by Karen Sampson Hoffman, MA, and Pamela Mercer
WHO IN THE WORLD OF ADHD ADVOCACY wouldn’t jump at the chance to see Dr. Russell Barkley and Dr. Edward Hallowell, rock stars of the ADHD field, on stage together? With great anticipation hundreds of researchers, clinicians, advocates, parents, and adults with ADHD gathered to hear what they thought would be a debate between the two men last November at CHADD’s 23rd Annual International Conference in Orlando.
Over the years, Barkley has faced criticism that he overemphasizes the impairment and risks associated with ADHD, such as school failure and substance abuse. Hallowell, in turn, has been accused of portraying ADHD as an asset and downplaying the devastation it can wreak on lives and dreams.
So it came as a surprise when, instead of a heated exchange, two men who have sometimes been portrayed as intellectual opponents came together to deliver a joint message: They agree much more than they disagree. Efforts by others to magnify their differences, they told the audience, merely hurt the cause of ADHD awareness.
“As soon as [Hallowell called me], I thought this provided a tremendous opportunity to clarify our positions and have a conversation,” Barkley told the packed ballroom of conference attendees. “This is not a debate. I think both of these views are mischaracterizations of very complex viewpoints.”
Hallowell said, "The enemy is ignorance and stigma and kids languishing in school and adults languishing in their careers. That's the enemy that Russ and I have spent our careers trying to vanquish. The enemy is not Russ's point of view and my point of view."
And so, to answer the question posed in the title ADHD: Gift or Curse? the message from both experts was: Neither… well, perhaps a bit of both.
From Barkley, the researcher’s perspective
Karen Sampson Hoffman
While the gentlemen actually share many similar points of view, including that there needs to be a greater public awareness of adult ADHD, they do differ in other regards. This is a good thing, Barkley said.
Barkley, a psychologist, took the audience through a very formalized presentation contrasting the views of the two experts. Both men have focused on adult ADHD in several books, detailing the symptoms and characteristics along with the shared risks presented by the disorder. Reminiscent of a college professor, Barkley used a tailored PowerPoint presentation highlighting his and Hallowell’s points of agreement and differences.
“Both Ned (Hallowell) and I agree ADHD is a dimensional disorder,” he said. “It connects up with the spectrum of human ability. These are normal people who happen, for various reasons, to be delayed or deficient in certain areas in psychological development. But they are certainly not an entirely different category of adult or child human being. This is not a personal failing; it is a disorder with strong neurobiological roots to it.”
Barkley acknowledged there are areas of clinical disagreement and said that there should be. “After all, science advances by criticism, not by agreement. What one needs to understand, however, is not to take the criticism personally. It’s an issue of debating ideas and not trying to undermine the character of individuals.”
Barkley detailed the symptoms and known causes of ADHD. He displayed ways in which his research and descriptions agreed and disagreed with those often attributed to Hallowell. The disagreements mainly come down to individual talents of people affected by ADHD versus the main findings of research on large groups of people, he said.
Barkley pointed out how his role and Hallowell’s role differ, between that of the clinical researcher and the therapist working one-on-one in the ADHD clinic. While Barkley looks at ADHD on the group level, Hallowell searches out the individual coping with ADHD.
“Both of those roles have a place here in understanding ADHD,” Barkley said. Hallowell is often thought to stress ADHD as a type of “gift,” Barkley said, while his own research highlights the struggles. Barkley said Hallowell likes to point to several famous examples of individuals who have started successful copier businesses or airline enterprises to assert the giftedness of those with ADHD, he said.
“Their ADHD may have helped them to some extent, but in the context of those around them,” Barkley pointed out, adding that supportive parents, coaches, and administrative assistants had a tremendous impact on their success. In Barkley’s research into groups of people, he said, “We come up with a portrait of averages, not a composite of any one person.”
Even while listing the challenges and potential negative outcomes faced by people affected with ADHD, Barkley made the point that the downside of the disorder is not a foregone conclusion.
“The majority of people do not experience these outcomes, even though they are more likely to do so, even when the percentage is higher when we take a look at a general population setting,” he said.
“Like other clinical career scientists, my focus is on the deficit and impairment associated with ADHD at the group level of analysis, not the individual level,” Barkley said. “The focus on group level data can homogenize the disorder and make it seem like everyone is the same and faces the same risks. You will find, though, there is a wide variety of people put under the tent of ADHD. Within this group of people you will have a wide range of people with success and even giftedness.”
Barkley also pointed out the areas where he and Hallowell disagree, touching on a recent New York Times blog written by Hallowell, in which Hallowell put forward the idea that the individuals with traits associated with ADHD settled and expanded the United States.
