from

fr om th
thee ed
edit
itor
orss of

Secrets
of the
ADHD
AD HD Brain
Why we think,
act, and feel
the way we do
 ADDITUDE
Strategies and Support for ADHD & LD
LD
A trusted source of advice and information for families touched by attention-de
attention-deficit
ficit disorder—
and a voice of inspiration to help people with ADHD find success at home, at school, and on the job.

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 Secrets
of the
ADHD Brain
Why we think, act,
and feel the way we do

What you don’t know about ADHD could change

your life
life..
BY WILLIAM DODSON, M.D.

A DHD IS A CONFUSING, CONRADICORY, INCONSISEN,

and rustrating condition. It is overwhelming to people who live
with it every day. Te diagnostic criteria that have been used or the last 40
years leave many people wondering whether they have the condition — or
something else entirely. Diagnosticians have long lists o symptoms to sort
through and check off. Te Diagnostic and Statistical Manual of Mental Dis-
orders has 18 criteria, and other symptom lists cite as many as 100 traits.
t raits.
Practitioners, including mysel, have been trying to establish a simpler,
clearer way to understand the impairments o ADHD. We have been look-
ing or the “bright and shining line” that defines the condition, explains the
source o impairments, and gives direction as to what to do about it.
My work or the last decade suggests that we have been missing some-
thing important about the undamental nature o ADHD. I went back to “If someone told me
the experts on the condition—the hundreds o people and their amilies I you could be normal
worked with who were diagnosed with it—to confirm my hypothesis. My or you could continue
goal was to look or the
t he eature that everyone with ADHD has, and that neu-
to have your ADHD, I
would take ADHD.”
rotypical people don’t have.
—David Neeleman,
I ound it. It is the ADHD nervous system, a unique and special
speci al creation
airline executive
that regulates attention and emotions in different ways than the nervous
system in those without the condition.

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The ADHD Zone
ALMOS EVERY ONE OF MY PAIENS PAIENS W WANS
ANS O DROP  HE
HE  ERM
ERM
Attention Deficit Hyperactivity Disorder, because it describes the opposite
o what they experience every
ever y moment o their lives. It is hard to call some-
thing a disorder when it imparts many positives. ADHD is not a damaged
or deective nervous system. It is a nervous system that works well using its
own set o rules.

u Studies suggest that ADHD symptoms are not correlated in any way
to IQ. However, it’s almost certain that people with an ADHD nervous FREE RESOURCE:
system use their IQs in different ways
ways than do neurotypical people.
people. 12 Amazing ADHD
By the time most people with the condition reach high school, they Superpowers http://
are able to tackle problems that stump everyone else, and can jump additu.de/superpower
to solutions that no one else saw.

u The vast majority of adults with an ADHD

ADHD nervous system are
are not
overtly hyperactive. They are hyperactive internally.
internally.

u Those with the condition don’t

don’t have a shortage of attention.
attention. They
They
pay too much attention to everything. Most people with unmedi-
cated ADHD have four or five things going on in their minds at once.
The hallmark of the ADHD nervous system isis not attention
attention deficit,
but inconsistent attention.
attention.

u Everyone with ADHD knows that they can “get in the zone” at least
four or five times a day. When they are in the zone, they have no
impairments, and the executive function deficits they may have had
before entering the zone disappear. People with ADHD know that
they are bright and clever, but they are never sure whether their abili-
ties will show up when they need them. The fact that symptoms and
impairments come and go throughout the day is the defining trait of
ADHD. It makes the condition mystifying and frustrating.

u People with ADHD primarily get in the zone by being interested in, or
intrigued by, what they are doing. I call it an interest-based nervous
system.. Judgmental friends and family see this as being unreliable or
system
self-serving. When friends say, “You can do the things you like,” they
are describing the essence of the ADHD nervous system.

u ADHD individuals also get in the zone when they are challenged or Secrets
thrown into a competitive environment.
environment. Sometimes a new or novel of the
task attracts their attention. Novelty is short-lived, though, and ev-
erything gets old after a while. ADHD the editors ooff Brain
from the

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u Most people with an ADHD nervous system can engage in tasks and
access their abilities when the task is urgent—a do-or-die deadline,
for instance. This is why procrastination is an almost universal
impairment in people with ADHD. They want to get their work
done, but they can’t get started until the task becomes interesting,
challenging, or urgent.

