ADHD OVERVIEW TOP 10 NEWEST FINDINGS ABOUT ADHD
ANSWERS TO DISTRACTION
NEW QUESTIONS and ANSWERS BY EDWARD HALLOWELL, M.D.
1. Q: It has been several years since the original version of Answers To Distraction came out in 1997. What do you think is the single most important scientific finding about ADD during those years?
A: There are many. If I had to choose one, it would be the follow-up data from the MTA study, the multi-modal treatment assessment study, the largest study ever done on the treatment of ADD in children. Now the subjects in the study have been followed for 8 years. The study shows that positive connections within family and elsewhere make a crucial difference in outcome. While medication makes the biggest difference immediately, as time goes by other factors come significantly into play, including the skill and knowledge of the doctor providing treatment, as well as the positivity of the connections in the life of the child. It is time for us all to take the force of connection in life far more seriously than we have.
2. Q: What single idea have you had in the years since Answers to Distraction was published that you believe is the most significant regarding ADD?
A: I believe it is the “cycle of excellence” that I outlined in my book “The Childhood Roots of Adult Happiness.” It describes a way for ANY child to achieve joy, success, and lifelong satisfaction. While it applies to all children, it is especially relevant to children who have ADD, as they so often struggle.
The cycle is a series of 5 interlocking steps. First is connection. This is the most important. Parents need to make sure their child lives a positively connected childhood. The child needs to feel positively connected at home, at school, on teams, in the neighborhood, and to life in general. This makes a huge difference. Grades matter far less that the feeling of positive connection.
Step 2 is to play. Any activity that engages the imagination qualifies as play. The opposite of play is doing exactly what you are told to do. Children discover what kind of mind they have and what they love about life through play. It is crucial to engage children’s imaginations if they are to become the kind of enthusiastic problem-solvers and life-lovers who excel in this world.
Step 3 is to practice and work. Practice that emerges from play tends to lay down habits of discipline that last.
Step 4 is to make progress and achieve mastery. This step is the great building block of confidence and self-esteem, as well as motivation. Those attitudes predict success and joy in life. They are crucial.
Step 5 is to receive recognition. It does not mean that you win a prize, just that someone you care about—a teacher, teammate, parent—notices the progress you’ve made. This in turn connects you to the person or people who recognize you, thus completing the cycle.
This cycle of excellence works! It is the perfect antidote to the pressure-packed excessively busy and frantic lives many children lead. For kids with ADD, it is a surefire way to build confidence and joy.
3. Q: You said that connection is the key to the cycle of excellence. Can you say more about that?
A: The beauty of connection is that it is readily available and free. Indeed, one of the great discoveries from neuroscience since Answers was originally published is the discovery of so-called “mirror neurons,” neurons that initiate imitation and empathy. It turns out we are wired to connect! Nature has wried into our brains the impulse to connect and join in with another person.
Parents should make sure their kids are connected in many and varied ways: connected to family, school, friends, teams, groups, clubs, nature, special places, activities, pets, the past, and some spiritual connection. Out of that will emerge a positive connection to life and to self.
Connection works magic. All a parent need do is trust it and build it. Create a connected childhood.
4. Q: What evidence is there for the power of connection?
A: There is an enormous body of evidence. To cite just one major study, the National Longitudinal Study of Adolescent Health, commissioned by the federal government after Columbine, looked at some 14,000 children across the country between the ages of 8 and 14. They looked at all the details of these children’s lives, and then they followed them over time.
They looked to see what factors, if any, would protect against kids getting into trouble, defining trouble as violent behavior, school failure, drug or alcohol abuse, depressed or suicidal feelings or gestures, or unwanted pregnancy. The two most salient predictors of which children would stay out of trouble were: 1) feeling of positive connection at home, and 2) feeling of positive connection at school.
Connection saves lives. Disconnection costs lives. The great good news is that connection is free, anyone can have it, and it is in infinite supply. But, parents must work to make sure it happens.
