Edward Hallowell, MD
Child and adult psychiatrist. Founder of The Hallowell Centers in Boston MetroWest, New York City, San Francisco, and Seattle. Host of the podcast “Distraction” (www.distractionpodcast.com)
Dr. Hallowell has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
CCPR: Thanks for speaking with us today, Dr. Hallowell. Please tell us about your work. Dr. Hallowell: I’m a writer, a speaker, and a practicing psychiatrist. I have offices in Boston, New York, San Francisco, and Seattle. I went to Harvard College, Tulane Medical School, Harvard residency, and fellowship at Mass Mental Health Center. After that I was on the Harvard Medical School faculty for about 20 years, then I devoted my time to lectures, writing, and raising my kids. My first book, Driven to Distraction, came out in 1994. It really caught on, bringing ADHD to the general public. Since then, I’ve written 19 more books.
CCPR: Driven to Distraction is a classic. But if you were going to suggest one or two more recent books, are there a couple that you feel are particularly useful to families? Dr. Hallowell: My favorite of all my 20 books is called The Childhood Roots of Adult Happiness, and it’s about raising children. I realized I knew nothing about promoting healthy children. I knew about misery, but I didn’t have an evidence-based game plan for how to bring out the best in children. We all want the same for our kids, but how do you get there? The book is a five-step plan that frees parents from the tyranny of what I call “the pyramid model,” which holds that in order to lead a wonderful life, you have to be number one in everything and go to Harvard, Yale, or Princeton—this thinking grips so many families and children, and it’s just not true.
CCPR: Tell us about your plan. Dr. Hallowell: The aim is to focus on attitudes, not grades and sports. Attitudes like confidence, self-esteem, optimism, the ability to get along with others, resilience—the ability to bounce back. Hopefulness, industry, the ability to initiate something new, come up with new ideas. All of those attitudes are things everyone can acquire. While only one person can be valedictorian, any child can acquire helpful attitudes.
CCPR: Sounds lovely. Dr. Hallowell: In terms of ADHD, the book I’d recommend came out in 2005 called Delivered From Distraction. And then I’ll have a book coming out next year that’s going to be called From ADHD to VAST. VAST is my new name for the condition. It stands for Variable Attention Stimulus Trait.
CCPR: Tell us about VAST. Dr. Hallowell: The current Adult Deficit Disorder model is slanted toward pathology and misses the good stuff that goes with this condition. It perpetuates stigma, shame, and feeling bad about yourself. It’s time to jettison that model. Yes, the condition can pose lots of problems. It can ruin your life. But it can become a tremendous asset, as it has for many artists, creators, chefs, and brain surgeons. It is a “vast” condition, full of variety—a trait, not a disorder, though it can be a disaster if you don’t manage it properly. Prisons are full of people with it, and it’s common in the addicted population, the unemployed, and the marginalized. But in addition, some of the wealthiest people, Nobel and Pulitzer Prize winners, and many entrepreneurs have it. The point of the book is to take the condition seriously and help you realize that if you handle it properly, it’s a superpower. The sky’s the limit. The book’s subtitle is A Bold New Understanding of Strength, Talents, Pitfalls, and Ultimate Success.
CCPR: How does this change everyday practice? Dr. Hallowell: One patient told me: “I feel as if I’ve been living my life with half my brain tied behind my back.” Getting the diagnosis, understanding himself, and then getting the meds freed him up in amazing ways. You say to yourself, “Think what I could have done had I had this diagnosis sooner.” It can liberate resources that you’re not otherwise able to organize. Having untreated ADHD is analogous to Niagara Falls—a lot of noise and mist until you build a hydroelectric plant. I’m in the business of helping these people build their hydroelectric plant; take their enormous energy, creativity, originality, drive, spunk, resilience, and channel it in such a way that they can be productive as opposed to letting that energy dissipate, as so often happens. My job is to say, “Yes, you’re right; you’re not lazy or lacking in discipline. You’re not characterologically flawed. You don’t have a deficit disorder. What you have is an abundance of attention, not a deficit of attention. But you have trouble channeling it, focusing it. You have trouble turning it into something useful. But don’t despair because I can tell you how to do it.”
CCPR: Can you give us an example? Dr. Hallowell: Medication is one major tool in the toolbox, but it doesn’t always work. There are other interventions. In the book, I write about this 8-year-old boy in Shanghai who was in trouble in school every day. They hit him with a stick every day. I gave his mother guidance over email with no medication but using education and cerebellar exercises. It was a combination of education, love, what I call the other vitamin C—vitamin Connect—and persuading the teacher not to hit him anymore. We eliminated fear (the real learning disability), gave him massive doses of love at home, and explained to him that he has a race car brain with bicycle brakes. This helped him be excited about who he is instead of ashamed, and it motivated him to strengthen his brakes, which we did using the cerebellar exercises. In three months, he was at the top of the class, not acting out, and loving school.
