Embracing neurodiversity 🧠++ With inspiration from stoicism and the OODA loop

I am happy to see that mental health and the concept of neurodiversity is gaining attention. As I describe below, it has taken me a long time to open up about my ADHD and find the best ways for me to live and work based on the example of others.

Following stories about their mental health, gymnast Simone Biles and tennis player Naomi Osaka took the opportunity to champion openness around mental health issues like ADHD and anxiety.

Tweet copied from Insider.com: “Simone Biles’ ADHD medication is banned in Japan, but a Tokyo 2020 exemption allowed them for athletes”.

Screenshot of Time Magazine, July 2021: “Naomi Osaka: ‘It’s O.K. Not to Be O.K.’”

Other public figures, like Michael Phelps, have also played a notable role in bringing attention to mental health, as Phelps did in a video for Child Mind Institute‘s Speak Up for Kids campaign based on his own experience of living with ADHD.

Michael Phelp’s video published on Child Mind Institute.

As I reread these messages from Biles, Osaka, and Phelps, I feel a sense of relief, a sense that I do not have to — nor should I — hide the fact that I have lived with ADHD symptoms for most of my life. So, from this perspective, I want to slow down and change track for a moment, turning away from the topic of my PhD project. Here, I want to provide a short overview of ADHD, including related challenges and strengths, which I and others living with ADHD need to manage daily. I also touch on this subject in other stories on Medium, which you can find here: Succeeding against the odds: oddly inspired by RPGs, Linkedin and more, and here: Disillusioned gamer, or cyber-gooonie.

Harnessing neurodiversity: a work-in-progress

A 2017 article in Harvard Business Review (HBR) highlights that neurodiversity, “the idea that neurological differences like autism and ADHD are the result of normal, natural variation in the human genome”, should be harnessed by companies to improve their workforce and gain a competitive edge. As the authors of the article in HBR note:

“A growing number of companies, including SAP, Hewlett-Packard Enterprise, and Microsoft, have reformed their HR processes in order to access neurodiverse talent — and are seeing productivity gains, quality improvement, boosts in innovative capabilities, and increased employee engagement as a result.”

Yet, the HBR article from 2017 also notes that “the neurodiverse population remains a largely untapped talent pool” and a more recent article that appeared in Fast Company in June 2021 underscores that neurodiversity remains underprioritized in today’s corporate diversity, equity and inclusion (DEI) programs.

There are numerous good reasons to embrace neurodiversity — as highlighted in the articles cited above — and a key step in this direction begins by making the invisible visible.

To do so, we need to engage in an open dialogue about how we can be stronger and better together, and not let our differences or disabilities stand in the way of personal and collective achievement.

Moreover, I believe that if we understand the disadvantages and embrace potential strengths associated with ADHD, we can increase the well-being of those affected by ADHD, as well as gain tangible work-related benefits, such as “productivity gains” and “innovation boosts” (Austin and Pisano 2017).

Such benefits can be derived by embracing and leveraging certain abilities associated with ADHD (e.g. hyperfocus, resilience, creativity, and high energy), often referred to as “superpowers” because, in contrast to people without ADHD, these abilities can be a lot more pronounced and ‘powerful’ in people living with ADHD (Sherrell 2021). Further, and importantly, “the best way to make the most of ADHD superpowers is to manage the person’s environment in order to allow them to flourish” (ibid.).

Beginning with my ADHD

‘It’s hard to really chill and sit still.’ Mos Def, Hip Hop (1999)

In my younger and more rebellious years, I did not enjoy learning or reading in any traditional sense, as I write about in another essay. I gravitated more towards the thrills of the skatepark and reading hip hop lyrics than any books of literary canon like, say, the Great Gatsby. By seventh grade, I was doing poorly in school and was sent to a small school for students with learning disabilities and what some might consider social misfits.

Indeed, the odds were not in my favour in terms of becoming a graduate of Oxford University, much less a PhD candidate at Goldsmiths, University of London, albeit largely a self-funded one at that.

My parents never went to university and I do not remember ever having discussed university education with any of them while growing up, not even with my maternal grandfather who was a university professor. My parents had managed to establish a robust middle class family throughout the majority of my childhood, but my sense of stability and economic security came crashing down when I was in my late teens and my parents divorced and my father filed for bankruptcy, losing his business of 25 years, retirement savings, and our home.

