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Loading ...The NY Times Health Blog recently posted a story that discusses Attention Deficit Disorder and how the diagnosis may not be all bad.
Did swimmer Michael Phelps succeed at the Olympics in spite of having attention deficit hyperactivity disorder — or partly because of it?
That question is at the center of a debate among doctors, parents and educators in the A.D.H.D. community. Mr. Phelps obviously has physical talents that propelled him to become a world-class athlete. But A.D.H.D. success stories like Mr. Phelps are behind a push for a new view of A.D.H.D. that focuses not just on the limits of the disorder, but its potential.
I can vouch for that. I preach it; I teach it; I live it. I chose the name of this blog based on the fact that I have ADHD. Ask my staff. Ask my parents. Ask my elementary school teachers.
I didn’t realize I had ADHD until I was actually practicing pediatrics and diagnosing it in children. The more I listened to their stories, the more clear it was that I had it as a kid. The more I thought about my childhood, the more sure I was that I would have been medicated as a child. The teachers would have begged my parents. I wasn’t bad; I was uninhibited, free-spirited, playful (or whatever other euphemism you choose). If I felt like doing something, I did it – whether it was running around on the school bus, or messing with my friends. I spent a lot of time in the principal’s office.
So how did I end up as a physician? As I progressed in my education, several things happened to increase my focus:
- I started drinking coffee. Caffeine is a stimulant, and does make me think clearer.
- The classes got harder. In elementary school, boredom was my enemy. When I was bored, I got into trouble.
- The classes got more interesting. The further I got in education, the more I truly cared about the subject material.
- I matured.
I could write much more about this, but I will save that for other posts.
So how do I function as a physician? Doesn’t ADHD get in the way? As is stated in this article about Michael Phelps, Attention deficit isn’t necessarily a bad thing. I don’t see my ADHD as a liability; I see it as key to my success, and I see my job as a PCP perfectly suited to my ADHD.
I don’t consider ADD/ADHD as a disease (something to be fixed) or even a disorder (something that is “wrong” with the person), but instead I see it as a personality-type. Everybody has things that they are good at and other things they are bad at. I am not good at sitting still for long periods of time – I want to get up and move around. I am not good at repetitive tasks – I want variety. I am bad at structuring my own schedule – I need external structure.
This is exactly why being a PCP is perfect for me (with modifications):
- I have a schedule that I must follow.
- Visits are usually brief, and after the visit I go to another room.
- Each visit is different from the last – I wouldn’t want to do just pediatrics or internal medicine; I really like the variety.
- It is hard to do, which keeps my focus up.
- I have nurses to remind me of things – and they do (thank goodness).
- I don’t feel constrained by rules – I like to use my creativity and think outside of the box.
- I get to sit and chat with people all day.
Despite this, I have always had an Achilles heel: disorganization. I had a very hard time keeping a paper chart organized. It took far too much self-motivation. That is why I have been so driven to implement an EMR: it forces structure on me and reminds me when tests are due.
I do self-medicate with vitamin C… You know, that chemical that made the empire known as Starbucks.
Downsides? Sure there are; but that is for another post.
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We’ve thought for a while that our son has ADHD – he was officially diagnosed two weeks ago and just started on meds. This did kind of freak me out a bit. So to reassure me, our family doc told me basically the same thing – he too had ADHD as a kid, and medicine works well as a career b/c he has a new task every 15 minutes. He reminded me that the sky’s still the limit for my son – he just needs to find a passion / career that works with his brain. Thanks fo reinforcing this
I actually just had this conversation with a friend of mine. I said almost exactly what you said here, “I don’t consider ADD/ADHD as a disease (something to be fixed) or even a disorder (something that is “wrong” with the person), but instead I see it as a personality-type.” I know many very successful people with it; they are highly intelligent. I’m glad we aren’t all cookie cutter people.
ADD’s a Fraud, a Fake, the easy way to explain why you always pay your credit card bills late. Hmm lets see, take basically normal kids and give them the exact same Chemicals that if they bought off the Street they’d get 20 years in a State Prison. Yeah, I didn’t pay attention in 4th grade either, set my Desk on Fire, and teased household pets, not because of some Catecholamine deficiency, but because of that “Y” chromosome. What a coincidence that ADD (Or ADHD, or whatever the Acronym of the month is) has about a 95:5 Male:Female ratio. Funny how nobody ever casually tells you they’re a Hebephrenic Schizophrenic at Happy Hour…
My sister has a very short attention span, and even though it’s made her schooling difficult, I have nothing but admiration for her and her ability to think outside the box. She sees things in ways that I could never have imagined in a thousand years, and draws associations that are unexpected but absolutely genius. I agree – being “ADHD” is not a disability unless you decide it is and let it become so.
