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PART 1
Boredom, ADHD,
and the Elements
of Interest
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CHAPTER ONE
The Premise
Psychiatrists and other clinicians, counselors, teachers, and parents encounter boredom from time to time, their own and the boredom of their patients, clients, students, and children. Perhaps more often they encounter the behavior designed, knowingly or not, to provide an escape from boredom. The behavior of escape may be brilliant, useful, humorous, original, and desirable, especially so when the avoider has attention deficit hyperactivity disorder (ADHD). The boredom avoidance can just as often be hyperactive, risk-taking, rule-breaking, novelty-seeking, and disruptive, especially when the avoider has ADHD. Boredom and escape from boredom are thus key elements of ADHDâits diagnosis, understanding, and management.
Children are born into a world where everything is novel and challenging, and their interest is abundant. Our efforts to keep the natural ability of children to interest themselves flowing throughout a lifetime require interest-seeking skills as less and less experience is novel and a great many restrictions apply. This book provides insights into the boredomâinterest continuum, interest-seeking behavior in ADHD, and examples applying Elements of Interest to otherwise boring situations age by age, from infancy on. We begin with a story.
A lifetime of untreated ADHD
Rob has retired from a job in a big city to live on a farm on the edge of a small town. As Rob and I talk, I notice that he frequently stops mid-sentence and says, âThat reminds meâŚâ And he goes off on an entirely different topic without finishing or returning to his thought on the first topic. Some idea or word he himself had used set him off on a new course without regard for the unfinished thought. A lot of people habitually interrupt others and get off track, but Robâs abrupt switches in the middle of his own thoughts seem unusual.
I mention to him that I have noticed this habit, and he acknowledges, âI get bored with what Iâm saying and I think of something more interesting.â
That statement encapsulates the premise of this book; boredom is the elephant in the ADHD room. When any of us becomes bored with what weâre thinking, saying, or doing, we begin to look around for something more interesting to think, say, or do. People with ADHD become bored more often and more intensely, and they find boredom more intolerable than those without ADHD. Reflexively they seek something more interesting. That mental response to boredom parallels the diagnostic events of inattention and impulsivity that characterize ADHD, while the physical need to escape boredom drives hyperactivity, the third diagnostic criterion.
Robâs history shows early signs of ADHD, although he was not diagnosed until much later. He was dismissed from two nursery schools for not doing as he was told and causing trouble, he says. His mother was frequently called into school to discuss Robâs fighting.
Rob succeeded in school, though not to his potential, in a very structured independent school. Writing was emphasized at this school at considerable emotional cost for Rob. I learned that a typical evening scene involved his mother standing over him as he struggled to write a short paper for school. He twiddled his pencil and jiggled his leg while his mother warned, âIâm going downstairs to do some laundry. When I get back I want you to have written three sentences.â When she returned, Rob had written nothing at all, and a tirade began: âWhy havenât you done anything? Just three sentences! You havenât written even one. I told youâŚâ Rob just couldnât write; he didnât know why. The more pressure that was put on him, the more impossible writing became.
Rob finally refused to go back to that school and graduated from a less demanding school that more often required short answer assignments. His high scores on university entrance exams got him into a prestigious university where, he says, âI learned a lot and read a lot of books but not the ones the professors assigned.â The assigned books did not give Rob what he needed: a high level of stimulation. Other books did, so he turned to them.
No wonder. Boredom is the feeling of too little stimulation, a discomfort that ADHD expert and author Edward M. Hallowell, M.D., describes from his own experience as âlike being asphyxiated.â1 Similarly, ADHD is characterized largely by a lack of stimulation caused by under-activation of the neurotransmitter dopamine across the synapses of the brain. The parallel between the disruption of stimulation that characterizes both boredom and ADHD is highlighted by the fact that stimulants are often a successful treatment for ADHD, just as the experience of stimulation relieves boredom.
Dopamine is linked to focus, curiosity, seeking, excitement, hope, and âthe idea of starting again.â2 Without sufficient stimulation of the dopamine system there is little neurological reward, which results in a poorly defined irritation, like an itch needing to be scratched, and so the bored person, with or without ADHD, is always looking for something different from what he is experiencing now. People with ADHD seek stimulation more than those without that condition and thereby often experience satisfaction, but often only by difficult trial and error.
Rob didnât make it through the first year in the university and, having already enrolled in the Naval Reserves, he lost his deferment status and was called to active duty. Based on results of Navy testing, he was chosen to learn some cutting-edge technologyâcomputers were in their infancy then. The work excited him, and, when heâd finished his service, he began a career in the space industry doing computer work that mostly university graduates were hired to do. He still jiggled his leg to provide kinesthetic stimulation, but the characteristics of this workâchallenge, novelty, problem-solving, and few rules about work habits, for exampleâallowed him to succeed. He had found a way to satisfy or circumvent his hyperactivity, impulsivity, and inattention.
