The positive aspects of attention deficit hyperactivity disorder: a qualitative investigation of successful adults with ADHD
The behavioural characteristics of ADHD do not exist in binary form (i.e. normal vs. abnormal); instead, they exist on a spectrum or continuum. This implies that some aspects of ADHD can be adaptive rather than impairing, or some adults may possess certain strengths or attributes that mediate and/or compensate for their ADHD-related deficits or impairments. More research is needed to clarify these observations. To explore and describe positive aspects of ADHD from the perspective of successful adults with ADHD. A phenomenological approach with open-ended interviews was used to collect data. The interviews were audio taped, transcribed verbatim and analysed using thematic content analysis. Six core themes (cognitive dynamism, courage, energy, humanity, resilience and transcendence) defined by 19 sub-themes were found. These themes were compared against attributes catalogued in the character strengths and virtues (CSV) handbook and classification for positive psychology. Two core themes (cognitive dynamism and energy) were not listed as virtues in the CSV, and neither were six sub-themes (divergent thinking, hyper-focus, nonconformist, adventurousness, self-acceptance and sublimation) listed as behavioural traits. We propose these constructs as positive aspects specific to ADHD, and the other constructs, as positive aspects relevant to people in general, with or without ADHD. This study offers insights into positive human qualities, attributes or aspects of ADHD that can support and sustain high functioning and flourishing in ADHD life. This study also addresses the question in the disability research about “how we might reconsider the behaviours associated with ADHD so that they are seen as valuable and worthy of conservation?”.
KeywordsAttention deficit hyperactivity disorder ADHD Positive aspects Positive attributes High-functioning Flourishing
ADHD is a neurodevelopmental disorder characterised by impairing levels of inattention, hyperactivity and impulsivity that tends to begin in childhood and often persists into adulthood. In adults, ADHD is often associated with poor outcomes in domains related to academic achievement, work performance and social relationships (Able et al. 2007). However, ADHD is highly heterogenous, with its behavioural characteristics that exist on a spectrum (Lubke et al. 2009). There is increasing acceptance that many mental health conditions including ADHD are dimensional disorders and that not all symptoms are associated with deficits or functional impairments (Epstein and Loren 2013). For instance, “high-functioning ADHD”, described by Weiss (2016), refers to adults who meet diagnostic criteria for ADHD, but are still able to function relatively well. Lesch (2018) concurred with this definition of “high-functioning (HF)-ADHD” and noted positive attributes like hyper-focus, eidetic learning, putting in twice as much effort, as examples of compensatory strategies that could be used to mitigate ADHD-related deficits or impairments. This definition of HF-ADHD is used within this study. This definition aligns with the notion that mental health is not only about absence of illness or disorder, but also about recovery, coping, well-being and flourishing (Repper and Perkins 2006; Seligman 2012). At the turn of the millennium, Seligman and Csikszentmihalyi (2000) introduced positive psychology to move away from a deficit-focused view of mental health, towards approaches that were more enabling, strength-based and emphasised positive aspects of human functioning and flourishing (i.e. positive emotions, engagement, relationships, meaning and accomplishment) (Seligman 2012). In his recent editorial, Lesch (2018) also stated that “the time is ripe to intensify discussion about how research on ADHD can be moved away from the deficit-focused view to a concept that is oriented towards resources a patient might be able to recruit, thus, from a psychopathologic definition to the individual’s potential to function at a high level despite impairment’s in attention, motor control, cognition and emotional regulation” (p. 191).