5. Q: How can a parent work to make sure a child is connected?
A: Above all else, enjoy your children! If you enjoy your kids, it is almost certain they feel positively connected to you and the family.Spend time together doing activities you like to do. Eat family dinner. Read aloud. Take walks. Play catch. Sew. Play board games. Watch TV together (no, TV is not poison, just do it in moderation). Turn off electronic devices long enough to converse. Have friends over. Expose your child to as many activities as possible to see what he or she likes. Keep in touch with grandparents. Make time for church, synagogue, or secular discussion of the spiritual aspects of life. Go to ball games, concerts, and have picnics. Visit the police station, the fire station, and the emergency room. Visit museums. Take walks through town. Visit big cities. Take weekends away together, if you can. Have a pet, if you can. Cook together, shop together, go to movies together. To learn more, get my book, “The Childhood Roots of Adult Happiness.”
It’s all fun. Creating a positively connected life is probably the single most positive step you can take as a parent both for your child and for yourself, and it is fun and free.
6. Q: You mentioned the recent discovery of “mirror neurons.” Are people who have ADD deficient in these?
A: Not at all! However, in order to activate the mirror neurons, and the ensuing process of empathy, it is required that you pay attention. This is why people of all ages who have ADD can seem at one minute exquisitely tuned in to the feelings of another person, then at the next minute seem totally tuned out.
7. Q: What advances in the field of medication have taken place since the original version of this book was published?
A: The most important point I’d like to stress is not new, but must be stressed because it is crucial. That is the primary importance of the psychology of medication. The response you get to any medication, ADD medications included of course, is partially determined by how you feel about taking the medication. To get the best response, you should want to take the medication, know that it is safe, like the doctor who is prescribing it, and feel hopeful for a positive result. The way to inculcate these feelings is for the doctor to take the time to educate the patient, and for the patient to take the time to ask all the questions he or she might have. A major reason that a medication fails to work is that the proper emotional conditions have not been created to give the medication its best chance of working well.
Having said that, several new medications have appeared. We professionals had high hopes for one of them, Strattera, because it is not a controlled substance, it does not have many of the side effects the stimulants have, and it did well in early clinical trials. Unfortunately, it has not proven to be as effective as we had hoped. While it is still a fine medication for treating ADD, it is a third or fourth choice.
The long-acting stimulants are now the mainstay of the medication treatment of ADD. These include the long-acting methylphenidate-based medications, like Concerta, Focalin XR, and Ritalin LA, as well as the amphetamine-based medications like Adderall XR and Vyvanse. You should work with your doctor until you find the right dose of the right medication that provides target-symptom relief with no side effects other than appetite suppression without weight loss. This can take some time to achieve, but it is worth taking that time.
8. Q: What other advances would you want to emphasize here?
A: We have made great progress in treating adults with ADD. They remain the single most overlooked group, especially adult women, but we are making progress. Any woman who feels frustrated by her lack of focus and organization should consider ADD as a possibility, especially if it leading her to underachieve in work or have trouble at home.
I have become especially interested in ADD in couples. My wife, Sue Hallowell, herself a therapist, teamed up with me in 2010 to write a book called “Married to Distraction: Restoring Intimacy and Strengthening Your Marriage in an Age of Interruption”
9. Q: How do you help someone of any age who resists the diagnosis of ADD get comfortable with it?
A: I tell them the truth. The truth is that ADD can be a major asset in your life, if you manage it correctly. I tell them about the many fantastically successful men and women I know who have ADD. The only time to be afraid is when you do not know you have ADD. These are the people who get into trouble. Once you know you have it, you can work with someone like me to turn it into an asset, to get on your way to being a champion in life. This is a totally realistic and achievable goal. That’s why making the diagnosis is such good news. Far from being something to fear, it is something to embrace.
10. Q: What is the best analogy you use to describe ADD?
A: Having ADD is like having a race car for a brain, A Ferrari engine for a brain. It will propel you to win many races in your lifetime. However, there is one problem. You have bicycle brakes! So, you need to see a brake specialist, someone like me. Once you get your brakes strengthened, then the race car can win races instead of spinning out on on turns.
To get the best outcome, it is CRUCIAL that you take a positive approach to treatment and that you work with a doctor who can help you do this. I see myself not as someone who treats disorders and disabilities, but as someone who helps people develop their talents and realize their dreams. That kind of positive approach to treatment makes all the difference in the world.