What’s Better, ADHD Or Attention Priority Difference?
by Jeffrey Rubin, PhD
Welcome to From Insults to Respect.
Recently, I came upon an article in The New York Times by Ellen Barry titled, “Autism, A.D.H.D., Anxiety: Can a Diagnosis Make You Better?” She begins by telling us about a woman in her early 50s who, upon getting a diagnosis of attention deficit hyperactivity disorder, “described it as a profound relief, releasing her from years of self-blame — about missed deadlines and lost receipts, but also things that were deeper and more complicated, like her sensitivity to injustice.” Other people Ms. Barry met who were given a “diagnosis” of autism spectrum disorder also experienced it as relief. Simply putting a name to it seemed to help.
Negative Effects Emerging
However, Ms. Barry notes that evidence is emerging that over the long term, diagnosing these conditions doesn’t help. “Yes,” she says, “there is a positive effect of lowered self-blame. But there is a negative effect as well–a greater pessimism about recovery.”
Defending her position, Ms. Barry describes a study that looked into this negative effect. The study identified no significant differences in the demographic characteristics or socio-emotional wellbeing of 9-year-olds with hyperactivity/inattention who had and who had not received a diagnosis of ADHD. However, by age 13, those who had a diagnosis at age 9 showed more emotional and peer relationship problems, worse prosocial behaviour, and poorer self-concept.
Other research found that those who were treated with A.D.H.D. medication, in the long run, did no better academically while suffering a variety of negative effects from the prescribed drugs such as becoming addicted to the drug, along with head and stomach aches,
Last year, a study found that even a medium strength daily dose of Adderall, the most commonly prescribed drug to treat A.D.H.D., more than tripled a patient’s likelihood of developing psychosis or mania. A high dose increased the risk by a factor of five. And yet, another study found that the height suppression found in earlier studies, which were thought to be temporary, found that nine years after treatment, the height gap remained. The subjects’ A.D.H.D. symptoms, meanwhile, were no better than those who had stopped taking the medication or who had never started.
Benefits To Realizing The Characteristics That Lead To An A.D.H.D. Diagnosis Are Often Not Permanent
Recent researchers have been discovering that A.D.H.D. behavior characteristics can be highly responsive to the environment. 
When the surroundings of a person with an A.D.H.D. diagnosis better matches the person’s interests and talents or home life improves, the behavior pattern that led to the “diagnosis” often improves as well.
We need people with different interests and talents to fill the various roles society values. Someone who enjoys painting houses might find sitting all day in front of a computer screen very boring, while others enjoy a job that has them engaging for hours on a computer. Fortunately, we have a need for both types, and conceptualizing one or the other as having a pathological condition does not appear to be helpful in the long run. Much better is to provide narratives that demonstrate people who find they are inattentive in certain settings, such as the typical school classroom, may very well do much better in some other environments better suited to them. More and more, research is demonstrating this is true.
In 2016, Arielle Lasky and other members of her research team published a paper that describes their discussions with subjects who had been given a diagnosis of A.D.H.D. as children, but were now in their mid-20s. Subject after subject spontaneously brought up the importance of finding their “niche,” or the right “fit,” in school or in the workplace. As adults, they had more freedom than they did as children to control the parameters of their lives — whether to go to college, what to study, what kind of career to pursue. Many of them had sensibly chosen contexts that were a better match for their personalities than what they experienced in school, and as a result, they reported that their A.D.H.D. symptoms had disappeared. In fact, some of them were questioning whether they had ever had a disorder at all — or if they had just been in the wrong environment as children.
The work environments where the subjects were thriving varied. For some, the appeal of their new jobs was that they were busy and cognitively demanding, requiring constant multitasking. For others, the right context was physical, hands-on labor. For all of them, what made a difference was having work that to them felt “intrinsically interesting.”
One subject, who was studying film in college, said that his ability to thrive in his chosen field made him question the years he spent being treated for A.D.H.D. “Originally, when I was first diagnosed with it, it was explained to me as attention deficit, just a lack of attention,” he said. “An ability not to have an attention span for very long. But I can have an attention span for extremely long for the things that I care about.”
A hairstylist told the researchers that her inability to concentrate in school vanished when she began studying hair. “If you sit up there and give me a lecture on a haircut, I will remember everything you said, word for word,” she said. “Stuff that I’m into, I am so immersed in it. But in school, it was awful.”
