Last week a psychiatrist writing in The New York Times asked a question the entire industry should have been bringing up for the past 50 years: What if ADHD isn’t really about “attention” at all?
He noted that when brain scientists talk about “attention,” they’re discussing the ability to pick out a relevant signal from all the noise all around us all the time, but that people diagnosed with ADHD mostly do just fine with that.
What Hunters struggle with is what he called “sustained engagement” — keeping focused on something for a long period of time. And, as every Hunter knows, that depends entirely on how interesting the object of that focus is: people with ADHD also have the ability to hyperfocus when something really tickles their attention. Think Thomas Edison trying 10,000 different filaments until he hit one that worked.
And, as the author of that Times article noted, sustained attention requires our brains deciding that it’s worth the effort, which is something entirely different from the ability to have attention at all.
He notes that we used to think that malaria was caused by “bad air” which is what “mal aria” translates to from the Latin/Italian of that day. We kept the word because we became used to it, even when we discovered it was a parasite, and nobody today is treated for malaria by giving them a trip to the countryside, like centuries ago.
Maybe we’re on the verge of the same thing with ADHD. In 1968, the DSM called it a “hyperkinetic reaction of childhood.” Then Canadian psychologist Virginia Douglas ran ADHD kids through a series of tedious lab tasks and argued, in her famous paper “Stop, Look and Listen,” that what was really going on was that the hyperactivity was the consequence of “sustaining attention and controlling impulses.”
In other words, kids were bad at doing boring tasks, so they must have some sort of “deficit” because “normal people” can deal with boredom. The DSM renamed the entire thing Attention Deficit Disorder in 1980, and seven years later they added “hyperactivity” back into the name.
But nowhere in the process did anybody ask how these studies would have turned out if the tasks kids had been given were actually things that mattered to them.
I ran up against this personally when my son was diagnosed with ADHD and told that his brain was disordered. I saw what kind of hurt those words caused him, and also knew that his brain was just fine; it was pretty much just like mine, after all.
So I published my first book on ADHD in 1993 to tell a different story and it’s now — in updated edition — a classic in the field.
In it I described the Hunter as tireless and capable of sustained drives, but only when “hot on the trail” of some goal. That’s what’s called “sustained engagement.”
A Hunter tracking an animal across miles of country doesn’t have an attention problem. But a Hunter sitting through a boring and probably unnecessary meeting about next quarter’s deliverables struggles, just as this author noted in the Times. One of those tasks registers as worth doing and the other one doesn’t.
The essay cites two pieces of research that fit this picture better than the author may realize.
The first is a 1992 experiment by the British psychologist Edmund Sonuga-Barke, who though to give “hyperactive” children a choice between a small reward right now and a bigger one later.
Everybody in the field had always assumed that the kids would grab the small reward in the “now” because they couldn’t handle delayed gratification, but, to his surprise, they only chose the immediate reward when doing so let them get them out of the room sooner. They could wait with no problem, in other words; they just couldn’t stand meaningless waiting.
Anybody who’s ever hunted or fished will recognize that distinction. A Hunter can sit still in the brush or a blind in the forest for hours, because that kind of waiting is full of meaningful information. Every sound and shift in the wind could tell you something about the animal you’re stalking. That’s very much not the case with our schools and workplaces, however.
The second notion he mentioned is my old nemesis Russell Barkley’s idea of “time blindness.” Barkley (often dismissively) describes people with ADHD as living in a narrowed present, an eternal now, where future consequences don’t carry much weight.
But a hunt happens entirely in the present: the animal is either there or it isn’t, and if you can catch it you’ll eat tonight and if you don’t you’ll go hungry..
Farming, on the other hand, is nearly the exact opposite experience. You plant the crops in April and harvest them in October, a process that requires a mind that’s capable of extending the urgency of now into a distant future.
School, mortgages, retirement accounts, and performance reviews almost all exist in Farmer time; when people can’t handle that, we diagnose them as broken.
This problem with the wrong name and the use of terms like “attention” “deficit” and “disorder” also do another, quieter kind of damage. The Times essay points out that people struggle with chronic lateness, boredom, a short fuse, or an inability to start anything without a deadline bearing down on them are often not diagnosed because none of those problems immediately invoke “attention.”
The author is clear that ADHD can cause real impairment and that treatment works; he cites observational research linking medication to lower rates of death, accidents, and substance abuse. I agree, and I’ve never told anyone to throw away a prescription for “Farmer pills” if they’re helping them.
Hunters engage when there’s novelty, when the stakes are real, when feedback is immediate, and when the body is moving. So break big projects into pieces that you can finish today. Invent deadlines and set reminders. And if you’re a parent, try having your kid do their homework in 15-minute slices with play or TV in between.
If this is the conversation you want to be part of, subscribe to Hunter in a Farmer’s World and pass this along to somebody who’s still carrying the wrong label around.
Considering name has changed in the past, I am curious if you and other readers have ideas for what a better new one should be?
Example from off the top of my head:
HTA - High Threshold Attention
I and both of my children are like this. I can focus intensely for a 12-hour stretch if it's on something I am passionate about - as they do. I'm good with projects of limited duration, done in service of a meaningful outcome. We're better when we have a mission.
When I was first diagnosed, I was relieved to know I wasn't alone. Pretty soon, I realized there are very few helpful resources. Medication helped. A few books were a little bit helpful. What ended up helping the most was a certified ADHD coach and a support group run by someone with ADHD - both of whom talked about learning to recognize behavior patterns under certain conditions, at different times of day. The purpose of which was to identify peak operating times in which to attempt to deal with tasks we would typically procrastinate to avoid (right up until completing those tasks became a crisis). Over time, I learned to write everything down. My calendar doesn't tell me what I'm doing tomorrow; it tells me what I did yesterday.