ADHD Myths & Facts

ADHD Needs a Better Name. We Have One.

ADHD is not purely a disorder; it is a mix of assets and liabilities. A more representative name for the condition is VAST, or variable attention stimulus trait. This new model recognizes the phenomenon of rejection sensitive dysphoria and its flip side “recognition responsive euphoria” — the super-charged response to perceived encouragement. Learn how to harness it here.

deficit disorder

 

ADHD Is Not a Deficit Disorder

ADHD is an inaccurate — and potentially corrosive — name. The term “deficit disorder” places ADHD in the realm of pathology, or disease. Individuals with ADHD do not have a disease, nor do they have a deficit of attention; in fact, what they have is an abundance of attention. The challenge is controlling it.

Therefore, we argue that a more accurate descriptive term is “variable attention stimulus trait” (VAST), a name that allows us to “de-medicalize” ADHD and focus instead on the huge benefits of having an ADHD brain.

VAST symptoms can, of course, negatively impact a person’s life, work, and relationships. Rejection sensitive dysphoria, a phrase coined by Dr. William Dodson, refers to the extreme emotional sensitivity and feelings of guilt, shame, and rejection often experienced by those living with VAST.

But with VAST there are always pairs; you can hyperfocus and then you can’t focus. You are distractible, but you’re also curious. So if individuals with VAST tend to succumb to perceived rejection, they can just as easily thrive with perceived recognition, an experience we call “recognition responsive euphoria.”

[Self-Test: Could You Have Rejection Sensitive Dysphoria?]

The Flip Side of Rejection Sensitive Dysphoria

Individuals with VAST are accustomed to receiving negative feedback in their personal, academic, and professional lives. Real or imagined criticism gets caught in the Default Mode Network — one of the primary networks in the brain that is active when a person is not focused — and creates the negative feelings that spiral into rejection sensitive dysphoria.

However, the Default Mode Network can have the opposite effect when positive recognition is perceived by someone with VAST. This positivity and encouragement super-charges the VAST brain with the same intensity with which negative feedback defeats it.

Those with VAST are often embarrassed to ask for encouragement, so supporters have to remember to offer accolades for goals met, effort expended, and movement in the right direction. Do not wait to praise perfection because perfection may never happen without praise along the way. Individuals with VAST thrive when surrounded by positive people and when they can step away from projects and people that are a chronic disappointment. These choices, sometimes paired with medication, create recognition responsive euphoria and lead people with VAST to success and happiness.

Just as a little negativity can tumble into anxiety and panic, a drop of praise can build into a tsunami of hope and motivation. Remember, key traits of VAST are resilience and an amazing ability to never give up.

This content came from the ADDitude webinar by Dr. Hallowell and Dr. Ratey titled “The Flip Side of Rejection Sensitive Dysphoria: How to Tap into ADHD Energy and Motivation,” which is available for free replay here.

[Do I Have ADHD? Take This Test to Find Out]

Updated on November 20, 2020

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  1. I too agree that ADHD (and especially DISORDER) is a damaging label for this population. In fact, in 2016 I renamed ADHD to Hyper Attention Activity Deficit – these folks can pay attention to many things at the same time and need to move! https://www.withunderstandingcomescalm.com/hyper-attention-activity-deficit/ The bottom line is we must focus on what kids CAN do and use those things to shore up their challenges. We can’t wait for the struggles to disappear before celebrating and honing strengths! Julie Skolnick, M.A., J.D., Founder of With Understanding Comes Calm, LLC and 2 Days of 2e Virtual Conference wwwWithUnderstandingComesCalm.com and 2Daysof2e.com

  2. Attention Direction Difference. Not a deficit or a disorder, a *difference*. ADDers are good at somewhat *different* things than neurotypicals. An apple is not a defective orange, and vice versa. Though the memory deficits suck.

    It seems to me that “neurodiversity” means ‘diversity of neurology’, which (I think, not my area of expertise) would include schizophrenia, bipolar disorder, neurotypical, autism, dyslexia, etc. rather than referring to specifically ADD / ADHD.

