Explainer
Attention
Care
Culture
Psychology
5 min read

How to help someone with ADHD to live well

Overstimulation, inner critics, and the quiet power that restores balance
An emoji-style brain divided in two with active emojis one side and calm ones the other.
Nick Jones/Midjourney.ai.

This week’s headlines about ADHD in the UK paint a troubling picture. NHS England commissioned an ADHD Taskforce which has warned that waiting lists for assessment and support are “unacceptably long”, with services buckling under the pressure of rising demand. In some areas, including Coventry and Warwickshire, NHS boards have even paused new adult referrals to prioritise children. Charities are already preparing legal challenges. 

Among the Taskforce’s key recommendations is a call for general practitioners to take on a bigger role. Rather than referring every suspected case to specialist services, GPs are to receive training to recognise and manage ADHD within primary care – a shift intended to relieve the enormous strain on the system. But this raises a human question as well as a policy one: while people wait (often for months or even years) what can families and friends do to help? And might some of these strategies reduce the need for crisis-level specialist support in the first place? 

Around  five per cent of the population is thought to have ADHD, though the true figure may be higher. Rising diagnosis rates have prompted some scepticism: are we simply getting better at recognising the condition, or is something new happening in our overstimulated modern world? 

Psychiatrists Edward Hallowell and John Ratey suggest that many of us now live in an attention environment that mimics ADHD. They call this phenomenon VAST: Variable Attention Stimulus Trait. VAST is not a disorder, and it is not “ADHD lite”; rather, it’s a product of neuroplasticity, i.e., the brain’s capacity to adapt to its environment. ADHD, by contrast, is neurodevelopmental – it is part of how a person’s brain is wired from the start. ADHD can’t be “undone” – nor would many want it to be. ADHD is a way of being that entails many strengths as well as struggles, as I have written about before. But where there are struggles, both ADHD and VAST respond to similar strategies for living well. 

Hallowell and Ratey describe the brain as operating through a set of overlapping neural networks. Two of these, the Task Positive Network and the Default Mode Network, play a key role in attention and focus. The Task Positive Network switches on when we’re engaged in a clear, structured activity: writing an email, cooking dinner, solving a problem. When it’s active, we’re absorbed and unselfconscious. The Default Mode Network, by contrast, takes over when we’re not focused on a specific task. It’s the realm of daydreaming, reflection, and big-picture thinking – reviewing what we’ve done, imagining what comes next. 

For most people, the brain glides between these two states smoothly. But in today’s hyperconnected, screen-saturated culture, many of us – especially those with VAST – flicker between them too quickly, never giving our Default Mode Network enough time to process what has just happened. The result is stress, restlessness, and mental exhaustion. 

In ADHD, though, the problem is different and deeper. Brain scans suggest that both networks may be running simultaneously, and the Default Mode Network in particular has a knack for interrupting. Imagine trying to finish a task while a running commentary in your head constantly questions its worth, urgency, or achievability. That’s the ADHD experience: the Default Mode’s chatter makes tasks hard both to start and to finish. 

But the Default Mode Network isn’t all bad. It can be a source of creativity, moral reflection, and meaning. It’s the voice that tells you a task matters, that something is worth your effort. Hallowell and Ratey liken it to the classic “angel and devil” on your shoulders – but the devil often shouts louder. That’s partly because the human brain is wired to prioritise threat. We remember criticism more vividly than praise, and replay social embarrassments more easily than successes. For people with ADHD, this negativity bias can be overwhelming. As Hallowell and Ratey put it: 

“People who have ADHD or VAST are particularly prone to head towards gloom and doom in their minds because they have stored up in their memory banks a lifetime of failure, disappointment, shame, and frustration. Life has taught them to expect the worst.” 

This relentless inner critic drives many ADHDers to self-soothe – ideally through human connection, but too often through less healthy means: food, alcohol, drugs, or risky behaviours. Statistically, people with ADHD are ten times more likely to develop an addiction, and their average lifespan is at least 13 years shorter than that of the general population. 

So how can friends and family help? Is there a way to interrupt the drive to self-medicate in self-destructive ways? The answer, remarkably, is so ancient and simple as to almost seem facile: it is love. 

