Chapter 1: What are the signs of ADHD in children and adults?
I never paid attention in school. I always doodled and everything. I was the only kid who couldn't sit in a circle and not get up during story time. That lack of concentration and the ability to focus has been detrimental to my career.
School was complicated. This is Molly Schmerling. So when I was really young, sort of in the elementary school age, it was a lot of meltdowns, a lot of coming home, feeling really overwhelmed with assignments, just this constant feeling of being too much, too kinetic, too loud, and just really feeling like people got some kind of social rule book that I never got.
Molly's mom saw her struggling and tried to give her tips, taught her how to do stuff like make lists so she could keep track of things. And it worked.
Chapter 2: How can ADHD impact professional life?
Molly graduated from high school, college, and eventually she went to grad school to become a therapist. But that too much feeling, it wasn't going away.
I was also balancing clinical work with my academic work. So I found myself just in a constant state of overwhelm.
One day she was sitting in her diagnostic assessment class.
We would literally go through each of the criteria and sort of talk about what this would look like with a particular client. And I do remember that when we got to the ADHD diagnosis section, we're going through each of the symptoms and I just had this like aha moment. We were talking about a client, but it could have been like she was talking to me.
I really had thought this is something that you get diagnosed with as a child and, you know, that's it. So being able to have her say, no, you'll have adults show up with all of these different symptoms. This is what that looks like.
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Chapter 3: What misconceptions exist about ADHD diagnoses?
I was completely shocked. And I was like, okay, I'm going to make an appointment now.
It's not just Molly. Of the 15.5 million adults in America diagnosed with ADHD, about half got that diagnosis in adulthood. I'm Jonquan Hill, and this week on Explain It to Me from Vox, we're talking about the fact and fiction surrounding attention deficit hyperactivity disorder, better known as ADHD.
I am Dr. Laura Knauss, and I am a professor of psychology at the University of Richmond, and I'm also a licensed clinical psychologist. Okay, I'm going to start with what feels like a basic question. What is ADHD?
I think this is maybe the most important question we'll talk about today, because I think a lot of the challenges when it comes to understanding ADHD kind of arise from the idea that sometimes when that term's being used, we're talking about different things.
ADHD can be a really challenging condition to diagnose if you're a clinician, because if we think about the core features of ADHD, so it's characterized by age inappropriate and impairing, either inattention, which is distractibility, difficulty organizing tasks and activities, And it can occur, inattention can occur by itself or with hyperactivity impulsivity.
What we know about these kinds of symptoms that people have is that they can be because of ADHD, but they could be the result of so many other either mental health conditions or other kinds of lifestyle factors. The way I like to teach people about it, though, is to talk about ADHD symptoms as really problems in self-regulation, especially when there's like a lot of distractions.
And so that's sort of one important way to think about ADHD. We heard from a lot of listeners who have ADHD, and there was a real range of the way it impacts their lives.
Growing up, I've had a lot of problems with ADHD. School, focusing, paying attention. I've always loved learning, but my grades never really matched. I made it through school, but I felt like it was a struggle to concentrate and to focus. I experienced time blindness a lot, so... If I have an appointment or something, it's my primary focus for the whole day to make sure I get there on time.
Yeah, is that typical of what you see in your patients with ADHD? Yeah, certainly. So the studies show that difficulties in like educational settings are one of the biggest places that these symptoms show up. And certainly like in kids, that's how children get identified a lot of times.
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Chapter 4: How has the understanding of ADHD evolved over time?
So we know that kids with ADHD are at greater risk in adolescence and adulthood for accidental injuries, becoming the victim of violence, you know, those problems with educational attainment, and becoming incarcerated. So actually the place in society where the rates of ADHD are probably the highest are in our prisons and jails.
And so I think it's really important that we strive for access for quality assessment and treatment for all that have ADHD, not just the folks that kind of make it into private treatment. Are you seeing an increase in people who have ADHD? Like, is that something that's happening? And if it is, why is that? That's such a great question. And I think...
To answer it, you have to draw a distinction between an increase in the people getting diagnosed with ADHD versus is it a true increase in what an epidemiologist would call the prevalence of ADHD in the population. So there's a clear increase. In fact, I was reviewing some papers right before I came on here for people getting diagnosed with ADHD more commonly.
But they really still can't find solid evidence that the prevalence of this like well-defined kind of neurobiologically related trait of ADHD is increasing. However, the thing I get concerned about as a clinician is there's clear evidence that for certain populations, ADHD is still vastly underdiagnosed and undertreated. And these are the people that probably also have the least access to care.
So it can be simultaneously maybe over and underdiagnosed depending on who you're talking about. I think we've seen a real rise in people talking about ADHD on social media and there are even ADHD influencers.
As a full-time content creator with ADHD, here are five tips that I use to make my life easier.
There are two types of ADHD anger.
I have ADHD, but I'm like really good at it. I have literally mastered having ADHD.
How accurate is what we're seeing online? So I had a lot of fun looking up the very recent research studies on this that are like fascinating. OK, so a couple of studies have taken the top videos, the top hashtag ADHD videos on TikTok and then had experts kind of rate the quality of the information that is in these videos.
