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16 Nov 2020

Hoogman M et al. Neurosci Biobehav Rev 2020; 119: 66-85; Epub ahead of print

Over the past decade there has been increased research surrounding a possible link between ADHD and creative thought (Paek et al, 2016; White & Shah, 2006; White & Shah, 2016). A previous meta-analysis that investigated psychopathology and creativity showed a possible negative association between ADHD and creativity (Paek et al, 2016). However, the meta-analysis was not aimed specifically at the link between ADHD and creativity; therefore, the authors believe that the design of the study was suboptimal for researching this link. The aim of the current study was to understand the link between ADHD and creativity using a systematic review.

Systematic searches were conducted on 5 December 2019 using PubMed® and Web of ScienceTM, the search query was restricted to studies published in English and journal articles only.* Studies were separated into clinical case-studies or population-based ADHD trait studies and were further separated by childhood (aged <18 years) and adult studies (aged >18 years) due to the developmental perspective of ADHD and creativity (Cassotti et al, 2016; Franke et al, 2018; Healey, 2014). Moderator analysis was performed for ‘type of creativity assessment’. It should be noted that this study did not take into account the effect of medication on creativity. Quality parameters were extracted from the identified studies and a 6-point range was used for scoring the studies; 0 indicated limited quality research and 5 indicated high quality research. Stimulant studies had a quality score range of 0–4.

Divergent thinking

There were 22 studies that investigated divergent thinking (ability to generate a number of alternative options to a single open-ended problem): nine of the studies were case-controlled and involved children with a formal ADHD diagnosis. Another four of the studies included children who did not have a formal ADHD diagnosis; one study measured how many individuals in a group of children with ADHD scored above the 90th percentile on the Torrance Test of Creative Thinking. A further five of the studies were case controlled and involved adults with a formal diagnosis of ADHD; three studies investigated divergent thinking in the general population. The studies that investigated divergent thinking task performance in children with ADHD overall showed either no difference between the children with ADHD and those without, or showed worse performance in children with ADHD. However, two of the studies did show enhanced divergent thinking in children with ADHD, but these studies were investigating elaboration which is a different feature of divergent thinking. In the studies that investigated divergent thinking in adults with ADHD the overall results were mixed, three of the studies noted adults with ADHD performed higher at the divergent thinking tasks than adults without ADHD. The population-based studies also had mixed results, one of the studies showed that impulsivity or hyperactive symptoms were related with better fluency performance (based on teacher-ratings). The second study found a positive association between hyperactivity and impulsivity symptoms with enhanced divergent thinking. The third study showed no association between ADHD symptoms and performance on the Abbreviated Torrance Test for Adults.

Convergent thinking

Systematic search of convergent thinking (a collection of related cognitive processes in the context of problem solving) provided a final selection of six studies. One of the studies was a large adult population study that reported on the relation between convergent thinking and self-reported symptoms. Null effects of ADHD symptoms on convergent thinking abilities were seen in three case-controlled studies that included children with ADHD. Negative effects of ADHD symptoms on convergent thinking were described in one child and two adult studies.

Creative abilities and achievements

There were no case-controlled studies of children with a formal diagnosis of ADHD using creative ability or achievement measures identified by the authors in their systematic search. However, four studies were found that included adults with ADHD (formally diagnosed or self-reported), three of the studies noted that adults with either a formal diagnosis of ADHD or self-reported ADHD symptoms had a higher rate of creative achievements compared with adults without ADHD in daily life. The fourth study did not show an association between creativity and an ADHD diagnosis. The systematic search highlighted two population-based studies which investigated the association between creative achievements and individuals with self-reported ADHD symptoms. One study reported a significant positive correlation between the number of self-reported ADHD symptoms and creative achievement scores. However, after controlling for academic achievement, there was no positive effect of ADHD symptoms on creative achievement. Whereas, a separate study reported a positive association between self-reported creative achievements in daily life and self-reported ADHD symptoms.

