J.Crew and Swatch, and appeared on television spots for Macy’s and Levi’s. Then he started doing set designs in Hollywood. But when he was eventually approached to be on Trading Spaces, Ty knew he’d found his niche.
“They needed someone like me—slightly sarcastic, knows his way around a building site—so I went on an audition and got a job being myself. I was blown away!”
Finding His Fit
Then came Extreme Home Makeover, which was originally intended to be no more than a thirteen-part series. When the producers asked him if he could build a house from top to bottom in just seven days, Ty laughed and told them:
“It’d make for a hell of a show, but you’d have to be nuts to try.”
Or if not nuts, at least have some of the advantages of ADHD. Rebuilding a home top to bottom, inside and out, in just seven days would leverage every single ADHD strength he had: multitasking, risk-taking, physical and mental energy, calm in the middle of chaos, a desire to move quickly from one thing to the next, as well as the ability to see the whole and all the moving parts of a project, and how they relate to one another. Throughout each project, he could remain hyperfocused because he was passionate about the project and loved the thrill. The pressure of having to do all that work within a tight time frame also stimulated his ADHD brain and left him with no time for boredom.
“It was as if the job created itself for me,” he says.
Today, Ty is the perfect poster boy for ADHD. He even wears a T-shirt that reads OMFG ADHD, and named his home décor business Art Design Home Décor (ADHD), ingeniously co-opting the diagnosis as his brand. This is a man whose enthusiasm is infectious, and his high energy and optimism are among the very attributes that can turn ADHD into such a powerful advantage. He not only accepts, he embraces ADHD strengths as a part of who he is and the success he enjoys today. Although it wasn’t always apparent to him that it was a blessing to be born this way, he now wears the ADHD label with pride.
Poster Child
Ty took the time to speak with me despite multiple projects on the go, including, incidentally, filming a public service announcement on ADHD awareness immediately after our phone interview. But ADHD advocate is just one of dozens of roles the Emmy-winning television star plays in a career that includes actor, entrepreneur, producer, writer, author, furniture manufacturer, artist and philanthropist. Through his chosen career, or I should say careers, Ty could not have found better outlets for his high energy, intense enthusiasm and curiosity, combined with a restless nature and low boredom threshold.
His is one of many success stories you will read about in these next pages. Instinctively, Ty has figured out how to leverage his traits into a stellar career that is uniquely suited to the way his brain is wired. By going public with ADHD, Ty also sets a great example, proving that you don’t have to live inside that box called “normal” in order to make it. In fact, being who he is, allowing his ADHD flag to fly, has enabled him to carve out an extraordinary career path that combines all his passions and strengths and opens him up to a world of possibility.
The lesson here is that the ADHD traits should never be suppressed. ADHD is a natural part of the human condition. Not only is it in the normal range, in many ways it can make us better than normal. No, it’s not innate to everyone; we don’t all jump from idea to idea or embrace spontaneity and risk—that would lead to utter chaos. It takes both so-called normal and ADHD to make the world go ’round. But it’s time to recognize that those with the ADHD trait play a tremendously important role in our society as innovators, explorers, leaders and risk-takers. We need them to shake things up a bit and challenge the status quo.
Of course, it’s not black-and-white. The world isn’t divided up cleanly into those who have it and those who don’t, because not all those who have ADHD possess it to the same degree. Like all psychological traits, it exists along a continuum, on a scale of 1 to 10. I am an 8 and I suspect, although I have not formally assessed him, that Ty is closer to a 10.
That means our brains are wired a little differently from those who fall lower on the trait continuum, and at the end of this chapter I will give you the tool—a quiz—to figure out where you or your loved one lie on the spectrum.
It’s Not a Disorder, It’s a Difference
So what exactly is ADHD? The trait is a combination of brain chemistry and genetics that affect the dopamine transporter gene and its receptors. Simply put, the brain reacts differently to stimulation in someone with an 8 or 9 or 10 on the scale, compared with someone who is calm and well organized or, say, a 1 on the continuum. In effect the risk, the pressure of a deadline, chaos or the possibility that you are about to go off a cliff actually causes a different reaction in those high on the ADHD scale. They actually feel a rush, or euphoria, not the panic, anxiety or dread many would experience who don’t have ADHD. These extreme states actually boost a feel-good response in the brain, which is why many with ADHD appear so focused and functional in the middle of a maelstrom.
I’ll delve more deeply into the science, diagnostics, demographics and terms in the next chapter, but here is a quick qualifier on the difference between ADHD and ADD:
Simply put, ADHD and ADD are exactly the same thing. ADD stands for Attention Deficit Disorder. In its earlier usage there was a modifier specifying either with or without hyperactivity. In 1987 the official diagnosis was changed to ADHD (Attention Deficit Hyperactivity Disorder). Today the most common usage is ADHD, encompassing all the symptoms of inattention, whether you have hyperactivity or not.
Generally speaking, an ADHD diagnosis means you have some of the following tendencies: difficulty focusing or staying on task; inattention to details; inability to sustain attention; trouble listening; disorganization; avoidance of tasks you don’t find interesting; frequently losing things; being easily distracted by external stimuli; and forgetfulness. People with six of these tendencies qualify as having the inattentive part of ADHD, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
The Flip Side
But there’s another way to look at what most in the mental health field like to regard as symptoms. Flip them around and you have the following: an ability to multitask; a propensity to thrive in situations of chaos; creative, nonlinear thinking; an adventurous spirit; a capacity for hyperfocus on something that fascinates you; resilience; high energy; a willingness to take calculated risks; and calmness under pressure.
Fascinating, the way a different lens can affect the view, isn’t it? Suddenly they become strengths, not debilitating weaknesses or character flaws.
One of the things I have noticed from my conversations with successful patients, interviewees and friends who rank highly on the ADHD continuum is that they have excelled precisely because they embrace their so-called symptoms. Perry Sanders, a highly accomplished entertainment lawyer, television producer and commercial real estate entrepreneur, has a classic case of ADHD, but he doesn’t see it as a big deal because this trait has worked so well for him in business that he can’t imagine how it could possibly be labeled a “disorder,” when it is, in fact, the most powerful tool in his box.
“People may not understand how my brain functions and view it as a problem, but it works well for me,” he says.
