Sean Ransom, PhD.
Assistant Clinical Professor, Department of Psychiatry at the LSU Health Sciences Center - New Orleans, and Clinical Director, Cognitive Behavioral Therapy Center of New Orleans.
Dr. Ransom has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Your patient is a 25-year-old music teacher with ADHD. Though her organizational skills have improved with methylphenidate, she complains that it impairs her performance as a jazz musician: “I feel self-conscious, like a robot.”
Popular lore holds that creative people have ADHD traits and that ADHD bestows advantages in creative thinking. Stock characters like the distracted artist or the absent-minded professor promote this generalization, but what does the research show? In this article, I’ll look at the relationship between ADHD and creativity and whether stimulants help or harm creative thinking.
There are many ways to measure creativity, but the two that come up most often are divergent and convergent thinking. Divergent thinking asks the respondent to create a variety of novel responses from a single prompt (eg, “Name all the possible uses of a newspaper”). This type of creativity is what’s most at play in jazz improvisation. Convergent thinking asks the respondent to come up with a single correct answer from a set of apparently unrelated stems (eg, “What is found in droves at the Sturgis Motorcycle Rally, at University of Arkansas sporting events, and at the world’s largest pork processing plant in Tar Heel, North Carolina?” See answer at end of article.*)
The research on creativity and stimulants is scant. Fewer than a half-dozen studies have examined psychostimulants’ effect on creativity, and added together, these studies provide data from fewer than 250 participants total. Early studies from the 1990s did not find any consistent effects on creativity when stimulants were used in ADHD, but two recent randomized controlled trials (total n = 67) did find a decrease in divergent creative thinking—the type that’s needed for jazz improvisation—when children with ADHD were treated with stimulants (Hernandez GGC and Selva JPS, Psicothema 2016;28(1):20–25; Ten W et al, Psychiatry Res 2020;284:112680).
What about when stimulants are given to healthy adults without ADHD? A handful of studies have looked at creative measures here with mixed results. One result that was replicated suggests that stimulants have different effects on creative and non-creative people. The researchers gave Adderall (10–20 mg) to healthy subjects with high or low creative traits and measured their convergent creative thinking before and after. The non-creative people saw a small gain in their creative abilities after taking Adderall, while the high creatives had a modest decrease (Ilieva I et al, Neuropharmacology 2013;64:496–505).
Researchers have also considered modafinil (Provigil), a wakefulness-promoting agent with benefits in ADHD. Modafinil has dopaminergic effects, and dopamine is thought to be a key neurotransmitter in the performance of creative tasks (Beversdorf DQ, Curr Opin Behav Sci 2019;27:55–63). Modafinil improves memory, executive functioning, and subjective task enjoyment in adults without ADHD, but it does not improve creative thinking and may even worsen it. In a study of 64 adults, modafinil broadly reduced divergent creative thinking (Mohamed AD, J Creat Behav 2016;50(4):252–267).
While this body of research is far from definitive, we can at least conclude that stimulants are not likely to improve creativity, and there’s a small signal that they may sometimes impede it in creative people.
Are people with ADHD more creative? A small number of studies over the past three decades have compared individuals with and without ADHD on measures of creativity, but the results have been wildly inconsistent. Furthermore, these studies were small and limited by idiosyncratic samples or other methodological problems, so no result seems to stand out as the clear answer—as attested by a 2016 meta-analysis that showed no difference in creativity between ADHD and non-ADHD groups (Park HP et al, Gift Child Q 2016;60(2):117–133).
A separate issue is whether creative people have mild ADHD traits that don’t meet criteria for the full disorder. It’s possible, for example, that highly creative people with ADHD symptoms use their creativity to cleverly compensate for what might otherwise be an impairment. This possibility emerges from a small but fascinating study that compared 89 children who were divided into four groups: a non-creative ADHD group, a creative ADHD group, a creative group without ADHD, and a control group that was neither creative nor diagnosed with ADHD. In the development of their study, however, these researchers discovered that a full 40% of the creative individuals without an ADHD diagnosis actually rated in the clinical range on the parent version of the Conners ADHD scale. These parents did not see their child’s symptoms as impairing, and these children’s teachers did not report ADHD-related problems at school (Healey D and Rucklidge JJ, Child Neuropsychol 2006;12(6):421–438).
What could be said, at best, is that functioning separates the distracted creative from the person with true ADHD. Because ADHD is a disorder of self-regulation, when a creative person has true ADHD, the impairments will show up in their creative output, which is likely to be disorganized, incomplete, and not up to the person’s potential. On the other hand, mild distractibility and a more spontaneous decision-making style might allow people to take in a broader swath of information and synthesize it into new ideas. Stimulants would usually not be indicated for these subsyndromal cases that lack impairment, but such people still might show up at your office and nervously admit that their focus improved when they illicitly “tried” their roommate’s Adderall.
Getting back to our example patient (the jazz musician with ADHD), we see this problem fairly often when treating ADHD, and the answer is usually to lower the dose of their stimulant. There’s a fine line between treating impulsivity vs dampening spontaneity; raising self-awareness vs heightening self-consciousness; and sharpening focus vs promoting hyperfocus. That line is different for each patient, and—at least anecdotally—can be fine-tuned by adjusting the dose.
TCPR Verdict: Pay attention when patients with ADHD report that they feel hyperfocused or less creative on their stimulant. It could be true, and a dose reduction can help patients shift more flexibly from tedious, detail-oriented tasks to those that require more creative flow. In addition, judicious use of immediate-release medications may help creative individuals who could benefit from short-acting stimulants for targeted activities (such as paying bills) but don’t need the effect in creative situations. There’s no evidence that stimulants improve creative thinking, and they may dampen it in creative people.