A search for the literature about the positive aspects of ADHD mainly yielded results about treatment. We do not doubt that treating ADHD in adults has many benefits (Kooij et al. 2010). But the point is hardly any empirical research was found about the positive aspects of ADHD. One study correlated high creativity with ADHD in adults (e.g. White and Shah 2006, 2011). In another international qualitative study, Mahdi et al. (2017) used focus group discussions and semi-structured interviews with 76 participants from five countries (Brazil, India, Saudi Arabia, South Africa and Sweden). The aim of this study was to explore ability and disability in ADHD from the participants own perspective using the WHO International Classification of Functioning, Disability and Health (ICF) framework. Pertinent findings were that although the participants reported a number disabling impairments in daily life, they also described positive aspects of ADHD (i.e. high levels of energy and drive, creativity, hyper-focus, agreeableness, empathy and a willingness to assist others). Mahdi et al. concluded that there was a need to appraise ADHD more broadly, extending beyond diagnostic criteria and into areas of ability versus disability, environmental facilitators versus barriers. The present study is therefore timely. It is one of the first to offer a meaningful contribution to contemporary research about the positive aspects of ADHD. Our overarching aim was to describe the nature and defining features of these positive aspects from the viewpoint on successful adults with ADHD (i.e. HF-ADHD and flourishing defines successful).
Purposeful sampling strategies used in this study (Palinkas et al. 2015)
To identify and select cases with knowledge and experience of the positive aspects of ADHD
To describe what is typical, normal or average
To capture different (or varying) views rather to identify a common core, although commonalities may emerge in the analysis of data
To collect information from participants who are easily accessible to the researcher
TCA procedure (Burnard et al. 2008)
Read and re-read the transcripts; make a note of initial ideas
Open and code the data by making notes in the margins (words or short phrases to summarise what the participant have said)
Collapse the coded data under potential themes. Work through the themes and cross out duplications
Compare the themes with the coded data and entire data set. Group similar and overlapping themes together
Ensure each theme is clearly named and defined
Handover the thematic data, with excerpts from the participants, to the researcher team for review and to finalise the core and sub-themes
Finalised themes constitute the main findings
Attributes of trustworthiness (Lincoln and Guba 1985)
How was it achieved
The extent to which a study explores what is was supposed to explore
This study describes positive aspects of ADHD from the perspective of the participants
The extent to which the findings are relevant to other people or fields of study
The themes found in this study were peer reviewed and then finalised. The findings are discussed in relation to the existing literature. Other studies and plethora of anecdotal evidence confirm similar positive aspects of ADHD as reported in this study
The extent to which readers can make sense of the research design and method
The aims of this study, phenomenological approach, interview questions, process of TCA are outlined and discussed
The extent to which the research process is free of bias
One researcher conducted the interviews, postgraduate students transcribed the audio taped interviews, another researcher analysed the data and the themes were peer reviewed. The findings are discussed in relation to the existing literature; excerpts from the interviews are cited in text. Truth-value, applicability and consistency have also been achieved
Findings and discussion
Core themes and defining sub-themes that represent the positive aspects of ADHD
…being a therapist is like giving your ADHD brain caviar…. being able to channel all that random energy that’s flying around in my head into one intense hyper-focused sort of beam…that’s what I mean by caviar for the brain….it is giving the brain a task that it’s almost designed for….. if you thought that an ADHD brain had been designed for something…. because I think the energy that the ADHD brain seems to have….it’s unfocused, quite scattered, chaotic and a bit random…but give that brain something that really you can tune into and it’s your interest, then all that random stuff just goes boom… I get this incredible intense concentration and that’s great for work….
I’m an artist…. a creative type… a bohemian…. you are most likely to be a creative person if you are a divergent thinker….and not convergent…..I am very creative and that’s through and through….I’m a fine art graduate, a musician, a published poet, an entrepreneur, a performer…
All the participants described naturally being curious as a positive aspect of ADHD. Curiosity refers to inquisitiveness, openness to experience, a desire to learn, and it may also be a mechanism that allows people to pursue their ambitions and discover meaning in life (Zuss 2012).
….. not fitting into mainstream education system firstly made me feel like an outsider…. But I think also ethnically… the way I grew up had a part of it as well…. because I didn’t fit there ….and going to art college…. I didn’t fit in there either…. there’s a lot of positives with ADHD but there tends to be a lot of people who are outsiders….