When the Default Mode Network first hits upon a negative self-judgement, its instinct is to reach outward – to seek comfort and belonging. If connection is unavailable, the “devil voice” finds substitutes in addictive or numbing behaviours. But when real, safe relationships are present, they act as a protective buffer. Studies show that people with ADHD who experience strong, consistent love from partners, friends and family have lower addiction rates, better health, and longer lives. 

Of course, loving someone with ADHD can sometimes demand extra patience. Your ADHD friend or family member is likely to be the most creative, empathetic, and generous person you know, yet also the one who forgets your birthday, arrives late, or leaves your message unanswered. None of this is intentional neglect; it is the Default Mode’s interference – the whisper that says, “They probably don’t like me that much anyway.” Understanding this dynamic transforms frustration into compassion. It helps us see that behind the missed text is someone fighting an invisible cognitive tug-of-war – a loved one who needs reassurance, not reprimand. 

Even for those without ADHD, our era of constant notifications and information overload is training our brains toward VAST-like patterns. We’re pulled between self-judgment and self-justification, between doing and ruminating, with little space for rest. Learning to quiet the inner critic and nurture connection is good for all of us. 

When we tune into the gentler side of our Default Mode Network – the voice that says “You are valuable to the people around you” – mistakes lose their sting, and perfection ceases to be the price of self-worth. 

The NHS may take years to fully resolve its ADHD backlog. But in the meantime, there is meaningful work that families, friends, and communities can do. We can offer the connection that helps quiet the inner storm by being the person who reaches out, forgives the lateness, and replies with warmth even when the other couldn’t. 

This may not shorten the waiting list, but it could lengthen lives. For the millions with ADHD, and the millions more living with VAST, love is not a sentimental afterthought – it is the neurological antidote to despair. 

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Review
Books
Culture
Wildness
6 min read

My open letter to Sally Rooney: dilatasti cor meum

You enlarge my heart.
A book cover depicts a yellow and white chessboard with pieces casting shadows of people.

This is silly, I realize. You’ll never see this. But I’ve just finished Intermezzo and I’m not sure what else to do with the bright sadness upon finishing it.

I can’t imagine I am your anticipated reader. I have children your age, for heaven’s sake. You write from, and about, worlds that are, in some ways, a foreign country for me. Sometimes I read your novels like Lévi-Strauss’s field notes from his years with the Nambikwara, describing the practices and rituals and mores of some foreign tribe—except that tribe includes my own children and the students I encounter everyday. Sometimes this makes me feel very old, and tired, and a little bit sad. Not in a judgmental way. I can’t imagine how hard it is to be 23 years old today. I feel badly about the world we’ve bequeathed to the twenty- and thirtysomethings that populate your novels. Your novels give me a glimpse into how they experience it. Which is what I love about the best fiction—the way it is a technology of mindreading, teleporting us into another’s perspective.

I don’t know, maybe it’s weird and kinda creepy that an old man like me gobbles up a novel like Intermezzo. Like a kind of voyeurism. I hope not. Because, in the end, what you achieve is at once the construction and revelation of a human world. And as Terence said, nothing human is alien to me.

This will sound crazy, but from the very first pages of Intermezzo I found myself reading with a strange sort of ache in my heart. Not a pain as much as a held-breath sense of ekstasis, of being stretched and pulled out of myself. I think now I’d say I was responding to what I can only describe as the tenderness you show your characters. I don’t mean for a second that you shrink from portraying their brokenness, even their brutality at times. But only that as you track their mystery and monstrosity you situate all of it in their ineradicable humanity. And in contemporary fiction, that is rarer than some might think. It speaks to me of a fullness that characterizes the matrix of your imagination, from which these characters were born. You don’t let them escape judgment; but that judgment comes from their own social worlds, not the caustic condescension of you as the narrator. This is where your mastery of free indirect speech is so uncanny: you stay near your characters, you listen closely, but somehow in the alchemy of your prose even their own harsh self-judgment is portrayed with tenderness and understanding.

