You, me, and ADHD

0:00Support for the show comes from 1Password. A password manager should be the first security purchase you make for your team. Why? Because compromised passwords are the number one way bad actors attack companies, and small businesses are their favorite targets. But unlike a lot of security challenges, passwords actually have a pretty simple solution. 1Password lets you manage all your business credentials so you can feel confident that your data stays secure as your company grows. Find out more at 1Password.com slash podcast offer and start securing every login.

0:56One Password lets you manage all your business credentials so you can feel confident that your data stays secure as your company grows. Find out more at onepassword.com slash podcast offer and start securing every login.

1:15I 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.

1:33School 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.

1:59Jonquilyn Hill: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. 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.

2:37And 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. I was completely shocked and I was like, okay, I'm going to make an appointment now.

3:13Jonquilyn Hill: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 John Glyn 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 arrives from the idea that sometimes when that term is being used, we're talking about different things.

4:06ADHD 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.

4:54And so that's sort of one important way to think about ADHD.

4:59Jonquilyn Hill:We heard from a lot of listeners who have ADHD, and there was a real range of the way it impacts their lives.

5:27a 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.

5:35Jonquilyn Hill:Yeah. Is that typical of what you see in your patients with ADHD? Yes, 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. And then when you're thinking about adults, the second place where the impairments show up most commonly is in the workplace. So, So, you know, what do we know about these settings? Well, they're settings where you really do have to sit down, concentrate on one thing for a long period of time. There's not a lot of physical movement or changing of activities really happening a lot of the time.

6:08And so these kinds of environments tend to, like, really put a strain on kind of self-regulation resources for people with ADHD. But it really goes beyond that. So I hear adults talk a lot of just struggling with adulting, right? Like pay our bills on time, keep up with kids' activities and all that stuff. And then relationships is another tough thing, right? In order to be in relationship with other people, a lot of times it requires a lot of kind of regulating your emotions, which can be challenging for adults with ADHD. And also, like, keeping your promises to other people and, you know, doing the things that you need to do to kind of fulfill your end of the social bargain.

6:47And that really affects people's self-esteem. So that's something we really have to work with in therapy. We also know ADHD does put people at risk for other mental health diagnoses. So from like depression, anxiety, substance use. 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.

7:29Jonquilyn Hill: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.

8:12However, the thing I get concerned about as a clinician is there's clear evidence that for certain populations, ADHD is still vastly underdiagnosed and undertook. And these are the people that probably also have the least access to care. So it can be simultaneously maybe over and under diagnosed depending on who you're talking about.

8:31Jonquilyn Hill: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. Okay, 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.

9:15And there's only a couple studies, but they all kind of land around that, like, basically, like, 50 percent of what's on hashtag ADHD TikTok videos is not accurate. So there's a lot of what I would call, like, maybe misinformation, you know, not that people are necessarily trying to spread misinformation. But I think a lot of the content tends to communicate personal experiences. And there's nothing inherently wrong with that. But if it's not accurate, it could point people in the wrong direction when looking for ways to better live their lives. So I think as a clinician and researcher, I treat the term ADHD with a lot of gravity and a lot more than I see it being used in daily life.

9:56I think this is true for other terms like OCD or how we use the term autistic. So why not say I'm having trouble resisting distraction instead of I'm so ADHD right now?

10:10Jonquilyn Hill: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.

10:27Support for Today Explained comes from Growth Therapy. Every chapter of life brings new challenges, and Growth Therapy can connect you with someone who's equipped to help you navigate them. Whether it's your first time in therapy or your 50th, Grow says that they make it easier to find someone who fits you from a network of thousands of independent licensed therapists across the United States. You can search by what matters, like insurance, specialty, identity, or availability, and get started in as little as two days. You can cancel up to 24 hours in advance at no cost. Grow says that there are no subscriptions, no long-term commitments, and you just pay per session.

11:06Whatever challenges you're facing, Grow Therapy can help. Grow accepts over 100 insurance plans. Sessions average about$21 with insurance, and some pay as little as$0, depending on their plan. You can go to growtherapy.com slash explain today to get started. That's growtherapy.com slash explained. growtherapy.com slash explained. Availability and coverage vary by state and insurance plan.

