ADHD needs a better name. Here's one that stays the same.

A response to Edward Hallowell and John Ratey’s article, ’ADHD needs a better name.  We have one’

As the founder of Different Keys and being an ADHDer myself, I understand that living with ADHD can often feel like navigating a world not designed for your unique strengths and challenges. One of the ongoing concerns many people with ADHD express is the inadequacy of the term ‘Attention Deficit Hyperactivity Disorder’. This name not only misrepresents their experiences but also perpetuates misunderstandings about the condition.

The VAST problem with ADHD

The pioneering, world-renowned experts Edward Hallowell and John Ratey (ADHD royalty, as I like to think of them) have pointed out that the term ADHD is misleading in several ways. Firstly, the idea of a ‘deficit’ in attention is a misconception. Many individuals with ADHD experience an abundance of attention, but they struggle to regulate it. This means their attention can be hyperfocused on certain tasks while it is almost impossible to direct that attention towards others.

Moreover, ‘hyperactivity’ is not always a visible, physical manifestation. Hyperactivity can often be an internal restlessness rather than overt behavior. This internalized aspect of ADHD is frequently overlooked (especially the diagnosis of women and girls) leading to further misunderstandings and stigmatization.

Hallowell and Ratey suggest the alternative term VAST (Variable Attention Stimulus Trait), which I’m not particularly enamored with for a number of reasons. So, at risk of insulting ADHD royalty, I will explain my treasonous thinking below:

Hallowell and Ratey argue that VAST (variable attention stimulus trait) is a more accurate descriptive term.  It avoids the term ‘deficit disorder’, and de-medicalizes the term to allow focus instead ‘on the huge benefits of having an ADHD brain’.

I have a slight bone to pick with this, because its comes a little too close to positioning ADHD as a ‘superpower’ - and this rightly annoys and frustrates some people. Any name that presents ADHD in a more beneficial light will reduce the public’s perception of it as a serious condition.  This will make it so much harder for people to get the support or adjustments they need.

There are two further points I wish to raise:

First, an acronym that is commonly understood to mean ‘extremely large’ is going to be problematic for the many people with ADHD who suffer from weight issues or eating disorders.  As another ADDitude article states - ‘several studies have shown that those with ADHD are prone to obesity and find it hard to lose weight’ (ADHD linked to eating disorders and Lighten up your ADHD Weight Loss guide).

My final point is that ‘trait’ is not at all suitable as a term.  I will explain why.  A trait is a single, definable, observable characteristic or quality possessed by something or someone.  So, we use words like ‘talkative’, ‘bossy’, or ‘shy’ to describe someone’s character traits; or we might talk about genetic traits that are passed down to offspring, such as red hair or blue eyes.  The science of behavioral genetics examines the biology of individual behavioral traits and their evolution as they are passed down through the generations over time. In all these cases, a trait is a singular thing with clear defining characteristics.

ADHD is not like this.  ADHD is a complex condition with a number of characteristic traits. The scientific term for a collection of characteristic traits is ‘phenotype’.

So, does that mean we should use VASP (Variable Attention Stimulus Phenotype) instead?

That’s certainly possible, but it’s almost inevitable that people who get a cheeky thrill from creating amusing acronyms (like me) would really want to replace ‘variable’ with ‘wandering’.  If you’ve heard Eric Tivers’ podcast - 'ADHD rewired, the podcast for ADHD adults who have really good intentions and a slightly wandering attention’ - you'll be very familiar with the pairing of those words.

Danger, WASPs!

So we could call ourselves WASPs (Wandering Attention Stimulus Phenotypes), but unfortunately I think that joke would wear thin very quickly.

So what should we do? 

I suggest we just keep it the same.

But different.

Attention Dysregulation & Hyperfocus Disorder:

a change without change and a new ADHD

I propose the term Attention Dysregulation & Hyperfocus Disorder, as one that better captures the reality of living with ADHD:

• Attention Dysregulation: Reflects the difficulty in managing and directing attention, rather than a simple lack of it.

• Hyperfocus: Acknowledges the capacity for intense concentration on specific interests or tasks, which is a common experience for many with ADHD.

• Disorder: I keep the term ‘disorder’ rather than use ‘difference’, ‘trait’, or ‘phenotype’ as this indicates a clear and clinically significant impairment.

While this behind-the-scenes-makeover of ADHD is still not perfect, it provides a more nuanced understanding of the condition. It replaces the previous misleading term ‘attention-deficit’ with one that is at the heart of the lived experience of ADHD: the difficulty we have regulating our attention.

This is followed by ‘hyperfocus’, a term that seems to contradict the first part.  However, this is by no means a bad thing and might actually be helpful - for, according to Hallowell and Ratey, this type of paradox is a characteristic feature of ADHD:

‘It helps to think of ADHD as a complex set of contradictory or paradoxical tendencies: a lack of focus combined with an ability to super focus; a lack of direction combined with highly directed entrepreneurialism; a tendency to procrastinate combined with a knack for getting a week’s worth of work done in two hours; impulsive, wrongheaded decision making combined with inventive, out-of-the-blue problem solving; interpersonal cluelessness combined with uncanny intuition and empathy; the list goes on’ (Hallowell and Ratey, in their book, ADHD 2.0, page 7, my italics).

So, despite beginning this post by disagreeing with ADHD royalty, it turns out I owe Hallowell and Ratey credit for providing the basis for this new definition. In true paradoxical ADHD fashion, I'm agreeing with them and disagreeing at the same time.

Looking Ahead

I recognize that this ‘behind the scenes rewrite’ of ADHD is only a temporary fix until neuroscience and medical research develop a more appropriate term - and because research in this area is progressing very quickly. that may not be very far in the future.

Until that time, this new ADHD comes with some great bonuses:

This no-change change means that ADHDers can still be ADHDers; ADHD charities can keep their names; books on ADHD can remain in print and relevant; ADHD websites can keep their domains; and government legislation and policy documents will not have to be amended.

But most of all, we can continue to build on the existing public awareness of ADHD, without us having to start all over again with a new name.

I’d love to know your thoughts on this.

Do you like this newly redefined ADHD?  Or is there an alternative term you prefer?

At Different Keys, we are committed to advocating for a better understanding and representation of ADHD. We invite you to join us in this journey, as we work towards a world that embraces neurodiversity and empowers individuals to thrive.

Stay different!

Paul