Hyperfocus: The Flip Side of ADHD?
Thinking about dysregulation, not deficit, of attention
Child Mind Institute
Mark had trouble believing his son could have ADHD. Sure, he was unusually active, and his pre-school teachers complained that he fluttered around the room like a butterfly when other kids were engaged in activities. But there was also Andy's ability to focus intensely on certain activities, like fishing or watching a movie. How could his 5-year-old be so single-minded for three hours at a stretch if he had an attention disorder?
Then Mark started thinking about his own past, and some telling similarities emerged. He recalls being really irritated by the rapid change in subjects in elementary and high school, being "dragged from one subject to the next." He wasn't very good at math then, and otherwise school was so easy he rarely had to really apply himself. But once he got to college and could give his attention over to things that interested him, especially math, he could work effectively for hours at a time. He calls this ability "hyperfocus."
Both father and son now have diagnoses of ADHD. They both take stimulant medication to address the impulsivity and distractedness that has been impairing for both of them. On the other hand, he considers hyperfocus a blessing—or at least a core component of his, and his son's, identity. Mark is a professor of applied mathematics, and hopes that Andy, too, will find a passion to match his focus.
Different Targets for Attention
Psychiatrist Edward Hallowell, the founder of the Hallowell Centers in New York City and Sudbury, Mass., prefers a different term than hyperfocus: "flow." The concept of flow comes from the research of psychologist Mihály Csíkszentmihályi, Dr. Hallowell says, and it is when "you're doing something that really matters to you that is challenging." It's also, he says, "when you operate at your best." This certainly seems to describe Mark's engagement with mathematics.
But focusing intently isn't always a good thing. Dr. Hallowell would call Andy's tendency to lose himself in a television screen not hyperfocus, or flow, but "screen sucking." Flow is "optimal," he says. Screen sucking is more like "stupor." But what connects them is they are both different modes of intense attention. ADHD, Dr. Hallowell says, is not a deficit of attention but "an abundance of attention, a wandering of attention, and the problem is to regulate it. People with ADD can pay super attention, but when they're not interested their mind goes somewhere else."
Is there no actual "deficit" in attention-deficit hyperactivity disorder? "I hope they change the name at some point," says Child Mind Institute neuropsychologist Michael Rosenthal, to more accurately describe the disorder. Many kids (and adults) with the disorder are perfectly capable of losing themselves in intense focus on things that interest them—sometimes to the exclusion of "things that aren't interesting for them to do but are important for them to do." For Dr. Rosenthal, flow and screen sucking are examples of the attentional dysregulation that is characteristic of ADHD.
"You have to consider it from a perspective where it's a disorder and part of the disorder is that you have trouble modulating your attention," says Dr. Rosenthal. "It's not an inherently good or inherently bad thing, but it is just what it is and it can be used for good things and used for bad things." When Dr. Rosenthal talks to parents like Mark, he finds it useful to describe the underlying causes of hyperfocus—to help them understand the behavior and get over the skepticism that attends an ADHD child who appears not to fit the ADHD mold.
The Mechanics of Hyperfocus
One approach is to take a neurological perspective. "There is a part of the brain, the frontal lobe, that is underperforming in kids with ADHD and as a consequence their reward systems are a little bit funky," he says. "So they'll get in to something and that thing is so rewarding for them that it's hard for them to shift their attention to something else." The other way to look at hyperfocus is as a behavioral one, following from the work of psychologist and ADHD researcher Russell Barkley. In this view, kids with the disorder have trouble exerting control over the depth of their attention, in the same way that they often have trouble controlling their physical actions.
Dominick Auciello, another CMI neuropsychologist and education expert, takes a more literary approach. "Often with parents I use the metaphor of a flashlight to talk about attention," he says. "The focus can be strong or weak, it can be broad or narrow, it can point this way or that way. But there is an executive—your hand—controlling that flashlight and regulating these things." The problem is that in kids with ADHD, that executive tends to be erratic, or even appear absent at times.
Hyperfocusing on stimulating or compelling activities isn't unique to ADHD. "We all pay attention better to the things that we're interested in, and it's more of an effort to pay attention to things we're less interested in," Dr. Auciello says. "Attention in 'normal' people is not perfect." However, it can become a real problem in kids with ADHD who have an impairing inability to "attention switch," as Dr. Rosenthal puts it. Luckily, when focusing on necessary tasks is the problem, hyperfocus can also be the solution.
The object of hyperfocus in kids is "usually the kind of thing that they're just really interested in and it grabs their attention," Dr. Auciello says. "And parents say, 'How can he do it there and not with his homework?' He proposes a sample solution for a child who has great difficulty sitting down and practicing reading. "Let's find the topics that are going to be interesting to him and maybe that will help him pay attention," Dr. Auciello says. "So instead of rigidly adhering to a curriculum, if our goal is to get him to engage in reading and practice and become a better reader, choose topics of interest."
Focus on Strengths, Not Screens
Whether you call it screen suck or hyperfocus, Drs. Hallowell, Rosenthal, and Auciello all agree that TV and video games aren't particularly good for people with typical attentional regulation and can be a real problem for kids with ADHD. "Part of the brain, the ventral frontal lobe, with certain kinds of video games and TV definitely, it kind of shuts down," Dr. Auciello says. It's unclear if this is harmful, but it's definitely not exercising the mind. "Those things are doing your brain's work for you," he concludes. Dr. Hallowell concurs; that "kind of stupor or trance state" is "quite non-productive."
Whether it's getting lost in a television show or engrossed in a topic of great interest, it's clear that focus and attention are abundant if sometimes hard to control in people with ADHD. For Dr. Hallowell, this is an often overlooked but critical fact. "Deficit is a tremendous misnomer," he says, and once you get beyond it the reserves of focus can do wonders for people with ADHD. "We as mental health professionals ought to spend a lot more time probing to find areas of talent. Most of the people who come to see us sell themselves short, and don't think they have any talent. When you find areas of talent then motivation will follow."
Though Dr. Rosenthal cautions that ADHD is still a disorder that can benefit tremendously from appropriate medication treatment, he also sees the self-esteem building value of hyperfocus for kids. "If you can hook his attention to something he's interested in and channel it in a positive direction he can do outstanding things."
Even with treatment, these children may need help shifting focus and completing things that need to be done. In addition to schedules and visual cues, Dr. Auciello has a radical tactic. "Ask the kid," he says. "You'd be surprised. You can't talk about it right in the middle when it's happening, but you talk about it at another time when he's not wrapped up in something or will be upset if you ask him to switch. Kids will give you good ideas as to what would be helpful to them."
Published: September 24, 2013