Driven to Distraction (Revised) Read online

  ABOUT THE AUTHORS

  Edward M. Hallowell, M.D., is in private practice in adult and child psychiatry and has offices in both the Boston area and New York City. He lives with his wife, Sue, and children, Lucy, Jack, and Tucker.

  www.drhallowell.com

  John J. Ratey, M.D., is a Clinical Associate Professor of Psychiatry at Harvard Medical School and is in private practice. He lives in the Boston area.

  www.johnratey.com

  ALSO BY

  EDWARD M. HALLOWELL, M.D.,

  AND JOHN J. RATEY, M.D.

  Answers to Distraction

  Delivered from Distraction

  ALSO BY

  EDWARD M. HALLOWELL, M.D.

  The Childhood Roots of Adult Happiness:

  Five Steps to Help Kids Sustain and Create Lifelong Joy

  CrazyBusy:

  Overstretched, Overbooked, and About to Snap!

  Strategies for Handling Your Fast-Paced Life

  Connect:

  12 Vital Ties That Open Your Heart,

  Lengthen Your Life, and Deepen Your Soul

  Dare to Forgive:

  The Power of Letting Go and Moving On

  Finding the Heart of the Child:

  Essays on Children, Families, and Schools

  (with Michael Thompson)

  Human Moments:

  How to Find Meaning and Love in Your Everyday Life

  Married to Distraction:

  Restoring Intimacy and Strengthening Your Marriage

  in an Age of Interruption

  (with Sue George Hallowell, LICSW,

  and Melissa Orlev)

  Positively ADD:

  Real Success Stories to Inspire Your Dreams

  (with Catherine Corman)

  Shine:

  Using Brain Science to Get the Best from People

  Superparenting for ADD:

  An Innovative Approach to Raising Your Distracted Child

  (with Peter S. Jensen)

  A Walk in the Rain with a Brain

  What Are You Worth?

  (with William J. Grace, Jr.)

  When You Worry About the Child You Love:

  A Reassuring Guide to Solving Your Child’s

  Emotional and Learning Problems

  Worry:

  Hope and Help for a Common Condition

  ALSO BY

  JOHN J. RATEY, M.D.

  The Neuropsychiatry of Personality Disorders

  Shadow Syndromes

  (with Catherine Johnson)

  Spark:

  The Revolutionary New Science of Exercise and the Brain

  (with Eric Hagerman)

  A User’s Guide to the Brain:

  Perception, Attention, and the Four Theaters of the Brain

  FIRST ANCHOR BOOKS EDITION, SEPTEMBER 2011

  Copyright © 1994, 2011 by Edward M. Hallowell, M.D.,

  and John J. Ratey, M.D.

  All rights reserved. Published in the United States by

  Anchor Books, a division of Random House, Inc., New York,

  and in Canada by Random House of Canada Limited, Toronto.

  Originally published in hardcover in slightly different form

  by Pantheon Books, a division of Random House, Inc.,

  New York, in 1994, and subsequently published in paperback by

  Touchstone, a division of Simon & Schuster Inc.,

  in New York, in 1995.

  Anchor Books and colophon are registered trademarks

  of Random House, Inc.

  Grateful acknowledgment is made to Frank Wolkenberg

  and The New York Times for permission to reprint excerpts from

  “Out of the Darkness,” October 1987. Copyright © 1987 by

  Frank Wolkenberg. Reprinted by permission.

  Cataloging-in-Publication Data is available on file at the

  Library of Congress.

  eISBN: 978-0-307-74316-9

  www.anchorbooks.com

  v3.1

  DEDICATION

  We gratefully dedicate this book to seven teachers of ours, seven psychiatrists who shared with each other a liveliness of mind, an independence of thought, a love of the work, and an appreciation of play.

  They taught us to listen and to see.

