Jul 25, 2017 | Research Updates
David Giwerc, MCAC, MCC
ADD Coach Academy
In this second blog, I will discuss what the research Entrepreneurship and Psychological Disorders: How ADHD can be productively harnessed revealed about the importance of hyper focus and how some of the world’s leading Entrepreneurs use the strength of hyper focus. I will also propose a few practical recommendations to expand the research I believe are critical to the success of an Entrepreneur with ADHD.
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Hyper focus, the Strength of ADHD Entrepreneurs to Catalyze Successful Outcomes and Recommendations for Expanding “Positive Approaches” Research
Wiklund et al. (2016). Entrepreneurship and psychological disorders: How ADHD can be productively harnessed. Journal of Business Venturing Insights, 6, 14-20. doi.org/10.1016/j.jbvi.2016.07.001
The final important element revealed in the research on the impact of ADHD on entrepreneurs (Wiklund et al., 2016) is that hyper focus was identified as among the greatest attributes for the ADHD entrepreneur. Hyper focus is the ability to focus intensely on a task at hand to the exclusion of all else – including forsaking eating and sleeping. This is often observed with ADHD entrepreneurs who are pursuing a business venture about which they are passionately enthused. David Neeleman revealed that he could not pay attention in the classroom, yet was able to hyper focus tirelessly on important issues within the airline industry, which eventually led to the founding of JetBlue.
Paul Orfalea was referred to as his company’s “chief wanderer,” spending 3 weeks on the road hyper focusing on how his own stores were operating and what his competitors were doing. He said it was his ADHD that compelled him to wander because he could never bear staying in one place too long. He also discovered that leaving headquarters removed him from the boring, mundane, daily routine of work that left little room for insight, inspiration and innovation, qualities that drove him to differentiate his product from that of his competitors, which helped placed Kinkos in the forefront of consumers’ minds, making it the world’s leading retailer for document copying and business services; Orfalea sold Kinkos to Federal Express for $2.4 billion in 2014.
This study reinforced what I have observed in coaching Entrepreneurs with ADHD for over 20 years. Every successful entrepreneur is involved with a business they love. The business enterprise is not derived from pressure to work in a business or workplace environment not suited to their ADHD and unique strengths.
These and other examples represent the restless, impatient nature of the entrepreneur with ADHD who experiences boredom while attending to the daily mundane grind of tasks, which impedes the ability to think creatively and innovate. Without sufficient mental stimulation, the entrepreneur with ADHD will seek out opportunities to explore new and interesting ideas, which may induce a state of hyper focus. This type of intense, intellectual attentiveness and vigor will lead to the attainment of a wider scope of knowledge, in a specific domain, often expanding their perspective, abilities and confidence, in a chosen field, thus increasing the chance for success when an intuitive decision needs to be made, which is a conjecture of Wiklund et al. (2016).
Future Research Recommendations:
Existing research on adult ADHD has not supported evidence for any positive effects of the diverse qualities inherent in ADHD. However, some anecdotal evidence suggests that some features ADHD may have positive implications in some settings, such as entrepreneurship.
The Wiklund et al. (2016) study is an important first step towards understanding how ADHD impacts entrepreneurship, albeit based on case study. It transcends the symptoms of ADHD and opens a new pathway for more formal academic/scientific study to investigate positive ways to approach ADHD and entrepreneurship.
There are at least three areas for future research: 1) the role of physical exercise in managing an entrepreneur’s ADHD symptoms and how a consistent exercise regimen may be a source of time-limited symptom management the promotes creativity; 2) identification and integration of unique information processing styles for improved communication of information, presenting business proposals, and assigning and managing tasks, which may inform strategic use of assistive technology in business settings; and 3) the use of the VIA character strengths survey (Peterson & Seligman, 2004) to identity self-endorsed character traits that may be associated with entrepreneurship. I can only conjecture that “creativity” would emerge as one of the core signature strengths in entrepreneurs with ADHD.
Many of the ADHD entrepreneurs in the study knew intuitively that they were different and stood out from peers in ways that might not have been perceived in positive terms. One of the most important messages of this research is that ADHD is not only a diagnosis; it is also, potentially, a unique difference that may bring with it unconventional strengths. When understood by entrepreneurs with ADHD in this way, it can be the catalyst for identifying who they are, including envisioning unconventional ways of doing things in order to create and build innovative and successful businesses.
