PDF Summary:Driven to Distraction, by Edward M. Hallowell and John J. Ratey

If you or someone you love has ADD, you know what a severe impact it can have on your quality of life—and you probably also know that it can be a huge strength. In Driven to Distraction, Edward M. Hallowell and John J. Ratey explore what we know about attention deficit disorder through the lens of real people who have it. Hallowell, a psychiatrist, and Ratey, a professor of psychology, both specialize in and have ADD.

In our guide, we’ll discuss what ADD is and its symptoms, theories on the possible causes of ADD, and potential treatments. We’ll also examine how our knowledge of ADD has changed since the book’s republication in 2011, as well as tips for how to minimize your negative symptoms and make the most of your strengths.

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(Shortform note: Parents of children with ADHD can help them hone their social skills by modeling such skills for them, discussing how they see these skills being used by characters on TV or in movies, role-playing social situations with them, and giving them immediate feedback on their social behaviors.)

Difficulties in school. People with ADD often struggle with tasks others can do easily, like listening in class or staying organized. Students who struggle with these and other skills required for school are often reprimanded or considered lazy, which can lead to a dislike of school or of learning itself.

(Shortform note: People with ADHD are often very intelligent but do poorly in school because the school structure demands behaviors that are particularly difficult for them. Students with ADHD have a legal right to accommodations designed to help them succeed. Accommodations may include things like extra time on assignments, fidget devices, and frequent breaks.)

Self-doubt. Many people with ADD report feeling like frauds, like they don’t deserve their successes because they should have been able to do better, or like their successes are due to luck or someone else’s hard work. It can often seem like their world is on the brink of collapse at any given moment, and this can lead to feelings of incompetence and inadequacy.

(Shortform note: Self-doubt often manifests as imposter syndrome, which can cause people to doubt their abilities and accomplishments and feel like they aren’t as good as others. They may also feel like imposters if they try to hide their symptoms of ADHD through masking. Masking involves imitating others to camouflage traits associated with ADHD, like hyperactivity.)

The authors say it's important to identify and treat secondary symptoms of ADD as well as primary ones because the treatment for the primary symptoms won’t necessarily mitigate the secondary symptoms.

The Treatment Process

Now that we’ve explained what ADD is and how it manifests, let’s discuss how to begin treatment. ADD can interfere with your success and quality of life, but finding the right treatment can reduce your symptoms and help you make the best use of your strengths. Indeed, people who have ADD can flourish when their unique needs are met.

(Shortform note: In addition to finding the right treatment, it can also help to develop a “growth mindset” in order to make the best use of your strengths. Helping children shift their focus from immediate rewards to long-term growth helps them manage their stress over difficult tasks and can even change the physiology of their brains, strengthening connections between neurons to improve learning and performance.)

Treatment involves diagnosing the condition, educating yourself and others about it, implementing structure in your life, participating in therapy, and taking medication as needed. Let’s look at each of those steps.

Obtain a Diagnosis

According to the authors, the process of diagnosis begins with the patient’s decision to seek help for the problems they’re having. In children, this can be prompted by academic or behavioral difficulties. In a school environment, it’s easy to spot the traits of ADD in children, especially if there’s an adult in the school who’s familiar with the condition. The authors estimate that at least 5% of children may have ADD, though underdiagnosis may be dragging this statistic down.

(Shortform note: There is debate about diagnosis rates of ADHD: Sources generally agree that it's frequently misdiagnosed, with some saying it's overdiagnosed—that people who don’t meet the criteria are receiving the diagnosis—and others saying it's underdiagnosed—that people who meet the criteria are given no diagnosis or are diagnosed with something else.)

According to the authors, parents who seek ADD treatment for their children eventually ask if they themselves might have it. Since it can be passed down genetically, it's probable that at least one parent of a child with ADD will also have ADD. Often they’ve received a different diagnosis for a condition that looks like ADD but have had limited success with the treatment, since treatment for ADD is so different from treatment for conditions that may present similarly.

