Why the Definition of ADHD is Often a Slippery Thing
Why the Definition of ADHD is Often a Slippery Thing
A dozen people with the same diagnosis each can seem very different in their behaviors, ranging from hyperactive to withdrawn, from forgetful to obsessively hyperfocused…
A boy or young man who has some serious constructive purpose will endure voluntarily a great deal of boredom if he finds that it is necessary by the way. But constructive purposes do not easily form themselves in a boy’s mind if he is living a life of distractions and dissipations, for in that case his thoughts will always be directed towards the next pleasure rather than towards the distant achievement. For all these reasons a genera¬tion that cannot endure boredom will be a generation of little men, of men unduly divorced from the slow process of nature, of men in whom every vital impulse slowly withers, as though they were cut flowers in a vase.
—Bertrand Russell, The Conquest of Happiness
Bill, 37, was diagnosed with ADHD (Attention Deficit Hyperactive Disorder) three years ago and takes Ritalin daily. He’s always been a whirlwind, flying from one thing to another his entire life. He’s flown through three wives, dozens of extramarital affairs, 23 jobs, and four attempts to finish his first year of college.
His IQ was once measured at 147, and another time at 121: he flew through the test the second time.
Bill likes to think on his feet, so much so, in fact, that he’s constantly pacing, and can’t tolerate meetings where he has to sit for more than fifteen minutes at a time. He’s gotten 14 traffic tickets in his life, all but one for speeding, and has been in three spectacular accidents, breaking a total of 11 bones. As a teenager he tried every drug that came by, and still enjoys cigarettes, coffee, and alcohol, although he insists that the only one of the three he’s addicted to is nicotine.
Margie, 29, was diagnosed with ADD last year and also takes Ritalin daily. She’s an attractive woman who’s been happily and faithfully married to the same man since she was 19. She has a degree in English and graduated cum laude, although she will tell you that to do that she had to work twice as hard as anybody else she knows.
She had a study partner through much of college, and leaned heavily on her husband for academic support as well. Her IQ consistently tests around 126, although most of her friends would describe her as “a little bit dingy.” She constantly forgets her car keys, her purse, directions to her destinations, and is always late for meetings or appointments.
She’s quiet, soft-spoken, and her home seems well-organized—until you look in the closets. Few people realize how smart she is, and many hardly even notice her because she so rarely speaks up or draws attention to herself. Many times she’s learned, after the fact and to her dismay, that people thought she didn’t like them or was judging them negatively because she was so withdrawn around them.
Kathy, 47, was diagnosed with ADD three years ago and takes Desoxyn daily. A registered nurse and the mother of four children ages 8 to 16, she’s described by her friends and relatives as “the responsible one.” Kathy can always be counted on to pitch in when things are tough, and her friends and relatives all know it. She’s patient, methodical, and well- organized.
She’s outspoken, and everybody knows exactly where she stands on just about any issue. In the operating theater she is one of the best nurses in the city: totally focused on the job at hand, anticipating the doctor’s needs, monitoring everything around her with a careful and practiced eye that rarely misses a thing. She can keep this pace up for hours at a time.
Bill, Margie, and Kathy are all very individual. If you were to line them up in a row and tell a stranger that they all shared an identical “psychological disorder,” that person would probably protest that you were wrong, that these three are as different as any three random folks off the street.
Yet all three have ADHD, at least by our current definitions.
The definition of ADHD is often a slippery thing. A dozen people with the same diagnosis each can seem very different in their behaviors, ranging from hyperactive to withdrawn, from forgetful to obsessively hyperfocused.
Because of this variability of the different aspects of ADHD, some experts such as Dr. Lynn Weiss have theorized that several subtypes of the condition exist, each manifesting in different ways. This is no doubt true, and even the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual (DSM) has now classified at least three subtypes of ADHD (“Primarily Hyperactive and Impulsive” “Primarily Inattentive” and “Combined Type”); some experts theorize there may be as many as a dozen more.
This variability has also given skeptics ammunition to argue that any condition with such a wide range of symptoms can’t be a real diagnostic category in and of itself. To quote the late Rush Limbaugh, “There is no such thing as ADHD.”
After all, they point out, a schizophrenic is pretty obviously schizophrenic, as is a person who’s manic, or severely depressed. Even the more recently defined and arguably gray-area conditions such as Post Traumatic Stress Disorder (PTSD) and Chronic Fatigue Syndrome (CFS) are rather clear when compared to the spectrum of behaviors various writers and diagnosticians have labeled as being facets of ADHD.
