Welcome to the first in a series of lessons called Clueless, designed for anyone aspiring to say something entirely wrong about ADHD. This is a public service I offer to ADHD non-believers whose baseless assertions are the fodder for this column. Without rampant misinformation, the Internet has less need for this blog.
The New York Times and Forbes Online have been particularly rich sources of distortion and error recently, and I am particularly indebted to them for the idea for this and several upcoming posts. Let’s begin!
Clueless #101: Make ADHD sound like a mostly excellent thing to have!
There are many variations on this theme. Last week, Forbes published a column by Dr. Dale Archer, a psychiatrist with 25 years of experience that articulated this myth better than I could hope to:
“It’s time we recognize that, with the right skills training, education and awareness, some of the most common traits of ADHD – restlessness, curiosity, resilience, an innate sense of adventure, and the ability to multitask—can be successfully leveraged as strengths.”
The thought that ADHD is a mixed blessing, a mere foible, a nuisance that is ultimately benign, sometimes even heartwarming in the end is at the center of the ADHD-is-not-a-disorder argument. If it has both pluses and minuses, then it’s just a redeemable characteristic, like the wiry kid who couldn’t make the football team, but then finds redemption playing lacrosse.
There are problems with this assertion that can be summed up like so: every single word is wrong. Follow me through these words. (That’s my emphasis in the quote above and the paragraphs below.)
‘Skill training’ and ‘education’ in the habits of success have been shown not to help ADHD children. In adults, cognitive behavioral therapy has been shown to reduce deficits but not to create strengths. The method of the proposed solution doesn’t work.
‘Awareness’ is specifically what people with ADHD measurably lack. Just how are we supposed to leverage lack of awareness to gain greater awareness?
‘Restlessness’ is energy without a target and is definitely not a strength. It limits participation and social engagement. Ever see anybody practicing their restlessness for a big project or social event? Any restlessness coaches out there who can help chase away our inner peace?
‘Curiosity’ has nothing to do with ADHD. Some have it and some don’t, just like the non-ADHD crowd. The good doctor just made this up. Same with ‘innate sense of adventure’ and ‘resilience’. Actually, anxiety, fear and PTSD–the polar opposites of adventurousness and resilience–are more common in ADHD than in the non-affected population.
Dr. Archer referenced this 2011 study to support his claim of ADHD ‘resiliency’, but neglected to reference this one from 2013 that refuted it. Oops.
Finally, he invoked the myth that people with ADHD are good at multi-tasking. This oft-repeated claim results from people with ADHD who jump from one task to another saying that this is a good way to get things done. It ignores the findings of experts in efficiency and executive function who find it highly inefficient. Juggling tasks isn’t a strength, but completing them is. This would be a good topic for a future lesson in clueless.
So there you have it. Making ADHD sound quirky but useful will require you to ignore tons of actual research as well as make up facts on the fly. We only parsed one sentence, but all the sentences in Dr. Archers’ article are rich in clueless. The whole article is breathtakingly wrong. Forbes set a very high bar hiring a psychiatrist to write it, but don’t be discouraged. I’m convinced that with practice, anyone could write an article of this caliber. Literally. Anyone.
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Physician specializing in diagnosis and management of attention deficit disorders and related conditions.
Attentionality 
Excellent rebuttal, Oren.
What most consumers don’t realize is that sites such as Forbes and, in particular, Psychology Today welcome all columnists, with very little vetting. They get free labor, and the more sensationalist their bent, the more publicity the columnist gets. And of course it draws more people to the site as well. Thus increasing ad revenues.
Forbes, though, actually has a few columnists who have taken on the ADHD-denying whackadoodles.
Now more than ever, news consumers must beware and vet their sources carefully.
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Whackadoodles is a great word, Gina. May I borrow it sometime?
It was shocking to see a psychiatrist echoing popular drivel without even a nod to evidence-based medicine. Few physicians are willing to go on record, in public, without studying some of the recent reviews and meta-analyses. I suspect that he, like Dr. Saul (“ADHD Does Not Exist”) thought more about readership than about the support and care families with ADHD need. OM
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A late follow up….
A freshly minted psychiatrist (from Stanford, where they don’t recognize ADHD) came to our local support/discussion group. And he cited Dale Archer.
Shoot me now.
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Sigh…
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Simple but meaningful
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Great work, Oren.
The idea that individuals with ADHD are more resilient than cognitively average individuals is preposterous. Resilient individuals are able to utilize their skills and strengths to cope and recover from problems and challenges, which may include job loss, financial problems, illness, natural disasters, medical emergencies, divorce or the death of a loved one. Because ADHD individuals already struggle in the areas of personal competence, social competence, family coherence, social support, and personal structure, the additional stress caused from external problems threaten their feeling of well-being and resilience.
Resilience can be fostered and developed. This is an intentional and conscious act on the part of the individual and it takes self-discipline.
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You know Oren, the problem with this debate is that it is too polarised and too rigidly constructed. This is going to be a long post so I will apologise for that in advance.
However I will start with two important comments that are unconventional but vital:
The matter of “positive aspects of ADHD” has turned into a very hot little war of political correctness- but it is one which ignores both the realities of the need to cultivate positive self esteem and the fact that any trait will have a good side and a bad side- and that the sensible person will harness the positive aspects of any fundamental trait they have.
In managing my ADHD, I have come to break it down into a series of traits.
I have used mindfulness training as my primary tool- and that tool gets sharper every time I use it.