References
Csikszentmihalyi, M. (1997). Flow and the Psychology of Discovery and Invention. HarperPerennial, New York.
Orfalea, P., & Marsh A. (2005). Copy This!: Lessons from a hyperactive dyslexic who turned a bright idea into one of America’s best companies. Workman Publishing Company, Inc.: New York
Logan, J. (2009). Dyslexic entrepreneurs: the incidence; their coping strategies and their business skills. Dyslexia 15 (4), 328–346.
Peterson,C., & Seligman,M. (2004). Character Strengths and Virtues: A Handbook and Classification. Oxford University Press: New York
Wiklund et al. (2016). Entrepreneurship and psychological disorders: How ADHD can be productively harnessed. Journal of Business Venturing Insights, 6, 14-20. doi.org/10.1016/j.jbvi.2016.07.001
Jul 25, 2017 | Events and Announcements, Research Updates
David Giwerc, MCAC, MCC
ADD Coach Academy
This is the first in a series of two blog posts discussing and reviewing
Entrepreneurship and psychological disorders: How ADHD can be productively harnessed
Wiklund et al. (2016). Entrepreneurship and psychological disorders: How ADHD can be productively harnessed. Journal of Business Venturing Insights, 6, 14-20. doi.org/10.1016/j.jbvi.2016.07.001
Entrepreneurship is often associated with ADHD symptoms such as impulsivity, hyper focus and highly passionate interests. ADHD is a neurodevelopmental psychological disorder also associated with several negative consequences such as poor academic performance, substance abuse, antisocial activities and arrests, and social exclusion and isolation.
Despite the negative public perception of ADHD, adults with ADHD may possess attributes and capacities which make them excellent candidates for entrepreneurship. There have been very few studies which have investigated the possibility that ADHD could have positive implications on Entrepreneurship.
In a recent (Wiklund et al., 2016) multiple case qualitative study of fourteen entrepreneurs previously diagnosed with ADHD, Researchers at Syracuse University, the University of Bath in the UK and the Technical University of Munich (TUM) in Germany used an inductive model highlighting impulsivity as key motivator for entrepreneurial action and hyper focus as a main impetus for its results, positive or negative.
This study also took into account factors that other research seemed to overlook or consider irrelevant, such as the success of several prominent entrepreneurs like business mogul, Richard Branson; Jet Blue founder, David Needleman; Ingvar Kamprad, who founded Ikea; and Paul Orfalea, founder of Kinko’s. All of these entrepreneurs revealed they have ADHD.
While there has been documentation of the problems associated with ADHD, the examples of successful entrepreneurship among the aforementioned individuals with ADHD raise the question of possible interconnections between ADHD and entrepreneurship.
One of the most intriguing outcomes of this research is the role impulsivity is thought to play in entrepreneurship.
Impulsivity increases the inclination for entrepreneurial action in situations of uncertainty. A key feature of this characteristic is that it bypasses any sort of risk-benefit analysis, but is rather driven by an internal sense of what “feels right” at the time. For entrepreneurs with ADHD, what is relevant is to not to wait or think. It is to act – NOW.
In the corporate and small business world, most executives detest impulsive decisions because they do not seem “rational.” Their rationale being: “How can you make a decision in the midst of uncertainty without a thorough and sober evaluation?”
Intuition appears to be the answer, at least based on interviews conducted in the study. One entrepreneur claimed that his decision-making style boosts productivity in his fast-paced business. By integrating more analysis into his decisions, he is fearful his productivity would suffer. From an entrepreneurial context, rationality does not drive an intuitive decision. Acting without thinking in uncertain situations is associated with greater intuitive decision making. Especially, if the entrepreneur has an expertise where they feel comfortable intuitively making an impulsive decision and trust their instincts, perhaps having trust in their ability to decide based on a thin-slice of information.
Many of the entrepreneurs interviewed for the study cited restlessness or impatience as a key trait in entrepreneurship. This restlessness can also be viewed as a manifestation of boredom, which spurs the entrepreneur to chase after new and stimulating projects in which to use their energy and passion. This kind of novelty seeking and restlessness is the sort of intuitive push that many of the entrepreneurs in the study attributed to their ADHD and which they credited as launching their entrepreneurial careers.