CCPR: Do you have data on this concept of reconfiguring ADHD? Perhaps studies on people who’ve been highly successful? Dr. Hallowell: Russ Barkley said to me, “Ned, nobody’s going to fund studies on success.” But I have a wealth of anecdotal evidence—famous people who have ADHD and are willing to talk about it. For example, Tim Armstrong, the former CEO of AOL and Yahoo!, and his wife Nancy are funding a documentary based on my strength-based approach that will come out in 2021. We’ll portray the road to success, with cameos by famous people who have this condition.
CCPR: There are studies of attention improving in young adults with ADHD during exercise, and some support for exercise as an adjunct treatment for ADHD (Rassovsky Y and Alfassi T, Front Psychol 2019;9:2747). Other cerebellar training techniques have yet to demonstrate efficacy in controlled trials. It will be helpful to do research on the exercises you describe. Dr. Hallowell: Absolutely. Roy Rutherford in England, and Jeremy Schmahmann at Harvard Medical School, who really put the cerebellum on the map, did MRI studies showing that the cerebellum occupies 10% of brain volume, but it’s got 75%–80% of the brain’s total neurons, with rich connections to the prefrontal cortex (Schmahmann JD et al, Neuroimage 1999;10(3 Pt 1):233–260). If you stimulate the cerebellum and indirectly stimulate the cortex, you get these amazing results. In addition to ADHD, it helps dyslexia, dyscalculia, and dyspraxia. Any exercises that challenge balance and coordination, such as skiing, skateboarding, and surfing, are helpful, as well as exercises that you can do at home.
CCPR: Such as? Dr. Hallowell: I prescribe exercises like standing on one leg and then the other leg with eyes closed, and other standing exercises on a wobble board or Bosu (a half sphere–shaped exercise device). Also, sitting on an exercise ball with your legs off the floor, then with your eyes closed. When you close your eyes, it is much more difficult. If you do these exercises 10 minutes twice a day, eye tracking is also improved, which can help reading problems.
CCPR: What about naysayers? Many look askance at developmental optometrists who prescribe eye exercises. Dr. Hallowell: This is totally different. Cerebellar exercises stimulate different parts of the brain. I don’t get naysayers; I just tell stories. I make no pretense to be a double-blind prospective study guy. I leave that to other people.
CCPR: Liz Torres also focuses on cerebellar function, often as part of understanding autism and related disorders. What you’re describing seems consistent with work in that field helping people to be more regulated, able to manage their sensory systems, able to connect in a meaningful way and, therefore, communicate and learn better. Dr. Hallowell: Right.
CCPR: How does this apply to everyday practice? Dr. Hallowell: Look for strengths and tell patients that it’s not a deficit of attention but an abundance of attention, and the challenge is to control it. A toddler on a picnic goes wherever her curiosity leads, with no regard for danger or authority. Telling her to sit still and be more disciplined won’t work.
CCPR: How might assessment differ from a typical child psychiatry practice? Dr. Hallowell: It probably doesn’t differ a lot, except in attitude. We have slogans on the wall, “No brain is the same; no brain is the best; each brain finds its own special way.” The culture of the offices is infused with positivity. Focus on your history from multiple sources. People with ADHD are not good self-observers. We do neuropsych testing if people can afford it, looking at such things as processing speed and memory.
CCPR: What is the role of medication in this model? Dr. Hallowell: We always offer medication. Some families decline, but I want them to make the decision based on facts and not on rumor and hearsay. And 9 out of 10 times when they learn the facts, they want to give it a try. We usually give a trial of medication in conjunction with coaching. Most don’t need psychotherapy. They need coaching—lifestyle revision—with tips on getting organized, dressing in the morning, or finishing homework. For adults, we talk about who makes a good match for a marriage partner, what makes a good job prospect, and how to get from A to B without too many detours.
CCPR: Tell us more about picking a partner. Dr. Hallowell: I tell people to find someone who loves them for who they are and doesn’t try to turn them into someone who doesn’t have ADHD; to find someone who helps them compensate for lapses in memory, organization, and focus, but not in a punitive or humiliating way. The partner benefits from new ideas, fun, and positive energy. People with ADHD, because they react too readily, are prone to marry people who have a lot of problems, which is something to watch out for. They are also prone to marrying people who seem like a caricature of a bad 5th grade teacher—constantly punishing, reprimanding, demeaning.
CCPR: What about job choices? Dr. Hallowell: Similar to relationships, people with ADHD are prone to reacting to the demands of a job, even if they’re not making real progress. This is often what school was like, so they’re used to it even though it isn’t good for them. I tell people they should find what they’re good at, what they love to do, and what someone will pay them to do. Where those three overlap, that ought to be where they spend most of their time.
CCPR: Can you give a quick example of that? Dr. Hallowell: Sure. I love speaking, writing, and working as a doctor. People are willing to pay me for those activities. And I delegate paperwork. But more than this, people need meaning and purpose, a larger mission, despite the ups and downs. Staying in the game is what matters. And the key to a great childhood and a great life is positive connection—to friends, family, pets, activities, work, nature, places, festivities. We’re living in an epidemic of disconnection. That’s what drives depression, suicide, addiction, and school shootings. Yet connection is free and infinite. People don’t take it seriously, or don’t know how to get it, because they’re shy or depressed. That’s where people need help from folks like you and me, or teachers or coaches or parents.