Prof. Maggie Sibley
Appearances
Science Vs
ADHD: Do We All Have It?
Pretty much. And like, you know, the point of getting a diagnosis, ideally, is to get treatment and help for what's wrong. And so if you get the wrong diagnosis, you might get the wrong treatment. And so it's important to get the right diagnosis. And Maggie gave me an example of this. She told me about a teenager that she was evaluating.
Science Vs
ADHD: Do We All Have It?
This kid had got referred to her by a school because he had a lot of problems paying attention in class. But as Maggie was talking to this kid, she realized there was other stuff going on here.
Science Vs
ADHD: Do We All Have It?
Maggie said that trauma can affect how your brain works and affect your coping skills in a way that can affect how you pay attention. And she realized that that was explaining his symptoms. So she diagnosed him with post-traumatic stress disorder.
Science Vs
ADHD: Do We All Have It?
And that matters because you don't treat PTSD the same way you treat ADHD. Right. So you don't just give someone stimulants to help them process their trauma, right? Right. Uh-huh.
Science Vs
ADHD: Do We All Have It?
I don't know. It could be. But I think the takeaway is that if you really struggle with this, don't assume it's just your ADHD. Something else could be going on for you.
Science Vs
ADHD: Do We All Have It?
There's another thing that's all over the Internet that's worth talking about. It's this idea that women and girls aren't getting diagnosed properly.
Science Vs
ADHD: Do We All Have It?
They get missed as children. Yeah. And they only figure out that they have ADHD if they ever do much later in life as adults. And this does seem to be true to some extent. So data from the CDC found that 61% of women with ADHD were diagnosed as adults compared to 40% of men. Okay. Do we know why?
Science Vs
ADHD: Do We All Have It?
So one hypothesis to explain this is maybe girls hide, push down their symptoms in order to fit in socially because there's a lot of pressure to do that. That's also a possible explanation for why autism is diagnosed later in life in females. We also know that women with ADHD are more likely to get diagnosed with depression and anxiety than men are.
Science Vs
ADHD: Do We All Have It?
And so maybe they're getting treated for that and then their ADHD gets missed.
Science Vs
ADHD: Do We All Have It?
Yeah, we're just starting to get some research on this. It looks like ADHD symptoms might actually fluctuate throughout the So there's one study that found that mid-cycle, people's impulsivity symptoms seemed to get worse. And at the end of their cycle, they got sadder and they were less able to cope with stuff.
Science Vs
ADHD: Do We All Have It?
And we also have research that found that women with ADHD suffer more postpartum and during perimenopause. So there might be something going on with estrogen levels changing in the brain combined with ADHD in the brain that's basically like a double whammy. That's actually how some of these researchers put it.
Science Vs
ADHD: Do We All Have It?
And Wendy, just to cap off this part of the episode, we started out by saying, gee, doesn't it feel like ADHD is everywhere? And it does. I have some stats I have not yet told you. And yeah, I have kind of a reveal here. It's really not that wild. It's not everywhere. Oh. So if you look at about 20 years ago, in 2003, the CDC put out data finding that among adults...
Science Vs
ADHD: Do We All Have It?
Today on the show, Rose is telling us all about the science of ADHD. Hey, Wendy. So I'm ready to talk to you about ADHD in the brain. Yeah. Tell me about dopamine. What's it doing? Yeah. I mean, that's what you hear online, that ADHD is caused by a dopamine deficiency. And this comes from the fact that dopamine is a chemical in the brain that helps us pay attention and feel motivated to do things.
Science Vs
ADHD: Do We All Have It?
And we know that stimulants like Adderall work by increasing the availability of dopamine and other neurotransmitters in the brain.
Science Vs
ADHD: Do We All Have It?
Well, okay. Wendy, there's more here. Scientists are pretty sure now there's a lot more going on.
Science Vs
ADHD: Do We All Have It?
I talked about this with Philip Shaw. He's a professor of developmental psychiatry at the King's Maudsley Partnership.
Science Vs
ADHD: Do We All Have It?