(Shortform note: Mothers of children with ADHD who seek treatment for their child are particularly likely to discover their own diagnosis through that process. This is because boys are more likely to receive an ADHD diagnosis in childhood than girls are, possibly because girls are less likely to exhibit the more disruptive symptoms of ADHD like hyperactivity. So women with ADHD frequently don’t receive their diagnosis until they’re adults.)

Indeed, it can be hard for an adult to receive an accurate ADD diagnosis. This is because there’s no equivalent environment like school that can act as a reliable method of screening. This can make an adult ADD diagnosis come as a big surprise, and people often only consider they might have ADD by hearing about it from others who have it. The authors estimate that ADD affects at least 10 million adults in America.

(Shortform note: Some people with ADHD are successful in school, but their symptoms become a problem when they enter the workforce, especially if they are undiagnosed. Additionally, unlike schools, companies are not necessarily required to provide accommodations for ADHD. So even if you do get an ADHD diagnosis, your company may not help you manage it.)

According to the authors, many patients express extreme relief upon learning they have ADD, as they have spent their lives feeling like they’re broken or bad for struggling with things that are supposed to be “easy” or “intuitive,” when in reality their brains naturally function in a way that makes these things difficult. Learning there’s a name, community, and treatment for these problems can be liberating and validating, and it's the first step in treating them.

(Shortform note: Social media has played a major role in spreading awareness about ADHD, and also providing a community for those who have it. Many people begin their journey to an ADHD diagnosis by hearing or reading something from a social media influencer.)

Go Through Testing

The authors say that once a diagnosis is suspected, the doctor will begin testing. There’s no one test that can definitively “prove” that someone has ADD. Testing consists mainly of examining the patient’s history through interviews, and it's ideal to have at least one other person close to the patient who can be consulted, as well. The authors point out that people with ADD typically aren’t very good at self-observation, so the insight from others in the patient’s life can be the most revealing.

A patient’s history includes but is not limited to:

• Any history in the patient’s family of ADD or of related conditions like substance abuse, mood disorders, or learning disabilities.
• The patient’s developmental history as a child, such as when they began walking and talking—delays or early development in some areas can be indicative of ADD.
• Behavior at home, such as disorganization, need for routine, or unusual need for stimulation.
• Academic history, such as teacher reports, the patient’s feelings toward school, and level of achievement versus perceived ability or potential.
• Professional history, such as under- or over-performance, conformity to workplace rules and expectations, and high creativity.
• Social history, such as difficulty understanding or being understood by others and ability to maintain relationships.

The Subjectivity of Testing

The term “testing” can make us view diagnosis as something clear and definitive since we often view test results as a binary of either “passing” or “not passing.” However, reviewing a patient’s history is extremely subjective. Patients and families can misremember things or misinterpret things they do remember, especially since ADHD interferes with memory and runs in families. Research also shows that every time you recall a specific memory, your brain may change it, making memories even more unreliable.

There are many other ways that a patient’s history may not be very reliable. A parent with ADHD may not notice the symptoms in their child because the parent behaved that way as a child and assumed all children did. If a child changes schools frequently, it may be difficult to get useful information from the schools about their behavior and performance. An adult reviewing their own history will have to rely heavily on self-observation when it comes to social history and professional history—something they aren’t necessarily good at.

However, recent research has been able to concretely identify differences in brain images of people with ADHD by studying MRI data. This type of research could one day give us the ability to confirm an ADHD diagnosis based on MRI testing.

Rule Out Other Conditions

The authors emphasize the importance of ruling out other conditions before deciding on an ADD diagnosis, as there are several conditions that can look like or overshadow ADD. There are also many conditions that can co-occur with ADD. It’s important to distinguish between ADD and these conditions to select the most effective treatments.

(Shortform note: Misdiagnosis is especially likely if the doctor only focuses on one or a few symptoms and ignores others. Diagnosing someone based only on their most obvious symptoms can lead them down the wrong treatment paths.)

Conditions that can co-occur with, be mistaken for, or mask the symptoms of ADD include:

Depression and anxiety. Both of these can occur as secondary symptoms of ADD or as separate conditions from it. If depression or anxiety is a secondary symptom, treating the ADD can help ameliorate it, but if it’s a co-occurring disorder then it will likely need a separate treatment regimen.