  3. I have trouble with the idea of “recognition responsive euphoria” and “rejection sensitivity Dysphoria” especially if the goal of calling us VAST is to de-medicalize the conversation. RSD and the new buzz phrase RRE presented here are indeed two sides of the same coin. Only it isn’t actually a dichotomic thing like a coin. Both experiences are real and a result of our emotional hyper-arousal. It’s more like a hydra. And it only further institutionalized what is nothing more than a biological difference by giving all these names to things that are interrelated. It sinks us deeper into the industrial medical complex’s idea that we need to be medicated and therapized. Indeed, these things help, but they are only necessary because we are forced into systems or capitalist industrial production. 200 years ago my ADHD/VAST traits were sociological advantages. Why is this not the bigger conversation? I don’t want some therapy bandaid. I want to help change the world’s view of how we measure societal value and success

  4. Sorry, I don’t think ADHD has any benefits. I don’t get anything from it but constant pain. But Im aware that this discussion is broader than the personal feelings of myself or anyone else. Non-ADHDers, who hold all the cards and run society, don’t think there are benefits to having ADHD, and we have to live in the world they make, define, and administer.

    Social model of disability 101, folks. Renaming ADHD will do nothing until NTs aren’t seen as superior and “normal.”

  5. While I appreciate the desire to more appropriately and positively present ADHD, the mental health, medical and educational communities are still often ignorant about executive dysfunction and the real difficulties it often presents to those who experience it. Changing the label as suggested may make it more difficult for children and adults to get the help they need. ADHD is not just about attention. Time management, emotional regulation, organization, impulsivity, shift in mood or attention and overwhelm from being unable to regulate all of this are other key symptoms. Yes. There are positives to ADHD. No doubt. But in a world where many still deny the science of the diagnosis, and many others don’t understand it or how to support people with ADHD, the suggested lable feels like a dangerous downplay of the complexity of ADHD.

  6. ADHDinPGH i couldn’t agree more !! I’ve been saying that for a long time and people keep giving me the positivity and resilience bs talk.
    If all it take is just a little negativity, whats the way out? If we live in the same planet is not possible to not fell negative sometimes.
    I read here that ADHD was easy to manage… take your pills, CBT, diet, exercise. Easy, right? For some people might be but i bet most people can’t afford doing all that. I know i can’t and every time i come here to try to figure something out to help myself i end up reading the same old same old : positivity, resilience and the miracle that is Mindfulness.

    I think you should all read this. Link: https://www.theguardian.com/lifeandstyle/2019/jun/14/the-mindfulness-conspiracy-capitalist-spirituality

    “Mindfulness, like positive psychology and the broader happiness industry, has depoliticised stress. If we are unhappy about being unemployed, losing our health insurance, and seeing our children incur massive debt through college loans, it is our responsibility to learn to be more mindful. Kabat-Zinn assures us that “happiness is an inside job” that simply requires us to attend to the present moment mindfully and purposely without judgment. Another vocal promoter of meditative practice, the neuroscientist Richard Davidson, contends that “wellbeing is a skill” that can be trained, like working out one’s biceps at the gym. The so-called mindfulness revolution meekly accepts the dictates of the marketplace. Guided by a therapeutic ethos aimed at enhancing the mental and emotional resilience of individuals, it endorses neoliberal assumptions that everyone is free to choose their responses, manage negative emotions, and “flourish” through various modes of self-care. Framing what they offer in this way, most teachers of mindfulness rule out a curriculum that critically engages with causes of suffering in the structures of power and economic systems of capitalist society.”

    https://www.theguardian.com/commentisfree/2012/jul/16/mental-health-political-issue

    “The radical therapist David Smail argues that Margaret Thatcher’s view that there’s no such thing as society, only individuals and their families, finds “an unacknowledged echo in almost all approaches to therapy”. Therapies such as cognitive behaviour therapy combine a focus on early life with the self-help doctrine that individuals can become masters of their own destiny. The idea is “with the expert help of your therapist or counsellor, you can change the world you are in the last analysis responsible for, so that it no longer cause you distress” – Smail calls this view “magical voluntarism”.

    Depression is the shadow side of entrepreneurial culture, what happens when magical voluntarism confronts limited opportunities. As psychologist Oliver James put it in his book The Selfish Capitalist, “in the entrepreneurial fantasy society,” we are taught “that only the affluent are winners and that access to the top is open to anyone willing to work hard enough, regardless of their familial, ethnic or social background – if you do not succeed, there is only one person to blame.” It’s high time that the blame was placed elsewhere. We need to reverse the privatisation of stress and recognise that mental health is a political issue.””

  7. Just to frame my comments:
    1) I am approaching 70 years of age. When I was 10, they gave me “diet pills” (=”speed”) so my mother, “could cope.”
    2) Got the formal psychological diagnosis of ADHD @ 44 years of age. I was generous; 2 of my 3 children have been formally diagnosed w/ ADHD and one grandchild as well.
    3) I have found Dr. Hallowell’s writings to be immensely beneficial. I have made a lot of lifestyle changes he and this site have suggested that have helped. I am also on a regimen of 40 mg of Strattera and 15 mg of Ritalin which also make a difference. My latest discovery has been Magtein (Magnesium L-Threonate) which is a natural supplement.