Yeah, but my point still stands. So there are other things going on in the brain that could help explain ADHD. And Philip and I talked about some of his favorite explanations.
Science Vs
ADHD: Do We All Have It?
So the first one has to do with the default mode network. Have you heard of this?
Science Vs
ADHD: Do We All Have It?
So if your mind is drifting, the default mode network is activated. We can see this in a brain scanner. But if you start thinking about something, like you start making dinner plans in your head or thinking like, oh, I better sit down and do my taxes next week or whatever, other areas of the brain light up. And in response, the default mode network kind of simmers down.
Science Vs
ADHD: Do We All Have It?
But what we see in people with ADHD, when researchers have gotten them into these scanners, is that the daydreaming network doesn't always simmer down when they're thinking about something else. It might kind of intrude.
Science Vs
ADHD: Do We All Have It?
There's another explanation that has to do with another network in the brain. Okay. So basically there are these pathways where different parts of the brain talk to one another.
Science Vs
ADHD: Do We All Have It?
And some of these loops are really important for what's called executive function, which can help us decide what we pay attention to.
Science Vs
ADHD: Do We All Have It?
So no, not necessarily. What scientists are starting to figure out is that there are probably a bunch of different kinds of ADHD caused by a bunch of different brain changes.
Science Vs
ADHD: Do We All Have It?
Philip says that some of his colleagues are actually calling it ADHDs, not ADHD. So maybe for some people, dopamine is the main issue. For someone else, the imbalance with the default mode network is the main issue. For someone else, it's these loops that are important for executive function. Or there could be some combination of these things.
Science Vs
ADHD: Do We All Have It?
And by the way, we should say that while these brain changes are meaningful, they're also small.
Science Vs
ADHD: Do We All Have It?
Yeah, so as we've said in a previous episode, stimulants help lots of people. So there was a trial of about 400 adults with ADHD, gave them Adderall, and they found that 65% of people given Adderall got better. That's compared to 20% of people who took the placebo.
Science Vs
ADHD: Do We All Have It?
So that's why stimulants are kind of the first line medication for people. Yeah. But obviously that's not everybody. Not everybody got better. And not everybody wants to take them or can take them or can get them, right? There's been a shortage.
Science Vs
ADHD: Do We All Have It?
Yeah, they can mess with your sleep, your appetite. So there are non-stimulant medications that are also fairly effective, but there's a lot of other things you can try. I mean, online, you hear all these tips and tricks, everything from body doubling to changing your diet. What is body doubling? It sounds so sci-fi. We'll get to it. I'm going to leave you in suspense.
Science Vs
ADHD: Do We All Have It?
But I called up a psychologist named Russell Ramsey to talk about this. And he does therapy for adults with ADHD. And he's like a lot of his patients come in and they're like, I don't really know how therapy is going to help me, especially with my main problem in life, which is like not getting stuff done that I need to get done. Procrastination.
Science Vs
ADHD: Do We All Have It?
So that's a lot of what Russ and I talked about. How to help a person with ADHD get motivated and avoid something called procrastivity. Can you guess what that means, Wendy?
Science Vs
ADHD: Do We All Have It?
Are you thinking of the prostate perhaps? I was thinking of like procreation. Oh, no. Here's how he defines procrastivity. Procrastivity.
Science Vs
ADHD: Do We All Have It?
So he gave me this example. There was a patient of his who at the time was a graduate student working at a lab. And she had to present a paper to her lab group the next week. Yeah. And so she knew that like this is going to be a drag. And she talked about it in advance in therapy with Russ.
Science Vs
ADHD: Do We All Have It?
So some time passes. She comes back for her next session. Russ follows up and he asks, so how did it go? Did you read the paper and make the presentation? And she said, you know what?
Science Vs
ADHD: Do We All Have It?
Don't do it. Read the article. She didn't read the article. She baked a cake.
Science Vs
ADHD: Do We All Have It?