The same healthy self-regard goes for Ty, who embodies many of the strengths of ADHD and possesses the self-awareness to identify exactly how each aspect of these traits has contributed to his success.
Of course, these are strengths anyone can have. I am not saying that this compendium of characteristics is exclusive to people with ADHD, but in my practice I have seen a striking predominance of these qualities in conjunction with each other. Taken to extremes, or under the wrong circumstances, they can be a problem. Multitasking, for example, might result in an inability to follow one thing through to completion. But they also can be useful, and certainly don’t require us to slap on a diagnosis.
Following are a few of the ADHD advantages as embodied by the examples of various success stories, which I will detail further with research and examples in Part II.
Nonlinear Thinking
Professional photographer and soccer dad Freddie, who is at least a 9 on the ADHD continuum, is a classic example of a nonlinear thinker. His brain is on warp speed, zigzagging from one thought bubble to the next, coming up with some incredibly original and creative ideas in the process. It’s hard to follow for most people, but makes perfect sense to him, and to everyone else with ADHD.
Freddie’s mental agility can also translate into distractibility. He’s a late bloomer who ricocheted from job to job on the most unlinear career path you could imagine, from fighting forest fires on the West Coast, to editing a start-up business magazine in Cambodia, to thought leadership consulting and PR for finance companies in Boston. Freddie found elements of each widely differing job description challenging and fun, but focus and follow-through became a problem, particularly in the corporate, nine-to-five roles. It was only when he discovered his talent for photography that it all came together.
Today, he roams to wherever his eyes and imagination take him, leveraging his nonlinear thought processes into profoundly moving visual images that capture moments in a human face, landscape or street scene that others simply wouldn’t see.
“It’s a way of seeing, using your peripheral vision and being in tune to your environment, and seeing how these seemingly random visual cues come together to tell a story,” he explains.
In other words, each photograph offers a glimpse inside his highly creative, nonlinear ADHD brain.
Impulsivity
The tendency to act quickly, sometimes with little thought, on that flash of insight, intuition or gut feeling, which entertainer Howie Mandel possesses in abundance, gets a bad rap. Most people fear this unpredictable quality and anticipate disastrous consequences. But it can reap huge rewards as well.
No one could ever accuse Howie, the hugely successful comedian, actor, producer, America’s Got Talent judge and game show host, of overthinking. He told me in a recent interview that he never planned on becoming a comedian. In fact, nothing in his life was ever planned.
“Everyone else I knew was charting a path to their future. I wasn’t charting, nor did I have a path,” he says.
But he had plenty of ambition. Howie wanted to become a millionaire, although he wasn’t clear on the specifics. According to the usual standards, he was already doing well before he became a comedian. By the time he was in his early twenties and engaged to be married, his career in carpet and lighting sales was chugging along, albeit with a few bumps, and he was on track to be a business owner with a secure middle- to upper-middle-class lifestyle.
But he was always the jokester. One night, when he and his wife, Terry, were hanging out with friends, one of them suggested he try performing at Yuk Yuk’s, a well-known stand-up venue in Toronto, and with no prior experience in performing, Howie signed up to take the stage on the club’s next amateur night.
The fact that it was a set date, and he was required to have his five-minute stand-up routine all planned out in advance, filled him with dread. Yet, with little preparation, he stood up on that stage, and had the audience in stitches with some filthy dialogue that just came to him, funny voices, and such a completely winning way of interacting with the crowd that he was invited back as a featured act. At first he genuinely didn’t know why they were laughing so hard, and threw his hands up the air, saying, “What, what?” The gesture went down so well it became the signature part of his act, as did his “borderline psychotic” persona, as he puts it. It was the beginning of a passion and obsession that prompted Howie to push further and further beyond the edge.
Within a year, he was on vacation in Los Angeles with Terry and some friends when he decided to go to the famed Comedy Store on amateur night. There he met an acquaintance from the Toronto stand-up circuit, who helped him sign up for a set and introduced him to the executive producer of a comedy game show called Make Me Laugh. He did his Yuk Yuk’s act, with a few more ad-libs, and impressed the producer so much, he was invited to audition for the show.
Howie attributes his greatest comedic successes to his spontaneity. His unique brand of humor is unexpected and out of the blue. “All those things I’ve done on impulse that have turned out great were because of ADHD,” he told me.
One of his most infamous shticks at that time happened completely on impulse. His “Donny the half man, half chicken” routine included placing a latex glove over his head and using the fingers as a cockscomb. One night, out of the blue, he decided to pull the glove farther down on his face, inflating and deflating it by blowing through his nose. The more the fingers rose up and down on top of his head, the more the audience laughed. His absurd comedic sense is a clear example of impulsivity and nonlinear thinking.
A Willingness to Take Risks
Not to be confused with impulsivity, another key attribute of those with ADHD is risk-taking. It means that some thought goes into certain decisions, although they are decisions most people would not dare to make. Another way of putting it is that they have an adventurous spirit.
In the case of Bradley, a truck driver from Texas, that willingness to put everything on the line and take a flying leap into the unknown gave him a career and a livelihood beyond his wildest expectations. Another late bloomer, Bradley, who is forty-seven, had been struggling to find his fit most of his adult life.
“I had five or six kinda careers, all related to driving and operating trucks and heavy equipment, and it all bored me to death,” he says.
He finally fell into long-haul trucking and, while he was good at it and able to hustle the work, the tedium became unbearable. But then he had the chance to drive an oversized load—a specialty kind of transportation that requires escort vehicles, route planning, and a variety of permits depending on the roads and route taken, coupled with the skill to handle a 120,000-pound payload.
Bradley loved the challenge and the fact that you would only have to haul about two loads per month, freeing him to pursue his many other interests. When he looked into it he found there was a need for qualified truckers to haul huge multimillion-dollar electrical control buildings from the factory to locations across the United States, he impulsively decided to go for it. For the first time in his life, Bradley had discovered something that met his need for adventure and that could sustain his interest. So he asked his mother to mortgage her house, and combined his own savings, so that he could buy the specialty tractor-trailer he needed for $250,000.