    I really appreciate this move to rename ADHD to VAST. I’m now a crusty old man so I don’t give a rip what people associate w/ a label. But, I understand that for the vast majority of people, “labeling” can have a real impact.

    20 years ago, while in an ADHD counseling session (w/ a counselor who “sort of” understood ADHD, I remarked, “I don’t have a deficit of attention a moment in my life. It’s just that my attention hasn’t been where someone wanted it to be. ADHD is terribly misnamed. What I (& others like me) have is a ‘variable attention-focus pattern.'” It was just a “mind burp” at that moment but until today, it was what I would use to try and help communicate what VAST truly is. It was reasonably accurate but it wasn’t catchy. I sign on fully to VAST. I think we use it and make it stick. And it will help a HUGE number of people embrace who they are and learn how to manage the Porsche engine they have under their hood.

    Congratulations and thank you!

  8. I agree that many do not emphasize the strengths of those with ADHD and it can often to be thought of as negative. This can lead to those with ADHD to think something is wrong with them. But, I am very hesitant to call this by a different name. My son and husband both have ADHD and I’m a teacher with many students who are affected by it as well. I think what needs to happen is that the school system and the resources available to families needs to change. I am afraid that if we focus on changing the name to “de-medicalize” this then the limited resources I already available will become even less accessible. I am afraid there will be even less understanding and compassion from those people who work with children with ADHD because they won’t even understand what it’s being called now. There has to be more understanding involved in how complex this really is, that it’s not just symptoms of hyperactivity and focus. That it’s much more than that. This would help these children to feel more accepted and help educators and parents be better prepared to provide the right strategies and ways to work with these kids to help them thrive.

  9. Hmm. It is what it is and the fact that ADHD has negative connotations is just par for the course. You can call it VAST, or anything else. It’s still going to be associated with something that makes us different and that normal people see as a weakness/strange/different/hard to understand.
    At the end of the day, it’s the actual disorder (or whatever you want to call it) that pisses me off, because THAT is what affects me. The fact its called ADHD is not what I’m thinking when trying to find my keys/wallet (because they aren’t in the fridge, like last time). People can label it as whatever – a new name isn’t going to make the slightest bit of difference other than create confusion –

    Whoever, “Wait, you have VAST??? I thought you had ADD?!”

    Me, “I do, although I call it ADHD.”

    Whoever, “So you don’t have ADD then?”

    Me, “Yes. ADD and ADHD are the same really. Hmmm, except without hyperactivity…”

    Whoever,”……… *blinks* Ok, so you DO have AD-something. But you don’t have VAST, yes?”

    Me, “Haha no, let me explain…wait, where are you going??”

  10. For a long time, I’ve thought of my Inattentive ADHD as something more like Attention Regulation Disorder. I have certainly experienced benefits from it, but I have no doubt that it is a disorder. I can still experience most of the benefits while on medication. But before I was treated, the problems clearly surpassed the benefits.

  11. Right on, KaiyuKitty! There is nothing good or positive about ADD (and don’t call me ADHD! I have never been hyperactive!). Renaming it VAST is merely a useless propaganda exercise IMHO. If you admit it, you have to explain it. You will have blown your cover and that you WILL regret.

    I’m a 60 + year old dude and have worked some 40 years as an engineer. I have also been called the carpet several times in both social and business situations and was accused of being rude and a social moron. To have a formal label would have destroyed the public image and reputation I have worked so hard to earn.

    My advice in this forum has been consistent:
    1. If you need help, get help.
    2. Read ADDitude to learn valuable advice.
    3.Keep a tight security lid on this $#!+. Going public will cause you social isolation and even your job.

  12. No. Just no. Having been doubly diagnosed with ADHD and my experience of it having been as essentially a deficit, I don’t need or want the pity of a PC-esque terminology change that performs a pseudo-whitewashing of the truth of its hardship that no amount of linguistic winking and nodding will ever change. ADHD has always had its doubters; among whom such a move would only make it a joke.

  13. I appreciate the article, video and discussions. Thank you ADDitude.

    My first comment is, the word disorder sounds too strong. One description is: “A derangement or abnormality of function; a morbid physical or mental state” and there are many others. You might say what about the medication, does it not prove that there is a disorder? Yes, my kid takes medication but only for school purposes. So it is primarily a non-compulsory socio-medical topic for us. Her psychiatrist also suggested that she could stop taking them in the future after graduation. For us, medicine is not a cure or a treatment but a helpful and important social facilitator. I would rather deal with her emotional outbursts through dedication and not medication.