References:
McMullen, J.S., & Shepherd, D.A. (2006). Entrepreneurial action and the role of uncertainty in the theory of the entrepreneur. Acad Manag Rev, 31, 132–152.
Hayward, M.L., Forster, W.R., Sarasvathy, S.D., & Fredrickson, B.L. (2010). Beyond hubris: how highly confident entrepreneurs rebound to venture again. J Bus Ventur, 25, 569–578.
Wiklund et al. (2016). Entrepreneurship and psychological disorders: How ADHD can be productively harnessed. Journal of Business Venturing Insights, 6, 14-20. doi.org/10.1016/j.jbvi.2016.07.001
Jul 24, 2017 | Research Updates
Gregory Mattingly, M.D.
Associate Clinical Professor,
Washington University
President, Midwest Research Group
As a young chemical engineer intent on pursuing a medical degree in interventional cardiology, the pioneering work by Rita Levi-Montalcini and Stanley Cohen not only changed my career but changed the face of neurobiology and all of medicine…
With the award in 1986 for the Nobel Prize in Medicine their pioneering discoveries of Neural Growth Factor and the influence of trophic factors on cell development upended our basic concepts about the brain and functional neurology. No longer were nerve cells seen as preordained to gradual decay and decline but the concepts of neural plasticity, regeneration, synaptogenesis and connectivity became the rage.
This month’s article by Akay and colleagues furthers our knowledge and understanding about the potential role of neural growth factors in ADHD.
Prior studies have demonstrated that brain derived neurotrophic factor-BDNF has an important role in neural plasticity, protecting against neuronal stress and maintaining cognitive function. BDNF is encoded by genes on chromosome 11 and specific genetic Val-Met polymorphisms of the BDNF gene are associated with either preserved or impaired neuronal function.
The Val-Val BDNF genotype was shown by Kim et al to predict a better response to OROS-Methylphenidate as compared to a Val-Met genetic substitution.
Val-Val individuals were able to increase BDNF levels in response to MPH treatment whereas Val-Met patients had lesser increase in BDNF and individuals with the Val-Val genotype had an overall greater improvement in ADHD symptoms in response to MPH treatment.
This past month, Akay et al published the results of a study which measured the pre and post MPH treatment levels of BDNF in 50 male ADHD patients and 50 non ADHD controls.
The mean serum pretreatment BDNF levels with ADHD were 2626 and 2989 pg/ml in healthy controls. ADHD individuals had a significant increase in serum BDNF in response to 8 weeks of treatment with MPH; 2626 to 3255 pg/ml (p = 0.04) with an even more extensive increase in the inattentive group (p = 0.005).
Other factors which have been constantly shown to increase BDNF include-exercise, sunlight sleep and improvement in mood disorders…all of which enhance the brain’s ability to remain plastic, encode new information and adapt to stress.
Our field is exploding daily with new innovations and a deeper understanding of the influence of genetic markers, the influence of neural growth factors and biologic predictors of treatment response. We stand at the edge of an exciting tomorrow both for ourselves and our patients!
References:
Kim et al; Int J Neuropsychopharmacol. 2011 Nov;14(10):1399-410. Val/Val genotype of brain-derived neurotrophic factor (BDNF) Val⁶⁶Met polymorphism is associated with a better response to OROS-MPH in Korean ADHD children.
Akay et al;Eur Child Adolesc Psychiatry. 2017 Jul 14. doi: 10.1007/s00787-017-1022-y. Serum brain-derived neurotrophic factor levels in treatment-naïve boys with attention-deficit/hyperactivity disorder treated with methylphenidate: an 8-week, observational pretest-posttest study.
Jul 18, 2017 | Research Updates
J. Russell Ramsay, Ph.D.
Associate Professor of Clinical Psychology
University of Pennsylvania, Perelman School of Medicine
A recent Online First article from the Journal of Attention Disorders, the flagship journal of APSARD, highlights the development of a brief questionnaire to assess potentially maladaptive thoughts that are common to adults with ADHD (Knouse et al., 2017). More specifically, the scale targets the types of cognitions that are not typically thought of as being problematic – positive thoughts.