This was at the start of one of the worst recessions in decades. Other truckers said he was crazy. Without customers, he’d never be able to cover his costs. He saw it differently. Though he barely will admit to having ADHD due to the stigma, he does admit to all the characteristics of the trait. And he saw this as his chance—maybe his only chance—to put those strengths to use. He had to go for it. So he put bids on jobs before he even had the truck, and then farmed them out to other truckers until he had his own vehicle. Within a year he was able to pay his mother back, and now makes a comfortable living for his family, bringing in $30,000 to $60,000 per job. Even better, he now has a reputation as one of the top drivers in the field, getting to pick and choose the best and most challenging deliveries.
FOREWORD
The time to view Attention Deficit Hyperactivity Disorder through a new lens is long overdue. Dr. Dale Archer’s The ADHD Advantage redefines all but the most severe cases of ADHD as expectable difference, not medical diagnosis. Hopefully, his work will help reverse the dangerous global trend that seeks to medicalize individual variability and medicate it into oblivion. Dale’s view is quite different. Rather than suppressing ADHD symptoms, he finds the adaptive strengths in them that can be leveraged with awareness and the right set of tools. Pills are not always the answer.
As chair of the task force that produced the fourth edition of the Diagnostic and Statistical Manual, I have been alarmed by the tripling of ADHD rates in just twenty years. It’s not that our kids are getting sicker. Human nature is remarkably constant. Some of the increase may be due to better recognition of real cases, but the evidence is overwhelming that we are in the midst of a fad largely engineered by drug companies’ misleading marketing to doctors, stressed parents and overworked teachers, as well as a quick-fix mentality and insurance demands that a diagnosis be made immediately on a first visit.
We are turning our kids into pill poppers. ADHD is now diagnosed in 11 percent of all children ages four through seventeen and is medicated in 6 percent. It is estimated that 15 percent of all children will get the diagnosis before they reach voting age. And the percentages get really crazy for teenage boys—20 percent are diagnosed and 10 percent are medicated. Remarkably, a child’s date of birth is the best predictor of whether he gets the label. The youngest kid in the class is almost twice as likely as the oldest to be diagnosed with ADHD. Misplaced diagnostic exuberance has turned age-appropriate immaturity into a psychiatric disease—and treats it with a pill, rather than just letting the kid grow up.
The rates of ADHD jumped because of three events during the late 1990s. First, new and very expensive ADHD drugs came on the market. This provided the means and motive for aggressive marketing. Twenty years ago, sales of ADHD drugs in the United States totaled a modest $40 million; now they have soared to an obscene $9 billion. Most of this money would be better spent to improve schools by reducing class size and adding gym periods so that fidgety kids could blow off steam.
Second, drug companies were allowed for the first time to engage in direct-to-consumer advertising. Ads peddling the ADHD illness to sell the profitable pill soon dominated TV, the Internet and print media. The misleading message was that ADHD is common, underdiagnosed, the cause of all school and behavioral problems, the result of a chemical imbalance and easily treatable with a pill. The marketing was mostly aimed at primary care doctors, who now prescribe the bulk of psychiatric medicines. They usually write quick and unnecessary prescriptions after a very brief visit, being forced into a premature diagnosis in order to get paid. Kids are hard to diagnose and change a lot from visit to visit without intervention—especially since they are often first seen on their worst day. Medication should be a last resort used only for the clearest, most impairing, most pervasive and most persistent disorders. Instead, the medicines are often passed out like candy.
Third, the first report from a multicenter study suggested that medication was superior to psychotherapy in treating ADHD. Subsequent follow-up studies failed to support the long-term effectiveness of medication, but these did not receive very much attention.
It is easy to overdiagnose and overtreat ADHD. It is defined by nonspecific symptoms and behaviors that are widely distributed in the general population: poor concentration, distractibility, impulsivity and hyperactivity. At the poles, the diagnosis is easily made. At one pole, the kid who presents with classic early-onset, severe ADHD is unmistakable. At the other are the kids who clearly do not have ADHD. But in between (at an arbitrary, flexible, fuzzy and heavily populated boundary), it is tough to distinguish clinical ADHD from normal kids who are no more than frisky and difficult to manage. Dale’s ADHD continuum describes this in detail—a new way of looking at symptoms that no longer warrants the immediate reflex of a prescription.
Overdiagnosis and loose prescription habits have fostered a thriving secondary market for pills originally intended for ADHD but instead illegally diverted for recreational use and/or performance enhancement. Remarkably, one-third of college students now use stimulants, as do one in ten high school students. Stimulant overdoses have quadrupled in recent years. And more than 10,000 two- and three-year-olds are already on stimulants. Things have gotten so out of hand that two federal agencies are now tussling over control of stimulant distribution: the Drug Enforcement Agency has clamped down on the production of stimulants, causing the Federal Drug Administration to express concern that not enough pills are available for legitimate use.
What started as a childhood epidemic is now also spreading rapidly to adults. ADHD promises to become a very popular diagnosis in this new market because virtually everyone would like to concentrate better and be less distractible. And the differential diagnosis in adults is particularly difficult because nonspecific ADHD-like symptoms accompany virtually every one of the psychiatric disorders. Far too often, ADHD is becoming a common add-on diagnosis—especially used by clinicians prone to prescribing polypharmacy drug cocktails. Adult ADHD should be diagnosed only when symptoms are clear-cut, definitely impairing and had their onset in early childhood. There is no such thing as late-onset ADHD.
So, how can we sort things out? How can we succeed in reducing the overdiagnosis of ADHD without risking underrecognition and undertreatment? This book is a good place to start by recognizing that the ADHD has inherent strengths that, until now, have rarely been discussed. Dale has identified and explored several key advantages, including resilience, an ability to be calm in a crisis, a propensity for multitasking and a penchant for nonlinear thinking. He discusses new research and gives dozens of real-life examples of how these strengths play out in the day-to-day lives of people who have attained a level of personal and professional success in multiple fields, whether they are CEOs, teachers, truck drivers or small-town doctors. In addition, he highlights two fields in which those with ADHD appear to excel: athletics and entrepreneurship.
His takeaway is that by trying to suppress and medicate ADHD out of existence, we risk suppressing the gifts that are part of the package. Dale offers an array of useful and insightful alternatives for leveraging these strengths without the aid of a pill. Overmedicating, he argues, could dim the light that could be the next great business leader, explorer or innovator.
