The Hyperfocus Myth

I recently came across a blog entry by a well-meaning psychiatrist who wanted to stress how important it is to not diagnose nonconformity as a disorder (the original blog entry is linked below). Certainly I cannot argue with that point!

However, the example she used was ADHD. In this example she attributes to the ADHD child a sense of internal focus: as if the child were simply “attending to something else” rather than the thing her parents would prefer she attend to. This is the hyperfocus myth — that in ADHD, the child is somehow focused strongly on one thing rather than another. The reality, unfortunately, is far less beautiful.

For those without ADHD, imagine if you were watching TV on a large, 50″ digital HDTV. Everyone is watching a person running across the screen. But one person is watching the same show on an old, noisy, 12″ TV. There’s just static, so their eyes are darting around the screen, trying to see the person all his friends are talking about. You would not describe him as “just attending to something else” — you would agree he’s trying and would very much like to attend to the person, but can’t find it!

*That* is the internal experience of someone with ADHD, and simply reframing it as “attending to something else” trivializes that experience and creates what I believe to be a potentially dangerous paradigm shift toward the myth of “hyperfocus” that pervades our field today. As Barkley so accurately describes it, the ADHD patient does not “hyper focus”, they “persevere.” It’s not that they are attending strongly to something else, but rather that they cannot generate enough affective signal to start focusing on something else. They are staring blankly into the screen, and would love to find the person running across the screen.

 

The original article can be found here:

Did Ferdinand the Bull Have ADHD?

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Barkley – ADHD is More Than an Attention Problem

Barkley describes more concisely than most how vital it is for us to move away from the current “pop psychology” description of ADHD. Indeed, the very name “ADD”, coined in the early 80s, has caused a profound level of professional confusion by naming a fundamental neurological disorder after a peripheral symptom it sometimes causes. This was made worse when, years later, an attempt to rename the disorder simply added another peripheral symptom (hyperactivity) to the mix. The result, “Attention Deficit Hyperactivity Disorder” is, as Barkley puts it, akin to calling autism “Hand Slapping Disorder.” It has resulted in a total obfuscation of very real and profound deleterious, pernicious, and pathogenic traits that are at the core of this disorder, and relegates clients into the periphery of psychotherapy as “bad kids with bad parents” rather than patients with a real, biological disorder with real, medically validated treatments.

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Explaining ADHD to a client

The very name “Attention-Deficit / Hyperactivity Disorder” is so ill-guided, it’s no wonder the general public and even mental health professionals completely misunderstand the disorder. The disorder is not about attention or hyperactivity, and as Russell Barkley often says, “calling it Attention-deficit Hyperactivity Disorder would be like calling Autism Hand-slapping disorder.” The reality is that the basis of the disorder lies in a difficulty perceiving emotion in time, or a “temporal myopia.”

To help clarify, I have decided to illustrate how John and I often explain ADHD to a client:

What’s going on underneath?

Your problem is not actually with attention. What you have is a difficulty recognizing the importance (relevance) of things you perceive. If you look at a “normal” person (someone without this difficulty), their brain naturally connects feelings to the things they perceive around them and to the possibilities of choices about the future. They may feel fear at the prospect of not finishing their current task, or excitement over the future rewards if they do. In other words, they have a strong internal language of emotions that help guide them throughout the day.

The ADHD brain lacks this powerful language, leaving an emotional void often described with words like boredom, dullness, or monotony.

Most people develop this connection between thought and feeling early in life, allowing them to develop an automatic system of self-control to move from the external (like teachers and parents) to the internal (self-motivation).

The result?

As you sit trying to decide what to do next, the future is not emotionally present. It is out of focus, emotionally speaking. Without emotional meaning, it is difficult if not impossible to continue looking at it! Instead, you look to the present, where the emotions still exist.

This is why, despite being told you “can’t pay attention,” you’re really good at attending to video games for hours on end or watching TV or playing a sport. All of these activities have quick, immediate emotional rewards, for better or worse. As long as you stay in the present, you are able to feel.

And this is why you might have had people call you “hyperactive.” Not because you have too much energy, but because you’re desperately trying to find something, anything, that isn’t painfully empty of emotion — as if you were stuck in a lonely, emotional void.

Understanding this unique way of being in the world is only the first step, but it is an important one if we want to work together to help with the difficulties that can come with it. Next time we will talk about some of the ways we can work together to do just that.

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Medication as Social Compliance

I am baffled by people’s crazy misunderstanding about the role medication plays in ADHD treatment. Despite this disorder being anything but an attention deficit. When properly adjusted the drugs only serve to support a more normal cognitive experience. Working with our existing memory system becomes easier, processing speed improves, and fitting words (and affect) to experience becomes less difficult, as does self-regulating emotion, motivation, and behavior.

The professionals in (and out) of the field still believe that drugs are a form of social control: once recent paper referred to ADHD medication as a “social leash,” because persons properly medicated are more socially compliant — as if a positive social outcome must mean the intentions of the physician were self-interested and harmful. Nevermind the positive effects experienced by the patient!

What these ill-informed professionals fail to understand (or acknowledge) is that these drugs allow a patient to more effectively make self-efficacious decisions. Cooperation (or “social compliance”, when vilified by these authors) is often a win-win arrangement — it is simply the most self-efficacious choice, not a dominance-submissive or win-lose exchange.

Indeed, the mere fact that one can measure the efficacy of medication by testing reading comprehension alone, without ever examining “social compliance” should be illuminating enough, since neurologically the capacity for reading comprehension and following rule-governed behavior share neuronal pathways.

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Focus with ADHD

I would like to call your attention to a new support group available on Facebook, Focus with ADHD. While this group is not a replacement for therapy or medication, it is a place where anyone struggling with ADHD or interested in learning more about ADHD can come and talk to like-minded individuals, ask for support or help when needed, and simply have a place where you can feel understood.

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Understanding ADHD

ADHD is horribly misunderstood, and it is our fault as therapists that this is true. For years, we have continued to call this disorder “Attention Deficit and Hyperactivity Disorder” despite all recent evidence pointing clearly to the idea that beneath it all, attention and hyperactivity have no more to do with the underlying deficit than, to paraphrase Russell Barkley, hand-slapping has to do with Autism.

All of us have within us the ability to orient in time — to be mindful of our present feelings, retrospective of our past experience, and prospective of future consequences. Fluid movement through our temporal perspective is vital to good decision-making. “ADHD” is what we call a person who is so rooted in the present, that they no longer move internally to the future. They are not avoiding an uncomfortable option that they thought about — they never thought about it in the first place.

To illustrate the difference between this temporal myopia and avoidance, we should examine Antonio Demasio’s work, which has highlighted the often under-appreciated importance of emotions in our decision-making process. When we move through time in our minds, we must be able to connect feelings to the various options we face if there is any hope of those options being realistic choices. Imagine a life where a present choice elicits a strong emotional response, while a future choice elicits no response at all? Would that future choice have any real chance of affecting the present moment?

With this model in mind, it becomes easier to see where both genetic and environmental influences take hold. On a biological level, we are all predisposed to ways of being in the world. Some of us may have strong emotional connections to the present, while others more easily connect emotionally to the future. Add to this relationships that might push you to connect more with the present or future.

Treatment, then, should focus not on “Attention” or “Hyperactivity”, but rather on aiding the client in developing emotional language for future events — in effect to reestablish a link between their emotions and the future.

What do you think? Post your questions or comments below!

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