introduction

All information processing is emotional . . . emotion is the energy level that drives, organizes, amplifies and attenuates cognitive activity.

—Kenneth Dodge, neuroscientist

Although the scientific understanding of ADHD has changed dramatically over the past decade, most people affected by this disorder—and many who diagnose and treat them—have not yet had the opportunity to gain a clear, up-to-date understanding of this complex condition. As you'll read in the chapters that follow, ADHD is not a simple problem of misbehavior, lack of willpower, or inability to focus attention. In this collection of true stories about extremely bright teenagers and adults, you'll find multiple examples of the ways that ADHD can cause even very intelligent individuals to experience chronic frustration and failure, which gets them “stuck” in their schooling or work and many other aspects of daily life. Fortunately, in most cases it's possible for a person with ADHD to get unstuck, and in these pages you'll find numerous examples showing how effective treatment has helped those suffering from ADHD to get back on track.

Clinical and neuroscience research has revealed that ADHD is essentially a complex set of dynamically interacting impairments of the brain's management system, otherwise known as its “executive functions.” These functions involve a number of critical operations of the brain, including the abilities to

• Get organized and get started on tasks
• Focus on tasks and shift focus from one task to another when needed
• Regulate sleep and alertness, sustain effort, and process information efficiently
• Manage frustration and modulate emotions
• Utilize working memory and access recall
• Monitor and self-regulate action

Everyone has trouble with these functions from time to time, but people with ADHD have much more difficulty with them than do their same-age peers. (I offer more detailed descriptions of these various executive functions in Chapter 1.)

the missing link: emotions

Despite progress made in ADHD research, one element has been lacking in most current descriptions of the disorder: the critical role played by emotions in every one of the executive functions. This book describes that missing piece. In 1996, neuroscientist Joseph LeDoux published The Emotional Brain, a book highlighting evidence of the central importance of emotion in the brain's cognitive functioning. He emphasized that emotions—mostly unconscious emotions—are powerful and critically important motivators of human thought and actions.1 This understanding of the essential role of emotion in all aspects of human behavior has not yet been integrated into current thinking about ADHD.

We must recognize the critical role of emotions, both positive and negative, in initiating and prioritizing tasks, sustaining or shifting interest and effort, holding thoughts in active memory, and choosing to engage in or avoid a task or situation.

To fully understand the role of emotions in ADHD, we must not only recognize that those with the disorder often have a hard time managing how they express their emotions but also acknowledge the critical role that emotions, both positive and negative, play in the executive functions: initiating and prioritizing tasks, sustaining or shifting interest and effort, holding thoughts in active memory, choosing to engage in or avoid a task or situation. As was observed by neuroscientist Kenneth Dodge, “All information processing is emotional . . . emotion is the energy level that drives, organizes, amplifies and attenuates cognitive activity.”2

Emotions—sometimes conscious, more often unconscious—serve to motivate cognitive activity that shapes a person's experience and action. For those with ADHD, chronic problems with recognizing and responding to various emotions tend to be a primary factor in their difficulties with managing daily life.

The stories in this book highlight the role that various emotions, positive and negative, played in the struggles of some of my patients with ADHD. Some readers of these stories might think, “Oh, this is a person with ADHD and several other disorders—anxiety, depression, or OCD. Their emotional struggles are just part of those additional disorders, not ADHD.” My response is that ADHD is not one silo of cognitive problems with another silo of emotional difficulties beside it. Problems with responding to and managing emotions are intimately, dynamically, and inextricably involved in ADHD.

Problems with responding to and managing emotions are intimately, dynamically, and inextricably involved in ADHD.

learning from patients and research

I am a clinical psychologist. For more than thirty-five years, I have spent most of my working hours talking with and listening to children, adolescents, and adults, most seeking help for problems related to ADHD. Many also have had additional difficulties with other problems involving emotions, learning, or behavior. My primary source of learning about ADHD has been the countless conversations with these patients—young and old alike—who shared with me ongoing stories of their struggles to recognize and overcome their attention impairments and to extricate themselves from feeling stuck in patterns of demoralizing frustration and failure. The stories in this book are based on my notes from conversations with some of these patients. All have been modified to protect the privacy of those involved, but the essential details of all are true.

Recently expanding research in neuroscience, psychology, and psychiatry has helped explain many puzzling facts reported by patients with ADHD, such as how they can focus and work energetically on a few favored activities, but simply can't get started or sustain enough effort for other activities that they know are important and want to do. In these pages, true stories of patients are intermingled with accessible explanations of research that will help you better understand each patient's struggles and the fuller nature of the relationship between ADHD and emotions.

One of my special interests over the years has been adolescents and adults who are especially bright. They have taught me that being smart is no protection from attention impairments. Not only is it possible for people with a high IQ to suffer from ADHD, but it's likely that they'll suffer longer without adequate support or treatment because the people in their lives assume, quite mistakenly, that anyone who is really smart can't suffer from ADHD.

Not only is it possible for people with a high IQ to suffer from ADHD, but it's likely that they'll suffer longer without adequate support or treatment because the people in their lives assume, quite mistakenly, that anyone who is really smart can't suffer from ADHD.

The patients I write about in this book are all extremely bright. They scored within the top 9 percent of the population on IQ tests, but they were stuck. They sought treatment because they were unable to get themselves out of chronically unproductive, self-defeating patterns of emotions, thought, and action. They felt trapped in their daily dealings with their education, their job, their relationships with others, or a combination of these. Their stories illustrate the persistent difficulties those with ADHD have in managing themselves and their emotions. Some are stories of amazing successes and impressive accomplishments; others are tales of ongoing frustration and tragic disappointment. Most are a mixed bag. Yet each story illuminates the complex role that emotions play in ADHD.

what you'll find in this book

Chapter 1 describes this new understanding of ADHD, drawing on the latest research findings by clinicians, researchers, and neuroscientists. Chapters Two through Twelve offer stories of real teenagers and adults with ADHD, highlighting their particular struggles with the disorder, with their emotions, and with related problems in their family or various other contexts. The final chapter summarizes some of the ways that emotions affect the life experiences of those with ADHD and what can be offered to appropriately support and treat those affected.

The stories that follow illustrate the limitations of diagnostic “pigeonholes.” The individuals you'll read about in these pages can't be neatly categorized under one or several diagnoses. Each person is a unique and complex combination of interacting strengths and difficulties in each of the shifting contexts in which he or she lives. There is great diversity among people with ADHD as well as in the varied settings in which they encounter daily life.

In telling stories of these adolescents and adults, I have also shared some of my own reactions and challenges as I tried to provide the help they sought from me. Many of the stories are success stories. I share the resources and strategies that contributed to these successes. Several stories also illustrate the significant obstacles and struggles that some people with ADHD may experience.

Stories in this book also illustrate what we currently know about how ADHD changes—sometimes for the better, sometimes for the worse—as a person progresses into the...