Finding his way has mostly meant finding a way to escape anything boring for the next several decades of his career and on into retirement. Boredom-driven, interest-seeking behavior often means being unconventional and breaking rules. Conventional is boring. Rules lock in boredom.
Moreover, being unconventional often has charm. When an old friend comes to town, Rob takes the day off from work and shows her around the city. He drives the wrong way up a one-way alley, taking a short cut to his favorite lunch place. He orders his favorite dessert and he and his visitor share the sumptuous confection before the lunch menu arrives. Then they order sandwiches. He has rather deliberately taken the power out of all the silly rules so that he can follow his impulses. He has also canceled all the rules that pertain to things not at hand: he doesnât write thank-you notes, he doesnât respond to invitations, he doesnât answer e-mails that he doesnât feel like answering, he doesnât waste time with boring pleasantries like âHow have you been?â A visitor to his house he may not have seen for years arrives to find him in the kitchen engrossed in deftly pouring pancake batter onto a griddle. Rob barely glances at the newcomer as he says cheerfully, âDo you want blueberries in your pancakes or pecans?â Thereâs no, âItâs good to see you, itâs been a long time.â Responding mainly to the immediacy of face-to-face stimulation is Robâs style but itâs more than a style. Itâs a way of life.
Meeting children he has not seen in years, he avoids the boring adult remark, âMy, how youâve grown.â He simply sees the child and a Lego set; he picks up a LegoÂŽ brick and says, âHow about if we put one there?â The child is enchanted to be immediately in sync with Rob without any embarrassing greeting. Rob and the child play with LegoÂŽ until one of them loses interest, which takes some time.
The charming side of ADHD got him a marriage partner. A lot of requirements came with her. There is almost always a downside to counter the upside as people seek and find stimulation. ADHD behavior often leads to conflict as the one with ADHD doesnât meet a spouseâs expectations. Rob was used to disappointing people. âI just expected to be yelled at for the rest of my life,â he says.
Now divorced, remarried, and still seeking stimulation in retirement, there is little downside to his current way of life. Rob is busy all day, every day. Something catches his eye that needs to be done or he wants to do, and heâs on it. When he arrived in this small town, he impulsively accepted volunteer jobs that interested him without considering if he would have time to perform them all well. He accepted invitations to work on committees and soon became an officer for several civic organizations, eventually running for public office. If itâs there in front of him, he engages it. At home he starts things, promises things, abandons things, and never returns to them. If someone mentions an unfinished project, he says, âYeah, I need to get back to that.â But he doesnât. He knows he wonât. He heads for something else that will engage him with its newness until itâs not new anymore. Rob treats his boredom from morning to night; he has not treated his ADHD.
Almost every move Rob makes can be explained by his remark, âI get boredâŚand I think of something more interesting.â A kidâs version of this statement is remarkably similar. In the following conversation, ten-year-old Harry has just explained to me that he loves a challenge. Then, quite out of the blue, it seemed, he startled me with a statement:
HARRY: Iâm crazy, too.
LETITIA: What do you mean by âcrazyâ?
HARRY: Iâm kind of crazy. Iâm not responsible. I also do stupid things.
LETITIA: Stupid things? You seem smart to me. I canât imagine you do stupid things. Do you mean silly things?
HARRY: Yes. Sometimes Iâll be responsible, but a lot of the time Iâm stupid and silly. Me and my friends will be talking and Iâll automatically change the subject completely and Iâll say something nobody is talking about. Then Iâll go back to what we were talking about.
LETITIA: So you go off topic sometimes.
HARRY: Like we were eating breakfast this morning and I said, ââŚâ
(What he said sounded like nonsense syllables to me even when I asked to have it repeated.)
HARRY: They said, âWhat?â And then we went on talking about what we were talking about before.
Perhaps someone has pointed out Harryâs digressions to him as I had done with Rob, or perhaps he has noticed them himself. I want to tell him and all those with ADHD, both adults and children, that any of us would go off topic if we saw the specter of boredom coming and felt compelled to jump out of the way. Robâs off-the-cuff explanation for his digressions, that he was bored with what he was saying, corroborates in simple words the premise that boredom is a major force that drives the behavior of people with ADHD.
The idea that boredom is key to the understanding and treatment of ADHD came to me originally from my work with child, adolescent, and family psychiatrist Lyndon D. Waugh, a mentor and author with whom I had collaborated on Tired o...