…Well, thrill-seeking is an ADHD thing…. I can list in my life having done white water rafting, bungee jumping, hand-glider pilot, riding a rocket ship motorcycle at the age of 60, which I really ought not to be now…. travelling to far flung places….so just adventure, novelty seeking, thrill-seeking…..I have done a lot in my life and achieved a lot and experienced a lot…… I would see a lot of that as being quite positive and a lot of that is ADHD drive…
…it’s interesting because being spontaneous that’s kind of being impulsive…it’s the same thing…. say an action can be described as impulsive if you say something inappropriate…or spontaneous if you say something which might be cute or might be funny…
A willingness to be brave or to take risks and be responsible for one’s actions relates to integrity. The participants said that being open about having ADHD made them feel authentic and honest, which are attributes that characterise integrity (Carter 1996). A hallmark of authentic behaviour and autonomy is intrinsic motivation. Ryan and Deci (2000) said “when intrinsically motivated, a person is moved to act for the fun or challenge entailed rather than because of external products, pressures or reward” (p. 56). It seemed like the participants intrinsic motivation allowed them to maintain a positive sense of self despite disclosing (or being open) about their disability. This certainly requires courage given the associations of ADHD with poor educational outcomes, criminality, substance misuse, socio-economic disadvantage and so on (Bernfort et al. 2008). The participants intrinsic motivation could also have been the driver for their impulsive and/or spontaneous adventures, or curiosity or the persistence they said was useful for achieving their goals (Von Culin et al. 2014).
…I’ve got all this energy…. a lot of energy…. whatever it’s to do with…. nature/nurture/spiritual stuff….
…I think there’s a sort of spirit… I can only talk about myself…but I mean…there’s a spirit of adventure in my ADHD….
…I think if you can learn how to harness it… if you can tap into the energy and direct it…if you can learn how to control and direct it and focus it on the right things, then the positives have huge potential…. huge…huge potential… I think people with what is called neurodiversity…. just look at some of the people who have neurodiversity in history…. There are people who have learnt how to use it and to harness it…I’d really like to learn how to….
…I think ADHD got me through my corporate career but it nearly cost me my mental health completely….having said that…..without that drive I would never have been that successful…I don’t think I’d have been as good a salesman as I became…and I don’t think I would’ve been able to go back to my career once I’d had a breakdown and actually go on to become even more successful…. I don’t think without ADHD I would have become as good a therapist….
The interpretation of will as a drive alludes to a type of behaviour called volition or purposive striving. Volition requires an individual to become energised by a strong desire to achieve something, then to strive relentlessly towards a threshold in which intrinsic motivation transmutes into a physical energy that drives performance and productivity (Deci and Vansteenkiste 2004). All the participants reported an abundance of physical energy as a positive aspect of their ADHD. It was viewed as a resource that bestowed several advantages, including feeling younger than their peers and being able to engage in different activities, such as sports, which certainly could have added to the participants positive sense of well-being (Gráinne et al. 2015).
…. that is happiness as well…meeting other people…it’s nice to connect to people. I find it nice to be able to connect to people or meet people and find out more about them… find out their stories that I don’t know…it just makes me feel good you know….the positive social butterfly aspect I suppose….that’s something I would say is ADHD related…you know…being a social butterfly….
…I didn’t know that ADHDer’s made great salesmen by the way…. you probably know that’s another good career for an ADHD person and my son is a brilliant salesman… I went out with my friends for my first ever visit to a customer and came back with this huge order…and the customer actually rang back and said look…I’ve actually ordered far too much, can I cut the order back….and I thought, oh, that’s interesting…I can do this…
…it’s always to do with putting on other people shoes…. I don’t know whether it’s part of ADHD…I have related to other people with ADHD and they have this sort of over developed sense to identify with other people’s emotions… it’s what I’ve found…
…the emotional rollercoaster…. the highs and the lows….makes you feel alive….this is an intense experience emotionally whether it’s part of ADHD….but I think it is….they say mood fluctuations are a negative aspect…but when you enjoy something or when you’re excited about something you think….all the enthusiasm…and the energy…would I feel this if I didn’t have ADHD…. would I have felt so much pleasure about the good news I just heard….
