The ADHD Advantage: What You Thought Was a Diagnosis May Be Your Greatest Strength

ISBN-13: 9780399573453

Media Type: Paperback

Publisher: Penguin Publishing Group

Publication Date: 08-09-2016

Pages: 304

Product Dimensions: 5.20(w) x 7.90(h) x 0.90(d)

Dr. Dale Archer is a medical doctor, a board-certified psychiatrist, and a Distinguished Fellow of the American Psychiatric Association. He also has ADHD and has never used medication to treat it. Currently, he is the medical director for psychiatric services at Lake Charles Memorial Hospital and was appointed by the governor to serve on the Louisiana Medical Advisory Board. A media veteran with more than 800 television appearances to date, Dr. Archer has appeared on most of the top national news shows to talk about various psychological issues related to current events, business, behavioral economics, politics, and more.

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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