“We have had immigrants over the generations who have watered down the gene pool so that modern life is not representative of people many years ago,” he said, rejecting the idea that ADHD is so common in the United States because of these possible ancestors.
Barkley also warned of problems in “championing” ADHD as a talent or gift. “There is a possibility of a loss of credibility. You will lose credibility with patience, and the larger advocacy community. And you may lose acceptance with the public; the public doesn’t have the time to hear how great your disorder is. You also have to understand that there could be a loss of services associated with this [idea].”
Also at risk would be the educational gains in the 1970s and 80s, along with services and support, he reminded them, touching on IDEA and the Americans with Disabilities Act.
“We would also caution people in oversimplifying both of our points of view, for the public and the politicians we have to work with,” he said.
Barkley conceded to Hallowell, however, that for some people, the struggles of ADHD offer a silver lining. “It is very possible by having a disorder it can cause some individuals to rise to that challenge and be better people than they would have been had that challenge not been presented to them.”
From Hallowell, the therapist’s view
Hallowell, a psychiatrist who has ADHD, has often been accused of suggesting that the disorder carries innate strengths that have not been borne out by the evidence. In a highly commented blog entry for The New York Times last October, entitled "It's In the National DNA," he argued that traits which he related to ADHD could have powered the pioneering spirit of the Pilgrims:
"Consider also the positives that so often accompany ADHD: being a dreamer and a pioneer, being creative, entrepreneurial, having an ability to think outside the box (with some difficulty thinking inside of it!), a tendency to be independent of mind and able to pursue a vision that goes against convention. Well, who colonized this country? People who have those traits! "
Exactly one month later, however, as he strutted across the stage of a well-lit ballroom at a DisneyWorld conference center, his unstudied poise and jovial delivery striking a contrast with Barkley's cerebral, behind-the-podium slide assisted presentation, Hallowell sounded a different, almost Barkley-esque note. "Let me be very clear. Very clear," he said. "ADD is not a gift. As defined in DSM-IV, ADD is horrible." The disorder can ruin school experiences, derail careers, and damage marriages, Hallowell (who says he still refers to the disorder as "ADD" by habit) added. "It is absolutely heartbreaking to deal with the ravages of this condition untreated, unrecognized."
To the charge that Barkley's view of ADHD is too dim and his view too rosy, Hallowell offered another take. He and Barkley are "two sides of the same coin.” There is a lot of work to be done and "squabbling," he said, doesn't help. He paid tribute to Barkley for being the first voice to seriously study ADHD, beginning decades ago when even fellow scientists scoffed at the notion of ADHD as a real disorder. "The field wouldn't exist without him," Hallowell said.
Barkley—the student of groups—spots trends, breaks ground, and commands respect around the world from experts and patients alike. Hallowell, who speaks primarily from clinical experience, emphasizes anecdote and personal observation honed from years of experience and scores and scores of patients. He speaks in generalities and appeals to hope and optimism, and his voice has resonated in bestselling books snatched up by people with ADHD and their families. His message to the public, he indicated at the conference, was one he imparted to his patients in order to get them to take treatment seriously and be motivated to lead full lives.
None of the pitfalls of ADHD will ever lead him to believe that it is a handicap, Hallowell said. "I'm not here to treat a disability. I'm in the business of unwrapping gifts," he said. “Don't start selling yourself short. Don't start saying, ‘I'm stupid.’ If you look outside the impairment and work tenaciously, you can find a great and glorious life."
Treatment is a pathway to unlocking a person's potential and enabling him or her to succeed. And the most important element of any treatment plan, Hallowell said, is hope. You don't get hope by listing the possibilities of bad outcomes but by telling stories of strengths, he told the audience. Without positives, there is the danger that "you will instill fear, loss of hope… and buying into the notion that you are a defective human being… the damage done by that can last a lifetime."
Hallowell conceded that ADHD is not in itself a talent, but repeated what he has frequently said before, that in his clinical experience ADHD and talent often go together. “We need to say, you know, outside of your ADD symptoms you've got some pretty good stuff.”
Yet as Hallowell recounted his personal troubles with ADHD, it was human kindness that seemed to emerge as the stronger link between ADHD and success. Now at the top of his profession, Hallowell, a best-selling author who also has dyslexia, told of growing up in a family plagued by mental illness and abuse and being sent to boarding school at the age of ten. So how did he thrive? How did a boy who had trouble reading become an English major and gain acceptance to Harvard? Hallowell's answer is familiar for adults with ADHD who have reached success: Somebody cared enough to go to bat for him. That person in his life was a first-grade teacher, a kindly, heavy-set woman who, he recalled, would put her plump arm around him as if to protect him while he struggled to read.
Harvard and English literature, he said, “never would have happened had it not been for that arm.”
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