  Doris Mezer Benaron, Jules Bemporad, William Beuscher, Thomas Gutheil, Leston Havens, Allan Hobson, and Irvin Taube all gave of themselves much more than this small dedication can acknowledge. During their years of teaching at the Massachusetts Mental Health Center in Boston, they taught us to be humble in our work. They taught us to go where the patient is and to sit down and listen. They taught us to connect with the patient, person-to-person. They taught us to look for the heart of the patient, to look for the sorrow and for the joy. We thank them from our own hearts.

  CONTENTS

  Cover

  About the Authors

  Other Books by This Author

  Title Page

  Copyright

  Dedication

  INTRODUCTION TO THE ANCHOR EDITION

  by Edward M. Hallowell

  1. What Is Attention Deficit Disorder?

  2. “I Sang in My Chains Like the Sea”

  THE CHILD WITH ADD

  3. “Sequence Ravelled Out of Sound”

  ADULT ADD

  4. Living and Loving with ADD

  ADD IN COUPLES

  5. The Big Struggle

  ADD AND THE FAMILY

  6. Parts of the Elephant

  SUBTYPES OF ADD

  7. How Do I Know if I Have It?

  THE STEPS TOWARD DIAGNOSIS

  8. What Can You Do About It?

  THE TREATMENT OF ADD

  9. A Local Habitation and a Name

  THE BIOLOGY OF ADD

  ACKNOWLEDGMENTS

  APPENDIX

  Where to Find Help

  INTRODUCTION

  TO THE ANCHOR EDITION

  Leading up to the publication of the first edition of Driven to Distraction in 1994, I remember a conversation I had with Jonathan Galassi, now the man in charge of the New York publishing house Farrar, Straus and Giroux. Friends since high school and college, Jon and I confide in each other on just about everything. As an editor, Jon had concerns about this new book I was about to send out into the world. “No one’s heard of attention deficit disorder, and from the title I’m worried people will think it’s a book about cars.” Nearly two million in sales later, Jon and I still chuckle on the fallibility of even the most perspicacious of editors.

  Back in 1994, few people had even heard of ADD, as it was then called (now it’s ADHD, soon to change again, no doubt!). Those few who had heard of it didn’t really know what it meant. It conjured up stereotypical images of hyperactive little boys disrupting classrooms and turning life at home into chaos. It was considered to be a condition found exclusively in children, almost all of whom were male. It was thought that children “grew out of” ADD, so that it disappeared by adulthood. Only a rare few doctors knew that ADD could continue on in adults and that females could have it as easily as males.

  I learned about ADD in 1981, the first year of my fellowship in child psychiatry at the Massachusetts Mental Health Center in Boston. Before then, if you’d told me a person had attention deficit disorder, I would have thought it was some psychoanalytic concept that referred to children who didn’t get enough attention. But then one of my teachers, Dr. Elsie Freeman, gave us a lecture on ADD.

  That lecture changed my life forever. As I listened to Elsie speak, my jaw dropped. I had the greatest “Aha!” experience of my life. Elsie was describing me. At last I found an explanation for the different ways I thought and behaved. I�
�d always excelled in school and college, so no one, including me, thought I had a learning disability. I knew I was a slow reader—and I have since pieced together that in addition to ADD I also have dyslexia—but I never had understood why I came up with different ways of solving problems, why I had an intuitive approach to so much, why I tended to think outside the box, why I could be so impatient so often, why I was so quick to draw conclusions, why I had an oddball sense of humor, and on and on. Although I am not what I now understand to be the classic version of a person who has ADD, I do have the condition for sure.

  More important, back in 1981, I realized that many more people had this condition than experts realized. I also knew it extended into adulthood. ADD became my subspecialty; I began to read papers about it and look for it in my patients.

  I also began a dialogue that continues to this day with my friend John Ratey. I met John in 1979, when I was a first-year resident at Mass. Mental, as it was called, a state hospital that was also a Harvard teaching hospital. John was my chief resident, part mentor, part friend, for that year. When I finished residency and started my training in child psychiatry, John and I remained in touch, meeting once a week to play squash and discuss what interested us. ADD became one of our lead topics.