The sorts of “incautiously optimistic” thoughts (Knouse & Mitchell, 2015) captured in this scale represent an important clinical pivot point in CBT for adult ADHD insofar as they are an intervention point for promoting the implementation of coping strategies, rather than succumbing to an avoidant thought, such as “I’ll just do this one thing first.”
Ultimately, the measure of CBT and other psychosocial treatments for adult ADHD is whether adults with ADHD are more consistent in their use of compensatory coping strategies for managing ADHD and improving functioning in real-world roles and endeavors. However, the scale outlined in this article is a quick and useful tool for identifying and tracking these sorts of ADHD cognitions.
Highlighted Article
Knouse, L. E., Mitchell, J. T., Kimbrel, N. A., & Anastopoulos, A. D. (2017). Development and evaluation of the ADHD Cognitions Scale for Adults. Journal of Attention Disorders, Advance online publication. doi:10.1177/1087054717707580
http://journals.sagepub.com/doi/full/10.1177/1087054717707580
Other reference
Knouse, L. E., & Mitchell, J. T. (2015). Incautiously optimistic: Positively valenced cognitive avoidance in adult ADHD. Cognitive and Behavioral Practice. 22, 192-202. doi:10.1016/j.cbpra.2014.06.003
Jul 12, 2017 | Research Updates
Stephen Faraone, Ph.D.
Professor of Psychiatry
SUNY Upstate Medical University
As a researcher who has devoted most of the past three decades to studying ADHD, I am surprised (and somewhat embarrassed) to see how little research has focused on how ADHD affects the romantic side of life. There are over 25,000 articles about ADHD listed on www.pubmed.gov, but only a few have provided data about love, sex and ADHD. Bruner and colleagues studied ADHD symptoms and romantic relationship quality in 189 college students. Those students who had high levels of both hyperactivity-impulsivity and inattentiveness reported that the quality of their romantic relationships was relatively low compared with students who had low levels of ADHD symptoms. Another study of 497 college students found that ADHD symptoms predicted a greater use of maladaptive coping strategies in romantic relationships and less romantic satisfaction. A study of young adults compared conflict resolution and problem-solving in romantic couples. It found that ADHD symptoms were associated with greater negativity and less positivity during a conflict resolution task and that higher symptoms predicted less relational satisfaction. But this was not true of the ADHD member of the couple only had inattentive symptoms, which suggests that the severity of ADHD symptoms might drive relationship problems. Unlike the studies of adults, the romantic relationships of adolescents with and without ADHD did not differ on levels of aggression or relationship quality, although only one study addressed this issue.
What about sex?
The study of adolescents found that, irrespective of gender, adolescents with ADHD had nearly double the number of lifetime sexual partners. That finding is consistent with Barkley’s follow-up study of ADHD children. He and his colleagues found that ADHD predicted early sexual activity and early parenthood. Similar findings were reported by Flory and colleagues in retrospective study of young adults. Childhood ADHD predicted earlier initiation of sexual activity and intercourse, more sexual partners, more casual sex, and more partner pregnancies. When my colleagues and I studied 1001 adults in the community, we found that adults with ADHD endorsed less stability in their love relationships, felt less able to provide emotional support to their loved ones, experienced more sexual dysfunction and had higher divorce rates.
The research literature about love, sex and ADHD is small, but it is consistent.
REFERENCES
Bruner, M. R., A. D. Kuryluk, et al. (2014). “Attention-Deficit/Hyperactivity Disorder Symptom Levels and Romantic Relationship Quality in College Students.” J Am Coll Health: 1-11.
Biederman, J., S. V. Faraone, et al. (2006). “Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community.” J Clin Psychiatry 67(4): 524-540.
Canu, W. H., L. S. Tabor, et al. (2014). “Young Adult Romantic Couples’ Conflict Resolution and Satisfaction Varies with Partner’s Attention-Deficit/Hyperactivity Disorder Type.” J Marital Fam Ther 40(4): 509-524.
Rokeach, A. and J. Wiener (2014). “The Romantic Relationships of Adolescents With ADHD.” J Atten Disord.
Barkley, R. A., M. Fischer, et al. (2006). “Young adult outcome of hyperactive children: adaptive functioning in major life activities.” J Am Acad Child Adolesc Psychiatry 45(2): 192-202.
Flory, K., B. S. Molina, et al. (2006). “Childhood ADHD predicts risky sexual behavior in young adulthood.” J Clin Child Adolesc Psychol 35(4): 571-577.