So one thing Russ has noticed is that a lot of people are opting for a task that's sort of broken into steps. Like baking the cake, there's a recipe. So it's like do this, then this, then this. And so he has found it can be really helpful for his patients to break their tasks down into kind of a recipe. And he likes to use what he calls if-then statements.
Science Vs
ADHD: Do We All Have It?
So like for the cake-baking scientist, he told her like, okay, so next time— Tell yourself, if I can sit down at my computer when I get home from work, then I can open the document. If I can open the document, then I can read the abstract.
Science Vs
ADHD: Do We All Have It?
If I can read the abstract, then I can. Real little instructions, one by one.
Science Vs
ADHD: Do We All Have It?
It's like the first step is like, that wasn't so bad. Maybe I can do the next step. That wasn't so bad. Maybe I can do the next thing. And before you know it, you're actually doing it. He also asks his patients to remind themselves of the bigger picture. Like, why am I doing this annoying task? How does it matter for my life or the goals you want to accomplish?
Science Vs
ADHD: Do We All Have It?
Yeah, he does. So Russ practices a form of therapy that's called CBT. And there are studies on CBT for people with ADHD that find that it can really help. A lot of these studies are looking at CBT plus medication. And so it seems like what works fastest is CBT with medication. People improve the fastest with that combination. But for some people, CBT on its own maybe could work.
Science Vs
ADHD: Do We All Have It?
So we have one study that found that they eventually caught up to the people who were also taking meds.
Science Vs
ADHD: Do We All Have It?
Yeah. I mean, there is a caveat here. So very recently, there was this big meta-analysis of treatments for ADHD. And when it came to CBT, they said that mostly these results were shown in clinician-reported ratings. So like your doctor says, my patient's getting better or not. And it didn't really show up for self-reported ratings.
Science Vs
ADHD: Do We All Have It?
So people were saying like, I'm not doing that much better on average, people in CBT. So like the positive results were mostly coming from the doctor saying this is working for my patient.
Science Vs
ADHD: Do We All Have It?
I mean, maybe people are improving in their coping skills, but this doesn't show up when asked about their core symptoms. Or maybe the improvement is subtle enough that the people themselves aren't noticing it as much as like an outside observer might be noticing it.
Science Vs
ADHD: Do We All Have It?
Well, I promised you I would tell you what the hell body doubling is. Oh, yeah. It sounds so weird. It just means having someone else there with you, even virtually.
Science Vs
ADHD: Do We All Have It?
Well, they might. So let's say you're a student, you're working on your homework. Having a friend in the room is also working on their homework. It's kind of like keeping you accountable. Okay. But Russ was like, yeah, yeah, sure.
Science Vs
ADHD: Do We All Have It?
Yeah. Another thing people talk about a lot online is listening to music or white noise. And there are some studies that get people with ADHD to do a task while listening to white noise or music and find that people do better when they have this sort of noise. Oh, that's cool.
Science Vs
ADHD: Do We All Have It?
Yeah, so people have looked into this somewhat, mostly in kids. Stuff like taking vitamins and minerals, omega-3s, omega-6s. But it's pretty iffy. Just a couple years ago, there was a big Cochrane review that kind of just poured cold water on the omega supplements helping kids with ADHD. Yeah.
Science Vs
ADHD: Do We All Have It?
No, I don't think so. No. Do you ever suspect that? Oh, whether you have ADHD?
Science Vs
ADHD: Do We All Have It?
And I didn't find anything in adults that would convince me that there are any supplements to take or diets to try or foods to avoid or eat to improve your ADHD.
Science Vs
ADHD: Do We All Have It?
Seems like really right now the best supported stuff to try, medicine, therapy, those are the best tools that we have for treating ADHD. And then some of this other stuff, body doubling, listening to white noise or to music, there's not really any harm to trying that. So if it works for you, that's great.
Science Vs
ADHD: Do We All Have It?
That sounds good. You might need a little help. You could enlist a... a really hot muscular guy named Lars to work on this with you. And if you choose to do that, you have our blessing here at Science Versus.
Science Vs
ADHD: Do We All Have It?
