PDF Summary:ADHD 2.0, by John Ratey and Edward Hallowell

Do you often feel distracted, tired, or bored—or do you know someone who does? If so, you or that person may be struggling with Attention Deficit Hyperactivity Disorder (ADHD). In ADHD 2.0, psychiatrist Edward Hallowell and professor of psychiatry John Ratey explain what causes this condition and what it’s like to live with it. They argue that people can succeed and thrive because of—not in spite of—having ADHD.

In this guide, we’ll begin by describing ADHD’s biological causes and its most prominent symptoms. From there, we’ll explore ways to minimize ADHD’s downsides and maximize its benefits, such as finding the right kind of challenge to stay engaged and building a strong support network. Our commentary will provide further insight into what causes ADHD as well as what it’s like to live with the condition.

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• In my next writing project, maybe I could intentionally slow down the pacing and describe every action in detail…

Signs of ADHD

We’ve discussed the strengths and weaknesses of ADHD; if they sound familiar, you might now be wondering whether you or someone you know has it. Hallowell and Ratey clarify that only a mental health professional can diagnose ADHD, but they describe three of its most common signs:

1) Racing, uncontrollable thoughts. People with ADHD have extremely quick minds, coupled with difficulty controlling or directing their thoughts. In other words, their thoughts move much faster than other people’s, but not always in useful ways—they often get stuck in cycles of uncomfortable, anxious, or brooding thoughts.

(Shortform note: A racing mind isn't unique to ADHD—it’s a feature of many conditions, and even neurotypical people sometimes find themselves overwhelmed by rapid, relentless thoughts. Practices to break out of racing thoughts include grounding techniques (deliberately observing and thinking about your present circumstances), a quick bout of intense exercise, and deep breathing exercises.)

2) Underachievement. People with ADHD frequently fall short of what others expect them to achieve. Parents, teachers, and bosses often mistakenly blame such underachievement on a lack of effort or interest. For example, a smart student who consistently underperforms in certain subjects may be struggling with undiagnosed ADHD.

(Shortform note: Often, this underachievement is the result of being “2E”: “twice exceptional.” 2E refers to someone who’s highly intelligent but also has a psychological disorder such as ADHD or autism. Notably, a 2E person’s giftedness often masks their disorder, especially during childhood—they’re smart enough to get through school in spite of their unique difficulties, though they don’t do as well as they could have done. This may explain why, instead of getting the diagnosis and support they need, 2E people (of any age) are often simply accused of laziness or apathy and shamed for not living up to their potential.)

3) General dissatisfaction. People with ADHD often feel that normal, everyday life isn’t “enough”—exciting enough, interesting enough, fulfilling enough, and so on. As a result, they look for ways to enhance or intensify their lives. Sometimes this results in incredible achievements, but it may also result in addiction or dangerous, thrill-seeking behavior.

(Shortform note: ADHD is characterized by chronic boredom and difficulty fitting in with peers, which helps explain why it so frequently leads to dissatisfaction with life. In fact, the authors may be understating how serious this dissatisfaction is: Untreated ADHD can lead to clinical depression.)

Now that we’ve briefly explained what ADHD is, we’ll devote the rest of this guide to explaining how to thrive with this condition. First, we’ll discuss the importance of finding the right kind of challenge to keep an ADHD brain engaged. Next, we’ll explain why social connections are important—and, often, difficult—for people with ADHD. Finally, we’ll explore some strategies for creating an ADHD-friendly lifestyle.

People With ADHD Thrive When Challenged

We’ve explained some strengths and weaknesses that come with ADHD. In this section, we’ll explore how to take advantage of the strengths to accomplish great things.

Hallowell and Ratey note that people with ADHD love a good challenge. Faced with a difficult problem, people with ADHD can enter hyperfocus and often become more productive than their neurotypical peers.

However, it has to be the right kind of challenge: something that engages their interest as well as pushes their limits. For instance, moving heavy rocks might be challenging, but it isn’t interesting—unless they first have to figure out how to move the rocks, which allows them to exercise their natural creativity.

