Every year around this back-to-school time, mainstream media feels obligated to run articles about ADHD; this past week it was The New York Times’ turn.
In a gentle, well-meaning explainer titled How A.D.H.D. Changes as You Age that starts out with a Southern California family where both the kids and the parents have been diagnosed with ADHD, it lays out the standard story with a small tweak from a recent study: little kids are hyperactive, but as they progress in school they become “inattentive” and, eventually, either “grow out of it” or, as adults, have a bit of both hyperactivity and inattentiveness.
I’ve been in the middle of this “What is ADHD?” maelstrom for the better part of 45 years, from running the Hunter School for ADHD kids in the 1980s to having published a bunch of books and lecturing all over the world on my Hunter/Farmer hypothesis. So, when I read this article in the Times, the sentence that jumped out at me about a third of the way into it was:
“As children age and start to have more responsibilities and expectations at school, inattentive symptoms become more prevalent, and ultimately more persistent.”
While the article doesn’t mention my work or the controversy, it basically says the same thing I’ve been saying for decades but apparently without realizing it: the kid didn’t change; he just got handed a bigger pile of Farmer’s work. Every year of school involves more rules, more sitting, more worksheets and tests, and more postponed gratification. All of which he’s trying to avoid because it hurts.
Michelle Martel, a psychology professor at the University of Kentucky, was the paper’s expert for this article, and she noted that, basically, children struggle more with inattention in a structured school environment where they’re expected to do things they’d rather not, and the “symptoms” of ADHD “improve” in adulthood (or even college) when a person can find a job that suits their Hunter temperament.
After Dr. James Swanson at UC Irvine added that trouble at home can make things worse, a few paragraphs later the article points out that this reflects “mounting evidence that people’s environments can influence their symptoms.”
Yeah, like I’ve been saying since I published my monograph on the hyperkinetic syndrome in the 1981 Journal of Orthomolecular Psychiatry. (That was before I’d developed the Hunter in a Farmer’s World concept, and had spent time with Ben Feingold so we were testing his diet out, but even then I noted that our rural setting, lack of television, use of horseback therapy, and a structured environment all seemed to ameliorate symptoms.)
The study the Times cites was published in the American Journal of Psychiatry that was a 2021 analysis from the Multimodal Treatment Study of ADHD, the big NIMH project that followed several hundred kids diagnosed in the late 1990s from early childhood into their mid-twenties.
They found that only about 9 percent of ADHD kids ever reached what the researchers referred to as a “sustained recovery” from the condition, while about 10 percent were full-blown ADHD no matter what. And the great majority — about two-thirds of the kids — fluctuated in and out of diagnosability (sometimes multiple times over the 16 years of the study) with a swing of six or seven symptoms between their least-ADHD and worst-ADHD stretches.
If ADHD was a fixed “brain defect,” you’d expect to find a fixed picture of symptoms over both time and changing circumstances. But the most amazing part of that study published in Clinical Psychiatry wasn’t mentioned by the Times: that for most of these young people their symptoms receded or were “in remission” when they were living/working in situations that had what they called “higher environmental demands.”
Not lower, higher. Living on their own, holding a job, paying their bills, raising kids: these things seem to have made their ADHD symptoms vanish:
“During remission periods, individuals with ADHD successfully manage increased demands and responsibilities.”
In other words, as life gets harder, as people face more varied and interesting challenges from rent check to a baby, the symptoms often go quiet. But, as you could easily predict, put that person back into a fluorescent-lit and boring classroom and those symptoms would come roaring back.
This has been my lived experience. For 23 years now, I’ve walked into a studio every weekday and done three hours of live radio, five days a week, and never once had trouble concentrating on it because every microphone, every camera-change, every caller, every breaking story is a new “rustle in the brush” that alerts and gratifies my Hunter instincts.
When I get home and have to deal with a massive stack of emails and the details of the radio/TV business, however, my mind starts to wander. Same brain, same day; the only thing that changes was whether the job at hand was a hunt or a harvest. Hunter work or Farmer work.
When Louise and I ran that residential treatment program and school back in the 1980s, kids who were called “unmanageable” in the referring classrooms could spend all day building a shelter in the woods without once being told to calm down or sit still. Same brain, different environment.
The Times article also correctly noted that hyperactivity in adults tends to “go underground.” The CDC says much the same thing.
That’s not the Hunter’s brain changing: it’s the result of either finding appropriate work (a good outcome) or decades of harassment for being who they are that’s taught them to hide their “symptoms” (a less-than-good outcome). The Farmers then write it up as “maturation” and congratulate the patient on having “outgrown” their ADHD.
There’s a broader body of work that underpins much of this. In a 2016 study based on that same MTA cohort, researchers found that the young adults who were tracked all those years repeatedly reported that when they found themselves with fast-paced, demanding, stimulating jobs they were most successful, and struggled the most with the slow, repetitive work. A meta-analysis the same year found the same thing; the symptoms changed based on the environment, not because the child or adult had aged or was suddenly “fixed.”
Hunters can thrive, in other words, in a hunting-like environment, but ask them to become Farmers and they’ll crash and burn whether they’re five years old or fifty.
A psychiatrist who’s spent years running an ADHD evaluation practice and is a regular in the comments section here, Ron Sterling made a version of this same point in a reader comment to the Times that they chose not to publish. Using lactose intolerance (something I also have, so can easily understand) as his metaphor, he points out that you don’t have symptoms until somebody hands you a glass of milk and you down it. Then, suddenly, you have “symptoms”!
He prefers “planner-adventurer” to Hunter/Farmer and focuses on working memory rather than my evolutionary story, but we’re both ending up largely in the same place: the symptoms only show up in a challenging environment that doesn’t match the abilities of the person being studied.
And, to be fair, this Times article is a real improvement over what the establishment was saying eighteen months ago.
When Paul Tough’s magazine piece pointed out that ADHD symptoms wax and wane with changes in a person’s circumstances, Psychiatric Times ran a rebuttal scolding him, reminding everyone that diabetes doesn’t go away on summer vacation. Now the Times’ own health desk is telling us all that ADHD symptoms track classroom, work, and life demands, and is quoting tenured professors saying so.
Where the Times article fails is not pointing out that if the symptoms change based on the child’s setting, perhaps what we’re all measuring isn’t dysfunction or disease, but a simple mismatch between neurochemistry/brain-wiring and environment.
The clear next step is for us to help Hunters, particularly Hunter kids, to find the things in their world and work that feel like the hunt, things with urgency, novelty, movement, and a personally meaningful outcome. Look for those situations and circumstances (and even teachers and subjects) where the symptoms “go away” and focus on and learn from those.
Instead of teaching Hunters to be good Farmers, we should be helping them find their own hunting grounds where they can both succeed and, as adults, prosper.
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Project Based Learning, PBL, is a very good way to let ADHD, and all students, follow their interests, and in so doing, make real discoveries and contributions, as well as not forgetting the academics learned, for they were woven into the study and shaped contribution OF their work.
Temple Grandin also advises to get all students off their phones and computers, with early exposure to all sorts of activities and interests out in the world. This helps them follow their drive to learn, and retain what learned, this a perfect approach for the challenge-seeking ADHD individuals.
Grandin: "Visual Thinking, The Hidden Gifts of People Who Think in Pictures, Patterns, and Abstractions."