While I have identified real remediable pathology under some of those traits (my restlessness and difficulty with alertness were parts of an underlying pain problem) I have also come to see that every trait any of us has has a positive side and a negative side, unless balanced with other traits. My divergent thinking is utterly ingrained, and I am happier to keep it than to lose it. I do have to restrain it though- so that I can be productive. The truth is- in attention terms– my creativity arises from the same mix of traits that manifests as ADHD.
The second idea runs on from that-
I am 52, and have worked as a doctor since I qualified at age 24.
I know perfectly well that the most effective clinicians are the ones who can encourage patients to feel optimistic and positive. Our most powerful medicine is the placebo of our skill which is an antidote to the low self esteem so prevalent in ADHD. We need to have a way of presenting things in a positive way to our patients and to ourselves as ADHD individuals.
On resilience:
I would challenge the idea that anxiety is the antonym of resilience. The real hallmarks of failure of resilience are depression, retreat into self isolation or suicide. The average ADHD person has only got where he got through sheer brute force and persistence. The fact that so many confuse the driven, hyperactive behaviour of the more successful ADDer with chronic hypomania is a side effect of this dynamic.
On traits and diagnostic categories:
The issues I mentioned above are hard to see for the mind that accepts the rigidity and the solidity of the concepts we use to classify and differentiate “mental illness”. There are cautions about this exact hazard in the introduction to DSM IV-tr, but these cautions seem to be forgotten by most clinicians- or to have never been read.
It is instructive to look in detail at the old concepts of ADHD – such as Minimal Brain Dysfunction, and DAMP (a Swedish concept that looks at co-morbid ADHD and coordination problems– a VERY, VERY common co-morbidity. Then you see that there is a degree of arbritrariness in the way we classify mental conditions- and a degree of arbritrariness in the way some elements of the diagnosis are removed and brought back at the whim of the committees that establish these diagnostic boxes.
Personally I found the diagnosis ADHD immensely helpful, as it told me to make my attention the focus of my recovery and I already knew at a subliminal level that the real experts in attention training have been with us all along- in the masters of meditation practices of Buddhism and related movements. Fortunately these techniques have now been operationalised into psychological therapies, such as MBSR, MAPS for ADHD,MCBT, MiCBT
and other less intensive techniques such as ACT (which I would not recommend for ADHD).
So far as unawareness goes:
I was fortunate enough to be taught to meditate by a very senior teacher who recommended that us more restless individuals, or individuals in pain initially practice lying down. I learned a body scanning technique and identified that most of my restlessness was due to chronic pain from postural issues. There has also been a chronic balance problem identified very recently.
However, my meditation training has now progressed to the point where I am a recognised meditation teacher within a Tibetan Buddhist lineage- so my management of my ADHD is now at least tolerably good in terms of stable meditation and mindful, compassionate speech.. (I still have some personal use for stimulants, but that is diminishing).
The mind wandering with lack of self awareness that is characteristic of ADHD is mindlessness, the antonym of mindfulness.
Once we learn to work with the challenges of restlessness- mindfulness is easy to teach even to people with ADHD. Our minds wander so much that initial progress can be vary rapid, and studies in drug addicted patients have (by imaging) demonstrated neuroplastic brain change in programs using 5 minute doses of breath mindfulness to a total dose of 10 hours practice over 8 weeks. (The traits that predispose to drug abuse are identical to the traits that define ADHD).
The practice rapidly improves mindlessness and also the terrible restlessness that most of us have suffered.and in this context the contrast between the way we were and the improvement is an advantage that can encourage much greater enthusiasm for the practice than in other patients. (Another example of the skill of finding and being able to exploit the good side of a problematic trait).
As I said, this is a somewhat unconventional view- but I think it is soundly based on careful observation. I would also suggest that the breadth of the approach I am outlining is a typical manifestation of the way the Attention Difference mind roams around and bumps into interesting facts. Fortunately we can keep the precious attention difference and lose the disorder.
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Au contraire, Andrew. The only people I know who make this a “binary” debate are people with poorly managed ADHD, some of whom see the world in all-or-nothing terms.
One can offer hope to people with ADHD without selling them “**** and shinola.” I do it all the time.
All it takes is a command of the best treatment guidelines, a sense of empathy and compassion, and the ability to communicate both with optimism.
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I think it’s true that some ADD traits can have positive value. It doesn’t mean it’s all la de da. For the trait to be so prevalent suggests it has some survival value. It just doesn’t fit well with modern life, hence the need for chemical support.
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“ADHD traits” are human traits. ADHD requires a preponderance of traits at a significant level, enough to cause impairment.
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P.S. Donna, actually no, there is no evidence that “for the trait to be so prevalent suggests that it has some survival value.”
That’s not how evolution works, though many in the public seem to have that idea.
Yes, sometimes there is “survival of the fittest.” But sometimes genes that actually poorly serve the organism don’t cause death prior to pro-creation. Yes, it can be as simple as that.
With ADHD, we know that sexual activity, on average, starts earlier and with more promiscuity and more unplanned pregnancies.
Perhaps the genes themselves have “survival value,” but that doesn’t mean they necessarily serve their host.
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Shocking News: CHADD or Shire (or both) has named Dale Archer an “ADHD Champion.”
When a grandiosely self-promoting ADHD denier (who has ADHD) peddles snake-oil that hurts ADHD’s public understanding—and gets rewarded with publicity and a rumored $100,000—I just don’t know what to say.
The world is completely upside down.
Vanity and perfidy have won. Honest, compassion, and integrity are the losers.
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Excellent information on ADHD. 5 Stars. By Gregg L. Friedman MD
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