Evolutionary recasting: ADHD, mania and its variants.
This paper reviews clinical observations and evolutionary theory in relation to attention deficit hyperactivity disorder (ADHD) on the one hand and mania and its variants on the other. Both groups of disorders resemble each other in regard to high levels of motor activity, perhaps occurring together more often than not, and are confounded in most existing research. Making distinctions requires isolating the contribution of activity level from other characteristics such as those of flawed executive functions for ADHD or grandiosity and lapses in reciprocity for mania. High activity level is an asset throughout nature except in extreme intensities or when it amplifies the characteristics of psychopathology. Fitness, social displays, and behavioral adaptations for survival are clues to some aspects of hypomania and ADHD. While hypomania can be a competitive advantage in certain niches, it appears there can be few opportunities for ADHD to do so. Indeed, the impulsiveness seen in ADHD is probably the outcome of flaws in executive functions rather than being the cause of them. Neither lapses in executive functions nor in reciprocity are apt to be domain general but may interact sharply with each person's repertoire of psychological adaptations. The author submits that a theoretical orientation as outlined here would not only help in better understanding the disorders under consideration, but could be useful in providing new directions to treatment decisions.