How the Rest of the World Functions

HE 90 PERCEN OF NON󰀭ADHD PEOPLE IN HE WORLD ARE “It is time for those
reerred to as “neurotypical.” It is not that they are “normal” or better. Teir in the mental health
neurology is accepted and endorsed by the world. For people with a neuro- game to recognize
typical nervous system, being interested in the task, or challenged, or find- how damaging the
ing the task novel or urgent is helpul, but it is not a prerequisite or doing it. deficit-based model
is to patients. It is
Neurotypical people use three different actors to decide what to do, how time to replace it with
to get started on it, and to stick with it until it is completed: the strength-based
1. the concept o importance (they think they should get it done). model, which doesn’t
2. the concept o secondary importance—they are motivated by the act deny that
carries ADHD
potentially
that their parents, teacher
teacher,, boss, or someone they respect thinks the
life-threatening risks,
task is important to tackle and to complete.
but also seeks out and
3. the concept o rewards or doing a task and consequences/punish- identifies the talents,
ments or not doing it. interests, and skills
A person with an ADHD nervous system has never been able to use the upon which the person
idea o importance or rewards to start and do a task. Tey know what’s im- can build a life of
portant, they like rewards, and they don’
don’tt like punishment. But or them, the success and joy.”
joy.”
things that motivate the rest o the world are merely nags. — Dr. Edward M. Hallowell
Te inability to use importance
i mportance and rewards as motivators has a lielong
impact on the lives o people with ADHD:

u How can those diagnosed with the condition choose between

multiple options if they can’t use the concepts of importance and
financial rewards to motivate them?

u How can they make major decisions if the concepts of importance

and rewards are neither helpful in making a decision nor a motiva-
tion to do what they choose?

Tis understanding explains why none o the cognitive and behavioral

therapies used to manage ADHD symptoms have a lasting benefit. Research- Secrets
ers view ADHD as stemming rom a deective or deficit-based nervous of the
system. I see ADHD stemming rom a nervous system that works perectly ADHD
well by its own set o rules. Unortunately
Unortunately,, it does not work by any o the ru
rules
les the editors ooff Brain
from the

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or techniques taught and encouraged in a neurotypical world. Tat’
Tat’ss why:

u Students with ADHD do not fit in the standard school system, which

is built on repeating what someone else thinks is important and rel-
evant.

u Adults with ADHD do not flourish in the standard job that pays
people to work on what someone else (namely, the boss) thinks is
important.

u People with ADHD are disorganized, because just about every orga-
nizational system out there is built on two things—prioritization
things—prioritization and
time management—that
management—that ADDers do not do well.

u People with ADHD have a hard time choosing between alternatives,

because everything has the same lack of importance. To
To them, all of
the alternatives look the same.

People with an ADHD nervous system know that, i they get engaged
with a task, they can do it. Far rom being damaged goods, people with an LIFE STORY:
ADHD nervous system are bright and clever. Te main problem is that they
Finding My Wings in
were given a neurotypical owner’s manual at birth. It works or everyone a Neurotypical World
else, not or them.
http://additu.de/wings

Don’t Turn Us Into Neurotypicals

HE IMPLICAIONS OF HIS NEW UNDERSANDING ARE VAS.
Te first thing to do is or coaches, doctors, and proessionals to stop try-
ing to turn people with ADHD into neurotypical people. Te goal should
be to intervene as early as possible, beore the ADHD individual has been

rustrated and demoralized

deck is stacked against him.byAstruggling in aapproach
therapeutic neurotypical
that world, where the
has a chance o
working, when nothing else has, should have two pieces:

u Level the neurologic playing field with medication, so that the

individual with ADHD has the attention
attention span, impulse control, and
ability to be calm on the inside. For most people, this requires two
different medications. Stimulants can improve a person’s day-to-day
performance, helping him get things done. They are not effective at
calming the internal hyperarousal that many with ADHD have. For
those symptoms, the majority of people will benefit by adding one
Secrets
of the alpha agonist medications (clonidine/Kapvay or guanfacine/ of the
Intuniv) to the stimulant. ADHD the editors ooff Brain
from the

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 Medication, though, is not enough. A person can take the right medica-
tion at the right dose, but nothing will change i he still approaches tasks
with neurotypical strategies.

u The second piece

piece of ADHD symptom
symptom management is to have an
individual create his own ADHD owner’s manual. The generic owner’s
manuals that have been written have
have been disappointing for peop
people
le
with the condition. Like everyone else, those with ADHD grow and
mature over time. What interests and challenges someone at seven
years old will not interest and challenge him at 27.

