What is the cough drop sign? Viral tweet perfectly sums up what it’s like to have ADHD

Dr. Ned Hallowell coined the term “the cough drop sign” in his 1994 book, “Driven to Distraction,” based on a story a patient told him. But the psychiatrist and leading ADHD expert, who has the condition himself, has experienced his own version of the anecdote many times in his life.

In the passage, which is going viral after ADHD (attention-deficit/hyperactivity disorder) advocate Jesse Anderson shared it on Twitter in late September, a woman tells Hallowell about a frustrating incident from when she was running errands.

What is the cough drop sign?

Here’s the patient’s full quote, as transcribed in “Driven to Distraction,” co-authored by Dr. John Ratey:

“Someone left (a cough drop) on the dashboard of our car. The other day I saw the cough drop and thought, I’ll have to throw that away. When I arrived at my first stop, I forgot to take the cough drop to a trash can. When I got back into the car, I saw it and thought, I’ll throw it away at the gas station. The gas station came and went and I hadn’t thrown the cough drop away. Well, the whole day went like that, the cough drop still sitting on the dashboard. When I got home, I thought, I’ll take it inside with me and throw it out. In the time it took me to open the car door, I forgot about the cough drop. It was there to greet me when I got into the car the next morning, Jeff was with me. I looked at the cough drop and burst into tears. Jeff asked me why I was crying, and I told him it was because of the cough drop. He thought I was losing my mind. ‘But you don’t understand,’ I said, ‘my whole life is like that. I see something that I mean to do and then I don’t do it. It’s not only trivial things like the cough drop; it’s big things, too.’ That is why I cried.”

The patient in question was “a very smart woman with a very responsible job and raising children and functioning in the world,” Hallowell recalled to TODAY. But like so many people with ADHD, she struggled with “little problems … the thing that you intend to do, want to do, mean to do, can do, and you just keep overlooking it,” Hallowell said. This is what he calls “the cough drop sign.”

For the Harvard-educated physician who’s written 22 books (most recently “ADHD 2.0,” also co-authored by Ratey), the cough drop signs in Hallowell’s own life range from leaving his groceries at the checkout after paying to wearing two different shoes and socks, something he only noticed after a patient pointed it out.

“Attention deficit is a complete misnomer,” Hallowell explained. “We don’t have a deficit of attention. We have an abundance of attention. Our challenge is to control it. … Boredom is our kryptonite. The minute we encounter lack of stimulation, we’re out of there, if not physically then mentally.”

“The cough drop is boring, so we just don’t bloody see it,” he continued. “We can see it — in other words, it lands in our visual cortex — but we don’t comprehend it in the sense of (acting) on it.”

“Why can’t I remember a f——g cough drop?”

ADHD affects 4 to 5% of U.S. adults and about 11% of kids, roughly a third of whom will retain the diagnosis into adulthood, according to the National Institute of Mental Health. Yet there’s so much shame tied up in experiencing the cough drop sign, according to Hallowell.

“Why can’t I remember a f——g cough drop?” he said, recalling the thought process of the patient when she broke down crying. “There’s just a tremendous amount of shame and frustration over knowing you’re smarter than your track record shows but not knowing what to do about that and just being told to try harder and you’re trying as hard as you can.”

He added that the outside world, including parents and teachers, often contribute to this shame. The cough drop patient’s father used to tell her, “You have no more sense than a bluejay,” Hallowell said.

Anderson, who shared the passage on Twitter, told TODAY via email that he read “Driving to Distraction” shortly after being diagnosed with ADHD six years ago and that the cough drop sign specifically “gave a voice to my deep shame, my flaws that felt uniquely broken in me. An answer to why my actions never seemed to match my intentions, why I was so often misunderstood.”

“Here was this random book, describing someone with the exact same flaws, and gave hope to the idea that maybe this wasn’t my fault after all,” Anderson added.

The replies to Anderson’s tweet echoed this sentiment. “This is such a familiar story,” one person wrote.

“This is the part that people who don’t have this problem refuse to understand: I often cannot hold the thought long enough to write it down,” replied another. “I can have a phone or notepad in my hand when the thought occurs, and still fail. I forget things faster than I can open a browser tab!”

It’s been decades since ADHD diagnoses surged in the ’90s, but the condition — which Hallowell calls a trait and never a disorder — is still deeply misunderstood, he said, adding that he wants everyone to appreciate the “pocket of positivity” that comes with ADHD.

“I describe ADHD as you’ve got a Ferrari engine for a brain, but you’ve got bicycle brakes,” Hallowell quipped. “(People with ADHD) are just naturally creative, original, think outside the box. … They tend to be very intuitive. … They’re very big hearted and generous.”

“If you manage it right, it turns into a tremendous asset,” he added.

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