…You have to behave totally differently…and that’s something… that…adaptability and being able to adapt yourself to any situation, I think would be something I’d attribute to ADHD…
…it’s a bit catch-22 because it is trying to find a balance between not being over aroused and not being bored…. life is always about finding a good balance and so it is that sort of walking a tight rope and trying not to fall down on either side… one side is over arousal and one side is boredom…but trying to just keep on that little bit of rope and keep a steady pace and erm…just get it to a place where it feels ok…does that make sense?…
… I think taking and reducing some of the levels of trauma people have in their bodies and minds can make a lot of difference…so you know…. it’s a whole package of stuff really….at the heart of it for me…it’s about self-monitoring and self-awareness…
… he talked about ADHD and mindfulness very eloquently and of course it makes obvious sense…because an ADHD brain wants to go on and mindfulness actually wants to do quite the opposite…so whilst mindfulness practice is not the easiest thing for somebody with ADHD to do…even in a limited way…I find it quite helpful…. mindfulness practice, I think is potentially one of the most useful things that an ADHD person could learn…
…I do something called E.F.T…Emotional Freedom Technique….. I use it on myself, everyday… that’s an extremely useful technique for moderating arousal… grounding, calming and dealing with high levels of uncomfortable emotions…
… there is strengths and weaknesses and how you can use your strengths, is by understanding I think, where your weaknesses are…. recognising those weaknesses, recognising those strengths and then maybe using those strengths to counteract those weaknesses…. I don’t know…. that’s it… as far as I’m concerned…
…we choose careers, we choose situations, we choose social environments that are friendlier to the way we are at processing information…
… you appreciate the good things you have…you try deal with the traits that make your life difficult…I didn’t choose to have ADHD…. but then you try to make the most of it so…. it’s a way like rationalising and accepting these traits…. I think it’s a healthy way of living and being… to try to focus on the positive aspects…
…It’s all about channelling the energy…. channelling the energy and learning how to do that in a way that actually is useful, helpful and not overly intrusive and not overly stressed…
Nietzsche, like Freud, believed that sublimation was good for psychological health (1887/1967a, b). The Nietzschean concepts of amor fati (love of one’s fate), eternal recurrence (the same thing always happens) and affirmation of life (say yes to life) asserted the importance of overcoming resentment and transcending nihilism (lack of purpose, or despair). In this way, people were free to enjoy life, felt motivated to pursue their goals and became happier and healthier (Reginster 1997; Gemes 2009).
… the whole thing about just starting a little jam session…was because we needed to do it and I just did it and that was brilliant…a beautiful experience….it was you know…it was really cool…. that’s something I will never forget….and neither will my friend either…so that was something beautiful…
The phenomenological approach that we used had intuitive appeal, because it underscores the uniqueness and validity of personal knowledge and lived experience, as well as, the importance of understanding a person’s construct of reality (Husserl 1983). However, this method also depends heavily on the participants use of language and ability to describe their views, perceptions and experiences in an articulate, expressive and reflective manner (Creswell and Poth 2017). Identifying and selecting participants capable of doing this can be challenging, but we managed to recruit suitable participants by using purposive sampling. Our sample size was relatively small, and the inclusion of females with ADHD may have offered different perspectives. However, small sample sizes are not unusual in phenomenological research. Giorgi (2008), for instance, suggested that “at least three participants offer a sufficient number of variations to come with a typical essence…… differences between individual experience and more general experiences of the phenomenon” (p. 37). While it does mean that generalising the findings of this study is not easy to do, we also argue that the positive aspects we found are relevant to other adults with ADHD regardless of sample size, age, gender or ethnicity. In qualitative research, generalising findings is not the aim; instead, the aim is to explore in depth and understand personal knowledge and lived experience (Creswell and Poth 2017). Besides other publications, including one international study reported on similar positive aspects associated with ADHD (Hallowell and Ratey 1995; White and Shah 2006, 2011; Mahdi et al. 2017). This does strengthen the reliability and transferability of our findings.