A young man who was training to be an auto technician said that in his new career, his A.D.H.D. was no longer an issue. “It’s just that I had to figure out what I wanted to do,” he explained. “I want to work with cars. I don’t get bored doing that. If people with A.D.H.D. are directed into areas where their strengths and interests lie, I’m pretty sure that they can naturally just go about dealing with it, instead of having to give people medications.”
Instead of characterizing A.D.H.D. as a medical disorder, which tends to lead people to believe they are defective, perhaps suggesting to them that they may have an “Attention Priority Difference” might be better. For some children, a different school, or a different kind of school, might produce the same profound shift that we are finding in recent research studies.
In a 2021 review paper, researchers found 14 studies in which receiving an A.D.H.D. diagnosis seemed to create a sense of “empowerment” by “supporting a sense of legitimacy accompanied by understanding and sympathy as well as decreased guilt, blame and anger.” In 22 other studies this team found, “a biomedical view of difficulties was shown to be associated with disempowerment. By providing an excuse for problems, a decrease in responsibility by all involved can occur, often followed by inaction and stagnation.” An additional 14 studies found that the diagnosis increased feelings of stigmatization. “The diagnosis can create an identity that enhances prejudice and judgment, which are associated with even greater feelings of isolation, exclusion and shame.”
Conclusion
Admittedly, the A.D.H.D.medical model provides parents and students a simple explanation for their children’s problems that can bring about relief and reduce blame, at least in the short term. However, the Attention Priority Difference model can do this as well and more accurately reflects the latest scientific understanding that a student’s environmental context can dramatically alter the concerning behavior. Rather than our society spending millions of dollars on drugs that people have become convinced is a quick fix to these problems, the Attention Priority Difference idea can offer for many a valuable alternative. It can motivate schools to provide more varied classroom activities that are designed to better match the various interests and talents of their students who are bored with the traditional approach that has students sitting at their desks doing seat work for unbearably long hours. And it can give these children a vision of their future in which things might actually improve — not because their brains are chemically refashioned in a way that makes them better able to fit into the world, but because they find a way to make the world fit better with whom they are.
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE
Hello Jeff, thank you for this article which exposes the dangers of psychiatric diagnoses.
Here’s how I see things. If we initially imagine that a newborn is a mass of flesh without a personality, then we will want to shape the child according to a developmental model that we consider optimal.
In my opinion, from this fundamental error, imposed by medical authorities in Cartesian cultures, stems the norm that we impose on the child. We thus develop an imaginary model of normality for children at each age.
Of course, this is wrong. For example, some children who didn’t read at the age when it was considered the norm start reading later when it’s the right time for them, and the delay is completely made up. And it is not even correctly applied. Children born a few months later appears to have more ADHD diagnosis than their older classmates.
However, I think this fundamental error leads to tremendous pressure being put on the child to conform to this absurd norm, with criticism from teachers, punishments, failing in class, parental anxiety, rejection, and medicalization.
Oh, this is bad. What do we do? We go to the authority. The same authority that imposed this absurd standard will now manage it by imposing another absurdity: a diagnosis of an imaginary illness.
I think the enormous relief described by those who receive this imaginary diagnosis corresponds to the cessation of pressures to conform.
It is not exactly relief. It is the beginning of stigmatization, possible segregation and severe medical mistreatment, with neurotoxic drugs that damage the brain, body, and psyche. Medical ethics are violated in multiple ways: dangerous drugs are prescribed to children without the slightest evidence of biological necessity. Informed consent is not respected. The information provided has no scientific validity. What is wrongly called a diagnosis has no causal value, blurred lines. The assumed prognoses are based on nothing. The imaginary condition becomes real physical and cerebral poisoning and a horrific, collective indoctrination. The condition that has been created perpetuates itself, and this may be escalated later with multiple so called psychiatric diagnoses like manic, bipolar, psychosis, and who knows what, and the poisons list keeps growing.
I think that this entire aberration, which I consider criminal, stems from a flawed philosophy. It was René Descartes who pretended to define what it means to be human and who conferred the associated rights with the exercise of logical, mathematical, masculine, unemotional, and non-spiritual thought. Auguste Comte and his positivism denied spiritual dimensions. Peter Singer, who considers the newborn not to be a human being. And all those who ignore the soul, its uniqueness, transpersonal psychology, past lives, life purpose, invisible guides, personal trials, and differences. Doctors, unfortunately, are trained in a perspective that reduces and dehumanizes the person by crushing all the evolving dimensions of the human being into the functioning of a biological system. What about the social dimensions? Environments? Traumas and memories? Bad habits? Conflicts? Rights violated?
