Delivered from Distraction

Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder was published in 2005 by Ballantine Books. A book of nearly four hundred pages.

Edward M. Hallowell and John J. Ratey are the two psychiatrists who introduced ADHD to a wide readership with Driven to Distraction in 1994. Both have ADHD. This book is a sequel written eleven years after that first book. It builds on the first book and aims to carry to the reader the knowledge accumulated in the intervening time.

I could not find a verified Turkish edition. The authors have an ADHD book published in Turkish, but I did not come across a record showing that this title is a translation of it; I am writing it under its English name.

The first chapter, written for the reader who won't finish the book

The first chapter of the book is a short summary written for those who will not be able to read the whole book. Its title says exactly that.

This did me a lot of good. That a four-hundred-page ADHD book opens with a single chapter that takes into account that the reader has ADHD is a small but meaningful gesture. I felt the exact opposite of the "who will finish such a dense text" feeling I had with Barkley's book.

Even if you read this chapter and put the book on the shelf, you have taken the basic framework: what ADHD is, how it is noticed, how it is diagnosed, what the main headings of treatment are.

As a writer, I would like to copy this gesture. At the start of every long text written about ADHD there should be a short door that admits that the reader may not be able to get to the next page.

A four-part structure

The book is divided into four big parts.

The first part describes what living with ADHD is like. Here the title of one chapter asks whether the picture is a wickedness, an illness or a kind of mind. The authors' answer is close to the third: they see ADHD as a trait, a way of being in the world, and say that it becomes a problem only when it impairs functioning.

The second part consists of three stories. Instead of describing the picture in the abstract, the authors show it through the lives of three people.

The third part is devoted to diagnosis. Here are self-assessment questions for adults, brain imaging methods, co-occurring conditions and how to tell ADHD from bipolar disorder.

The fourth part is the thickest: treatment. Its title promises to use the power of the picture and avoid its traps. Medication and non-medication approaches, coping with procrastination, disorganization and forgetfulness, nutrition and exercise, supplements, sexuality and choosing a partner, even adapting twelve-step programs to ADHD are in this part.

The idea of "a kind of mind"

The question of the first part sets the whole attitude of the book.

The authors refuse to see ADHD as a moral flaw; this is something I agree with completely. They also find the word illness narrow. According to them, ADHD is a form of mind: one that works very well in some environments and struggles in others.

This idea has a nice side. It opens the door to looking for the problem also in the mismatch between the person and the environment. Accommodations at work or school rest on exactly this logic.

But the diagnostic criteria require that symptoms clearly impair functioning. The "kind of mind" frame is very prone to softening this impairment. While reading I carried two feelings together: feeling valued and feeling that my difficulty was being made small.

The strong and weak side of the diagnosis part

What is written on co-occurring conditions and on telling it from bipolar is among the most valuable parts of the book. ADHD rarely comes alone; anxiety, depression, learning difficulties and substance use often accompany it. Being confused with bipolar disorder is also a real clinical problem. The book's warning to the reader on this is apt. If you are interested in the subject, you can also look at the article ADHD or bipolar.

The self-assessment questions work for getting to know yourself but are not a diagnostic tool. Finding yourself in a list of questions is a good reason to go to an assessment, but is not sufficient grounds for the diagnosis itself. The same goes for the tests going around on the internet; I took up the detail in the article are online ADHD tests reliable.

The weak side is the space given to brain imaging methods. The book devotes a chapter to quantitative EEG (qEEG) and SPECT scans.

Today there is no brain imaging or EEG test whose validity for diagnosing ADHD has been proven. Diagnosis still rests on the clinical interview, developmental history and rating scales. In particular, the use of SPECT scans in diagnosing ADHD is an expensive practice that is seriously criticized in the field.

The authors do not put these methods in place of diagnosis, but devoting a chapter to them reflects the hope placed in these technologies in 2005. That hope did not materialize. This chapter needs to be read today as a historical document. If you are curious about the current state of the diagnostic process, the article how is ADHD diagnosed in adults offers a more reliable framework.

The cerebellum and the Dore program

In the treatment part the book also mentions exercises aimed at stimulating the cerebellum, and in this context gives space to the Dore program.

The studies supporting this program were later heavily criticized in terms of scientific rigor. It is interesting to see that in ADHD 2.0, written sixteen years later, the same cerebellum idea returns as balance exercises: the authors have not given up on this line, but the evidence has not grown stronger either.