11:40Support for Today Explained comes from Samsara. A lot of companies have to get products from point A to point B. That means hiring drivers, which in turn means insurance, dash cams, and accepting the fact that accidents can happen. That's exactly where Samsara comes in. Samsara brings AI dash cams, vehicle tracking, and asset visibility together in one simple platform. Samsara says that they want to help you protect your drivers, cut costs, and operate smarter. Their AI dashcams capture real-time video that can help prove when your drivers aren't at fault, which might help protect them from false claims.

12:19Samsara's data shows companies that use their system have reduced fuel costs and improved driver retention thanks to better visibility and coaching. You don't need to wait for the next accident to take action. You can go right now to samsara.com slash explain to request a free demo and see how Samsara brings visibility and safety to your operations. That's Samsara.com slash explained. Samsara. Operate smarter.

12:53Jonquilyn Hill: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 the medical literature, we can rewind the clock all the way back to 1775. A German physician named Melchior Adam Weikard is now the first documented clinical case description. A young chaplain, for example, is supposed to meditate about the Savior's sufferings. Every humming fly, every shadow, every sound, the memory of old stories will draw him off his task to other imaginations.

13:39Even 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.

14:28So 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. So a number of name changes. And then it wasn't really till like the 90s that even in clinical spaces, the idea that ADHD persists into adulthood became a prominent thing. For a long time, it was like, well, this kid's just going to outgrow this so we don't have to worry about it in adulthood.

15:05But now we know that is not the case.

15:08Jonquilyn Hill:Do we know what causes ADHD? Like, is this environmental? Is this genetic? Yeah. What causes this? So what we find when we're talking about the core ADHD symptoms, right, so the inattentive and or hyperactivity impulsivity, the extent to which this varies between people is about 80 percent heritable. 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. it. 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.

15:55And 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.

16:06Jonquilyn Hill: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?

16:43I'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'd 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.

17:21Therapy for specifically for ADHD works best when it is really tailored to the problems that people with ADHD face. 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.

18:06And finally, I guess I would say there's a lot of exciting things, but there 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 in the National Resource Center for ADHD if they have a question about, like, what's the evidence for this kind of treatment.

18:36Jonquilyn Hill: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. 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.

19:24Jonquilyn Hill:Coming up, how those girls and women are finally getting the help they need.

19:34Eczema is unpredictable, but you can flare less with Epglis. A once-monthly treatment for moderate to severe eczema. After an initial four-month or longer dosing phase, about four in ten people taking EBCLIS achieved itch relief and clear or almost clear skin at 16 weeks. And most of those people maintain skin that's still more clear at one year with monthly dosing. EBCLIS, LibriKizumab, LBKZ, a 250 milligram per two milliliter injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema.

20:04Also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBCLIS can be used with or without topical corticosteroids. Don't use if you're allergic to EBCLIS. Allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with EBCLIS. Before starting EBCLIS, tell your doctor if you have a parasitic infection. Ask your doctor about EBCLIS and visit EBCLIS.lily.com or call 1-800-LILY-RX or 1-800-545-5979.

20:33When you want your spring break to feel like. And your kids pool day to feel like. And your hotel bed to feel like. Oh, and room service to feel like. Because at Hilton, hospitality feels like. Your cabana's ready. Would you like fresh towels? It matters where you stay. Book now at Hilton.com. Hilton for this day.

21:08Jonquilyn Hill:We're back with Explain It to Me. I remember back in elementary school, it seemed like ADHD was something only boys had. But that's changing. Thanks, in part, to Dr. Julia Schechter. I am a clinical psychologist and an associate professor at the Duke University School of Medicine. And I also lead our Duke Center for Girls and Women with ADHD. Why'd you choose to focus specifically on girls and women with ADHD? So as a clinician, you know, what I was seeing is that girls and women who were coming into the clinic were just a little bit more complicated. And they didn't seem to fit the description of ADHD that I'd learned about in graduate school or kind of saw more often in the clinic.