They can click the link to the transcript. And that link is in our show notes.
Science Vs
ADHD: Do We All Have It?
Yeah, I talked about that idea that it feels like it's everywhere right now with a professor and ADHD researcher. She's named Maggie Sibley. She's at the University of Washington. And she says there's a lot of reasons for this. One thing we talked about was these online quizzes about ADHD that have popped up.
Science Vs
ADHD: Do We All Have It?
Yeah, and I just wanted to call out here, like, we had so many listeners call in, leave voicemails, send us voice memos, email, comment on Instagram, and tell us about their experiences with ADHD. And I listened to every one of those voice memos and read all those comments. So even if you didn't hear yourself in the episode, you It was really important for me to hear from everybody.
Science Vs
ADHD: Do We All Have It?
And I thank everyone for sending all that stuff in. It was super helpful.
Science Vs
ADHD: Do We All Have It?
Well, to find out, I thought you and I could take a brief quiz, actually. Rose! Which sounds bad, but really what I have for you is this is a valid science-backed questionnaire. Uh-huh, uh-huh. It doesn't diagnose you with ADHD. It's more of a checklist to see if you're at risk of having it. And this questionnaire has man's blessing. Uh-huh. And it basically maps onto the main symptoms of ADHD.
Science Vs
ADHD: Do We All Have It?
Yeah, put an X if it's never, rarely, sometimes, often, or very often. Okay. For all these symptoms.
Science Vs
ADHD: Do We All Have It?
How often do you have difficulty getting things in order when you have to do a task that requires organization? I'm going to say sometimes.
Science Vs
ADHD: Do We All Have It?
How often do you feel overly active and compelled to do things like you were driven by a motor?
Science Vs
ADHD: Do We All Have It?
What? Just kidding. How often do you find yourself talking too much when you are in social situations?
Science Vs
ADHD: Do We All Have It?
How often do you have difficulty waiting your turn in situations when turn-taking is required? Never.
Science Vs
ADHD: Do We All Have It?
Well, a few years ago, researchers gave this checklist to a sample from the U.S. population, and they found that the average person got about a two. Oh! And five or more is like, maybe you should get evaluated for ADHD.
Science Vs
ADHD: Do We All Have It?
Yeah, yeah. Whoa! That's so funny. Yeah. I mean, so if you get this higher score, that's when you would probably want to go to the doctor and get checked out. But what we can see from this questionnaire is that the symptoms that we're looking for with ADHD, it's still basically this classic picture that we probably have in our heads.
Science Vs
ADHD: Do We All Have It?
So for some people, it's largely about having a hard time staying focused. For other people, and especially when they're younger, it's more about being hyperactive. And there are people who have both. And these core symptoms, they really haven't changed recently.
Science Vs
ADHD: Do We All Have It?
And, you know, it is stuff that a lot of us might experience from time to time. Yeah. But when doctors are trying to figure out if someone has ADHD or not, what matters is how severe it is. How much does it impair your life? Does it get in your way? Yeah.
Science Vs
ADHD: Do We All Have It?
Right, and if you had so much trouble that you were, like, cutting in line at the pharmacy that the pharmacy banned you from the store, like, that's the kind of problem.
Science Vs
ADHD: Do We All Have It?
But you can, and you do. Yes. Or thinking about that question about missing appointments, we all forget appointments now and then. But Nagi told me this example of a patient of hers that kept forgetting to pick her kid up from school over and over. That's a bigger problem, right?
Science Vs
ADHD: Do We All Have It?
And we actually asked listeners with ADHD to call in and tell us about their experiences. And a lot of what they talked about was pretty hard stuff. Like this listener.
Science Vs
ADHD: Do We All Have It?
OK, so let's start with hyper focus. So this is the idea that for some people with ADHD, when they are able to focus, they can do it really intensely and they can work on something for hours and hours. People tell stories about forgetting to eat or go to the bathroom.
Science Vs
ADHD: Do We All Have It?