(Shortform note: Enjoying a challenge isn’t unique to ADHD; many people enjoy tackling a task that’s hard enough to be interesting, but not so hard that it feels hopeless. So, what’s the right level of difficulty? In Atomic Habits, James Clear says the ideal challenge is one where you succeed about half of the time. If a challenge is much easier than that, you’ll get bored; if it’s much harder, you’ll get frustrated.)

Tip: Leverage Natural Interests

The authors say that people with ADHD often have a couple of things they’re exceptionally good at or extremely passionate about. These things naturally hold their interest and therefore can be the key to making the most of their ADHD strengths.

For adults with ADHD, finding a job that involves these interests is crucial to their happiness, their sense of fulfillment, and often their financial stability. Their success or failure has less to do with how difficult the job is than with how well it holds their attention. They might find a simple but boring job far more difficult than a complicated but interesting one.

(Shortform note: If you have ADHD, you might find that you struggle at work for reasons that have nothing to do with your ability to do the job. For example, if you struggle with time management and schedules, you’ve likely been branded as unreliable at least once in your career. Similarly, your difficulty concentrating might have given you a reputation for being absentminded or careless, when in reality, the problem is that your job isn’t engaging your interest. Because of struggles like these, people with ADHD tend to switch jobs or get fired more often than their neurotypical peers.)

For children with ADHD, the same principle holds true: They’ll do much better in school if the schoolwork leverages their natural interests. For example, a child with a natural interest in music might find math more interesting if someone explains how much math is involved in music—time signatures, beats and rhythms, how musical notes represent fractions of a measure, and so on.

(Shortform note: If you’re a parent of a child with ADHD, how can you support them in school? It’s not always possible to align schoolwork with your child’s interests, which can make school and especially homework a struggle. It often helps a child with ADHD stay on task if they have a set time and place to do their homework every night. Also, children with ADHD tend to get distracted and frustrated easily, so schedule homework time for when you can be nearby to offer encouragement and guidance as needed. Finally, it’s worth checking what accommodations your child’s school can offer. Some common accommodations include extra time for exams, frequent breaks to get up and move around, and extra help with staying organized.)

However, some people may not even realize what their natural interests are. In that case, the authors suggest they make a list of everything they’re good at and everything they love doing—in particular, they should write down anything they find easy that other people seem to struggle with. That list can become a guide to finding jobs they’ll enjoy and excel at.

(Shortform note: This advice comes with a caveat: ADHD interests are often intense but short-lived. In other words, if you have ADHD, you might write down something you love doing now (say, woodworking), only to find that it no longer holds your interest in a month or a year. Therefore, when making such a list, try to emphasize activities you’ve loved for many years already, since (hopefully) that’s a sign your interest won’t fade anytime soon.)

People With ADHD Need Connection

We’ve discussed the importance of meeting the intellectual needs of people with ADHD; now, we’ll move on to discussing their social and emotional needs. Halloway and Latey say that people with ADHD have a deep-seated need for interpersonal connection—in other words, for love.

The authors emphasize the importance of connection for several reasons. First, people with ADHD often struggle in social situations, which makes it more important for them to nurture the connections they do have. They tend to miss or misunderstand social cues that come naturally to neurotypical people, and they also tend to impulsively interrupt conversations or blurt out inappropriate things. As a result, they find it difficult to fit in, and they may come across as rude or self-centered.

(Shortform note: If you have ADHD, you may find that you struggle to maintain long-lasting bonds with your friends even if you’re able to improve your ability to notice and respond to social cues. This is because people with ADHD often don’t pick up on friendship degradation: when friends drift apart after not speaking to each other for a while. You might still feel just as close to your friends after not speaking to them for several months, or even several years. As a result, you may have tried to connect with someone you haven’t talked to in a long time and been shocked to discover that they no longer considered you a friend.)

Second, people with ADHD tend to carry a lot of trauma, which can lead to lifelong physical and mental health issues—but deep interpersonal connections can undo a lot of that damage and help them live healthy, happy lives. This trauma comes from a lifetime of failed relationships (romantic and otherwise) and lost jobs, as well as shaming, insults, and punishments for not functioning well enough in a neurotypical-dominated world.