Honestly, it reminds me a lot of how the mystical tradition portrays God, that Creator of all creators, the Narrator who is in love with every feeble creature, every loathable antihero, which is to say every single one of us, protagonists in dramas we don’t realize. There’s this marvelous line in The Cloud of Unknowing where the medieval sage says, “It is not who you are or what you’ve been that God sees with his merciful eyes, but what you want to be.” This will make you cringe, but your narration echoes that. You see what Peter and Ivan want to be. And in so doing, you help me look at all the human beings around me with the same sort of eyes. Or at least I want to be that person.

OK, this is, like, crazy word association, but as I was reading Intermezzo a line of prayer kept coming to mind. You might know it. It’s from the Psalms. It’s part of Prime, the first hour of the Divine Office. St. Teresa of Ávila talks about it a lot. Dilatasti cor meumYou enlarge my heart. You dilate my heart. You widen the scope of what my heart can take in and absorb. This, in the end, is what Intermezzo does. For me, at least.

It’s funny, you know. I finished the second half of the novel while I was attending the annual conference of the Hegel Society. (I thought you’d get a chuckle out of that.) So in the margins of Intermezzo I have scribbled notes like: Recognition! Master/slave dialectic!3 But it’s really not so crazy, is it, because, like Hegel, you seem to intuit how much we long to be seen, to be recognized, and why that means passing through the crucible of forgiveness to achieve reconciliation. This is why I think you are attuned to a below-the-surface rumbling in your generation that, against all the forces of capital and Distraction, Inc. and just the bullshit of consumer nihilism, can’t quite shake a yearning, or at least a wondering, if there’s something more—something like “meaning” or significance we could feel pulled into. I love it that, in Intermezzo, this culminates in a vision of community. (I’m trying not to spoil anything here, since, ahem, my wife hasn’t been able to finish the book yet.) Being known, being seen, being forgiven, being loved. Belonging.

My aforementioned (long suffering, forgiving) wife loves a song by the Highwomen called “Crowded Table.” She plays it full blast in our kitchen when she’s preparing for dinners when she gathers beloveds near. “I want a house with a crowded table / and a place by the fire for everyone.” I thought of the bridge of the song at the end of Intermezzo.

Everyone’s a little broken
And everyone belongs.

I finished your book on a packed train from Boston to Philadelphia and decided not to be embarrassed that I was weeping. The older I get, the more paternal I become, I’m realizing. I don’t think that’s an expression of control or “paternalism” in the negative sense. At least I hope not. It’s more that the older our kids get, more of the world is filled with people who look like the children I love. I don’t mean that I infantilize them, either. I treasure the adults they’ve become.

I’m not describing this very well. What I’m trying to say is, I am just an inveterate dad. I can’t help it. So as much as I read your novel as a scholar or a philosopher or a fellow human, I couldn’t help reading it as a dad. And when I spent time with Peter and Ivan and Sylvia and Naomi, I just wanted for them what I want for my own children and their spouses—for them to know they are loved and held dear and for them to find their people. It’s silly and sappy, but I wanted to talk to Ivan and Peter and tell them: It’s possible. There is still love in the world. Even more incredibly: there is forgiveness. Intermezzo has the audacity to not only hope this but to portray it. I know it costs you something to do so in a literary world that prizes cynicism and distance.

Maybe I wept at the end of Intermezzo because it was as much a mirror as an icon. Despite the generational gap, you gave me occasion to see my own life reflected back to me. In the mirror is an us (“The that is we and the we that is I,” as Hegel put it). I look in the mirror of longing & hope that is your novel, and looking back I see my wife, Deanna, who has been forgiving me for over 35 years, letting me know I am beloved. And we’re surrounded by our children, the overflowing of our own love, these children who have become such dear friends, who have forgiven me more times than I can count. And in that mirror their spouses are alongside them, our dream come true—the beloveds they have found who forgive them and welcome them home over and over again. It’s a crowded table. And there’s always more room. Everybody’s a little broken, and everybody belongs.

I guess what I want to say is: I admire your courage to write a novel that tells the truth—that love gets the last word because it is the first word that speaks us all into being, the origin of the world.

Gratefully,

A reader

 

This article first appeared as a post on James K.A. Smith's Quid Amo Substack. Reproduced by kind permission.