    Re the VAST, I would rather change ADHD as ADHC replacing disorder with the word condition. Why? Let me give a different example. I see parallels between ADHC and non-heterosexuality. The medical establishment chose not to diagnose non-heterosexual behavior as a disorder and I agree with that. I would call both a condition because a medical term better not be used if the social damage it creates outweighs its medical help (plus the non-heterosexual group does not any cure at all) but I have already argued that most ADHC people would be ok if they did not have a school requirement. I have no experience in certain ADHD areas such as oppositional defiant disorder but still think schools are the primary reason medication is used.

  14. My daughter was diagnosed with ODD, then ADHD, and then DMDD.(Disruptive Mood Dysregulation Disorder). To me,they are “basically” the same; a hardship in regulating one’s attention and/or mood. It is done more by external situations/factors than internally, wherein lies the issues. That said, it can be greatly beneficial as well as challenging. IE; Hyperfocusing on something you enjoy can make you a valuable expert in that area vs being good at handling multiple things at the same time! My daughter benefits tremendously from her medicines that enable her to control her attention/moods better vs not being able to control them well. This definitely increased her self-confidence while therapy helped in many other invaluable ways. While it isn’t a deficit per say, it is in my view an inability to regulate oneself fully, which leads to all the other associated conditions. Maybe Attention Regulation Differences… ARD would be a good name, which would include all the other associated conditions talked about in this article. They come about because these differences are unseen, therefore some view our differences as being bad. While our differences are challenging, they are neither bad or good. They are just different. All we need are strategies and an environment we can thrive in.

  15. My 16 yr old grandson bristles at being identified as someone with ADHD. He responds that he doesn’t have Autism and doesn’t want us to talk about ADHD. I agree that Deficit Disorder is a negativel connotation especially to someone who is hyper sensitive to criticism, I think renaming it VAST will create confusion as previously suggested. I do like ADHC, attention different hyper condition or even ADC, attention different condition.

  16. While I appreciate the thought that has gone into the name VAST, I agree with others here. The acronym ADD and ADHD are too well associated with our condition and trying to convince the general public to go with a new acronym is going to be very hard and distract from the bigger issue at hand.

    ADHD is going to continue to be viewed as a disorder as long as society is structured in a neuro-typical fashion. What pisses me off about my way of being is that I am forced to conform to a system that is optimized to squeeze the most production out of people and then place value on the individual based on their performance. So essentially, my value as a person is equivalent to how much shit I can get done in an hour. So of course, if you don’t perform well, it is assumed (never spoken, just understood) that you are a lesser person who doesn’t deserve certain “luxuries” of society.

    Renaming ADHD isn’t going to change a damn thing about how we are viewed. As long as we live in a system that values a person based on their productivity and money-earning potential, we are going to be lesser citizens.

  17. I agree that ADHD perhaps needs a better name, or a redefinition. But VAST is not the answer.

    ADHD is a a developmental disorder much like Autism. Our brains are difference, and no ADHD is not a disease.

    When I talk about myself, I always refer to myself as an ADHD person. I am ADHD. I don’t ‘have’ ADHD, because ADHD is part of me.

    To say “I am VAST” is … not good. Vast is understood in the meaning of ‘endless, wide, expansive’. If I told someone ‘Oh yeah, I’m VAST’, they’d be so confused and think I was weird.

    VAST also fails to solve the societial issues as many others in the comments have rightly pointed out. The system and stereotypes and the MISINFORMATION is what needs to be focused on.

    And when better to focus on this than right now? October is ADHD Awarenes Month!

    VAST isn’t the answer. But it’s a good discussion to have on the table about how we can reframe the understanding of ADHD.

  18. My kneejerk reaction is that to “de-medicalize” ADHD with a euphemism is to downplay the obvious effects medicine has on treating the condition. Yes, there are positives to having an ADHD focus pattern, but it’s imperative to emphasize that for many, left medically untreated, the condition becomes an obstacle (however big or small) in maintaining relationships and work patterns in a neurotypical world.

    I am fortunate not to have experienced much stigma since my diagnosis, and with greater awareness of ADHD, most people understand and accept the differences that come with it. When non-ADHD people tease about others having “ADD moments” when distracted may be a broad generalization and may not quite capture the complexity of the condition, but it’s understood that there’s something different, and it’s not malicious (again, in my experience).

    VAST may be a great way to frame the way we think, focus, and process, but to replace what’s known for the sake of “de-medicalization,” however noble the cause, will only draw more confusion. This isn’t like replacing multiple-personality disorder with DID.

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