I turned to my grandfather for advice when I was in my early twenties, feeling very lost after a few years of dabbling as a graphic design technician, working in bars, playing amateur theatre, and wrestling with mild to severe depression. Frustrated, I held on to my passion for philosophy and sociology, which I had discovered through friends from theatre groups, and I developed aspirations of educational achievement which seemed beyond my reach.

When I mustered the courage to ask my grandfather for advice, he basically told me in his unforgettable, slightly frightening and thunderous voice — almost yelling, as he was known to do:

“Do not holdt back. It requires BOW SPLASH! Yes, to get ahead in life, you have to make BOW SPLASH!”.

I was in my early twenties and I had never heard that expression before: “bow splash”, referring to the splash of waves forming at the bow of a ship — and my grandfather clearly did not refer to small bow waves or splashes. He wanted me to understand that I would have to move through new terrain, that it would not be smooth sailing all the way, and I should not be afraid nor should I throttle back in rough seas. On the contrary, I should expect and take delight in large bow waves, which are a sign of high resistance, internal as well as external. He almost seemed to say that, if you do not make large bow waves, then you are not doing it right.

To my grandfather, bow splash was the ‘very stuff of a vigorous life’, like flying upside down was to Tom West, the former and now historic captain of young gung-ho computer engineers who were adamant to make their own big bow splash and get “a machine [computer] out the door with their names on it” as Tracy Kidder writes in the Soul of a New Machine.

Combined with having ADHD, my background from a hybrid working class and upper middle class upbringing makes me an outlier in terms of educational attainment. As a small case study in social mobility, I was enabled by government funded education, grants and loans, and good fortune, including social capital in the form of family role models. My grandfather’s belief in me and emerging expectations especially seemed to propel me forward with a newfound strength and resilience that would enable me to start a family and complete two master’s degrees before he passed away in 2016. During one of my last visits to my grandfather, he suddenly turned to my daughter, a very active an inquisitive six year old, and said: “young lady, you also do not sit still”. She stopped and looked at him for a couple of seconds with an expression of surprise, which then turned into a shrug, as if to say, “well, I don’t know why, but that’s the way it is”. Indeed, maybe that’s the way it is.

As I describe below, I have not overcome ADHD. My family and I live with ADHD, including the bow waves and the splashes that I make as I steer my body and mind through life, along and often against the current.

Understanding ADHD: a network of symptoms

In my view, ADHD clearly emerges as a contested medical category (e.g. Filipe 2016; Horton-Salway 2011) with symptoms that, according to the National Institute for Health and Care Excellence (abbreviated with the ironically joyful moniker ‘NICE’), ‘can be mistaken for other conditions or overlooked altogether’ (NICE, 2018). Moreover, given various causes and the relatively short epidemiological history of ADHD, I have found it difficult, like many others (see e.g. Nielsen 2017), to identify with my diagnosis amidst the skepticism surrounding issues of over-diagnosis and lack of objectivity in diagnostic procedures. Though, coming to terms with “my ADHD” has helped me to understand and manage ADHD-associated symptoms, which include, for instance, being easily distracted, impulsive, hyper-active or hyper-focused, bordering on obsessive and aloof.

For sure, all people experience these features, or quirks, of the human psyche to some extent. However, ADHD emerges as a set of complex interactions in a network of symptoms (Silk et al., 2019) which pose unique challenges for me and others who experience more than 10 or 12 out of 18 specific ADHD symptoms defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Also, adding to the complexity of ADHD, Frank et al. (2018) highlight that ‘while [problems with self-regulation] are strongly correlated with the core ADHD symptoms of inattention and hyperactivity-impulsivity, they do not correlate strongly with neuropsychological tests of executive or top-down cortical control (Barkley 2010) suggesting that, like core ADHD symptoms, they result from deficits across multiple neural networks and cognitive processes’ (Franke et al. 2018).

In the ongoing process of understanding ADHD, the condition still appears to escape but a single or few causal explanations. In short, symptoms like inattention and hyperactivity cannot easily be linked to a single biochemical factor, such as a relatively low brain level of dopamine — a neurotransmitter that plays a key role in executive brain functions that support self-regulatory behaviour and awareness.