  All through the 1980s and into the 1990s, John and I explored the topic, comparing notes on patients, speculating on what more went into ADD than was in the books. John also realized that he had ADD, so we made quite the logical pair to look into it in depth.

  There were no good books on the subject written for the general public at that time, so I began to write handouts to give to my patients. I’d stack them up on the floor of my office. After I’d written about twenty such handouts it occurred to me that I ought to write a book. More and more patients—of all ages—were seeking help for ADD. Rather than reach only the few who found their way to my door, I wanted to write a book that could reach many more people.

  John encouraged me to do it. We brainstormed. Then I wrote a proposal, which was accepted. I was surprised that it was accepted by a trade book publisher, because the topic was unknown to the general public. This was not a diet book, a cookbook, or even a book on a common condition like diabetes or arthritis. It was a book about a condition most people had never heard of.

  As I worked on the book, I’d call John Ratey now and then to let him know how it was going. He would give me encouragement when I’d inevitably ask, “Will anyone read this book?” And he’d listen as I’d read him a paragraph or two, and give feedback. But it was my wife, Sue, who had to listen to most of the book. Poor Sue! She had the impossible task of giving useful criticism but also saying she loved the book. I’d get annoyed at her every criticism, but I was smart enough to take every single one of them and make changes in the book.

  When the book came out, it sold briskly at first, because the ADD community had got word of it in advance. I figured we’d have a quick burst of sales, then it would settle into its obsolescence.

  That didn’t happen.

  Much as Elsie Freeman hit a nerve when she lectured about ADD to me, Driven to Distraction hit a nerve in the general public. People were ready to understand the symptoms of ADD not as moral failings or evidence of “badness” or “lack of discipline,” but as a neurological condition not under the control of individual will.

  For some people, this was, and still is, heresy. The old moral model dies hard. It still lives on in the minds of certain groups and individuals. At the heart of the moral model beats the conviction that willpower controls all human emotion, learning, and behavior. Under this model, the cure for depression is to cheer up. The cure for anxiety is to suck it up. And the cure for ADD is to try harder. While trying harder helps just about everything, telling someone with ADD to try harder is no more helpful than telling someone who is nearsighted to squint harder. It missed the biological point.

  But in 1994, with the moral model still shaping the public’s views on ADD, many people attacked me for arguing that ADD derived from genes and biology, not from bad parenting and weak character. I remember being on National Public Radio in the 1990s with a psychiatrist by the name of Peter Breggin. The show originated in NPR’s Boston studio. For an hour, Dr. Breggin harangued vituperatively. He attacked ADD as a bogus diagnosis concocted by the pharmaceutical industry and supported by irresponsible parents who wanted to excuse their children’s poor behavior rather than step up and learn how to be good parents. I did my best to offer the science that proved my point of view to be correct—that ADD is a valid diagnosis, that its etiology is primarily genetic, and that while good parenting will help any child and bad parenting harm any child, bad parenting certainly does not cause ADD.

  At one point I remember asking Dr. Breggin, “Just to be clear, are you telling us that there is no such thing as true ADD, and that every case of what is diagnosed now as ADD is in fact simply bad behavior caused by bad parenting?”

  For once, Dr. Breggin had a short reply. “Yes,” he said.

  When the show was over, we both walked out into the lobby of the NPR station. Dr. Breggin asked where his limo was to take him to the airport. He was told that limos for guests are not in the budget of NPR. Dr. Breggin got upset, and repeated his request for a limo, this time quite emphatically. Rather than watch what was to happen next, I stepped in and volunteered to take Dr. Breggin to Logan myself. Since I live in the Boston area, I had my car outside. On the ride to the airport, Dr. Breggin and I had a genuinely pleasant conversation. I realized that he was a good man, simply defending what he thought was right.