Parents are the first line of protection against the glut of medicating. Increasing physical activity can help fidgety kids. Enroll them in a team sport, swimming, yoga, martial arts, dance or tumbling—anything to let the kid blow off steam and acquire discipline. This book lays out a host of pragmatic options for both children and adults to improve education, career and relationships. Not every difference is a sign of dysfunction. Kids differ in the pace of their development. Immaturity is not a disease. Medications can be helpful, sometimes essential, for clear-cut and severe cases when all else has failed, but only as a last resort, not as a careless panacea.
We don’t help our kids by giving them an inaccurate ADHD diagnosis and prescribing unnecessary medication. We help our kids by loving them, accepting them and helping them to find and use their strengths.
—Allen Frances, MD
Chair of the DSM-IV Task Force
Author of Saving Normal
AUTHOR’S NOTE
To respect the privacy of a few individuals mentioned in this book, names and identifying details have been changed. First and last names are used for those who were willing to be fully identified.
INTRODUCTION
What do David Neeleman, founder of JetBlue; John Chambers, CEO of Cisco; and business mogul Sir Richard Branson have in common? They, along with the singer Pink, Ty Pennington, Adam Levine and countless other high-profile achievers have publicly embraced their diagnosis of ADHD, and for good reason. For many, this trait is a blessing, not a curse.
It’s time to dispel the widespread misperception that this is only an affliction in need of a fix. Even its name—Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder—features a double whammy of negative connotations from those two D-words, implying that someone who possesses its typical characteristics is both broken and deficient. But this loaded term is a complete misnomer, because ADHD is not a minus. Leveraged and understood, it can be a huge plus! Just consider what David Neeleman has to say about the most overly diagnosed and medicated condition in mental health:
If someone told me you could be normal or you could continue to have your ADD, I would take ADD. . . . I can distill complicated facts and come up with simple solutions. I can look out on an industry with all kinds of problems and say, “How can I do this better?”
He goes on to state that if there was a pill he could take to make it go away, he’d refuse to take it, and he’s absolutely right. Far from being a group of symptoms that need to be medicated and managed, the most common features are, in fact, strengths that some of the world’s most accomplished people have leveraged to attain new heights in their chosen fields.
Those with ADHD are life’s entrepreneurs, CEOs, leaders, explorers, champion athletes and out-of-the-box thinkers, with extraordinary abilities to work under pressure, rebound from crises, multitask and conceive of ideas outside the restrictions of linear thinking. While people with ADHD can have trouble focusing on any one task, if something piques their interest they can become hyperfocused, able to carry an idea or task through to new heights of achievement. They are also an overwhelmingly positive bunch, possessing an innate resilience, high energy and a sense of humor that allows them to get past the many challenges of day-to-day living, and to keep on trying.
Look closely at many of the world’s most cutting-edge CEOs, those who have created new products, transformed their industry landscapes and founded their own businesses from scratch, and chances are you’ll find they possess a greater or lesser degree of the ADHD trait. These are the people who push the boundaries of what’s possible and refuse to accept the restrictions of the status quo, and that is a good thing.
Simply put, ADHD can be best understood as a brain with a very low boredom threshold. (Yes, this is greatly simplified; I wish it were so easy.) People who have it chafe against the mundane and routine, and yet they excel in chaotic situations. Centuries ago, they would have been the restless ones in the village during times of plenty. But when famine or catastrophe struck, they were the fearless leaders who found new lands or new ways of surviving. A research study found high populations of those with the genetic background for ADHD in far-flung places like Siberia, Tierra del Fuego and Australia, prompting scientists to refer to the dopamine transporter gene associated with ADHD as the “explorer gene,” something we’ll be exploring in more detail in Chapter Four.
Now, I can’t say for certain that this set of genes led the dawn of civilization, but there is no question they gave our adaptable and risk-taking ADHD forebears an evolutionary advantage. This genetic trait still exists in our species for a reason. Impulsivity, for example, which gets a bad rap today, could mean the difference between life and death in times of grave danger, when there is no time to waste analyzing a decision. Think about it. Our ADHD forebears were the prehistoric survivors who could calmly make a split-second decision to jump off a cliff to save themselves from a charging saber-toothed tiger. Jumping off a cliff may look crazy. But in fact, this impulsive act, or what some might call a gut instinct, is a split-second calculation based on the odds of survival. After all, a possible broken limb is better than being mauled to death. That quick reaction may be your only real chance of survival.
Today, in these turbulent times of economic, social and technological transition, the ADHD adventurer’s moment has come again, and you will meet many who are finding new frontiers as they travel, explore and discover.
These next pages will challenge the standard view that individuals must suppress their adventurous natures and attempt to squeeze into our ever-narrowing definition of what is defined as normal by focusing on the many positives of a condition that, for many, has contributed to the unique position they hold in the world today. We need to recognize, embrace and skillfully use the best of this ADHD trait, not manage or stifle or “normalize” the very qualities that could define our next generation’s leaders.
This book explodes the myth that ADHD is a problem that needs to be fixed. Of course, many do struggle with the “symptoms,” and need treatment. Yes, there is a flip side to some of these strengths in the absence of self-awareness and the use of certain strategies to overcome the weaknesses. But for too long, educators and mental health experts have been overdiagnosing and overprescribing to the detriment of our nation’s children. It’s a fact that’s only just beginning to get recognition from former proponents of stimulant use among members of the medical community.
In the spring of 2014, Dr. Keith Conners, who was among the first physicians to legitimize ADHD as a diagnosis, called our surging diagnosis and prescription rates “a national disaster of dangerous proportions.”
ADHD diagnoses have been climbing exponentially. Statistics vary depending on which study you cite, but in the United States the National Center for Health Statistics reports that 6.4 million American kids (11 percent) ages three through seventeen have been diagnosed. Even more disturbing is the number of children now on medication for ADHD: 3.5 million; up from 600,000 in 1990, according to the Centers for Disease Control and Prevention (CDC).
“The numbers make it look like an epidemic,” Dr. Conners told the New York Times. “Well, it’s not. It’s preposterous. This is a concoction to justify the giving out of medications at unprecedented and unjustifiable levels.”