Write Your Own Rules

HE ADHD OWNER’S MANUAL HAS O BE BASED ON CURREN
successes. How do you get in the zone now? Under what circumstances do FREE RESOURCE
you succeed and thrive in your current lie? Rather than ocus on where you How to Control and
all short, you need to identiy how you get into the zone and unction at re- Harness Your ADHD
markable levels. http://additu.de/hfocus
I usually suggest that my patients carry around a notepad or a tape re-
corder or a month to write down or explain how they get in the zone.

u Is it because they are intrigued? If so, what, specifically, in the task or

situation intrigues them?

u Is it because they feel competitive? If so, what in the “opponent” or

situation brings up the competitive juices?

At the end o the month, most people have compiled 50 or 60 different

techniques that they know work or them. When called on to perorm and
become engaged, they now understand how their nervous system works and
which techniques are helpul.
I have seen these strategies work or many people with ADHD, because
they stepped back and figured out the triggers they need to pull. Tis ap-
proach does not try to change people with an ADHD nervous system into
neurotypical people (as i that were possible), but gives lielong help because
it builds on their strengths.

Secrets
of the

ADHD
from the
the editors ooff
Brain

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Truths About the ADHD Nervous
System
An explanation, finally, of why we act the way we do.
BY WILLIAM DODSON, M.D.

W hat I have come to understand—something that people with ADHD

know rom an early age—is that, i you have an ADHD nervous sys-
tem, you might as well have been
be en born on a different planet.
Most people with ADHD have always known they are different. Tey
were told by parents, teachers, employers,
employers, spouses, and riends that they
t hey did
not fit the common mold and that they had better shape up in a hurry i they
wanted to make something o themselves.
t hemselves.
As i they were immigrants, they were told to asimilate into the domi-
nant culture and become
bec ome like ever
everyone
yone else. Unortuna
Unortunately
tely,, no one told them
how to do this. No one revealed the bigger secret: It couldn’t be done, no
matter how hard
hard they tried. Te only outcome would be ailure, made worse
by the accusation that they will never succeed because they don’t try hard
enough or long enough.
It seems odd to call a condition a disorder when the condition comes
with so many positive eatures. People with an ADHD-style nervous sys-
tem tend to be great problem-solvers. Tey wade into problems that have FREE RESOURCE:
stumped everyone else and jump to the answer
answer.. Tey are affable, likable peo-
ple with a sense o humor. Tey have what Paul Wender called “relentless Exaggerated Emotions
determination.” When they get hooked on a challenge, they tackle it with Why ADHD riggers
one approach afer another until they master the problem—and they may Intense Feelings
lose interest entirely when it is no longer a challenge. http://additu.de/6a
I I could name the qualities that would assure a person
person’’s success in lie, I
would say being bright, being
b eing creative with that intelligence, and being well-
liked. I would also
a lso choose hardworking and diligent. I would want many o
the traits that ADDers possess.
Te main obstacle to understanding and managing ADHD has been b een the
unstated and incorrect assumption that ADDers could and should be like
the rest o us. For neurotypicals and ADDers alike,
a like, here is a detailed portrait
por trait
o why those with attention deficit do what they do.

1. Why We Are So Sensitive Secrets

YOU CANNO MANAGE HE IMPAIRMENS OF ADHD UNIL of the
you understand how you process emotion. Researchers have ignored the ADHD Brain
from the
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emotional component o ADHD because it cancan’t
’t be measured. Yet emotional
disruptions are the most impairing aspects o the condition at any age. For
example:

u Nearly everyone with ADHD answers an emphatic yes to the ques-

tion: “Have
“Have you always been more sensitive than others to rejection,
teasing, criticism, or your own perception that you have failed or
fallen short?” This is the definition of a condition called rejection-
sensitive dysphoria.
dysphoria. When I ask people with ADHD to elaborate on it,
they say: “I’m
“I’m always tense. I can never relax. I can’t just sit there and
watch a TV program with the rest of the family. I can’t turn my brain
and body off to go to sleep at night. Because I’m sensitive to my
perception
percepti on that other people disapprove of me, I am fearful in per-
sonal interactions.” They are describing the inner experience of being
hyperactive or hyper-aroused.
hyper-aroused. Remember that most kids after age 14
don’t show much overt hyperactivity, but it’s still present internally, if
you ask them about it.