To provide a bit more detail, what we might call the network of ADHD symptoms (cf. Silk et al., 2019) is grouped into two domains, or interrelated spheres, with 9 Inattentive and 9 Hyperactive symptoms according to the DSM-5 developed by the American Psychiatric Association ( Filipe 2016; Horton-Salway 2011). Emerging from a combination of these ADHD symptoms (10 to 18 symptoms for adults and 12 to 18 symptoms for children) the condition was described in a scientific report published by the Nature Research Journal as ‘one of the most common childhood psychiatric disorders [… and] a major public health problem’ (Liu et al. 2018). That is to say, that ADHD research is published in prominent scientific journals and recognised as a widespread neurodevelopmental disorder or abnormality with a variety of symptom profiles associated with a person’s level of distractibility and hyperactivity which interferes with ‘normal development, or functioning, of a person’ (Franke et al. 2018) in a contemporary context.

As underscored by NICE and numerous academic studies, ADHD is associated with significant recognised disabilities, meaning ‘impairments in social, educational, and occupational functioning’ which affect somewhere between 3 and 7% of the global population. Although, the prevalence of ADHD it is not easily figured, as the condition is coupled with diagnostic challenges, which means that the condition can be over-diagnosed, or it may be overlooked before it becomes manifest as tangible personal issues such as unemployment and depression coupled with severe loss of functionality, both of which I have experienced (Faraone et al. 2003; Liu et al. 2018).

Furthermore, as noted by Mahdi et al., while ‘ADHD typically causes impairment across different life domains, the degree and profile of its individual impact might differ significantly’ (Mahdi et al., 2017). Hence, it is important also to note that: ‘differences in functioning can be influenced by personal factors (e.g., self-esteem and self-efficacy) [as well as] environmental factors (i.e., factors not inherent to the individual, e.g., family, work, recreational opportunity […,] laws, and societal attitudes’ (Bölte et al. 2018).

Appraising ADHD-associated strengths

ADHD is also associated with “specific strengths” (Mahdi et al., 2017) that warrant appraisal and support so as to alleviate impairments. For instance, focusing on the strengths of ADHD, Mahdi et al. conducted a qualitative study, including focus group discussions and semi-structured interviews with 76 research participants from 6 countries, to assess views on the abilities and disabilities associated with ADHD. On the positive and less frequently studied side of ADHD, they highlight that a ‘high level of energy and drive, creativity, hyper-focus, agreeableness, empathy, and willingness to assist others were the most consistently reported strengths associated with ADHD’ (ibid.).

Notably, these positive sides of the neurodevelopmental disorder we call ADHD were indicated by a majority of the study’s participants (n = 54, 71%). Moreover, as the study points out, this small-n case study provides some interesting preliminary findings which call for further examination of the positive abilities associated with ADHD and how to assess such abilities and their impact on how people work and their well-being. Furthermore, this work has contributed towards building on the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) to provide an internationally accepted standard for assessing the functioning of individuals with ADHD, with an appraisal of strengths as well as impairments (Bölte et al. 2018; Mahdi et al., 2017). On that note, it is important to consider that while a person with ADHD might have certain strengths, related or unrelated to ADHD, the ability to benefit from and leverage those strengths depends on personal factors as well as an enabling environment.

To me, the most obvious upside of ADHD is a high level of energy and hyper-focus, while the most obvious downside is attention deficit, that is, when I feel my thoughts wandering adrift as if every mundane moment has a decreasing gravitational pull on my attention, to the extent that I can even doubt whether I can count to twenty without getting distracted. Also, while hyper-focus can be a strength, it can also make me emotionally or socially detached — unless, of course, I’m focusing on an interesting conversation, in which case I might seem too enthusiastic. Needless to say, then, a hyper-active mind is a challenge. However, I try to tell myself that ‘attention deficit’ does not equal ‘awareness deficit’ — I can willingly limit negative impacts of my ADHD by being aware of my focus and observing when it starts to drift and then steering it back where it needs to be or dialing back, just a little, on my enthusiasm. I can pilot my ADHD mind so to speak, even though I can’t fly like this real Army Aviator with ADHD.