“Honor dies where conflict of interest lies,” says Dr. Allen Frances, a professor emeritus at Duke University and the former chairman of the DSM-IV Task Force (DSM referring to Diagnostic and Statistical Manual of Mental Disorders, which you will be hearing more about in the coming pages). Dr. Frances, one of the most respected experts in this field, has expressed his outrage at how closely tied the so-called thought leaders in ADHD are to Big Pharma, and has become an outspoken critic of this trend to overdiagnose and medicate even toddlers, which he aptly calls “reckless.”
Interestingly, the state-by-state variability ranges from 5.6 percent in Nevada to 15.6 percent in North Carolina. What does that say about the validity of a diagnosis? Why do three times more kids in North Carolina have ADHD than in Nevada? Is it the water, or is the desert a cure? Even more stark is the comparison with the United Kingdom, where the average diagnosis rate is less than 2 percent. Or France, where the percentage of kids diagnosed and medicated for ADHD is less than 0.5 percent!
This profound discrepancy is fueled by Big Pharma, overworked teachers, psychiatrists, stressed-out parents, a pop-a-pill mentality and our microwave culture. In a highly competitive environment where it pays to conform and be “normal,” there’s an unhealthy tendency for parents, doctors and educators to identify something as a problem in the hopes of finding a cure.
ADHD wasn’t even recognized as a condition until 1980, much less treated, but it’s since become one of the most searched terms on the Internet, more than sex and death (but, interestingly, below Twitter, Facebook and Google). When college students are abusing drugs like Ritalin to ace tests and one of the hottest stories in sports involves suspensions of NFL players doping with stimulants, and kids in middle school aren’t allowed in class unless they take their medication, something is seriously wrong.
It’s time to say the pendulum has swung too far and must head the other way. Look, I’m not suggesting that in severe cases treatment for ADHD is not indicated, but do more than one in ten kids really merit the diagnosis? What’s needed is a drastic shift in the way we diagnose, view and handle what is more of a distinctive personality type than a debilitating psychological condition. We need to understand that ADHD isn’t just something that flicks on and off like a switch. It exists along a continuum, on a scale from 1 to 10, and only a few with the diagnosis have symptoms that are severe enough to merit the highest ratings of 9, 10 or 10+ and hence require medication, but as a last resort—not first. For most, all it takes is awareness and a few simple adjustments to leverage this trait into your greatest strength.
I am going to give you the tools and information to turn back this tide. As parents, children, teens and adults with ADHD, you deserve a brand-new perspective about this diagnosis, as well as a range of prescriptions (not pills) to help you or your loved one identify the many strengths of this trait. By the end of this book, you will be able to develop a life’s path that fits, and enhance the best of ADHD to maximize potential in school, career, relationships and life.
Part I will define ADHD, its history, genetics and pathology, put it into historical context and speculate on the many extraordinary figures throughout the ages, such as Christopher Columbus, Leonardo da Vinci, Mozart, Eleanor Roosevelt, Virginia Woolf and Benjamin Franklin, who probably had this trait in abundance. It will examine the effect an ADHD diagnosis has on a child, and propose innovative and practical ways to harness their potential with descriptions of progressive academic programs that could serve as a blueprint for educators and parents.
There will also be a quiz to help you determine where you, or your child, sit on the ADHD continuum, and data that describes how ADHD typically manifests according to age group.
This section will also discuss when treatment may be needed and those last-resort instances when it’s appropriate to medicate, with strong caveats about the potential side effects, the tendency to overmedicate and the abuse of these stimulant drugs. It will also offer some alternative methods that, instead of suppressing the strengths, improve the focus and calm necessary to maximize them—including, but not limited to, mindfulness practice, strategies on how to study, how to kick into hyperfocus mode and the beneficial effects of exercise. Diet will also be addressed, but not in a way most would expect. You are not necessarily what you eat!
Part II will focus on the many advantages of ADHD, using success stories from all walks of life, from real people with everyday jobs all the way to high-profile celebrities, doctors, lawyers, athletes, CEOs and entrepreneurs—to highlight these strengths. Conversations with everyone from small-business owners to business moguls will illuminate how nonlinear thinking can spawn entire industries, and a low boredom threshold can lead to multiple interconnected businesses that make up a multibillion-dollar commercial empire.
It’s worth noting here that the vast majority of people interviewed for this book were more than happy to be on the record and share their stories with the world. This is striking, because for most books in the mental health field it’s almost impossible to reveal identities due to stigma. The interviewees’ eagerness to fully participate shows that a positive shift in perceptions has begun, helped in part by the high-profile celebrities, athletes and businesspeople who have publicly embraced their diagnoses. The New York Times has also done some stellar reporting over the past two years, putting misunderstandings about ADHD and its overmedication in the spotlight. The Times’ coverage has doubtless helped to raise awareness and change attitudes toward the diagnosis. But make no mistake, the stigma still exists, and can affect perceptions in certain career fields, which is why a small handful of our interview subjects requested anonymity.
Part III will illustrate how these strengths can be leveraged in entrepreneurship, athletics and relationships. It will end with the best advice gleaned from the scores of successful ADHDers on the best way to find your fit. Because, more than most people, those with ADHD must have passion to be truly engaged and stimulated by their life’s work.
Because there is no one-size-fits-all tool for a trait that has many individual variables, we have laced this book with dozens of inspirational stories. Men and women of all ages and backgrounds have experiences and insights to share, from Christopher Lauer, the young German politician who stands on the podium and, with little to no preparation, gives some of the most rousing speeches of any Berlin public figure, to fashion designer Kelly Dooley, the consummate multitasker whose brand has become a cult favorite among celebrities. You will meet business moguls and athletes, like NFL quarterback Dave Krieg, one of the most prolific passers in NFL history. And middle school teachers, like Tichelle Harris, who switched from a career in banking to teach and transform the lives of underserved kids, doing all that she can to inspire other young ADHDers like herself, who might not otherwise get the mentoring they need inside the public education system.
Each of these ADHDers has a life and career story as unique as their fingerprints, having carved out jobs and businesses for themselves that are as fascinating as they are unconventional and unexpected. But the one thing they all have in common is a tool kit with specific and practical tips. In their self-awareness, developed through life experience, research or with the support of understanding and educated family members and partners, they have come up with ways that work for them to manage their time, recharge, refocus and follow through. Their particular tools may not work for everyone, but they will inspire you to assemble your own kit to better leverage the strengths of the ADHD trait.