(Shortform note: Depression and anxiety co-occur with ADHD at extremely high rates. Approximately one-third of people with ADHD have also suffered from depression, and half of people with ADHD have an anxiety disorder.)

Substance abuse. This may also be a secondary symptom of ADD or its own disorder. Some people with ADD find that substances like alcohol or drugs mitigate their undesirable symptoms, which can lead to excessive use, dependence, or addiction. If it’s a secondary symptom, treating the ADD can potentially resolve the substance use problem, but if it occurs as a different disorder it may need a separate treatment.

(Shortform note: People with ADHD often use substances to self-medicate for their symptoms, which makes treating the substance use tricky. People self-medicate because it works, meaning the positive aspects of controlling their symptoms outweigh the negative effects of the substance use. In cases where substances—marijuana, for instance—aren’t abused, they can be an effective way to manage ADHD.)

Certain personality disorders. Some aspects of ADD may mirror symptoms of personality disorders that would require a separate diagnosis. The emotional difficulties associated with ADD, for example, can look similar to the extreme mood changes of bipolar disorder. The feelings of rage and sensitivity to rejection can look like borderline personality disorder. The impulsivity and extreme frustration can look like antisocial personality disorder. In all of these cases, a person with ADD may have been misdiagnosed with one of these disorders, leading to ineffective treatment.

Other learning disorders. The authors specifically discuss dyslexia, which they say is the most common learning disorder, as well as autism spectrum disorder, and other cognitive disorders. They estimate that the rate of co-occurrence between ADD and other learning disorders, depending on how they’re defined, ranges between 10% and 80%.

Is “Disorder” an Accurate Term?

There is nothing abnormal about having a disorder of any kind, and many Americans have learning or personality disorders. That being said, there are many in the ADHD community—including Hallowell himself—who are pushing to change the name of the condition to remove the word “disorder.” They argue that ADHD is just a set of traits that includes both strengths and weaknesses and that “disorder” doesn’t make this distinction clear as it suggests a disease that needs to be cured, when ADHD is really just a different—not necessarily worse—way of functioning.

Some have suggested just dropping the word “disorder” from the name and calling it attention deficit (and/or) hyperactivity. In a recent article, Hallowell and Ratey suggest the term variable attention stimulus trait, or VAST. They argue that this name removes the medical-sounding terms “deficit” and “disorder” and emphasizes the beneficial traits of the condition.

Another term that removes the terms “deficit” and “disorder” is neurodivergent, though this applies to a much broader range of conditions than ADHD alone. This refers to any condition that causes your brain to function differently from the way a neurotypical brain functions. The conditions the authors discuss above (personality disorders and learning disorders, as well as ADHD itself) are all examples of neurodivergence.

The authors also emphasize that it's important to avoid diagnosing yourself and that you should always consult with a professional if you suspect you have ADD.

(Shortform note: While an official diagnosis is ideal, it may not be accessible to everyone with ADHD. For one thing, the specific tasks involved in getting a diagnosis—researching providers, setting appointments and sticking to them, and remembering personal history—also happen to be tasks that are difficult for people with ADHD. Additionally, high healthcare costs and a lack of insurance can make diagnosis inaccessible to many, and it may be difficult or impossible to find a doctor knowledgeable about the condition in your area.)

Educate Yourself and Others About ADD

Once you’ve received a correct diagnosis, the authors recommend that you begin educating yourself about ADD. This involves learning as much as you can about ADD and teaching family, teachers, and peers about it. Because ADD impacts every facet of a person’s life, it's important to help others understand what’s going on and what they can do to help.

(Shortform note: Part of the goal of educating others about ADHD is to reduce the stigma around the condition, but that stigma can also make it difficult to tell others about your ADHD in the first place. While it’s likely essential to tell people like teachers or romantic partners about your ADHD, you may not feel the need to tell peers, employers, or family members. Ultimately, it's up to you to decide whom to tell about your ADHD and how much to tell them.)

Regarding how much to tell children, the authors advise being as honest as possible. A child with ADD will benefit from understanding what’s going on in their brains, and keeping them in the dark about it will likely cause secondary symptoms like low self-esteem and self-doubt.