Psychostimulants and creativity

Systematic search for the effect of psychostimulants on creativity provided a final selection of 12 studies; six studies of children with ADHD, two studies of adults with ADHD and four studies of adults without ADHD. Overall, six out of the eight studies that involved individuals with ADHD reported no effect of methylphenidate on convergent and divergent thinking, creative abilities or achievements. Null effects of methylphenidate on creativity were also noted in the four studies that included adults without ADHD. The overall conclusion of these 12 studies is that the evidence is not strong enough to determine whether psychostimulants have a negative effect on creative performance in people with an ADHD diagnosis or a higher level of ADHD symptoms.

Quality of the creativity studies

The average quality rating was calculated to be 0.5 (limited quality research). The authors stated this rating was mainly due to two large population-based studies that had suboptimal creativity assessments.

Neuroscience of ADHD and creativity

Several studies were identified that highlighted possible evidence of a mechanism of potential overlap between genetic factors associated with creativity and ADHD. However, many of the studies did not meet current standards for genetic testing in terms of replication, sample size and correction for multiple testing. Additionally, in terms of neuroimaging studies, there was only indirect evidence of overlap between brain regions (prefrontal cortex, striatum, amygdala) and brain networks (default mode network and executive function network) involved in ADHD and creativity.

There were numerous limitations of this study, which included the scarcity of evidence pertaining to the possible link between ADHD and creativity. The largest limitation was that the statistical power of the majority of the studies was low. There were 14 different instruments used to measure creativity and not all of them measured the same constructs. A meta-analysis could not be performed due to the variation in tasks used and the limited number of results available from creativity studies. Additionally, many of the studies were performed in an artificial setting, which may alter the perception of the results collected under these conditions regarding performance on creativity tasks. Finally, the quality performance highlighted that many of the studies were not providing enough information regarding psychiatric comorbidity, age, sex and IQ matching.

In brief, the authors suggested that a focused research agenda would improve understanding of the link between ADHD and creativity. This improvement may aid in the treatment and coping mechanisms for ADHD, increase quality of life for the individuals with ADHD and reduce stigmatisation.

Read more about creativity and ADHD here

 

*Search queries included: 1. ADHD OR attention deficit hyperactivity disorder AND creativ* OR “divergent thinking”; 2. ADHD OR attention deficit hyperactivity disorder AND “convergent thinking”; 3. ADHD OR attention deficit hyperactivity disorder AND creative abilities OR creative achievement; 4. creativ* AND stimulant*
Inclusion criteria included: a design that was empirical or quantitative; a behavioural performance measure that involved a creative process or achievement; reported on human subjects; included subjects with an ADHD diagnosis based on assessments made by a professional or including subjects with information about ADHD symptoms using a questionnaire or interview
Quality parameters included: appropriate matching of study groups (age, sex and IQ); type of ADHD assessment for diagnosis or symptoms; availability of comorbidity information; and sample size. Psychostimulant studies had an additional parameter of study design (double-blinded and placebo-controlled)

Cassotti M, Camarda A, Poirel N, et al. Fixation effect in creative ideas generation: opposite impacts of example in children and adults. Think Skills Creat 2016; 19: 146-152.

Franke B, Michelini G, Asherson P, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol 2018; 28: 1059-1088.

Healey D. Attention-deficit/hyperactivity disorder and creativity: ever the twain shall meet? Kaufman JC (Ed.), Creativity and Mental Illness. Cambridge: Cambridge University Press; 2014, 236-249.

Hoogman M, Stolte M, Baas M, et al. Creativity and ADHD: a review of behavioral studies, the effect of psychostimulants and neural underpinnings. Neurosci Biobehav Rev 2020; 119: 66-85.

Paek SH, Abdulla AM, Cramond B. A meta-analysis of the relationship between three common psychopathologies—ADHD, anxiety, and depression—and indicators of little-c creativity. Gift Child Q 2016; 60: 117-133.

White HA, Shah P. Uninhibited imaginations: creativity in adults with Attention-Deficit/Hyperactivity Disorder. Pers Individ Dif 2006; 40: 1121-1131.

White HA, Shah P. Scope of semantic activation and innovative thinking in college students with ADHD. Creat Res J 2016; 28: 275-282.

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