Still, while I or others may experience certain ADHD-associated strengths, like a high level of energy and the ability to direct attention (hyper-focus) towards a task for an abnormally long period of time — ‘provided that the activity or topic [is] a core interest’ ( Mahdi et al., 2017) — ADHD is a disability that can affect social interactions including formal and informal relationships. Importantly, then, supportive individuals, such as friends and colleagues, including ‘individual personal characteristics and resources’ (ibid) are critical to overcoming ADHD-related impediments, just as these are important for overcoming impediments of other disabilities.

Harnessing the ADHD-mind: inspiration from stoicism and fighter pilot tactics

Taking inspiration from Dr. Edward Hallowell’s take on ADHD, I imagine that living with ADHD is a bit like driving a rocket-powered car or flying a jet airplane with bicycle brakes.

To build on the metaphor, I would say that in order to stop and refuel, or change course, I don’t need ‘motivation’ or ‘drive’, but some serious braking systems. I need some space-grade air thrusters to slow down and stay present when my mind is racing on the cusp of escape velocity and I actually have to stop what I’m doing and move on to the next task or activity. Sometimes, I need external arresting cables (read: external cues from a friend or colleague) to stop what I’m doing and be present while my mind is roaring like a fighter jet touching down on the deck of an aircraft carrier. In addition to external cues, I find it necessary to constantly maintain my braking systems through endurance training which seems to enhance my ability to control my inner dialogue, both when I need to tell my mind to throttle down and turn off the afterburners, or to turn on the “attention module” and follow some concrete sequence of tasks and ‘just fly straight’ rather than ‘flying upside down’. That is, if flying upside down means taking an alternative and potentially risky approach to achieving a desirable outcome, as it apparently meant to the mysterious and legendary Tom West.

Endurance training: a snapshot after one of my favourite crossfit workouts, which is good for practicing pace and consistency. 15 rounds for time (or 20 rounds for time). 1 round = 15 push-ups (okay to break up in 2 or 3 sets), 5 strict pull-ups, 10 V-ups and 15 Jumping squats. Focus on efficiency between movements. The pull-up bar is right above mat on the floor, so I can turn and grab the pull-up bar directly after the push-ups, and transition directly to V-ups when I jump down on the floor.

I have an inkling that many people with ADHD are quick to identify these ADHD-like characteristics when they feature in stories about our role models, like when I read about West’s affinity for flying upside down, or how David Goggins, Carl Alsing, Michelle Obama, and Scott Kelly avoided or dealt with a tendency to procrastinate, which can be a great challenge for people living with ADHD (Altgassen et. al. 2019).

For sure, the description of my ADHD symptoms above is a bit over dramatic. My daily life is certainly less dramatic than flying in space or landing jets on an aircraft carrier. However, and staying with the aeronautical metaphor, it may require some of the same discipline to steer the ADHD-mind and avoid a sense of “getting behind” the airplane, (i.e., dopamine-driven impulses), when it feels like the airplane or an impulse is in control rather than the pilot (i.e. executive brain functions, see e.g. Kelly 2017:152). Surely, we do not have to subscribe to every aspect of stoicism, or be devoted readers of Meditations by the Roman Emperor, Marcus Aurelius (a much-venerated stoic philosopher) or avid listeners of the Daily Stoic Podcast, to agree that the pilot should have control — or the ability to take control — of the airplane’s velocity and braking systems.

Although, stoicism — a branch of philosophy that upholds human reason as the primary source and driver of civil and ethical conduct — does speak to the challenge of figuring out the controls and how to maneuver the ship or the airplane and perform what fighter pilots refer to as the OODA Loop — shorthand for Observation, Orientation, Decision and Action.

The OODA Loop is a basic flight maneuver which describes four steps in a tactical response to a changing or threatening situation. Based on what we know from research on the correlation between irrelevant information processing and distractibility (i.e. attention deficit disorder), it seems that the ADHD-mind is predisposed to perform either relatively many or few OODA Loop cycles per minute by virtue of being either hyper-alert and easily distracted by external or internal noise, or hyper-focused and oblivious (Bubl et al. 2015).

Hence, the challenge is, first and foremost, to master the observation phase; including our thoughts and signals we sense in our environment, and the orientation phase; how we evaluate and distinguish between salient information and noise so as to keep our attention focused on things that matter most, according to the various and context-specific information filtration rationales we need to deploy when we are writing, riding a bike, grocery shopping, climbing a mountain, or flying a fighter jet.

