Author: Edward M. Hallowell, M.D., and John J. Ratey, M.D.
APA Style Citation
Hallowell, E & Ratey, J. (2021). ADHD 2.0: New science and essential strategies for thriving with distraction—from childhood through adulthood. New York, NY: Ballantine Books.
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Authors Edward Hallowell and John Ratey are psychiatrists who have attention deficit hyperactivity disorder (ADHD). Their personal knowledge both in the field and in life offer a valuable perspective on ADHD, a condition that occurs in at least 5 percent of the population. ADHD is often misunderstood as individuals who are lazy or disrespectful, a condition that children will grow out of, or a condition created by pharmaceutical companies. The authors hope to dispel these myths and see the strengths of this condition, while focusing on some tools for management. Hallowell and Ratey often explain ADHD with the analogy, “A person with ADHD has the power of a Ferrari engine but with bicycle-strength breaks. It’s the mismatch of engine power to breaking capability that causes the problems. Strengthening one’s brakes is the name of the game.”
ADHD is different for everyone, but there are some commonalities. Some of these indicators include distractibility, impulsivity, and hyperactivity. Optimism and creativity have also been associated with ADHD. Rather than a deficit of attention, there is actually an overabundance of attention that can be challenging to control. There can also be an intolerance of boredom and a need for stimulation. There is often a set of contradictory tendencies, such as a lack of focus mixed with hyperfocus or procrastination mixed with a surge of productivity. This is just a sampling of the telltale signs of ADHD. As for the cause of ADHD, there is a highly genetic component and certain environmental stressors, such as lack of oxygen at birth, early infections, or other brain functioning problems. The mother’s behavior during pregnancy can also raise the risk for ADHD. Another explanation is the modern lifestyle that has been training our brains to go faster, multi-task more frequently, and require constant stimulation. The authors introduce a new term called VAST: the variable attention stimulus trait. This term refers to individuals with ADHD symptoms, but not meeting the criteria for a diagnosis. The term is also meant to shift away from attention deficit to the variability of attention and detoxify the label of ADHD. The focus has often been on the problematic side of the condition, but there are useful tendencies associated with ADHD as well.
Hallowell and Ratey provide the brain basics and explain current research findings. They walk the reader through the task-positive network (TPN) and default mode network (DMN) and take care to explain the difference between a neurotypical brain and someone with ADHD. They also explain the cerebellum and vestibular system’s connection to ADHD. The cerebellum is involved in physical balance, but it has also been found to control emotional equilibrium. By working doing exercises to increase balance, it has helped control the braking power needed with ADHD. Hallowell and Ratey share a particularly powerful case study of a young boy in China who was struggling with ADHD. After his mother attended a talk done by Dr. Hallowell, the two corresponded through email to set up a treatment program. The treatment program was set up based on connection, education, a strength-based model, and balance exercises. Within a few short weeks there was great improvement for the child.
Several chapters are dedicated to providing a better understanding what helps with ADHD and offer tools for therapy. Not feeling understood and a lack of connection often plague individuals with ADHD. Tips are provided for creating rich social connections. Boredom is the kryptonite for those with ADHD and many problematic behaviors become present when bored. But it is the strengths that are often ignored. A strength-based model is about identifying and using those strengths while being appropriately challenged. Creating the right environment can be powerful. This includes organization and daily structure, proper nutrition and sleep, surrounding oneself with positivity, and finding the right type of help. Behavioral therapy, such as applied behavioral analysis (ABA), has been found particularly helpful to develop a new set of skills, and social learning for adjusting to social situations. Exercise has also been found to be beneficial to improve mood and motivation and maintain focus. Studies have found that after just 20 or 30 minutes of moderately paced exercise subjects have increased their focus. Using brain breaks in the classroom is encouraging movement. To enhance balance, yoga and meditation have also been found helpful. The authors also acknowledge the tool many fear, which is medication. The use of stimulants has been found effective on average 70 to 80 percent of the time. The authors encourage using a risk/benefit analysis and discussing the medication options currently available. They explain the difference between methylphenidate and amphetamine medications. Many wonder why the use of stimulants for a hyperactive brain, but that stimulants raise the levels of dopamine and norepinephrine, both of which are not balanced in the ADHD brain. Hallowell and Ratey point out the stimulants stimulate the brain’s brakes, providing more control. They also discuss stimulant-like drugs, outlier drugs, and the concern of addiction and abuse.
ADHD is not the same for everyone. With the power of knowledge and a better understanding of the condition, hopefully individuals can learn to reframe their thoughts and actions. Rather than seeing all of the problems, there are also strengths associated with ADHD. There is amazing potential, creativity, and energy. The authors leave the reader with, “Each of us finds a different way; there is no one right way. But what a liberating message it is for all of us to know that no brain is the best, and each of us has the magnificent, lifelong chance to find our own brain’s special way.”
Other Related Resources
Dr. Hallowell, The Hallowell ADHD Centers
ADHD 2.0: A Conversation with Author Ned Hallowell
Distraction Podcast: ADHD 2.0 Reveals New Science and Strategies
WHYY PBS, "ADHD 2.0" with Dr. Edward Hallowell
Psychological Concepts and Figures
Attention deficit hyperactivity disorder (ADHD)
Nature v. nurture
Applied behavioral analysis (ABA)
Task-positive network (TPN)
Default mode network (DMN)
Variable attention stimulus trait (VAST)