I am curious about one thing – is it possible for a person to be a ridiculously well-behaved child, but then completely lose all attention span AFTER reaching adulthood? I’m in PA school now… literally in class right now.
Agree with you and Chrys – ADHD is more of a personality type than a “disease.”
And I’m like you – I’d go nuts without variety in life.
Just wish my personality type had an “on-off” switch sometimes.
By the way, the comic is hilarious.
I wonder; can I claim to have “Management-Induced ADHD” as a means of getting out of meetings where people will attempt to cause “death by Powerpoint”?
Such good information. Everyone with and parent of ADHD should read it. You took what some would use as an excuse and found the positives.
Thanks
Any good sources for learning to cope? My husband has a hard time with focus, which can be aggravating at home, but job/life-threatening at work, which involves heavy machinery. It’s one thing to stop eating dinner and clean a baseboard with a q-tip…quite another to lose attention when a spinning blade is cutting a large piece of metal.
He does drink a good bit of coffee, but sometimes his heart rate is in the stratosphere at bedtime.
Jean:
He needs treatment. He should talk to a doctor who deals with this kind of problem. Either that, or he should get a different job.
Two of our three daughters have ADHD, and the difference between them and their middle sister is striking.
I think you made a good point about improving in school as the classes get more difficult and more interesting. Our oldest daughter excelled at her AP classes in high school, but only turned in lackluster performances for some of the more mundane studies.
Now that she’s in college and has a goal of becoming a lawyer, she is carrying a 3.9 GPA and has been on the Dean’s List every quarter.
The ADHD ability to hyperfocus really comes in handy.
Hello “Dr. Disracted”. Me too and pass the “vitamin C”! During residency, I could drink upwards of 25-30 cups of coffee a day – in addtion to gallons of iced tea. When I was finally diagnosed, I was told I was self-medicating. I’m down to three cups of java at day (no meds) now. I guess “I matured”.
ADD is what you make of it. I don’t consider it a “disease”.
Indeed, I make my living as an Indpendent Contractor/Locum Tenens. Lots of moving around and new situations. And I THRIVE on it now (although, because of the reason I’m doing Locums, that took a while).
The ability to “hyper-focus” is a great asset in difficult clinical situations. And EMR (once I learn it) should be much better than paper charting.
Blogged about my experience here: http://drjshousecalls.blogspot.com/2007/02/attention-mental-health-advocates-heres.html
Dr Rob, I really enjoyed this post; I think that over time the threshold for ADD/ADHD diagnosis has significantly changed. I’m certain that I fit the personality type as a kid, and you’re right; in the medical world it’s more a bonus than a hindrance. Dr Johnson’s comment resonates pretty heavily with too. Rock on team!
I think Dr. Rob falls into the usual trap of looking back and thinking “oh, I was distractable, therefore I would have been diagnosed with ADHD.” No. You wouldn’t. Every kid at a certain age is distracted to a point. Kids with “real” ADHD are so distracted they look like they are hallucinating. They have so many cuts and bruises on their arms and legs from tripping over themselves and getting into dangerous situations that their parents are under suspicion for child abuse by child protective services. They are the kids picked up by the cops for breaking curfew and running across the highway. They are the kids for whom every single anti-drug message from “just say no” onwards is useless because they cannot control their impulse in the moment. What Dr. Rob, and a lot of the lay public without a true ADHD kid thinks, is that “normal childhood” is being medicalized as a disorder. What they fail to realize is that for every bell curve, there are people in the 2nd or 3rd standard deviation from the norm whose lives are severely impaired. That is why it’s called a disorder. What people like Dr. Rob end up doing, however, is giving medications to the kids in the 1st standard deviation who really don’t have a severe illness, and then complaining about how it’s all a big scam made up by drug companies. Spend some time in the household of a kid with REAL ADHD. You’ll never doubt it again.
Greg: Sounds like you know more about ADHD than me (a pediatrician) and more about me than me.
Good for you.
Thank you for this wonderful article. It very closely explains my husband and his adult ADHD. He is an artist who loves to be challenged, to create, needs variety and needs to have structure, reminders, etc. I am thinking of starting him on some significant caffeine! ;-P
“Yeah, I didn’t pay attention in 4th grade either, set my Desk on Fire, and teased household pets…”
Similar behaviors are seen in serial killers.