u
Thethose
for emotional response
response
with the to the
condition. Theperception
perception of failure
term “dysphoria” is catastrophic
means catastrophic
“difficult to Each patient
own brain has his
library and
bear,” and most people with ADHD report that they “can hardly stand own way of storing that
it.”
it.” They are
a re not wimps; disapproval hurts them much more than it material. No wonder
hurts neurotypical people. the average person
with ADHD cannot
u If emotional pain is internalized, a person may experience depres- access the right piece
sion and loss of self-esteem in the short
shor t term. If emotions are exter- of information at the
nalized, pain can be expressed as rage at the person or situation that moment it is needed.
wounded them.

u In the long term, there are two personality outcomes. The person
with ADHD becomes a people pleaser,
pleaser, always making sure that
friends, acquaintances, and family approve of him. After years of
constant vigilance,
vigilance, the ADHD person becomes a chameleon who has
lost track of what she wants for her own life. Others find that the pain
of failure is so bad that they refuse to try anything unless they are
assured of a quick, easy, and complete success. Taking
Taking a chance is too
big an emotional risk. Their lives remain stunted and limited.

u For many years, rejection-sensitive dysphoria has been the hallmark

of what has been called atypical depression.
depression. The reason that it was
not called “typical” depression is that it is not depression at all but Secrets
the ADHD nervous
ner vous system’s instantaneous response to the trigger of of the
rejection. ADHD Brain
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u Until recently, all that a person with ADHD could do was to wait for
his dysphoria to dissipate over time. Clinical experience has found
that up to half of people with rejection sensitivity can get some relief
from the alpha agonists,
agonists, either clonidine (Kapvay) or guanfacine
(Intuniv). More investigation and research are called for, but if you
think that you may have rejection-sensitive dysphoria, talk with your “Researchers have
ignored the emotional
doctor about it. component of ADHD
because it can’t
be measured. Yet
2. Why We Don’t Function Well in a
emotional disruptions
Linear World are the most impairing
HE ADHD WORLD IS CURVILINEAR. PAS, PRESEN, AND FUURE aspects of the
are never separate and distinct. Everything is now. People with ADHD live condition.”
in a permanent present and have a hard time learning
lear ning rom the past or look-
lo ok- —William Dodson, M.D.
ing into the uture to see the inescapable consequences o ttheir
heir actions. ““Act-
Act-
ing without thinking” is the definition o impulsivity, and one o the reasons
that people with ADHD have trouble learning rom experience.

ningItand
alsodoing
means thatopeople
parts a task with ADHD
in order.  aren’t
asks
asks good
in the at ordination—plan-
neurotypical world have
a beginning, a middle,
midd le, and an end. Tey don’don’tt know where and how to star
start,
t,
since they can’t find the beginning. Tey jump into the middle o a task and
work in all directions at once. Organization becomes an unsustainable task
because organizational systems work on linearity, importance, and time.

3. Why We Are Overwhelmed

PEOPLE IN HE ADHD WORLD EXPERIENCE LIFE MORE INENSELY,
more passionately than neurotypicals. Tey have a low threshold or outside
sensory experience because the day-to-day experience o their five senses
and their thoughts is always on high volume. Te ADHD nervous system is
overwhelmed by lie experiences because its intensity is so high.
Te ADHD nervous system is rarely at rest. It wants to be engaged in
something interesting and challenging. Attention is never “deficit.” It is al-
ways excessive, constantly occupied with internal reveries and engagemen
engagements.
ts.
When people with ADHD are not in Te Zone, in hyperocus, they have
our or five things rattling around in their minds, all at once and or no
obvious reason, like five people talking to you simultaneously
simultaneously.. Nothing gets
sustained, undivided attention. Nothing gets done well.
Secrets
Many people with ADHD can’tcan’t screen out sensory input. Sometimes this
is related to only one sensory realm, such as hearing. In act, the
t he phenomenon of the
is called hyperacusis (amplified hearing), even when the disruption comes ADHD Brain
rom another o the five senses.
s enses. Here are some examples: from the
the editors ooff

