Conclusions
To the best of our knowledge, this study is the first report to confirm the possibility of JFK’s diagnosis of ADHD in line with valid diagnostic criteria. However, ADHD did not prevent JFK from achieving success because he was able to surround himself with competent, detail-oriented people (principally, his brother, Robert, who had the exact opposite personality to JFK), and he was willing to delegate to them both responsibility and authority.10 Although the concept of ADHD had not existed during his lifetime, JFK preferred the central stimulant amphetamine for pain management,3 which, unintentionally, may have served as self-medication for his ADHD condition.
Pinals et al.2 discussed that the presentation of pain, including LBP in JFK, was centralized and could be attributed to CNS dysfunction. CNS dysfunctions that cause centralized pain are assumed to be a common basis for disorders such as myofascial pain, failed back syndrome, fibromyalgia, IBS, and chronic prostatitis, many of which could be identified in Kennedy’s medical history. More recently, ADHD has been suggested to be associated with CNS dysfunction in chronic pain, and this pain can be improved by ADHD medication (methylphenidate and/or atomoxetine).7 In addition to pain disorders, conditions such as fibromyalgia, IBS, insomnia, malabsorption, hypothyroidism, and allergies, which were present in JFK, are all physical disorders associated with ADHD.20Given this information, ADHD appears to be a plausible cause of the numerous illnesses that afflicted JFK.
Moreover, in a previous study,21 symptoms in patients with chronic pain, including persistent chronic nonspecific LBP, improved with ADHD medications; it was found that the pain and ADHD symptoms of patients with chronic pain and comorbid ADHD tend to improve with ADHD treatment. The results showed that 35 of 110 patients (31.8%) with chronic pain at various sites, who were referred to a psychiatrist at a pain clinic, were finally diagnosed with ADHD. Of these 35 patients, 21 received adjusted ADHD medications (methylphenidate and/or atomoxetine). Twenty of the 21 medicated patients (95.5%) experienced an improvement in their ADHD symptoms, and 14 of 21 patients (66.7%) experienced a simultaneous improvement in their pain symptoms, as evaluated using the numerical rating scale (NRS). The NRS scores of the 14 patients decreased by 4.6 ± 2.6 points (64.7 ± 30.1%). Moreover, considering that there were only 7 patients with persistent chronic nonspecific LBP (among the 21 patients with chronic pain at various sites) who received adjusted medication, 7 of 7 (100%) experienced reduction in pain symptoms, as measured using the NRS (4.3 ± 2.6 points, 65.3 ± 28.2%).
Additionally, Kennedy’s son was diagnosed with ADHD,5,6 and numerous tragedies have been attributed to thrill-seeking behaviors in the Kennedy family, suggesting the possibility of genetic ADHD.5 On the positive side, such thrill-seeking behavior increases the likelihood of gaining spectacular success, as demonstrated by the Kennedy family’s position in politics.5
Furthermore, behind JFK’s success, his continued anxiety and fear of rejection from his father, who forced him to become a politician like a surrogate doll, was one of the main conflicts in JFK’s life.3 As suggested by Lumley et al., JFK’s centralized pain would have improved if he had been able to sufficiently resolve conflicts by facilitating emotional processing, such as writing “an unsent letter” to his father.1
The limitation of this study is that the ADHD diagnosis of JFK is a hypothetical diagnosis based on the description in the published literature, as the authors did not directly examine JFK.
The President’s Panel on Mental Retardation,22organized by Kennedy as one of his frontier policies, contributed to the creation of the term “developmental disability,” which now includes ADHD in the United States Public Law.23 After 60 years, the seeds of his ideals have budded and borne findings of a link between ADHD and centralized pain, and is about to pave the way for the treatment of centralized pain—a condition that he had suffered from during his lifetime.