Jeremy, age 12, sits in my office flanked by his mother and father. We have concluded our intake stage of his attention deficit disorder (ADHD or ADD) evaluation — meaning that we have pinpointed Jeremy’s symptoms, struggles, and triumphs through his words, and we have noted the observations of his parents and teachers; all that’s left is for me to explain ADHD to him and his parents. We are gathered for the all-important diagnostic feedback session, in which I will tell them what my team and I have gleaned from our “history lessons.”
Jeremy and his parents seem tense. Jeremy, his baseball cap on backward, stares at a spot on the floor, as if he wants to be somewhere else. Mom and Dad lean forward, looking at me with anticipation and fear written on their faces.
I get to the point. “I have great news for you. We’ve learned a lot about you, Jeremy, and guess what? You have an amazing brain. Your brain is incredible.”
Jeremy looks up, and Mom and Dad lean back a bit. “Your brain is like a Ferrari. Do you know what a Ferrari is?” Jeremy nods, smiling. “Well, your brain is like a Ferrari race-car engine. It is very powerful. With the right care, you will win many races in your life.”
I pause. “But there is one problem.” Parents and son shoot looks at me. “You have bicycle brakes. Your brakes are not strong enough to control the powerful brain you’ve got. So, sometimes, you race past places where you mean to stop, or you ignore instructions you mean to hear. But don’t worry. I am a brake specialist. I will help you strengthen your brakes, so you can become the champion you are.” For the next 15 minutes, we discuss the race-car brain outfitted with bicycle brakes.
Russell Barkley, Ph.D., has described the neurological underpinning of ADHD as a relative state of disinhibition, giving rise to three negative symptoms: distractibility, impulsivity, and hyperactivity. A person with ADHD can’t inhibit incoming stimuli, which causes him to be distractible, and he can’t inhibit outgoing impulses, which causes him to be impulsive or hyperactive.
In other words, a child with ADHD has weak brakes. The aim of treatment is to strengthen those brakes. While Jeremy, his parents, and I discuss this idea, the fear in the room subsides, as if an approaching high pushes a nasty storm out to sea.
Gradually, the sun shines through, filling the room. Worry and fear melt into relief and enthusiasm. Jeremy’s parents start sharing stories. “Let me tell you about when Jeremy’s brakes failed him last week,” says Jeremy’s dad, and all three of them start to laugh. A potentially tense meeting turns into a fear-free discussion, as we brainstorm strategies for winning life’s races.
In my 30-plus years of helping people of all ages who have ADHD, I have learned that the moment of delivering the ADHD diagnosis ranks among the most crucial. It can determine the arc of a person’s life. Done right, a diagnosis can be accurate without sacrificing hope or limiting growth.
In many doctors’ offices, diagnosing ADHD is the opposite. It comes with negative terms, and the mood is somber. As one parent told me, “I felt we were being told my child had cancer.” Parents and the child listen, but they don’t hear the words. They sink into their chairs, as they feel their hopes diminish. “Your son has a deficit,” they hear. “Your son has ADHD.” “Your son has a disorder.” They think, “ADHD is very bad, and I don’t know if I can deal with this.”
“At that moment,” one mother said to me, “I saw my son’s hopes and dreams going up in a bonfire. The doctor didn’t mean for me to feel this way. He didn’t mean for Tommy to cry all the way home. But that was exactly the effect of his words on my son.”
It shouldn’t be like that. It is time for those in the mental health game, especially those of us who diagnose and treat ADHD, dyslexia, and other issues of learning, to recognize how damaging the deficit-based model is to patients. It is time to replace it with the strength-based model, which doesn’t deny that ADHD carries potentially life-threatening risks and deficiencies — a Ferrari with faulty brakes is scary, no? — but also seeks out and identifies the talents, interests, and skills upon which the person can build a life of success and joy.
I say to people, “I am not in the business of treating disabilities. I am in the business of unwrapping gifts.” That is not to say I regard ADHD as a gift. As defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), ADHD means trouble. But if you look past the troubling symptoms, you can usually find evidence of a child’s gifts.
It takes a lot of work to develop a person’s talents, especially one who has ADHD. But a strength-based approach fuels such development. One mom told me that, after she and her son visited with me, after I had described the power of her son’s brain, he bellowed on the ride home, “Look out, world, here I come!”
Research supports a strength-based approach. Carol Dweck, Ph.D., a pioneering psychologist from Stanford University, has spent her career proving the value of a “growth mindset” over a “fixed mindset.” People of all ages achieve more and feel more motivated and enthusiastic if they believe they can learn what they need to reach their goals and grow into the person they want to become.
A growth mindset can be taught and learned by anyone — there are many successful people with ADHD. If you work and study hard, the sky’s the limit! Since there are Nobel, Pulitzer Prize, and Oscar winners who have ADHD, as well as billionaires and CEOs of major companies, that limit is not an exaggeration.
Positive psychology, which has invigorated the field of mental health over the past decade, supports a strength-based approach and the positive emotions it generates. People overlook how much emotion matters to learning. Until the person has positive feelings about himself, learning will never be optimal. The father of positive psychology, Martin Seligman, Ph.D., writes in his book, Flourish (#CommissionsEarned): “Greater well-being enhances learning… Positive mood produces broader attention, more creative thinking, and more holistic thinking. This is in contrast to negative mood, which produces narrowed attention and more critical thinking.”
The deficit-based model of ADHD also encourages stereotyping. Anyone who spends time at a school quickly notices that kids of all ages disparage the students in “special education.” So-called “sped” kids are, in the words of other kids, “stupid,” “air heads,” or “losers.” The stereotyping elicited by learning differences is the last widespread, unaddressed prejudice, the last “ism” spreading through our schools, breaking the spirits of millions of children.
This should not be. The documented damage done by stereotyping, in which a stereotyped group performs down to expectations, is called “stereotype threat.”
But we are one attitude shift away from changing that. As world-renowned psychologist Timothy D. Wilson writes in his groundbreaking book, Redirect (#CommissionsEarned): “One remarkable thing about these deficits in performance [related to stereotype] is how easily they are corrected [emphasis mine]. A simple reinterpretation of a meaning of a test can eliminate the achievement gap. So can attempts to reduce the salience of the negative stereotype — by, for example, emphasizing positive aspects of one’s group or introducing people to a positive role model from the stereotyped group (for example, a female math whiz).”
Lots of research proves that playing up a child’s strengths instills attitudes that lead to success and well-being. All people work harder and perform better when they believe they can grow and flourish, when they feel optimistic about their futures, and feel they can excel, despite disappointment and defeat. Their beliefs allow them to greet each day with “Look out world, here I come!”
Edward Hallowell, M.D., is a member of ADDitude’s ADHD Medical Review Panel.
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