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 >Te slightest sound in the house prevents alling asleep and over-
whelms the ability to disregard it.
> Any movement, no matter how small, is distracting.
> Certain smells, which others barely notice, cause people with ADHD
to leave the room.
People with ADHD have their worlds constantly disrupted by experiences
o which the neurotypical is unaware. Tis disruption enorces the perception
o the ADHD person as being odd, prickly, demanding, and high-maintenance.
But this is all that they have ever known. It is their normal. Te notion o be-
ing different,
different, and that difference being percei
perceived
ved as unacceptable by others, is
made a part o how they are regarded. It is a part o their identity.

4. Why We Love a Crisis

SOMEIMES, A PERSON WIH ADHD CAN HI HE DO󰀭OR󰀭DIE
deadline and produce lots o high-quality work in a short time. A whole
semester o study is crammed into a single night o hyperocused perec-
tion. Some people with ADHD create crises to generate the adrenaline to
get them engaged and unctional. Te “masters o disasters” handle high-in- “It may look llike
ike I’m
tensity crises with ease, only to all apart when things become routine again. procrastinating, but
Lurching rom crisis to crisis, however, is a tough way to live lie. Occa- I’m waiting around
sionally, I run across people who use anger to get the adrenaline rush they until my brain finds
need to get engaged and be productive. Tey resurrect resentments or slights, that “sweet spot”
rom years beore, to motivate themselves. Te price they pay or their pro- — that moment in
ductivity is so high that they may be seen as having personality disorders. time when the matter
becomes urgent
enough to motivate me
to move.”
5. Why We Don’t Always Get Things Done
— Stacey Turis, author
PEOPLE WIH ADHD ARE BOH MYSIFIED AND FRUSRAED by
the intermittent ability to be super-human when interested, an andd challenged
and unable to start and sustain projects that are boring to them. It is not that
they don’t
don’t want to accomplish things or are unable to do the task. Tey know
they are bright and capable because they’ve proved it many times. Te lie-
long rustration is never to be certain that they will be able to engage when
needed, when they are expected to, when others depend on them to. When
people with ADHD see themselves as undependable, they begin to doubt
their talents and eel the
t he shame o being unreliable.
Mood and energy level also swing with variations o interest and chal- Secrets
lenge. When bored, unengaged,
unengaged, or trapped by a task, the person
p erson with ADHD
of the
is lethargic, quarrelsome, and filled with dissatisaction.
ADHD
from the
the editors ooff
Brain

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6. Why Our Motors Always Run
BY HE IME MOS PEOPLE WIH ADHD ARE ADOLESCENS,
their physical hyperactivity has been pushed inward and hidden. But it is
there and it still impairs the ability to engage in the moment, listen to other
people, to relax enough to all asleep at night, and to have periods o peace.

Soby
levels when the distractibility
stimulant medication,and
theimpulsivity
person withare brought
ADHD mayback
not to
benormal
able to Most of my patients
do not own or wear
make use o his becalmed
be calmed state. He is still driven orward as i by a motor on a watch. For them,
the inside, hidden rom the rest o the world. By adolescence, most people time is a meaningless
with ADHD-style nervous systems have acquired the social skills necessary abstraction. It seems
to cover up that they are not present. important to others,
But they rarely get away with it entirely
entirely.. When they tune back into what but people with ADHD
has gone on while they were lost in their thoughts, the world has moved on never got the hang of
without them. Uh-oh. Tey are lost and do not know what is going on, what
it.
they missed, and what is now expected o them. Teir reentry into the neu-
rotypical world is unpleasant and disorienting. o the person with ADHD,
the external world is not as bright as the antastic ideas they had while lost
in their own thoughts.