Doc-
Thanks, man. From a guy (not physically a kid, anyways) who actually has been diagnosed with ‘real’ ADHD, and a bookworm who couldn’t bring himself to concentrate on the words on the page– It’s really, really good to hear I might be able to get myself a white coat some day. Don’t think I didn’t know it would be hard, but it’s wonderful knowing it’s not impossible.
Disease, disorder, or personality, I strongly think that the DSM rightly categorizes it with a lot of other states that can really wreck havoc with life. Kudos to you guys pushing through it.
And to Frank: The fact that I pay my bills on time aside, you’ve got some muddled facts there… It’s not exactly a goldmine of objective study out there, but try to look beyond the bias?
And while I’m on about the DSM, there’s a whole letter difference between ADD and ODD, and if you want to change another, let’s make it OCD for the win, huh? Comorbidity doesn’t imply causality, Greg; don’t fall into that usual trap.
I love being a Psych student. It gives me such a chance to be well-informed.
I keep forgetting to change my blogrolling links! Sorry ’bout that.
I had a reading disorder/dyslexia as a child. Like, in 6th grade, I was going to the high school for geometry class, but doing 2nd grade spelling. And it was humiliating. If they had a treatment for that, avoiding the humiliation would have been excellent. Don’t misunderstand me, putting me in with my class for spelling wouldn’t have been helpful, and probably the “work at your own pace” class I was in was the best way to make things a little less painful, but still….
And somehow, at puberty it got better. I still have some problems with spelling, but mostly, nothing a spell checker can’t help!
Like others, I wanted to quickly thank you for your article. I am a second year medical student who was diagnosed with ADHD as a child. I am sure this is almost impossible for some people to believe, but I honestly do not think I would have been successful in achieving my goal of attending medical school if it were not for my ADHD. My strong desire to learn about many different subject areas (I was a biomedical engineering major with an anthropology minor! haha) and my involvement in research (I just always wanted to “know more”) definitely set me apart from other applicants.
However, I was hoping you could provide me some insight on your experiences in medical school. I have a very difficult time dealing with the “memorize and regurgitate” focus of the curriculum, because I find it nearly impossible to memorize facts without a “big picture” context to fit them into. I consider myself to be a good problem solver, and I thought that this would really lend itself to practicing medicine, but now that I am in medical school it seems as though the way they want me to learn is just not suited for my way of thinking. Anyways, any advice/input would be greatly appreciated.
Thanks again for the great article
Emily, I feel your pain. And I agree about the difference between college and medical school. I had three majors – Chemistry, Biology and Classical Civilization/Latin.
In college, the multiple choice test was not so prevalent (especially in the junior and senior years) – and I thrived on essays and the mini-disertation – I graduated Phi Beta Kappa.
But when I hit medical school, it was like hitting a wall (and that’s how I now descirbe ADD to parents – kids hit a wall – some hit it early – some hit it later – but they all hit the wall). I struggled from day one with the”memorize and regurgitate” aspect of the first two years of medical school – and multiple choice tests were a nightmare. I suffered from crippling test anxiety.
Later during and after residency, sitting still for one day of an “in-service”, or two days for a board exam, was absolute torture. I wanted to run from the room screaming – every nerve was on-fire. I was acutally eventually diagnosed because of those problems. But not before some disappointing setbacks.
My performance on tests did not match my clinical skills or knowledge base. I mean, I am very good clinically – and routinely deal with very tough clinical/intensive & neonatal care situtations.
I can hyperfocus like nobody else.
In retrospect, I do find it ironic that, despite working (like a slave) for a world-renowned medical center, none of my learned mentors seemed to pick up on my difficulties and steer me towards the assistance I needed.
I was out of residency and struggling with my board exams before (humiliated and embarassed by the troubles I was having) I finally sought help. The diagnosis – the knowledge – was power. It explained so much and it really did set me free. I did some very intense “test-taking” strategy/training, and I ultimately was successful in passing my boards. But it was an exquisite form of demoralizing torture.
Indeed, to this day, the certifying boards (in my case, the AAP) does not seem to recognize that doctors with ADD exist. When I recertified, it was great – because the test could be taken at home – at the computer – at my own pace – no pressure a few questions at a time. It was a great learning experience – very satisfying. But the AAP recently re-instated the “in-house/closed book” exam as a part of their “maintenance of ceritification” process (they say it’s about “public trust”), and it’s just so wrong, so unfair and so only about money. I have to re-certify in 2 years and I’m really dreading it.
