ADHD 2.0 by Edward H. Hallowell, MD and John J. Ratey, MD
A book review.
Posted January 10, 2021
ADHD 2.0 by Edward H. Hallowell, MD and John J. Ratey, MD
A Book Review
25 years ago, as a psychiatrist and Chief Medical Officer of a Harvard teaching hospital, I finally learned that young people did not “grow out” of ADHD (Attention Deficit Hyperactivity Disorder). I discovered, as well, the legion of preventable hardships so many individuals with this condition suffered because they had not been properly diagnosed, thereby not receiving effective treatment. Both in children and adults. I realized the pervasive stigma leveled against adults with ADHD because of their "underachievement" in work. The disruptions in their most important relationships — with family, friends, and intimate relationships — were painful to all involved. And shame corroded their self-esteem and darkened their moods.
I should have known better. As should have so many others.
Then Dr. Edward (Ned) Hallowell, a fellow Boston psychiatrist at the time, published (with Dr. John Ratey) his first book, Driven To Distraction (1994). It became a #1 New York Times bestseller. It opened our eyes and substituted hope for despair. A rocket, also known as Dr. Ned Hallowell, took off; he became, still is, “a game-changer" in the lives of countless people who no longer need to miss the bus to a life replete with sustaining relationships, contribution, and dignity. Bravo!
You need not read through (though you would enjoy and learn from them) Hallowell’s "library" of previous books and medical articles he has written to pick up and read ADHD 2.0. That’s because he is an author who blends his previous work with all that is new into each book he publishes. He writes with clarity and humanity. He gives us scholarly material in everyday English. He is funny too! Both Hallowell and Ratey take ADHD personally and seriously: Because they too have this condition, and clearly are exemplars for making a big and rewarding life with ADHD.
ADHD, they stress right off, can be an invaluable asset in a person’s life. ADHD can be beneficial, in fact, propel success in relationships and business, as well as with professional and artistic achievements. It can generate “out of the box” thinking; high levels of energy, imagination, and creativity; ingenuity; generosity; and keen humor. That’s why we hear from many nationally recognized figures that they have ADHD, and credit it for helping in their successes.
Or ADHD can be a curse, impairing a person in school, work, and relationships. The downside of ADHD includes impulsiveness; impatience, and restlessness; disorganization and the inability to focus (and with that procrastination, often misunderstood to be laziness); and a propensity to overuse drugs and alcohol. Unchecked, these problems can be the reason for a life of “under-achievement” with its shame and regrets.
That is their message to parents whose children have ADHD, to adults with this condition, and their loved ones. This is not a cautionary message, meant to hurt and discourage. Quite the opposite: It is a message of hope because it signals that we each hold the power to shape our fate. “Treatment,” therefore, means the ways we can maximize the dimensions of ADHD that produce success in a person’s life and minimize the problems that foreclose future success and contribution.
How can that be done? To mine the gold "how-to," drawn from ever increasing scientific knowledge of how our brains (neuroscience), bodies, and hearts work. The more scientists and doctors know — and the more each person with ADHD and their family knows — the more "gold" we all will mine.
The new and quite useful concept introduced in this book is “VAST” — Variable Attention Stimulus Trait. What this means to me is that the symptoms or successes we witness in people with ADHD are the manifestations of variable attention. Think about that, because it identifies the path to success; namely, minimize those variations (symptoms) that interfere with a good life, and maximize those that lead to a really good life.
Rapidly increasing neuroscience discoveries have revealed that the cerebellum, located at the base of our brain, occupies 10% of its volume and 75% (!) of its neurons. The cerebellum (in harmony with the inner ear’s vestibular system) has been well known to coordinate our balance and physical movements. But we now also know this part of the brain is instrumental in “balancing” emotions and thinking. The scientific proof, moreover, is that improved cerebellar functioning reduces the negative, unwanted symptoms of ADHD. Wow! – because a set of balance exercises (done anywhere, anytime, and for a few dollars spent on a big ball or balance board) is a highly effective “treatment” to maximize functioning in people with ADHD.
When Hallowell is asked, “What is the most important, the #1, treatment for ADHD?" he says “connection." Read about that in this book because it sounds so counterintuitive until you understand that human connection trumps about everything else in life. Remember Harry Harlow’s infant monkey experiments you read about in "Psych 101," including the old, grainy, B&W pictures and videos? Where the monkeys chose connection to a soft rather than wire "mother surrogate" monkey, even though the latter was the source of their food. And among us humans, what's it that predicts a long and healthy life? (see The Harvard Study of Adult Development, going on since the 1930s). The answer is not fame and fortune, but, rather, enduring and trustworthy relationships. In men, not only women. Connection, attachment, thus is #1 on Hallowell’s “treatment” plan for ADHD.
No discussion about ADHD is complete without considering medications, psychostimulants in particular (like Concerta, Adderall, Ritalin, and the variety of amphetamines, dextroamphetamines, and lisdexamfetamine — all with their brand name and generic preparations). There is a Medication Table starting on page 122 of ADHD 2.0 that provides all you need to know about what is available. I learned some time ago that the psychoactive medications for ADHD have an indisputably immediate and robustly effective action. This is why Dr. Hallowell urges his patients (and readers) to “consider” them. About 80% of patients respond; 20% do not — but that’s an impressive response rate. When asked to rank (1 to 5) “what works for ADHD?” he places medications at #5. He knows they can significantly help a lot of people, even if they are not at the pinnacle of his pantheon of ADHD treatments. Hallowell also is a doctor who appreciates the additive effects of different, safe, and effective mind/body interventions.
There is so much more to be learned from this remarkably clear, personable, digestible, and useful book. And all of it is as commonsense as the examples I provide here. 5% of people in the US (and many other countries), have ADHD/VAST. They are seeking to make a winning life with ADHD. That can be achieved, at far greater rates than now exist.
If it’s the bottom of the 9th, the home team is down by 1 run with one man on base, who do you send to the plate? Hallowell! Once again, Dr. Ned Hallowell, in collaboration here with Dr. John Ratey, has hit the proverbial ball out of the park.
Dr. Lloyd Sederer is a psychiatrist, public health doctor, and writer. His new book (#13) is Ink-Stained For Life.