So, while a ‘normal’ person with a so-called neurotypical mind does experience some symptoms of the ADHD-mind, like hyper-activity or distractibility, a person living with ADHD experiences more symptoms in a dynamic network of symptoms more often and perhaps with greater intensity.

Why am I sharing these reflections on ADHD?

As I mentioned in the beginning, I believe that it is important to be open-minded and well-informed about the various and complex aspects of ADHD so as to persevere disability. Also, and perhaps more importantly, it is my experience that this awareness better enables me, and hopefully others, to leverage ADHD-related strengths and limit possible impairments. With this perspective in mind, I want to share my experience of living with a disability that affects a significant percentage of the world’s population and, if I can, provide insights that might help further our collective understanding of what it means to live and work with ADHD, as an individual, a colleague or fellow student. Finally, and perhaps most importantly, I feel and believe that this level of transparency better enables me to be the most authentic and best version of myself.

References

Aurelius, Marcus (1964). Meditations. London: Penguin Books.

Altgassen M, Scheres A, Edel MA. (2019) Prospective memory (partially) mediates the link between ADHD symptoms and procrastination. Epub.

Bubl E, Dörr M, Riedel A, et al. (2015) Elevated background noise in adult attention deficit hyperactivity disorder is associated with inattention. PLoS One.

Bölte S, Mahdi S, Coghill D, Gau SS, Granlund M, Holtmann M, Karande S, Levy F, Rohde LA, Segerer W, de Vries PJ, Selb M. (2018) Standardised assessment of functioning in ADHD: consensus on the ICF Core Sets for ADHD. Epub.

Cash, Meredith (2021) Simone Biles’ ADHD medication is banned in Japan, but a Tokyo 2020 exemption allowed them for athletes. Insider.

Faraone SV, Sergeant J, Gillberg C, Biederman J. The worldwide prevalence of ADHD: is it an American condition? World Psychiatry.

Filipe AM. (2015) Making ADHD Evident: Data, Practices, and Diagnostic Protocols in Portugal. Medical Anthropology.

Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, Cormand B, Faraone SV, Ginsberg Y, Haavik J, Kuntsi J, Larsson H, Lesch KP, Ramos-Quiroga JA, Réthelyi JM, Ribases M, Reif A.(2018) Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. European Neuropsychopharmacology.

Friedman, Nathan (2021) Companies are leaving neurodiversity out of their DEI conversations — and that’s a mistake. FastCompany

Goggins, David (2018) Can’t hurt me. Master your mind and defy the odds. Lioncrest Publishing.

Horton-Salway M. (2011) Repertoires of ADHD in UK newspaper media. Health.

Liu, A., Xu, Y., Yan, Q. et al. (2018) The Prevalence of Attention Deficit/Hyperactivity Disorder among Chinese Children and Adolescents. Sci Rep 8, Nature.

Mahdi S, Viljoen M, Massuti R, Selb M, Almodayfer O, Karande S, de Vries PJ, Rohde L, Bölte S. (2017) An international qualitative study of ability and disability in ADHD using the WHO-ICF framework. Epub.

Nielsen, Mikka (2017) My ADHD and me: Identifying with and distancing from ADHD, Nordic Psychology.

National Institute for Health and Care Excellence (2018) Attention deficit hyperactivity disorder: diagnosis and management. NICE guideline [NG87].

Obama, Michelle (2018) Becoming. New York : Crown, an imprint of the Crown Publishing Group.

Osaka, Naomi (2021) ‘It’s O.K. Not to Be O.K.’. Time.

Pisano, G. and Robert D. Austin (2017) Neurodiversity as a Competitive Advantage Why you should embrace it in your workforce. Harvard Business Review.

Kelly, Scott (2017) Endurance A Year in Space, A Lifetime of Discovery, London: Random House.

Kidder, Tracy (1981). The Soul of a New Machine. Little, Brown and Company.

Sherrell, Zia (2021) 6 strengths and benefits of ADHD. Medical News Today.

Silk TJ, Malpas CB, Beare R, Efron D, Anderson V, Hazell P, et al. (2019) A network analysis approach to ADHD symptoms: More than the sum of its parts. PLoS.

Swann, Nathanial (2021) “I’m a U.S. Army Aviator — and I Have ADHD and Anxiety.”. ADDitude, ADHD Adults.

World Health Organization. International Classification of Functioning, Disability and Health (ICF).