(Shortform note: Not only does not telling your child about their ADHD harm them in the present, but it also harms them in the future. Adults with undiagnosed ADHD often describe feeling like they are barely getting by in life and like everything may fall apart at any moment. Being honest with your child about their ADHD can help them avoid major issues later in life.)

Similarly, the authors recommend being honest with the child’s peers and classmates. If a student is given accommodations for their condition in school, other students are bound to notice. Correctly educating those children about why those accommodations are being made can help normalize the condition. Conversely, treating ADD like something to hide creates a stigma around it, which can compound feelings of shame and guilt.

(Shortform note: Reading stories that positively represent people with ADHD is one way to educate peers about ADHD and remove the stigma around it. Some children’s books that feature characters with ADHD include Curious George, A Wrinkle in Time, Anne of Green Gables, and Percy Jackson and the Olympians.)

Bring Structure to Your Life

Once everyone involved has a strong understanding of ADD, the next step the authors recommend is to implement structure to help organize your thoughts and actions. Adding structure to your life can involve memory aids such as reminders, keeping notepads in strategic places, making lists, and setting routines and schedules. Establishing a pattern for your life, like doing the same tasks on the same day at the same time every week, can turn them into habits, which takes the burden off the brain to remember to do these things.

(Shortform note: Many organizational systems were designed by and for neurotypical people, which can make it difficult for people with ADHD to incorporate them. Because of the spontaneous way people with ADHD think, it may be most helpful to carry a journal to write down the ideas that come to you in the moment—and then disappear just as quickly.)

Seek Out Therapy

You can implement education and structure on your own, but according to the authors, it may also help to have a therapist to guide you through the treatment process. The authors specifically recommend participating in psychotherapy and getting a coach to help you stay on track. Let’s first look at therapy and then at coaching.

In beginning psychotherapy, it’s important to find a therapist who is knowledgeable about ADD. This will make it easier for them to understand you and your needs and for you to bond with them.

(Shortform note: To find a therapist who’s knowledgeable about ADHD, you can begin by checking your health care plan for providers in your network that specialize in ADHD. If you don’t have a health care plan, you can also contact your local health department and ask about providers, or refer to directories from professional organizations.)

The authors say that group therapy can be particularly effective in treating ADD in both children and adults. This is because, especially for children, many of the symptoms of ADD will only present in a group setting and not in one-on-one therapy sessions. For instance, if the child struggles with sitting still in class, interrupting classmates or the teacher, and paying attention to a lesson, these symptoms may not come up in therapy unless it's in a group setting.

(Shortform note: Because the symptoms of ADHD are more likely to show up in a group setting, it's probable that many children who are homeschooled have undiagnosed ADHD since they’re educated in a one-on-one or small-group setting. Homeschooled children who receive an ADHD diagnosis may benefit even more from group therapy as it gives them the chance to practice social skills they would normally use at a traditional school.)

Further, group therapy helps adults meet others who understand them and their struggles. They can relate to and validate each other’s difficulties and can also teach each other about strategies they’ve found effective. According to the authors, ADD often hinders connection with others, and strengthening connections can be one of the most effective treatments for the condition.

(Shortform note: In a recent article, Hallowell offered suggestions of additional avenues for cultivating connection besides connecting with other people. These include connecting with animals and nature, connecting with ideas and information, and connecting with activities you love. All of these, he says, contribute to a person’s happiness and confidence.)

According to the authors, ADD can cause difficulties not only for the person with the condition but also for others close to that person. The distractibility of ADD can make people believe that their loved one with ADD doesn’t care about what they have to say, and the forgetfulness can make them seem thoughtless and rude.

An individual with ADD may also become the scapegoat for all of the family’s problems, as their perceived lack of effort makes them an easy target. Similarly, a sibling may feel neglected if another child seems to get more parental attention than they do, and ADD draws a lot of attention.

Couples and family therapy can be useful in helping everyone deal with the condition. However, by the time such therapy is pursued, it’s likely that resentment and hostility will have developed within the group. Families and couples should approach therapy with a willingness to change and a desire to make things better for everyone.