7. Why Organization Eludes Us

HE ADHD MIND IS A VAS AND UNORGANIZED LIBRARY LIBRARY.. I con-
tains masses o inormation in snippets, but not whole books. Te inorma-
tion exists in many orms—as articles, videos, audio clips, Internet pages—
and also in orms and thoughts that no one has ever had beore. But there
is no card catalog, and the “books” are not organized by subject or even
alphabetized.
Each person with ADHD has his or her own brain library and own way
o storing that huge amount o material. No wonder my patients ofen can-
not access the right piece o inormation at the moment it is needed—there
is no reliable mechanism or locating it. Important items (God help us, im-
portant to someone else) have no fixed place, and might as well be invisible
or missing entirely. For example:
Te child with ADHD comes home and tells Mom that he has no home-
work to do. He watches V or plays video games until his bedtime.
b edtime. Ten he
recalls that he has a major report due in the morning. Was the child con-
sciously lying to the parent, or was he truly unaware o the important task?
Secrets
of the

ADHD
from the
the editors ooff
Brain

10
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ADDITUDE
Strategies and Support for ADHD & LD
8. Why We Forget Sometimes
FOR SOMEONE WIH ADHD, INFORMAION AND MEMORIES HA
are out o sight are out o mind. Her mind is a computer in RAM, with no
reliable access to inormation on the hard drive.
Working memory is the ability to have data available in one’s mind, and

to be able
action. TetoADHD
manipulate that
mind is ulldata to minutiae
o tthe
he come up o
with
liean answerare
(“Where ormy
a plan o
keys?” REMEMBER THE MILK!
ips to Improve Working
“Where did I park the car?”), so there is little room lef or new thoughts Memory http://additu.
and memories. Something has to be discarded or orgotten to make room
de/mem
or new inormation. Ofen the inormation they need is in their memory…
somewhere. It is just not available on demand.

9. Why We Don’t See Ourselves Clearly

PEOPLE FROM HE ADHD WORLD HAVE LILE SELF󰀭AWARENESS.
While they can ofen read other people well, it is hard or the average person
with ADHD to know, rom moment to moment, how they themselves are
doing, the effect they are having on others, and how they eel about it all.
Neurotypicals misinterpret this as being callous, narcissistic, uncaring, or
socially inept. aken together, their vulnerability to the negative eedback
o others, and the lack o ability to observe onesel in the moment, make a
witch’s brew.
I a person cannot see what is going on in the
t he moment, the eedback loop
by which he learns is broken. I a person
p erson does not know what is wrong or in
what particular way it is wrong, she doesn’
doesn’tt know how to fix it. I people with
ADHD don’t know what they’re doing right, they don’t do more o it. Tey
don’t
don’t learn rom experience.
Te inability o the ADHD mind to discern how things are going has
many implications:
e Many people with ADHD find that the eedback they get rom other
people is different rom what they perceive. Tey find out, many times (and
ofen too late), that
t hat the other p
people
eople were right all along. It isn
isn’t
’t until some-
thing goes wrong that they are able to see and understand what was obvi-
ous to everybody else. Ten, they come to believe that they can’t trust their
own perceptions o what is going on. Tey lose sel-confidence. Even i they
argue it, many people with ADHD are never sure that they are right about
anything.
r People with ADHD may not be able to recognize the benefits o Secrets
medication, even when those benefits are obvious. I a patient sees neither of the
the problems o ADHD nor the benefits o treatment, he finds no reason to ADHD Brain
continue treatment. from the
the editors ooff

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Strategies and Support for ADHD & LD
 t People with ADHD ofen see themselves as misunderstood, unappre-
ciated, and attacked or no reason. Alienation is a common theme. Many
think that only another person with ADHD could possibly ““get”
get” them.

10. Why We’re Time Challenged

BECAUSE PEOPLE WIH ADHD DON’ HAVE A RELIABLE SENSE THE GET-IT-DONE
GUIDE FOR ADHDERS
o time, everything happens right now or not at all. Along with the concept
o ordination (what must be done first; what must come second) there must Overcome Overwhelm
also be the concept o time. Te thing at the top o the
t he list must be done first, http://additu.de/tm
and there must be time lef to do the entire task.
I made the observation that 85 percent o my ADHD patients do not
wear or own a watch. More than hal o those
t hose who wore a watch did not use
it, but wore it as jewelry or to not hurt the eelings o the person who gave it
to them. For them, time is a meaningless abstraction. It seems important to
other people, but ADDers have never gotten the hang o it.

WILLIAM DODSON, M.D., board- certified in psychiatry, specializes in treating

adult ADHD in Greenwood Village, Colorado. This article is adapted from his
forthcoming book, What You Wish Your Doctor Knew About ADHD.

Secrets
of the

ADHD
from the
the editors ooff
Brain

12
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