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Chapter 5: What are the common treatments for ADHD?
So why not say I'm having trouble resisting distraction instead of I'm so ADHD right now? The way we think about ADHD has changed a lot over the years. How did it become the disorder we know today? That's next.
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Chapter 6: How does ADHD affect women differently than men?
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I'm JQ, back with more Explain It To Me. ADHD is definitely having a moment right now. But Dr. Laura Now says it goes back, way back. The traits we associate with ADHD probably have existed in humans as long as they've been humans. But in terms of like the medical literature, we can rewind the clock all the way back to 1775.
A German physician named Melchior Adam Weikert is now the first documented kind of like clinical case description.
A young chaplain, for example, is supposed to meditate about the saviour's sufferings. Every humming fly, every shadow, every sound, the memory of old stories, will draw him off his task to other imaginations. Even his imagination, if and when it is copious, entertains him with a thousand minor subjects.
the case description kind of pops up in different languages. And so it was sort of independently discovered in different spots, kind of all the way through the 1800s. And then kind of in the early 1900s is where we start to see mental disorders in general, they're becoming kind of diagnostic criteria
for things, and ADHD didn't become part of the diagnostic system that's used in the United States until 1968. Oh, wow. It was referred there to hyperkinetic reaction of childhood. This disorder is characterized by overactivity, restlessness, distractibility, and short attention span, especially in young children.
So as you can see, the emphasis there being on the hyperactivity kind of piece of it. And then kind of moving into the 70s and 80s, it evolved a little bit to not just kind of focus on the behavior, but also the cognitive processes. So that's where we get a name change to attention deficit disorder. So notice we're adding that attention piece there. Yeah, yeah, yeah. So a number of name changes.
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Chapter 7: What role do hormones play in ADHD symptoms?
So it's about as heritable as differences in human height. The place where the environment becomes exceedingly important is in the extent to which somebody with these ADHD traits experiences impairment.
We do know that modifying the environment in particular ways, helping clients learn new skills, giving frequent and really helpful feedback, like these are ways that adults with ADHD can, you know, they still have ADHD, but they're going to function better like with their symptoms.
And so that's what I get really jazzed up as a clinician is like helping people figure out how to like hack their lives, right, to succeed more even in the presence of ADHD. OK, one of the well-established ways to treat ADHD is with certain stimulants like Adderall or Ritalin. But those don't work for everyone.
I don't like stimulants. I think they do a great job for everyone, but I just do not like how they make me feel. In middle school, I was prescribed Ritalin, but it only lasted for three hours, and I would get in trouble when it would wear off before the next dose kicked in.
What are some of the other ways ADHD is treated? Yeah, first of all, I think people do not need to feel that if a medication is not the right choice for them, that it's some sort of moral imperative, right? I'm like, whatever tool in the toolbox, you know. There are non-stimulant classes of medication, so Stratera, which is a brand name, Adamoxetine,
From the research overall, they don't tend to be as effective as the stimulants. And they have a different side effect profile, though. So the other thing is everybody's brain is, like, a little bit different. And so it would be so nice if we could just say, like, well, everyone is going to respond to this drug.
But, like, if the caller doesn't like how a stimulant makes them feel, that's totally fine. And they totally should talk to their doctor about, you know, trying some of these alternatives. Therapy specifically for ADHD works best when it is really tailored to the problems that people with ADHD face.
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Chapter 8: How can individuals with ADHD find support and community?
So where we really see like the big effects or the larger effects right now for adult ADHD is these treatments like CBT for adult ADHD, where you're working on skills that address the inattentive symptoms, the impulsive symptoms and that sort of thing. In the more kind of biological therapy space, there is some exciting stuff going on with something called transcranial magnetic stimulation.
So this is, and I'm not an expert on it by any means, but it's a way of kind of stimulating the brain in certain ways that is showing some signs of being able to relieve symptoms, you know, at least for some limited periods of time.
And finally, I guess I would say there's a lot of exciting things, but they're always with this disorder have been a ton of unproven or disproven treatments out there. So I just encourage kind of buyer beware. I am on the professional advisory board for an organization called CHAD, Children and Adults with ADHD.
And I would just encourage listeners to go to CHAD's website and the National Resource Center for ADHD if they have a question about like, what's the evidence for this kind of treatment? Has the profile of who we think of as a person with ADHD changed over time?
I hope so, because I hope that's where we're going, that we can recognize that ADHD affects all different kinds of people, regardless of socioeconomic status, race, gender. One of the prominent stereotypes has been that ADHD is a male-only disorder.
Now, it's certainly true that ADHD is more likely to be diagnosed in males, but there are plenty of women and girls with ADHD that are very affected by the disorder. And it's possible that because of our stereotypes about what ADHD is and who has it, that especially in the past, some girls might not have been diagnosed even when they needed help.
Coming up, how those girls and women are finally getting the help they need.
Hey everybody, Ested Herndon here. I wanted to let you know that Vox Media is returning to South by Southwest in Austin for live tapings of your favorite podcasts. Join us for March 13th through March 15th for live tapings of Pivot, Teffy Talks, Professor G's Markets, Where Should We Begin with Esther Perel, and the special live taping of Today Explained, hosted by yours truly.
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