  Many people back then agreed with him. Fortunately, however, science intervened. The 1990s was the decade of the brain. Science uncovered more and more evidence, from imaging studies to genetic studies to family studies, proving that ADD was a true biological entity. Furthermore, ongoing studies proved that, if undiagnosed and untreated, ADD can cause severe impairment. In other words, it was crucial to make this diagnosis and do something about it.

  In discussing what’s happened over the past decade and a half with Dr. Russell Barkley, one of the leading researchers in the field, I was particularly interested in Dr. Barkley’s comment that ADD is more impairing than any syndrome in all mental health that is treated on an outpatient basis. More impairing than anxiety, more impairing than depression, more impairing than substance abuse. The “morbidity” of untreated ADD is profound. Twenty-five percent of the prison population has undiagnosed ADD. Most of the kids in the juvenile justice system have untreated ADD. Traffic accidents are eight times more common than in the general population. If you have ADD, you are 40 percent more likely to get divorced than if you don’t, and 30 percent more likely to be unemployed. Estimates run as high as 40 percent of the addicted population having ADD, and a significant proportion of the eating-disordered population.

  In other words, untreated, ADD can be a disaster.

  I also asked Dr. Barkley what he sees as the leading developments in the field in the past fifteen years, beyond identifying the scope of the problem. He named the identification of ADD in adults as one leading issue. Here again, the need for education is paramount; 90 percent of adults who have the condition don’t know it! If they did know it, they could transform their lives from lives of struggle, underachievement, and turmoil to lives of joy, fulfillment, and success. Regardless of whether the person is a child as young as five or an adult as old as eighty-five, the diagnosis of ADD can change a life dramatically for the better. As impairing as ADD can be if untreated, it can be hugely gratifying to get it treated.

  This is where my work has focused since Driven to Distraction first came out. I am a clinician—someone who sees patients on a regular basis—as well as an educator and a writer. It has been my mission to bring the good news of how profoundly a diagnosis and treatment of ADD can help individuals, couples, families, businesses, and other organizations.

  Now that most people in the general public have heard of ADD—or ADHD—we need to help them under
stand what it is, what treatment is all about, how commonly it occurs in adults, how medication alone is not sufficient treatment, and how many positive attributes can emerge once treatment begins.

  I routinely see people surge from lives of struggle to lives of success once they get treatment for their ADHD. I see the positive attributes emerge and take over, attributes like creativity, originality, the ability to think outside the box, tenacity and grit, big-heartedness, entrepreneurialism, and humor. I see careers turn around and marriages saved. I see children go from failing in fourth grade to top of the class in fifth. I see children change from nervous, misunderstood underachievers to proud and confident leaders of the class.

  That’s why the biggest change I’ve seen in the past fifteen years is not the biggest change most experts have seen or the world at large knows about. Most people now acknowledge—and see all too well—the damage that ADHD can do, the impairment it causes, the school experiences it ruins, the careers it sabotages, the marriages it breaks up.

  I see all that, too. But I see the progress, perhaps more clearly than anyone because I treat so many people of so many ages. I see the triumphs, the successes, the dreams-come-true.

  I also see how essential a comprehensive treatment plan is, a plan that incorporates education, understanding, empathy, structure, coaching, a plan for success and physical exercise as well as medication. I see how important the human connection is every step of the way: connection with parent or spouse; with teacher or supervisor; with friend or colleague; with doctor, with therapist, with coach, with the world “out there.” In fact, I see the human connection as the single most powerful therapeutic force in the treatment of ADHD.

  Led by Peter Jensen, M.D., the Multimodal Treatment Assessment (MTA) study bears this out. The largest study done on the treatment of ADHD, the MTA study first identified the primary importance of medication in treating ADHD. But follow-up shows that the children who do best are the children who have positive human connections in their lives.

  We in psychiatry have been falling in love with our somatic treatments, especially medication, over the years since this book was first published. And rightly so! Medications have changed the face of the treatment of all mental conditions for the better. But, we must not forget the primary importance of the human connection.