I tried complaining once. But it feel on deaf ears. Given that we’re talking about the Academy of Pediatrics – the specialty that deals with ADD the most, I find it both disappointing and ironic.
Re: “the big picture”. I will share with you an experience I had during my senior year in residency. I was in a one-on-one session with a clinical professor. We were talking about some fairly complicated ICU type stuff (ventilators, I think), and while asking me questions, he stopped me cold and said, “You don’t do very well on your in-services do you”? Taken aback, I started to pout, but he smiled and said, “No. I don’t mean that in a bad way. I mean that you look at things differently. It’s not black and white with you. It’s shades of grey. You see the bigger picture. It’s a good thing. And you’re the person I want by the beside with me. Don’t let anyone tell you that just because you have a hard time on tests that you’re a bad doctor.”
Only after I was diagnosed, did that converstion really register with me. In multiple choice testing, I see the right in every answer – and it’s so much harder to sort out “the best” answer – or “A and C but not D” and that kind of garbage.
If you’re having the same kinds of problems (and it sounds like you are), my best advice to you is to discuss it with your advisers and seek educational and test-taking interventions early.
I wish I had had the knowledge that you do many years sooner than I did. That knowledge is power. And that will be the key to your success.
As my Mama (a 1st grade teacher for thirty years) likes to say, “ADD is a reason. It’s not an excuse.”
My son has ADHD and is the most wonderful, caring boy around. I am lucky to live in a school system willing to work with me and help me develop a plan for him. He is not medicated. Instead, I did the research and tried a drastic dietary change for our entire family. As a single mom with a full time career, cutting out the processed food was difficult; however, it did the trick. For the last two years he has been successful both academically and socially, both areas he had difficulties with before ‘The Change’, as my children refer to it. We simply cut out whites (sugar, flour, etc), cut out processed foods and cut out red and yellow food colorings. You don’t realize that giving an ADHD child something that you used to eat for breakfast, like Froot Loops, is essentially setting them up for failure for the entire day! Is our life a cake walk now? Nope! He still sneaks candy from his friends or has things not on the approved list. (I’m not a food Nazi!) But, we no longer have daily fits and fights. He gets along a lot better with his peers and siblings. He’s doing well in school. He’s also exploring his mechanical aptitude, which was something he could never do before. He’s reading for pleasure. Oh, and we, too, self medicate with vitamin C.
this is my thought..add or adhd or whatever is kind of like the appendix…maybe it was useful a gazillion years ago but no more…in the days where we were the hunted as much as the huntee the ability to be restless and always looking around would have ben useful….concentrating on one thing and not paying attention to everything else probably would have made you something’s lunch. just throwing it out there for consideration
kris:
My thoughts exactly. It is not bad – just situational. Our current situation makes the playing field favor those who are not distractible (in general). If you can make it by school, then it favors those who are more imaginative, quicker thinkers, and able to “hyper focus.” School breeds followers, not leaders. Leaders, however, are better at survival.
I understnd that ADHD may come into the way for my plan of becoming a doctor. I really love to be a doctor becuase this is how my gifts and talents from God can be offered to the world. I am a student in Cornell University, struggling to get my work done, stirving to keep my room clean, trying hard to go to my classes. I have lots of fears. i am afraid to be bored in medical school, in residency, in my career. I am very creative. I can sometimes hyperfocus before my exams. By doing this, i maintained a 3.8 GPA in Cornell. I am still very worry about my futureL whether I could be, and should be a doctor.
KP – I find it an asset overall. My creativity and my intellect are always being stretched. I can think of no better job for ADHD than primary care (and perhaps general surgery). The more you specialize, however, the more you end up risking boredom. There are no long-term projects, you go from room to room not knowing what will be next. I love it and never get bored.
Med school wasn’t that boring because I knew there was a reason to learn the information (most of it). Plus, the fear of failing (which was a sure thing if I didn’t study hard) was enough to motivate me.
Creativity is an asset in a diagnostician. It sounds like medicine would be very good for you.
Thank you, Dr. Rob, for starting such a great blog. I am currently a first year medical student who was diagnosed with adult ADHD a year ago. I was always an honor role student in elementary and high school. In college I was a Latin American Studies major; where I excelled in my humanities courses, but had some challenges with the pre-med courses. I still preserved though in wanting to fulfill my dream of becoming a doctor. I have never been a good standardized test taker, because it is very hard for me to think ‘with-in the box’. I am a very creative person who does not process information the same way as others. I always new that something was different in my thinking process and this was highlighted when I took the MCAT. Due to my scores my pre-med advisor suggested that I get tested for ADHD/ADD. It was recommended that I take some ritalin for my condition. However, I feared the side effects of the medication and decided not to take it.