(Shortform note: The authors stress the importance of connection in healing from trauma, but they don’t explain why it helps so much. Close relationships provide support and encouragement that helps with healing from trauma as well as reducing stress and improving self-image. Connection with others can even help reduce symptoms of anxiety and depression. In this way, the benefits of connection directly counter many of the effects of trauma.)

Tips for Fostering Connections

People with ADHD need to connect with others, yet they often struggle to do so. To help solve this problem, the authors offer several pieces of advice about how to nurture interpersonal connections.

First, a person with ADHD could choose two close friends and make a point of connecting with them at least once a week. For example, a weekly video chat or movie night could provide the sort of regular human contact that they need to thrive.

(Shortform note: The authors assume that readers already have some close friends to connect with, but that may not be the case. For example, one study showed that in 2004, the average American had zero close friends. In fact, it’s notoriously hard for adults to make friends, and even harder for adults with ADHD. One reliable way for adults to make new friends is to join a group that interests them, where they’ll naturally meet other people who share that interest and interact with them regularly. However, making new friends may also require a certain amount of boldness—to make friends they wouldn’t make otherwise, people may have to accept invitations they’d normally turn down or try making the first move to start a new friendship.)

Second, they could talk to people they know but don’t consider good friends, such as coworkers or the bartender at their favorite bar. While this isn’t as powerful as having deep connections with close friends, a strong network of acquaintances does help them feel seen and appreciated by their local community, increasing their sense of connection.

(Shortform note: The importance of acquaintances is a fairly new discovery. Casual acquaintances weren’t seriously considered in mental health research until 2014, when a series of studies showed the impact they could have on people’s happiness. In short, the more acquaintances you have—and the more frequently you interact with them—the happier you’ll be. This holds true regardless of whether or not you have ADHD.)

Finally, a person with ADHD could consider getting a pet. A friendly animal is a guaranteed source of love and comfort. Therefore, pets can be helpful for someone who needs more connection in their life.

(Shortform note: Research supports the authors’ idea that pets are a good source of connection and love and therefore improve their owners’ mental health. Another potential benefit of owning a pet is having more opportunities to get outside and exercise—going on walks and playing with pets can reduce stress, lower blood pressure, and help you lose weight. Exercise is particularly helpful for people with ADHD for reasons we’ll discuss later in the guide.)

Creating an ADHD-friendly Lifestyle

In this final section, we’ll discuss how people with ADHD can adjust their lifestyles to minimize the downsides of their condition and harness their natural strengths. The three strategies we’ll discuss are establishing structure, prioritizing physical and mental health, and taking medication to relieve ADHD’s negative symptoms.

Establishing Structure

Halloway and Ratey say that structure and schedules help mitigate some of the problems that come with ADHD, especially time management and memory issues. However, people with ADHD tend to resist structure—structure is predictable, and predictability is boring.

(Shortform note: It’s common to feel trapped by structure and routine. For example, putting something into a calendar often makes it feel like something you have to do. Then, you get stuck going from one commitment to the next with no time for rest or spontaneity. Therefore, it may be helpful to remember that a calendar is just a tool, not a prison—it can’t control you or punish you. This is an especially helpful tip if you have ADHD, since people with that condition tend to resist any form of control, commitment, or structure.)

The authors suggest starting small with structure by making daily to-do lists with just two tasks each. Writing those tasks down is a reminder that they’re important, and accomplishing the tasks will provide a quick hit of dopamine, which boosts motivation.

Once someone’s reliably accomplishing their two tasks each day, they can start adding more items to their daily lists and making more detailed schedules as they feel the urge to do so.

(Shortform note: This strategy takes advantage of what Mark Manson (The Subtle Art of Not Giving a F*ck) calls the motivation loop. Manson says many people misunderstand how motivation works—they think motivation has to come first, and it leads to action. However, in reality, motivation and action are a cycle: Motivation can lead to action, but taking action also creates more motivation to keep going. Therefore, by starting with some small action (such as making a to-do list with only two items), people can motivate themselves to keep improving their lives—for instance, by boosting their productivity by gradually adding more to-do list items.)

Healthy Body, Healthy Brain

Hallowell and Ratey say that by taking proper care of their bodies, people with ADHD can mitigate many of their psychological symptoms. Two treatments for ADHD are good sleep habits and regular exercise.