I think our culture has to change. An interesting model is the Finnish education system. Is this because Finland remained a land of shamanism for a long time?
Thank you, Luc Thibaud, for your thoughtful analysis regarding the dangers of psychiatric diagnoses. You mention the Finnish education system as an interesting model. Here’s a brief description of its early childhood education philosophy.
“Finnish early childhood education emphasizes respect for each child’s individuality and chance for each child to develop as a unique person. Finnish early educators also guide children in the development of social and interactive skills, encourage them to pay attention to other people’s needs and interests, to care about others, and to have a positive attitude toward other people, other cultures, and different environments. The purpose of gradually providing opportunities for increased independence is to enable all children to take care of themselves as “becoming adults, to be capable of making responsible decisions, to participate productively in society as an active citizen, and to take care of other people who will need his (or her) help.”
My best,
Jeff
Thank you for this very thought-provoking essay. Our son was diagnosed as having ADHD at 12 years old, although we knew since preschool that he exhibited “signs” of having difficulty in educational settings when compared to the majority of other children, as well as teacher reports. He was learning in religious school at that time and we felt that moving him to a more traditional middle school with “trained special educators” was the best decision, even though he was in a classroom with less than 10 students and now moving up atypical class of 25 students. We didn’t tell him he had ADHD, just that he “learned differently” and that moving him to our zoned school would provide him with teachers that were trained in teaching kids who learned differently. He was completely distraught at having to leave this small religious school, crying and giving us every reason why he should stay, but we (stupidly) stuck to our guns and moved him because we thought it was for the best (I happen to be a special education teacher with that “training”). We did consider his spiritual/religious needs and the damage we were doing by making this move (we thought we could take care of those needs by attending weekly services at our house of worship), but he was missing the day to day connection he had with God as well as his “family” (his word) of friends. We assured him he would create a new family of friends in his new school where teachers would better understand how to teach him.
Well…..needless to say, this was a terrible decision. He ended getting in with “negative influences”in public school where his ADHD was being managed with medication. He did better academically with a special ed and general teacher in his classrooms up to 12th grade, made it to college but ended up telling us that he must have a low IQ (he was now in his mid-20’s) since he “learned differently”. We had to assure him that it was never an IQ issue, but he spent all those years thinking he must be “dumber” than the other kids, even though somewhere along the way we explained the diagnosis of ADHD. He went off the meds in high school.
He was relieved to hear that, but I’m sure this all took a toll on his psyche for all those years (and maybe still does). He’s very successful now in finance, lives in Manhattan, works for a hedge fund, and talks about what a great childhood he had. However, my wife and I wonder what effect all this has had on his self-esteem. He definitely a degree of his religious/spiritual connection that he used to have, and there was a gap of connection we as his parents lost for a few years, which is not so atypical during adolescence. Thankfully, this improved. He still takes his ADHD meds to help focus him at work, and believes it helps him. We don’t try to talk him out of it or give him other alternatives because he’s 27 years old and believes that it’s helping him to be successful. I wish the idea of Attention Priority Difference had become part of our vocabulary at that time. Maybe it will come up with him now when the time is right.
Thank you again for this article/essay. I always learn so much from your messages as well as the wonderful responses you receive.
Hi Robert Schweitzer,
Thanks for sharing with us your personal experiences raising a child that was “diagnosed” as having ADHD. I’m glad to hear he is currently very successful in his career. Being now 27 it makes sense to let him make his own decision about whether or not to take an ADHD drug. I do suspect, from the research findings, that the drug is not helping him to be successful. It is easy to become convinced that certain drugs are more helpful than they are, particularly with drugs like the type of stimulants promoted as ADHD treatments. After tolerance sets in and the stimulant effect wears away, people typically develop a withdrawal reaction to the drug. During the withdrawal process, the people experiences worse performance, and think this is how they are if they had never become use to the drug. When they go back on it, they see they are doing better relevant to how they were during withdrawal and the illusion of the effectiveness of the drug is created.
My Best,
Jeff
My Best,
Jeff