Presentation / Debate at SimplyWellBeing adult ADHD group meeting: Hammersmith Irish Cultural Centre, 20th March 2011
“Thanks again to Andrew [Lewis] for inviting me to offer a few comments on whether ADHD can have advantages, or should even be seen as a gift, rather than a disorder.
Just to mention that when I talk about “ADHD”, I mean what I usually write as “ADD / ADHD”, because the distinction is important to many people who do not have significant hyperactivity.
It’s now just over a year since I first met Andrew. In that very first meeting, he suggested I give a talk in this Sunday morning group, on ADHD diagnosis and medication. The fact that I’m back now suggests that he does not entirely regret that impulsive decision.
If we look at impulsivity, rather than the other two aspects of ADHD, inattention and hyperactivity, it’s probably easiest to see the potential advantages. Another word for impulsivity is spontaneity, and many people who are the opposite of impulsive, who never do anything unless they have thought through all the possible consequences, often feel oppressed by their lack of spontaneity. People who lack spontaneity may well have mild Asperger syndrome or autistic spectrum conditions.
One interesting thing about ADHD, which Andrew and I have discussed, is that if you look at perhaps the four most prominent US specialists, the psychiatrists Ed Hallowell and John Ratey say that ADHD often, maybe always (1), has advantages of creativity and originality; while the psychologists Russell Barkley and Thom Browne both tend to say that abilities and talents in an individual are separate from ADHD.
Who is right? Despite what Andrew may be going to say, I think this is logically a very difficult question. I really don’t know the answer, and for the moment I’m not convinced that it really matters, as long as the individual person with ADHD is advised that the self-understanding, and possibly treatment, which goes with the diagnosis, tends to free up previously undeveloped abilities and talents. Both sides of this particular debate agree on that.
Hallowell, Ratey, Barkley and Browne are working and writing in the US, and not the UK. There is a reason, I think, why we should perhaps make sure the psychologists’ views are heard over here, maybe even at the expense of the psychiatrists’, at least for a while. And I am speaking as a psychiatrist myself.
The more you stress the advantages of any disorder or condition, the less serious you tend to make it sound. Even before the current climate of financial savings, which is affecting the NHS, public opinion in the UK was very sceptical about ADHD.
The idea that you need assessment by a professional, for a neurodevelopmental condition that is a hidden gift, could sound like an indulgence to many people. I might be wrong though, because diagnosis of dyslexia has increased substantially over the last couple of decades,
despite similar claims.
The idea that you need treatment for a hidden gift, with ADHD medication which can have side effects, and can sometimes be abused, will probably sound like “enhancement” rather than “treatment” to many sceptics. I am not at all sure that the UK is ready to allow psychological enhancement with Ritalin right now.
Again, I might be wrong, and it could be that concerns of this kind motivate the better development of non-medication-based approaches, as well as medications other than Ritalin.
But for the moment I will stick to talking about treatment of a “disorder” rather than a “diversity” or even a “condition”, and leave it up to my patients to decide whether the gifts that their ADHD has been holding back, are part of their ADHD or not.”
(1) I think they lean towards “always” rather than “often”. But they are not fully explicit on this: see Delivered from Distraction (2005), pages 5 and 14-15
A recent study from Sweden, published in the British Journal of Psychiatry (1), appears to confirm a link between high ability and bipolar disorder. Over seven hundred thousand teenagers were followed up to see if they were admitted to psychiatric hospital in their twenties and thirties. Then their school examination grades at 16 years were compared with those of the other students who had not developed such severe mental and behavioural problems.
The adults with bipolar disorder had done better in exams as teenagers, especially in humanities subjects such as Swedish and History (but not Art). Those who had been good at Sport seemed to have a lower chance of developing bipolar disorder later.
This is an interesting study which is in keeping with the suggested link between bipolar disorder and creative ability. However, it does not mention the possibility that adult ADD / ADHD, which also can sometimes lead to hospital admission, may have been the real problem in many cases. Like much research of this kind, the diagnosis was made a long time ago (1988 – 1997), when there was even more scepticism about adult ADD / ADHD than there is now (2).
(1) Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. http://bjp.rcpsych.org/cgi/content/abstract/196/2/109
(2) For an example of how creative ability may be linked to ADD / ADHD, see my Blog piece on Vincent Van Gogh: https://drnmblog.wordpress.com/2010/02/05/vincent-van-gogh-did-he-have-add-adhd/