There is a similar picture with supplements. The effect of many supplements on which hope was placed at the time of the book's writing remained small in later controlled studies or could not be shown. Omega-3 is the best-known example of this; it has an effect, but a limited one.

Where the book is really good

These criticisms do not erase the book's value.

Medication is treated seriously, side by side with non-medication approaches. The decision is in every case made together with a doctor.

The parts devoted to everyday problems such as procrastination, disorganization and forgetfulness are practical. To the "so what do I do" question I found lacking in the first book, there are many more answers here.

The chapters on sexuality and choosing a partner go into subjects almost never talked about in ADHD books. Acknowledging that ADHD extends to the most intimate places of a relationship is in itself a relief for a reader who carries shame about it.

Adapting twelve-step programs to ADHD is an interesting idea too. It is not a method with an evidence base, but as a suggestion to meet the shame and loneliness in ADHD with group support it is thought-provoking.

The authors' respect for people with ADHD is felt on every page. They do not blame, they do not belittle.

Why the three stories work

I thought of skipping the three stories in the second part at first. I was impatient to move on to the diagnosis and treatment chapters.

When I read them, I realized that this part carries the rest of the book. The criteria in the diagnosis chapter stop being an abstract list when they match concrete scenes in these people's lives. The suggestions in the treatment chapter also gain meaning when you go back and look at these stories.

I also know that case narration has a risk: a single life can look to the reader like a general rule. In this book the authors present the stories as examples, not as prescriptions. Still, this distinction needs to be kept in mind while reading.

Reading it today, as a woman diagnosed late

Reading this book twenty years later, as a woman diagnosed in adulthood, is a strange experience.

On the one hand, that the book takes adult ADHD seriously is valuable for its time. It says that adults also live this picture and that the diagnosis can come at any point in life.

On the other hand, the most decisive parts of my own story are missing from the book's world: symptoms explained for years only by anxiety or depression, looking orderly from the outside while coming apart inside, the invisible labor spent to keep a system standing. I learned these from other sources. This book does not fill that gap but opens the road up to it.

The strengths narrative is here too

The tendency of Hallowell and Ratey to read ADHD as a talent continues in this book too. The book's promotional text describes people with ADHD as original, charismatic, energetic people, and this frame is maintained throughout the book.

As a reader, this both did me good and unsettled me. I want to feel valued. But when things are really going badly, a sentence that reminds a person of their charisma does not help much.

The treatment part proposes a step-by-step framework that puts strengths at the center. The idea is nice, and its application is left largely to the reader.

From 2005 to today

The book was written in the DSM-IV era. DSM-5 (2013) raised the age-of-onset criterion from seven to twelve and lowered the number of symptoms required above seventeen from six to five. Adult diagnosis is now far more established.

Understanding of heredity has also become clearer. The 2019 review by Faraone and Larsson gives heritability as about 74 percent. The book already treats genetic factors; in this respect it cannot be counted as outdated.

On ADHD in women, however, the book carries the limits of its time. Subjects such as symptoms looking more inward in women, masking and the effect of hormones have been researched far more since then.

Medication options have also changed. Do not take the medication information in the book as current.

If you have read Driven to Distraction

The two books complement each other. The first one recognizes you, the second tries to do something.

There are repeated parts: the language of case narration, the emphasis on strengths, the general tone. But this book contains far more practical chapters and gives more space than the first book to subjects such as relationships, sexuality and co-occurring conditions.

If you are going to read only one and are looking for what to do after the diagnosis, this book is more useful.

How to read it

You do not need to read it from start to finish, and the authors do not expect you to.

Start with the first chapter. Then read at least one of the three stories in the second part; it makes the picture concrete.

If you are in the diagnostic process, read the third part but read the brain imaging chapter as a historical document.

Use the fourth part like a reference section: go to whichever subject is bothering you that week.

Do not let the size of the book frighten you. Feeling that you have to finish a four-hundred-page book in one sitting often ends, for a reader with ADHD, in never opening the book at all. This book is written to be read in pieces. Reading a single chapter in a week is also progress. It is enough to write in the margin of the chapter you read the one thing from it that you want to carry into your life.

I would recommend this book to an adult who has just been diagnosed, to a couple looking for the traces of ADHD in their relationship, and to someone who has read Driven to Distraction and is looking for the second step. For current information on diagnosis and medication, however, it is not enough on its own.