Tip #1: Good Sleep Habits

Halloway and Ratey say that people with ADHD often struggle to get a good night’s sleep, and fatigue makes their symptoms much worse. That’s why it’s crucial for them to make sleep a priority.

(Shortform note: Many of the symptoms of sleep deprivation are almost identical to those of ADHD, which may explain why the two conditions compound each other. As neuroscientist Matthew Walker explains in Why We Sleep, sleep deprivation leads to inattentiveness, difficulty regulating your emotions, and memory loss.)

The authors suggest that people with ADHD set a firm time to be in bed with the lights out. They also give a couple of tips to maximize sleep quality: First, turn off any screens (phone, computer, TV, and so on) to avoid unnecessary stimulation. Second, make the bedroom as dark as possible; light tricks the brain into thinking it’s still daytime, which makes it much harder to get to sleep. Finally, if needed, use air conditioning or open a window to keep the room comfortably cool.

(Shortform note: Turning off screens and making the bedroom dark and cool can all be part of a regular bedtime routine. Having such a routine will get you into the habit of going to bed at the same time each night, as Hallowell and Ratey suggest. Other common practices that the authors don’t suggest here include taking a relaxing bath or shower, stretching to release muscle tension, practicing meditation or deep breathing exercises to quiet your mind, and reading a good book as a calming before-bed activity.)

The authors also recommend a shift in mindset. People with ADHD tend to suffer from the “fear of missing out” (FOMO), but they must recognize that good sleep habits will make them happier than whatever events they’re afraid of missing. This mental shift will help them get to bed on time, rather than staying up late in an attempt to be involved in everything.

The Biology of Sleep Deprivation and Sleep Difficulties for People With ADHD

Staying up late due to the fear of missing out on mood-boosting events may be counterproductive because of the negative effects sleep deprivation can have on mood. Some research suggests that sleep deprivation affects your mood because it makes your amygdala hyperactive. The amygdala is the part of your brain that controls your emotions, meaning you may become more emotional and more sensitive to stressful situations when you’re sleep deprived. Some people report that sleep deprivation not only strengthens their negative feelings like anger and sadness, but it also weakens their positive emotions like joy.

Furthermore, sleep difficulties for people with ADHD aren’t always psychological, like FOMO is; they can be biological as well. If you have ADHD, your natural sleep cycle may start later than neurotypical people’s cycles. In other words, you don’t start feeling tired until later than most people do, and you don’t naturally wake up as early as other people. This can cause a lot of problems if you need to wake up early in the morning for school or work. This is also why darkening the room when you go to bed is so crucial—artificial light makes your brain think the sun is still up, which pushes back your natural sleep cycle even more.

Tip #2: Regular Exercise

Hallowell and Ratey say that regular exercise is a natural way to boost dopamine and norepinephrine levels—the same effect that stimulant medications like Adderall achieve artificially. They recommend at least 20 minutes of exercise a day for maximum effect, but even just a few minutes of vigorous exercise can provide a quick boost to energy and focus.

(Shortform note: In addition to boosting dopamine (associated with motivation) and norepinephrine (associated with focus), regular exercise also boosts levels of serotonin, which is associated with happiness. Together, these three neurotransmitters are highly effective at easing ADHD symptoms. However, maximizing those benefits may take more exercise than the authors suggest—some other experts recommend 30 to 40 minutes of exercise, four to five times a week. There is research supporting the idea that brief bursts of intense exercise can boost concentration in the short term, but the effects last for about an hour at most, meaning that you’ll need to find opportunities to get up and move regularly throughout your day.)

Exercise can even help correct some of the structural differences in an ADHD brain. Remember that the cerebellum tends to be underdeveloped in people with ADHD, which inhibits their emotional control, focus, and coordination, among other things. The cerebellum is highly malleable thanks to a phenomenon called neuroplasticity: the brain’s ability to grow and repair itself. As a result, exercises that train balance and coordination can strengthen the cerebellum, which in turn will help mitigate some symptoms of ADHD.

For example, joining a sports team—which promotes focus and discipline as well as physical strength and coordination—could be an excellent choice for people with ADHD (as long as the sport is something they’re interested in).