ADHD, however, either because it’s a relatively new category to psychiatry or because it may actually represent a spectrum of subtypes or even different conditions, is a bit harder to nail down.
There are those whose ADHD is hyperactive and expressive: the classic problem-boy in school. And in those whose ADHD is internalized, their days are filled with raging discussions in their own mind but few words ever escape their lips. The ADHD of some people expresses itself as disorganization, whereas for others it’s best observed in their tendency to hyperfocus when charged with stress but to be unfocused or impulsive in ordinary daily circumstances.
So what is this thing called ADHD? Where did it come from?
In my books on the topic I’ve put forth as a primary model the concept of Hunters and Farmers.
ADHD, I argued, is something that was once an adaptive psychological and physiological mechanism providing our hunter/gatherer ancestors with an edge over the world in which they lived.
Their distractability was actually a continual scan for danger or opportunity in the world of the forest or jungle; their sense of doom was a hyper-vigilance that protected them from predators or enemy warriors; their impulsivity eliminated the problem of indecisiveness which could cause them to miss out on a meal if they were busy doing a task while something edible ran by; their seeking out of sensation and risk facilitated their hunt, leading them into areas where food could be found (along with the other predators also attracted by that food).
I originally proposed the Hunter/Farmer model of ADHD merely as a paradigm, a story that children or adults could tell themselves about who they are and where they came from. This would be less disempowering than a medical model that says, “You’re mentally disordered.”
Over the years since I first proposed it, however, a number of scientists have come forth with evidence that there may actually be some (perhaps even much) truth to the notion that ADHD is a vestigial survival mechanism handed down to us from our ancestors.
But it’s also not that simple.
We know, for example, that something very much like ADHD can be caused by some types of illness. The earliest diagnostic category which we now call ADHD was, in fact, a set of behaviors observed among children who had suffered from the brain infection of encephalitis. It was then called Minimal Brain Damage (MBD), later redefined as Minimal Brain Dysfunction as doctors noticed the symptoms among people who’d never had encephalitis. Then finally it was known as Attention Deficit Hyperactive Disorder and its current variations.
There’s also the very real issue of whether a person with a mild case of ADHD has a disorder at all: they may, in fact, be even more functional and successful in many arenas than their peers who don’t have ADHD. While severe ADHD can lead to failure in many aspects of life, even here it may be what causes people like Thomas Edison or Evil Kneevil to be as successful as they can be in particular and limited areas of their lives.
My first three books on ADHD tried to define the symptoms of ADHD, offered a reframing of it into something that could be useful in some context, and shared with people specific strategies for understanding, overcoming, or even using their ADHD to good advantage.
More recently, my work seeks to understand more deeply what this thing we call ADHD is — to explore some ideas about where it came from, and why so many people today are being diagnosed and medicated for it.
You’ll find here a spectrum of theories and ideas ranging from the medical to the metaphysical, from the common-sensical to the esoteric. All are concepts that have (in my opinion, at least) some merit—and none of them totally explain ADHD. Yet each idea offers us a bit wider insight, a broader view, a deeper understanding into this condition which is increasingly becoming part of the average person’s vocabulary.
Keep in mind as you read this site and these newsletters that I’m neither endorsing nor advocating any of these particular points of view: HunterInAFarmersWorld.com is intended as a platform for discussion as much as education.
I continue to believe that the Hunter/Farmer model is probably the best and most accurate explanation for why we have ADHD in our gene pool. I think it offers the most comprehensive insights into what we can do to help people with ADHD succeed in work, school, and relationships, but even that is far from a certainty.
Nonetheless, each of these ideas bears consideration. The more insights we can gain into ADHD and its relation to our lives, and work or school situations, the stronger a grip we can get on the lever of change in our lives.
It may well be that what we’re calling ADHD now will, in ten years, be broken into a dozen other, different categories, many having little or nothing to do with attention, deficits, or disorders. Some of the articles on this site explain not what ADHD is but why we’re seeing it being diagnosed and treated so much. While they may seem synonymous, these different hooks into ADHD represent a significant difference in point of view.
It’s my hope that this website and these articles will stir debate and dialogue about what ADHD is, where it came from, and why so many people are wearing the label. This is an important issue regardless of any individual position, and people advocating different points of view will probably find both ammunition and refutation in the pages on this site.