Entrepreneur Shane Jordan, for example, who owns a thriving chain of computer repair shops, talks about how the singular focus of riding his motorbike or landing a plane—his two favorite hobbies—creates a stillness and calm in his mind that’s as good as a week’s vacation on a beach for someone without ADHD. Trade show and real estate CEO Kenneth “Bucky” Buckman shares how he manages his high energy by listening to his body, which shuts down every six months or so and forces him to rest, so that he can power up again for the next business challenge. Home decorating start-up owner Anita Erickson filters out the distraction of all the thoughts running through her brain by writing them down on lists. The simple act of writing it down helps her to mentally de-clutter, so that she can focus on the main priorities of her day.
Where applicable, we will include these takeaways, to help those with the diagnosis, as well as their family members, spouses, teachers and peers, better leverage their strengths. Specific and practical information will be offered, in quick bullet points, at the end of the relevant chapters, the better to suit fast minds eager to get to the point!
But by far the most important takeaway from the book is that there is a vast world of possibility out there for people with the ADHD trait. The key to a successful life because of, not in spite of, ADHD is acceptance. Be proud of who you are and recognize that your unique combination of genetics, brain chemistry and personality could land you in the pages of history. No, your brain does not work like a “normal” brain. So what? It’s a matter of leveraging its characteristics as strengths, choosing the right career and education path and maintaining an awareness of what works, without struggling to try to fit into a box that teachers, family, peers and the rest of society call “normal.” ADHD is not a disorder; it’s a difference that, in the right context and with a set of customized tools, can help you or your child become one of life’s explorers, leaders, inventors or entrepreneurs. This trait is precisely what can give you the edge. It’s your distinct advantage, so go ahead, embrace it!
I should know. I am a psychiatrist with ADHD and, no, I have never taken medication for it. Instead, I’ve stayed busy, leveraging my restless nature and innate curiosity to establish a thriving practice, develop multiple successful psychiatric programs and launch several successful businesses and author a New York Times best seller, Better Than Normal.
Interestingly, I did not even realize I was an ADHDer until I wrote the Better Than Normal chapter on ADHD. (Physicians aren’t always the best at self-diagnosis.) The more I delved into the research, the more I recognized myself, and the many ways I had instinctively leveraged the strengths of this trait over the years. The revelation was transformative, and bringing more consciousness to everything I do has greatly enhanced my life. Sure, I need to work around certain aspects of this trait: I’m easily bored, get distracted and linear thinking does not come naturally. But I’ve learned alternative ways of achieving my goals that in the end are so much easier for me, and today I consider the ADHD trait my greatest gift.
PART I
Exploding the Myth
CHAPTER ONE
Born This Way
When Extreme Home Makeover star Ty Pennington was attending grade school in Atlanta, Georgia, his teachers didn’t know what to do with him. It was so bad that, when his mother, who was studying to be a child psychologist, asked the school principal to let her observe the school’s ten “most challenging children” in the classroom, he replied, “Mrs. Pennington, I don’t think you want to see this.”
Within the twenty minutes his mother watched her son from behind the door, Ty tried to climb out the window, swung from the blinds, slapped his classmates on the back of their heads, stripped off most of his clothes and rode his desk around the room as if it were a jeep. It wasn’t that he was trying to be a bully. He just needed an outlet for all his pent-up energy, and the extra attention was an added bonus.
“To call me distracting would be an understatement,” he shared with me. “I got so bored and far behind what was being taught that I found my entertainment by entertaining the class.”
Class Clown
But he suffered for it. Moving from school to school, getting his butt kicked at recess, he gained a reputation for being “a certain type of kid.” He became so well known for his boisterous conduct that by the time he hit middle school, his teachers had him permanently sitting in the hallway. It wasn’t until his family moved to the suburbs and Ty started at a new school where he wasn’t known that his grades started to improve. A new environment and stimuli alleviated his boredom, which in turn helped him focus more. It worked for a while, until the novelty wore off and he began earning the same reputation again.
This was during the seventies, long before ADD or ADHD even existed as a diagnosis, so Ty suffered the pain of not knowing why he was different. He was simply branded a “problem child.” Like a multitude of others, his early school experience was tortuous and demoralizing. The H in his ADHD—Hyperactivity—was especially pronounced. No one, with the exception of his more enlightened mother, believed he would become a success in life. No one else was interested in making sure he got an education. Instead, they put him on antihistamines to keep him drowsy and under control while they focused on teaching the kids in class they deemed “worthy, with a future.”
Ty’s self-esteem took a beating. He was the kid who couldn’t be trusted not to burn down the house if he was left alone. But as he got older, he saw a glimmer of hope. He took up soccer, which channeled all that extra energy and built up his self-confidence.
“All of a sudden it came together and I could read the field. I went from sitting on the bench to scoring hat tricks repeatedly in a game,” he says.
Learning to Learn
After his first year in college, Ty was finally diagnosed with ADHD, and the knowledge that his brain was different from others’ helped him to see that he was not necessarily a bad kid, or less capable than his peers. The diagnosis was a shock at first.
“It was not what I wanted to hear at that age,” he told me. “I was going through a lot, questioning my parents, authority, the meaning of life. . . . And then to find out I had a mental difference. It was rough.”
But his doctor, who also had ADHD, helped Ty to recognize his strengths. This newfound self-awareness was also a relief. He finally understood why he couldn’t retain anything he’d read and the words were just a blur. A visual thinker, he’d draw, and those visual cues would remind him of the answers in class. He’d been sketching some macabre scenes of wagons drawn by rats, carrying giant severed fingers—scenes that had him sent to the therapist’s office. But his therapist told him he had a gift, which gave Ty the courage to work full-time as a carpenter to put himself through art school, where he excelled.
There were a few years of house painting and modeling to pay the bills before he made it in show business and became a household name. Ty was anything but an overnight success. He modeled for J.Crew and Swatch, and appeared on television spots for Macy’s and Levi’s. Then he started doing set designs in Hollywood. But when he was eventually approached to be on Trading Spaces, Ty knew he’d found his niche.
“They needed someone like me—slightly sarcastic, knows his way around a building site—so I went on an audition and got a job being myself. I was blown away!”