(Shortform note: In Behave, neurologist Robert Sapolsky goes into more detail about neuroplasticity. He explains that the brain works like a muscle: The parts of it that get used most often grow bigger and stronger. Neuroplasticity also works in reverse, meaning the parts of the brain that don’t get used as much can become weaker. For people with ADHD, who are naturally impulsive and disinclined to focus on things that don’t interest them, this could mean that they’re making their own symptoms worse by strengthening the impulsive parts of their brains and weakening the thoughtful, rational parts.)

Finally, people with ADHD shouldn’t overlook the importance of exercising their brains. The authors suggest practicing mindfulness meditation, which trains people to observe their own thoughts without reacting to them. Mindfulness is extremely helpful for controlling impulses and quieting a racing mind.

Impulsiveness Versus Mindfulness

Mindfulness is the practice of acknowledging thoughts and sensations without judging them, thereby taking away their power to control your behavior. It means recognizing and identifying experiences but not thinking of them as “good” or “bad.” That, in turn, stops you from trying to chase after good experiences and avoid bad ones. In other words, mindfulness is the practice of acting thoughtfully instead of reacting impulsively.

For example, suppose you start feeling hungry. If you’re an impulsive person, you’ll immediately think of this hunger as “bad” and stop whatever you’re doing to go get something to eat. On the other hand, if you practice mindfulness, you could acknowledge the feeling of hunger without thinking of it as something “bad” you must immediately get rid of by eating. You would first examine that feeling of hunger and determine whether your body really needs food or if something else (boredom, perhaps) is creating the urge to eat.

Also, since mindfulness meditation involves choosing a single thing to focus all of your attention on, it naturally trains you to calm racing thoughts and quiet your mind. Doing so isn’t easy, especially for people with ADHD, so it may take a lot of practice before you can bring your thoughts under control. However, some ADHD experts say that meditation is a highly effective—even crucial—part of treatment.

Medication

According to the authors, medication is often helpful for controlling ADHD symptoms, especially in the short term. ADHD is commonly treated with stimulants like Adderall or Ritalin, which boost alertness and mood. These stimulant medications also help people with ADHD stay calm by reducing their impulsiveness.

(Shortform note: There has been some research into using caffeine—which is much more readily available than prescription stimulants—as a treatment for ADHD. The research shows that caffeine does have some benefits, especially for boosting attentiveness, and consuming it is significantly better than pursuing no treatment. However, other studies suggest that caffeine is significantly less effective than Ritalin at controlling hyperactivity and less effective than Adderall at controlling both hyperactivity and impulsiveness. Furthermore, it’s not advisable to combine caffeine with prescription stimulants, as that increases the risk of side effects like high blood pressure and insomnia.)

There’s a lot of social stigma around ADHD medication. Some people are afraid of addiction—either becoming addicts themselves or having a loved one get addicted to the medication. Others think that the pharmaceutical industry is running a scam to diagnose as many people as possible with ADHD and sell them drugs they don’t need. The authors counter that ADHD medication is proven to be safe and effective, and opposing the use of medication to improve people’s lives is ignorant and cruel.

Addressing Concerns About Diagnosis and Treatment

There may be some merit to people’s concerns about ADHD overdiagnosis. Some studies have suggested that ADHD is overdiagnosed—although, if true, this is the result of errors in diagnosis and not a pharmaceutical industry conspiracy. For example, multiple studies have shown that the youngest students in a class are more likely to be diagnosed with ADHD than their older classmates. This may be because their relative immaturity makes them seem to have ADHD symptoms like inattentiveness and hyperactivity when they’re actually developmentally normal for their age.

Concerns about addiction may also be valid but are possibly overstated. Stimulant medications are known to be addictive when used incorrectly (such as taking too high a dose or using them too often). However, the risk of addiction is minimal so long as the patient has a prescription and takes their medicine only as directed.

Some experts would say the authors downplay the side effects of prescription stimulants like Adderall, especially in young children. Such medicines can delay a child’s growth, cause insomnia, and raise their blood pressure, among other health risks.

Ultimately, if you or your child are diagnosed with ADHD, discuss any concerns about medication with your psychiatrist. Then, you can work together to come up with a treatment plan that’s both effective and safe.