I knew that medical school would be a challenge, but I am struggling to pass my courses. I am in an accelerated program where all this information is being jam packed into such a small amount of time. It’s hard for me to memorize all this information without having time to make any connections. All the test are multiple choice (formatted like the USMLE), which is hard to train myself to start thinking like the test format. It’s hard for me to memorize all this information, organize an effective note taking process, and master the information. Now I’m wishing that I would have taken the drugs. If there is any other medical students with ADHD, can you please share some of your successful studying strategies? Are there any natural methods that one can use to increase brain concentration and focus? I am just loosing confidence in myself and its not like me to give-up. I know I have a long road a head, and I’m scared that I’m having so much difficulty so soon.
I am an international student at Penn. A recent transfer student, Junior standing. I am likely to have ADD. no hyperactivity just the daydreaming, distractable, cannot get anything done type. It was never a problem until I left my small college in my small town and came to Penn. After a semester of hell, a C+ on biology, lots of Bs and one A, after a semester of not being able to get to the second half of my Bio exam, never finishing a test on time, never being able to get my readings done before class, I decided to get tested for ADD. Before Penn, I would fall behind but somehow catch up. I had the parents reminding me of what i need to do, I had the teachers expecting A after A from me, I had friends dragging me to study groups and asking me to explain chapters after chapters to them, expecting me to know the answer of everything. I had an entire support system, an entire way of life that disappeared once I made the transfer. What disappeared too is any chance of me getting into medical school, now that I have a 3.0 GPA. I am seeing a doctor monday and I might be given medication. Out of control is what I feel, all the time. I would try to focus, try to read a page or type an essay. I would try. But the next thing I know is that my mind is wondering around. I stare but cannot see. I try and listen but hear nothing. I am trapped in an endless uncontrollable disaster. I would have a neurobiology presentation in a month but I could not start focusing and working on it until 12 am the night before. It’s 6 am and I am still working. I am tired. I go to sleep and decide to wake up in 4hours to review the presentation one more hour and then head to class. I put the alarm. Come 10 am the alarm beeps, I wake up turn it off take a look at my presentation, rest my head while I review everything, open my eyes it’s 2pm, I just slept through class. The same thing happens again and again. This is frustrating. I am always late to class, ten twenty thrity minutes every time. I would wake up early, get ready early, open up a book, read through, Oh i need to check my email, CNN breaking news this and that happened, leave the email, read the news, oh I need to review for my math class i have a quizz soon, where’s my book, this place is a mess i need to clean it, i start cleaning, oh no i’m going to be late i have got to leave, I grab my coat, where are my keys, shoot I misplaced my keys, I’ve got to run for class forget the keys, I leave without my keys and get to class late again. Different events, different order, same outcome. Every time.
iso (sorry for the late response): My studying always consisted of copying things. If I had a discreet task, I could stay on task. If I had the vague “study” plan, I’d wander away. I would highlight the textbook and the notes I took, then copy down what I had highlighted. Then I would read through what I wrote down and highlight only the salient stuff and copy that once more. This final sheet was what I’d memorize.
nada: Love the last couple of sentences. Very funny. I think there are a lot of ADD folks in medicine. I’d say a simple mind doesn’t get distracted as easily as one that is always churning.
i am there. so there. i am a returning premed student in my 2nd year. i am also non traditional down to the last detail. i am married, 2 children under the age of 7 and i am told it is my newly diagnosed ADHD that allows me to hold down a full course load and run a home and family. i am addicted to caffine, if i could run it thru my veins, i think i may. however, i am hitting a wall and hard. i have not been given any sort of “special accomodations” to take exams and now (b/c the classes are larger and louder) my exam scores are not matching my knowledge of the subject–if it is multiple choice, i struggle while i do exceptionally well on written or essay. i am becoming increasingly frustrated when trying to focus on very broad, very general, non relating subject matter. the subject matter that has to do directly with human body, medicine, systems…i dominate, talk to be about anything else, i drift and bad. organization is killing me, i need a personal assistant. i am increasingly becoming discouraged with my scores when i know i know the information, i am frustrated b/c i can’t keep focus when i know my gpa depends on it, and i panic over every grade….good or bad. i am terrified i will never make it to medical school b/c i am just now learning of this “gift” and i am not quite sure how to manage it yet.
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