Overbey, G. A., W. E. Snell, Jr., et al. (2011). “Subclinical ADHD, stress, and coping in romantic relationships of university students.” J Atten Disord 15(1): 67-78.
Jul 12, 2017 | Research Updates
J.J. Sandra Kooij, M.D., Ph.D.
Dr. J.J.S. Kooij, MD PhD & Dr. D. Bijlenga, PhD
Full citation: Bijlenga D, Tjon-Ka-Jie JYM, Schuijers F, Kooij JJS. Atypical sensory profiles as core features of adult ADHD, irrespective of autistic symptoms. Eur Psychiatry. 2017 Jun;43:51-57.
Hypersensitivity in several sensory modalities is a feature of autism-spectrum disorder (ASD), and ‘hyper- or hyporeactivity to sensory input’ has been added to the criteria for an ASD diagnosis in DSM-5. Hyper- and hyposensitivity are described as atypical responses to any of the sensory modalities: vision, audition (hearing), touch, taste, olfaction, the vestibular system (balance), and activity level. In clinical ADHD populations, abnormal sensory sensitivity has also been reported, however research is scarce. Micoulaud-Franchi et al. (2015) showed that adults with ADHD have increased deficits in filtering out irrelevant auditory information such as the sound of a refrigerator turning on and off, which may be viewed as auditory hypersensitivity. Abnormal sensory sensitivity was especially related to increased inattention scores in ADHD. Auditory hypersensitivity has also been earlier reported in a study describing general functioning of a large group of adult ADHD patients (Kooij et al, 2001). Another study showed hypersensitivity to pain in adults with ADHD compared to norms (Treister et al, 2015). More studies have been done among children with ADHD. The systematic review by Ghanizadeh (2011) included 11 studies among children with ADHD, showing that in most of these studies, increased sensory sensitivity for all sensory modalities have been reported. Moreover, some studies indicate that the ADHD medication methylphenidate normalizes some of the sensory hypersensitivities, suggesting that the hypersensitivities are related to a dysregulated dopaminergic system.
As we know, in many cases, ADHD and ASD are comorbid. We investigated in this study the prevalence of sensory hyper- and hyposensitivity among 116 adults with ADHD, controlling for autistic symptoms.
We used the Adolescent/Adult Sensory Profile-NL (AASP-NL) and the Autism-spectrum Quotient (AQ) questionnaires. The prevalences of hyper- and hyposensitivity and autism-spectrum symptoms were compared to norm values.
As expected, adults with ADHD had more autistic symptoms than norm groups, and they reported also more hyper- and hyposensitivity compared to controls. This was especially apparent in the Activity level and Auditory sensory modalities. Sensory hypo- and hypersensitivity were both related to an increased ADHD score, even showing a dose-response relationship, but not to any autistic symptom or comorbid psychiatric disorder. As much as 43% of the females with ADHD reported sensory hypo- and/or hypersensitivity, compared to 22% of the men with ADHD.
Sensory hypo- and hypersensitivity may be viewed as key features of adult ADHD, especially in females, regardless of any autistic symptoms. Future research should be directed at the implications of this sensory dysregulation for the understanding of the pathophysiology of (female) ADHD, and on the usefulness of assessment of atypical sensory profiles in the diagnostic procedure of ADHD in adults.
References:
- Micoulaud-Franchi JA, Lopez R, Vaillant F, Richieri R, El-Kaim A, Bioulac S, et al. Perceptual abnormalities related to sensory gating deficit are core symptoms in adults with ADHD. Psychiatry Res 2015;230:357–63.
- Kooij JJ, Aeckerlin LP, Buitelaar JK. Functioning, comorbidity and treatment of 141 adults with attention deficit hyperactivity disorder (ADHD) at a psychiatric outpatients’ department [Dutch]. Ned Tijdschr Geneeskd2001;145: 1498–501.
- Treister R, Eisenberg E, Demeter N, Pud D. Alterations in pain response are partially reversed by methylphenidate (Ritalin) in adults with attention deficit hyperactivity disorder (ADHD). Pain Pract 2015;15:4–11.
- Ghanizadeh A. Sensory processing problems in children with ADHD, a systematic review. Psychiatry Investig 2011;8:89–94.