Finding His Fit
Then came Extreme Home Makeover, which was originally intended to be no more than a thirteen-part series. When the producers asked him if he could build a house from top to bottom in just seven days, Ty laughed and told them:
“It’d make for a hell of a show, but you’d have to be nuts to try.”
Or if not nuts, at least have some of the advantages of ADHD. Rebuilding a home top to bottom, inside and out, in just seven days would leverage every single ADHD strength he had: multitasking, risk-taking, physical and mental energy, calm in the middle of chaos, a desire to move quickly from one thing to the next, as well as the ability to see the whole and all the moving parts of a project, and how they relate to one another. Throughout each project, he could remain hyperfocused because he was passionate about the project and loved the thrill. The pressure of having to do all that work within a tight time frame also stimulated his ADHD brain and left him with no time for boredom.
“It was as if the job created itself for me,” he says.
Today, Ty is the perfect poster boy for ADHD. He even wears a T-shirt that reads OMFG ADHD, and named his home décor business Art Design Home Décor (ADHD), ingeniously co-opting the diagnosis as his brand. This is a man whose enthusiasm is infectious, and his high energy and optimism are among the very attributes that can turn ADHD into such a powerful advantage. He not only accepts, he embraces ADHD strengths as a part of who he is and the success he enjoys today. Although it wasn’t always apparent to him that it was a blessing to be born this way, he now wears the ADHD label with pride.
Poster Child
Ty took the time to speak with me despite multiple projects on the go, including, incidentally, filming a public service announcement on ADHD awareness immediately after our phone interview. But ADHD advocate is just one of dozens of roles the Emmy-winning television star plays in a career that includes actor, entrepreneur, producer, writer, author, furniture manufacturer, artist and philanthropist. Through his chosen career, or I should say careers, Ty could not have found better outlets for his high energy, intense enthusiasm and curiosity, combined with a restless nature and low boredom threshold.
His is one of many success stories you will read about in these next pages. Instinctively, Ty has figured out how to leverage his traits into a stellar career that is uniquely suited to the way his brain is wired. By going public with ADHD, Ty also sets a great example, proving that you don’t have to live inside that box called “normal” in order to make it. In fact, being who he is, allowing his ADHD flag to fly, has enabled him to carve out an extraordinary career path that combines all his passions and strengths and opens him up to a world of possibility.
The lesson here is that the ADHD traits should never be suppressed. ADHD is a natural part of the human condition. Not only is it in the normal range, in many ways it can make us better than normal. No, it’s not innate to everyone; we don’t all jump from idea to idea or embrace spontaneity and risk—that would lead to utter chaos. It takes both so-called normal and ADHD to make the world go ’round. But it’s time to recognize that those with the ADHD trait play a tremendously important role in our society as innovators, explorers, leaders and risk-takers. We need them to shake things up a bit and challenge the status quo.
Of course, it’s not black-and-white. The world isn’t divided up cleanly into those who have it and those who don’t, because not all those who have ADHD possess it to the same degree. Like all psychological traits, it exists along a continuum, on a scale of 1 to 10. I am an 8 and I suspect, although I have not formally assessed him, that Ty is closer to a 10.
That means our brains are wired a little differently from those who fall lower on the trait continuum, and at the end of this chapter I will give you the tool—a quiz—to figure out where you or your loved one lie on the spectrum.
It’s Not a Disorder, It’s a Difference
So what exactly is ADHD? The trait is a combination of brain chemistry and genetics that affect the dopamine transporter gene and its receptors. Simply put, the brain reacts differently to stimulation in someone with an 8 or 9 or 10 on the scale, compared with someone who is calm and well organized or, say, a 1 on the continuum. In effect the risk, the pressure of a deadline, chaos or the possibility that you are about to go off a cliff actually causes a different reaction in those high on the ADHD scale. They actually feel a rush, or euphoria, not the panic, anxiety or dread many would experience who don’t have ADHD. These extreme states actually boost a feel-good response in the brain, which is why many with ADHD appear so focused and functional in the middle of a maelstrom.
I’ll delve more deeply into the science, diagnostics, demographics and terms in the next chapter, but here is a quick qualifier on the difference between ADHD and ADD:
Simply put, ADHD and ADD are exactly the same thing. ADD stands for Attention Deficit Disorder. In its earlier usage there was a modifier specifying either with or without hyperactivity. In 1987 the official diagnosis was changed to ADHD (Attention Deficit Hyperactivity Disorder). Today the most common usage is ADHD, encompassing all the symptoms of inattention, whether you have hyperactivity or not.
Generally speaking, an ADHD diagnosis means you have some of the following tendencies: difficulty focusing or staying on task; inattention to details; inability to sustain attention; trouble listening; disorganization; avoidance of tasks you don’t find interesting; frequently losing things; being easily distracted by external stimuli; and forgetfulness. People with six of these tendencies qualify as having the inattentive part of ADHD, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
The Flip Side
But there’s another way to look at what most in the mental health field like to regard as symptoms. Flip them around and you have the following: an ability to multitask; a propensity to thrive in situations of chaos; creative, nonlinear thinking; an adventurous spirit; a capacity for hyperfocus on something that fascinates you; resilience; high energy; a willingness to take calculated risks; and calmness under pressure.
Fascinating, the way a different lens can affect the view, isn’t it? Suddenly they become strengths, not debilitating weaknesses or character flaws.
One of the things I have noticed from my conversations with successful patients, interviewees and friends who rank highly on the ADHD continuum is that they have excelled precisely because they embrace their so-called symptoms. Perry Sanders, a highly accomplished entertainment lawyer, television producer and commercial real estate entrepreneur, has a classic case of ADHD, but he doesn’t see it as a big deal because this trait has worked so well for him in business that he can’t imagine how it could possibly be labeled a “disorder,” when it is, in fact, the most powerful tool in his box.
“People may not understand how my brain functions and view it as a problem, but it works well for me,” he says.
The same healthy self-regard goes for Ty, who embodies many of the strengths of ADHD and possesses the self-awareness to identify exactly how each aspect of these traits has contributed to his success.
Of course, these are strengths anyone can have. I am not saying that this compendium of characteristics is exclusive to people with ADHD, but in my practice I have seen a striking predominance of these qualities in conjunction with each other. Taken to extremes, or under the wrong circumstances, they can be a problem. Multitasking, for example, might result in an inability to follow one thing through to completion. But they also can be useful, and certainly don’t require us to slap on a diagnosis.