You know, I thought of you because I remember back when we worked in the office together, you would just like power through like for hours. It was crazy. I would have never thought of this as a symptom, though.
Science Vs
ADHD: Do We All Have It?
Yeah. A lot of people who experience hyper focus say they really like it. Some people who called in said that this is their superpower. Like one listener told us that when they're in this hyper focus state, they can do something in a few hours that it would take other people days to do.
Science Vs
ADHD: Do We All Have It?
particular task that you've been sucked into yeah exactly it seems like a paradox and the going hypothesis that I've been hearing from scientists is that maybe what's going on with ADHD is they have problems with the control of their attention so not just like problems with attention but problems with how to control it so to Maggie it wouldn't be a paradox at all
Science Vs
ADHD: Do We All Have It?
So the same thing that makes it hard for someone to stay on task might make it hard for them to move on to other things that should be now taking their attention. Like, you know, I was saying earlier, people forget to go to the bathroom. You should be aware. Like, I have a full bladder. I should go to the bathroom.
Science Vs
ADHD: Do We All Have It?
You know, it makes me think that some people do say that hyperfocus is a problem. It's not necessarily a superpower. It can mean that you get way too focused on the wrong thing or at the wrong time.
Science Vs
ADHD: Do We All Have It?
Well, it's not in the DSM, which is, you know, the psychological Bible. It's not? Yeah, it's not part of the diagnosis of ADHD. So officially, no. But there has been a little bit of research on this, and it has given us some clues that We have a couple studies that have found that people who score higher on that questionnaire that we just took, they were more likely to experience hyperfocus.
Science Vs
ADHD: Do We All Have It?
No, but it really hasn't been studied very much at all. So right now it seems like it's plausible that people with ADHD experience a state of hyperfocus. More often and maybe differently than people without ADHD. We just don't have a lot of research one way or the other on it. That's interesting.
Science Vs
ADHD: Do We All Have It?
Yeah, it doesn't sound like it has anything to do with that profile we were talking about earlier, like the typical ADHD set of symptoms, which are all about, you know, attention and focus. But a lot of people are sharing stories about being emotionally overwhelmed, dysregulated, very reactive, very sensitive. Here's one listener who called in.
Science Vs
ADHD: Do We All Have It?
This is tricky. I looked into it. It's like it's almost in the diagnosis. The DSM does say that low frustration tolerance, irritability, and mood lability, that's basically moodiness. It says that all of those are associated with ADHD.
Science Vs
ADHD: Do We All Have It?
And there is a study that found that people who scored higher on that test that we just took, they also scored higher on a test that measures emotional dysregulation, which suggests there might be some connection here.
Science Vs
ADHD: Do We All Have It?
I talked about this with Maggie and other scientists, and they think it might be tied to impulsivity, which we know is common in people with ADHD. So we know that some people with ADHD have trouble regulating their behavior. Maybe this also applies to emotions. Like they could have a tough time regulating emotions like they have a tough time regulating behavior.
Science Vs
ADHD: Do We All Have It?
But some people are taking this a step further and they're saying that people with ADHD have this particular emotional problem where they are really sensitive to criticism. Like their mood totally plummets if they feel like they're being rejected or criticized. And some doctors have even named this. They call it rejection sensitivity dysphoria.
Science Vs
ADHD: Do We All Have It?
This is an idea that the Internet has really caught hold of. But I looked into it. There's hardly any evidence for it. There's really just one paper, which is about four patients.
Science Vs
ADHD: Do We All Have It?
And when I talked to academics about this projection sensitivity thing or the emotional dysregulation thing, they said it might be a part of ADHD. But for some people, something different might explain what's going on. So maybe they have ADHD, but they also have another condition on top of that. That's very common.
Science Vs
ADHD: Do We All Have It?
We know a lot of people with ADHD also have a mental health diagnosis or they're neurodivergent in some other way, like they have autism. Studies pin it at at least 60% of people who have ADHD have another diagnosis. And anxiety and depression are some of the most common ones, which, you know, could also be associated with being really sensitive people. to being criticized or perceived rejection.