Six core themes (cognitive dynamism, courage, energy, humanity, resilience and transcendence), further defined by 19 sub-themes, constituted the main findings of this study. Most of these themes were catalogued in the CSV, which suggested they were relevant to people in general, with or without ADHD. The core themes—cognitive dynamism and energy—and sub-themes—divergent thinking, hyper-focus, nonconformist, adventurousness, self-acceptance and sublimation—were not catalogued in the CSV. We proposed these attributes as specific positive aspects of ADHD. The eminence of “energy” in ADHD life was certainly striking. Some participants described how they used, regulated or sublimated their energy into productive ends, while others expressed a desire to learn how to do this. Perhaps, it is time to reconsider vital energy. In positive psychology, vital energy is associated with behavioural traits like zest and vigour, which contain positively toned states that support mental health and well-being (Peterson and Seligman 2004).
This study also addressed the question in the disability research about “how we might reconsider the behaviours associated with ADHD so that they are seen as valuable and worthy of conservation?” (Freedman and Honkasilta 2017; p. 582). This question came from Garland-Thompson’s (2012), compelling case to conserve disability, which she described as “preserving intact, keeping alive and encourage to flourish” disability in society. Garland-Thompson argued for sociocultural ideas and norms about disability to be reshaped. She recommends a move away from eugenic logic, which proposes the elimination of disability in society because it causes too much “pain, disease, suffering, functional limitations, abnormality, dependence, social stigma and economic disadvantage”, towards an understanding of disability as a benefit and resource for society to keep or conserve. From this viewpoint, we argue that the positive aspects of ADHD found in this study are benefits, resources, skills or strategies that can be used to mediate and/or compensate for ADHD-related deficits or impairments.
This is a study that reaches out to people with lived experience of ADHD: service users, patients, family members, carers, partners, to say that not all symptoms of ADHD are maleficent. Recovery, high functionality and flourishing with ADHD are possible. Too often people with lived experience hear about ADHD in relation to deficits, functional impairments and associations with substance misuse, criminality or other disadvantages on almost every level of life (school, work, relationships). Perhaps other researchers should replicate this study or undertake other research to document attributes that can promote or sustain well-being and flourishing in ADHD life. This emerging field of ADHD research is much needed. Findings from such research may appeal to practitioners who utilise cognitive-behavioural therapy, coaching or other psychological or behavioural interventions to treat or support people with ADHD. This study affirms the positive human qualities, assets and attributes in ADHD that can promote and sustain high functioning and flourishing.
We thank the people who gave up their time to participate in this study. We also thank the Executive Committe Members of the UK Adult ADHD Network (https://www.UKAAN.org) for their advice and support.
Compliance with ethical standards
Conflict of interest
The author(s) disclosed receipt of the following potential conflicts of interest. J. Sedgwick has received speaker’s honoraria from Shire and receives an educational grant towards PhD tuition fees and conference costs from the Royal College of Nursing (RCN) Foundation. P. Asherson has received funds for consultancy on behalf of KCL to Shire, Eli-Lilly, and Novartis, regarding the diagnosis and treatment of ADHD, and has received educational/research awards from Shire, Eli-Lilly, Novartis, Vifor Pharma, GW Pharma and QbTech and is a speaker at sponsored events for Shire, Eli-Lilly, and Novartis. All funds are used for studies of ADHD. The other author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in this study.
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