Following are a few of the ADHD advantages as embodied by the examples of various success stories, which I will detail further with research and examples in Part II.
Nonlinear Thinking
Professional photographer and soccer dad Freddie, who is at least a 9 on the ADHD continuum, is a classic example of a nonlinear thinker. His brain is on warp speed, zigzagging from one thought bubble to the next, coming up with some incredibly original and creative ideas in the process. It’s hard to follow for most people, but makes perfect sense to him, and to everyone else with ADHD.
Freddie’s mental agility can also translate into distractibility. He’s a late bloomer who ricocheted from job to job on the most unlinear career path you could imagine, from fighting forest fires on the West Coast, to editing a start-up business magazine in Cambodia, to thought leadership consulting and PR for finance companies in Boston. Freddie found elements of each widely differing job description challenging and fun, but focus and follow-through became a problem, particularly in the corporate, nine-to-five roles. It was only when he discovered his talent for photography that it all came together.
Today, he roams to wherever his eyes and imagination take him, leveraging his nonlinear thought processes into profoundly moving visual images that capture moments in a human face, landscape or street scene that others simply wouldn’t see.
“It’s a way of seeing, using your peripheral vision and being in tune to your environment, and seeing how these seemingly random visual cues come together to tell a story,” he explains.
In other words, each photograph offers a glimpse inside his highly creative, nonlinear ADHD brain.
Impulsivity
The tendency to act quickly, sometimes with little thought, on that flash of insight, intuition or gut feeling, which entertainer Howie Mandel possesses in abundance, gets a bad rap. Most people fear this unpredictable quality and anticipate disastrous consequences. But it can reap huge rewards as well.
No one could ever accuse Howie, the hugely successful comedian, actor, producer, America’s Got Talent judge and game show host, of overthinking. He told me in a recent interview that he never planned on becoming a comedian. In fact, nothing in his life was ever planned.
“Everyone else I knew was charting a path to their future. I wasn’t charting, nor did I have a path,” he says.
But he had plenty of ambition. Howie wanted to become a millionaire, although he wasn’t clear on the specifics. According to the usual standards, he was already doing well before he became a comedian. By the time he was in his early twenties and engaged to be married, his career in carpet and lighting sales was chugging along, albeit with a few bumps, and he was on track to be a business owner with a secure middle- to upper-middle-class lifestyle.
But he was always the jokester. One night, when he and his wife, Terry, were hanging out with friends, one of them suggested he try performing at Yuk Yuk’s, a well-known stand-up venue in Toronto, and with no prior experience in performing, Howie signed up to take the stage on the club’s next amateur night.
The fact that it was a set date, and he was required to have his five-minute stand-up routine all planned out in advance, filled him with dread. Yet, with little preparation, he stood up on that stage, and had the audience in stitches with some filthy dialogue that just came to him, funny voices, and such a completely winning way of interacting with the crowd that he was invited back as a featured act. At first he genuinely didn’t know why they were laughing so hard, and threw his hands up the air, saying, “What, what?” The gesture went down so well it became the signature part of his act, as did his “borderline psychotic” persona, as he puts it. It was the beginning of a passion and obsession that prompted Howie to push further and further beyond the edge.
Within a year, he was on vacation in Los Angeles with Terry and some friends when he decided to go to the famed Comedy Store on amateur night. There he met an acquaintance from the Toronto stand-up circuit, who helped him sign up for a set and introduced him to the executive producer of a comedy game show called Make Me Laugh. He did his Yuk Yuk’s act, with a few more ad-libs, and impressed the producer so much, he was invited to audition for the show.
Howie attributes his greatest comedic successes to his spontaneity. His unique brand of humor is unexpected and out of the blue. “All those things I’ve done on impulse that have turned out great were because of ADHD,” he told me.
One of his most infamous shticks at that time happened completely on impulse. His “Donny the half man, half chicken” routine included placing a latex glove over his head and using the fingers as a cockscomb. One night, out of the blue, he decided to pull the glove farther down on his face, inflating and deflating it by blowing through his nose. The more the fingers rose up and down on top of his head, the more the audience laughed. His absurd comedic sense is a clear example of impulsivity and nonlinear thinking.
A Willingness to Take Risks
Not to be confused with impulsivity, another key attribute of those with ADHD is risk-taking. It means that some thought goes into certain decisions, although they are decisions most people would not dare to make. Another way of putting it is that they have an adventurous spirit.
In the case of Bradley, a truck driver from Texas, that willingness to put everything on the line and take a flying leap into the unknown gave him a career and a livelihood beyond his wildest expectations. Another late bloomer, Bradley, who is forty-seven, had been struggling to find his fit most of his adult life.
“I had five or six kinda careers, all related to driving and operating trucks and heavy equipment, and it all bored me to death,” he says.
He finally fell into long-haul trucking and, while he was good at it and able to hustle the work, the tedium became unbearable. But then he had the chance to drive an oversized load—a specialty kind of transportation that requires escort vehicles, route planning, and a variety of permits depending on the roads and route taken, coupled with the skill to handle a 120,000-pound payload.
Bradley loved the challenge and the fact that you would only have to haul about two loads per month, freeing him to pursue his many other interests. When he looked into it he found there was a need for qualified truckers to haul huge multimillion-dollar electrical control buildings from the factory to locations across the United States, he impulsively decided to go for it. For the first time in his life, Bradley had discovered something that met his need for adventure and that could sustain his interest. So he asked his mother to mortgage her house, and combined his own savings, so that he could buy the specialty tractor-trailer he needed for $250,000.
This was at the start of one of the worst recessions in decades. Other truckers said he was crazy. Without customers, he’d never be able to cover his costs. He saw it differently. Though he barely will admit to having ADHD due to the stigma, he does admit to all the characteristics of the trait. And he saw this as his chance—maybe his only chance—to put those strengths to use. He had to go for it. So he put bids on jobs before he even had the truck, and then farmed them out to other truckers until he had his own vehicle. Within a year he was able to pay his mother back, and now makes a comfortable living for his family, bringing in $30,000 to $60,000 per job. Even better, he now has a reputation as one of the top drivers in the field, getting to pick and choose the best and most challenging deliveries.
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