ADHD and Misplaced Blame

Misplaced blame can be a major source of distress for people with ADHD and their loved ones. Various aspects of ADHD, including memory issues, rejection sensitivity, and difficulty with social cues, can lead someone with ADHD to take on the blame for everything that goes wrong in their relationships. Self-blame becomes an even more natural response if a sibling, parent, or peer tells you that something is wrong and that it’s your fault.

On the other hand, a person with ADHD may be prone to laying the blame for their own symptoms on others. This can cause extreme tension in relationships, and it can even lead to abusive behavior. Group therapy with families and couples can be vital in helping all parties stop playing the “blame game” and work together toward positive change.

Coaching

The authors also advise using a coach—someone such as your therapist, a friend, or a loved one who can put in the time and effort to help you manage your condition. Coaching can be as simple as a 10-minute meeting or phone call every day to check in on what you need help with, what you have coming up in your life that may be impacted by your ADD, and to provide encouragement.

(Shortform note: Evidence shows that coaching can help you manage your ADHD symptoms by increasing accountability for your actions, managing stress, and building self-confidence. Also, like therapy, coaching can be done in a group setting or one-on-one.)

Medication

According to the authors, some people with ADD can successfully manage their condition through a combination of education, structure, and therapy. Others may need to add a medication to their treatment regimen. Medications used to treat ADD include stimulants, such as Ritalin, Concerta, and Adderall, and antidepressants, such as Wellbutrin and Strattera. These drugs work by increasing the brain’s levels of certain neurotransmitters: norepinephrine, dopamine (in the case of stimulants), and serotonin (in the case of antidepressants). This improves focus and can also act as a mood stabilizer.

(Shortform note: Adding a medication to your ADHD treatment regimen can be difficult if you have co-occurring disorders. It may be necessary to treat those other conditions before addressing ADHD if their symptoms are severe. Medications used to treat other conditions like depression or substance use may make ADHD symptoms worse, and ADHD medication may make symptoms from those other conditions worse.)

Once an ADD diagnosis is made and you opt for medication, you’ll need to identify the specific symptoms you want to target—for instance, inattentiveness, difficulty regulating emotions, or trouble staying organized. Selecting these target symptoms will make it easier to tell if the medication is helping. The effectiveness of medication varies from person to person, and it doesn’t work for everyone, but for some, it can be life-changing.

(Shortform note: Identifying your target symptoms can be overwhelming, so it’s helpful to start by identifying which ones interfere the most with your life. You may want to ask family members or friends to help you identify these if you're having trouble narrowing them down. Sometimes you may need to start with a behavior—such as interrupting others frequently or losing things—and then trace that back to the symptom—which could be impulsivity or distractibility.)

Still, medication can be a tricky subject, as it carries social stigma and misconceptions. Patients with ADD—and particularly parents of children with ADD—may resist trying medication. They may feel like depending on a medication is a weakness, or they may object to what they see as “drugging” their child. Despite some common misconceptions, medications don’t cloud your senses or strip away your personality, nor are they addictive at the dosage level they’re given to treat ADD.

Some people may also feel that being put on medication is proof that there’s something wrong with them or that they have a cognitive disability when they don’t believe that label applies to them. The authors emphasize that these feelings should not be dismissed but rather handled respectfully, and that no one should ever feel pressured to take medication they don’t want to take.

Sources of Concerns About Medication and Counterarguments

Part of the stigma associated with ADHD medication results from its misuse by people without ADHD. Some people take stimulant medication to get high or to counteract sedating substances, which leads to the misconception that people with ADHD are taking it for the same reasons. However, in people with ADHD, stimulants do not provide this “high” but instead have a calming effect, allowing them to better manage their symptoms.

Other people are hesitant about stimulant medication because some of them are amphetamines, which are notorious for being highly addictive and harmful. However, this is only the case when they’re used improperly, at higher doses than prescribed, or for recreational purposes.

The idea of being dependent on a medication for a psychiatric issue is also off-putting to some. But we usually have no problem with the idea of depending on a medication for a physical ailment. For instance, few people would argue that someone with epilepsy should stop taking their medication because they shouldn’t be dependent on it. Presenting the prospect of ADHD medication to patients by comparing it to medication for physical conditions can help them feel more comfortable with it.