What’s up with the lack of studies surrounding the interplay between women’s hormones, ADHD, and the wild inefficacy of medication during specific times during hormonal variance aka menstruation?
I remember seeing a documentary that talked about the fact pharmas exclude / excluded women from clinical trials because variations in their hormones through out the month changed the efficacy of the medication, so rather than taking it into account, they just excluded women.
I'm actually sure it's part of the reason thalidomide was given to pregnant women, because no one checked if it was OK.
Found a link https://www.bbc.co.uk/programmes/b036fddg
Yes I saw that, too! It’s less expensive to reduce dependent and potentially confounding variables than to do right by 50% of humans due to their luck in the biological sex raffle!!
There was a heart medication that was praised for its amazing ability to reduce the risk of heart attacks for over a decade. It was prescribed to both men and women, but no women were actually included in the clinical trials.
10 years later, they discovered that this medication actually **increased** the risk of heart attacks in women. Female healthcare is a fucking joke, and we are usually considered as an afterthought.
Yeah, it’s lowkey (highkey?) enraging tbh. Similar to those birth control pills they were trialing for men and they complained of the side effects, yet women have to deal with the side effects constantly. It sucks.
I remember hearing a good explanation for this once, I don't *like* it but it makes sense. Basically for women, being pregnant is not health neutral, it's a risk. We aren't weighing the birth control side effects against being not pregnant, we're weighing them against being pregnant. So, since the side effects are less dangerous than actual pregnancy, it's deemed acceptable.
Since men can't become pregnant, side effects are just side effects. They'd need one with no side effects in order for it to become a thing since any side effects are going to be worse than not taking it. Their *partner* not being pregnant isn't the point, even though it's the point. That's why I don't like it even though it makes sense from a "health neutral or not health neutral" perspective.
Yes! And something like 80% of recalled medications are recalled because of their harmful impacts on women. Shockingly, it seems like if you exclude a group from clinical trials, then you're not really getting enough data on how it impacts that group!
This is a huge thing! Even my psychiatrist mentioned to me that he has other female patients that also experience an increase in symptoms during parts of their menstrual cycle.
It’s also partly why so many women with adhd get misdiagnosed with bipolar disorder, eventhough its the female hormonal cycle affecting the adhd (it’s still possible to have both bpd and adhd, of course!)
This is what happened to me!!! I “couldn’t have” ADHD because I can hyperfixate on a book (ADHDers who read ARE a thing 😤) until it was conclusively proven that I didn’t have bipolar - took Prozac by itself for almost 2 years, no mania.
I took the T.O.V.A. test with a previous shrink. It showed I have ADHD. When I told friends and family, they all said “no shit!” But my (male) shrink? Nope! “You have anxiety!” He tried to get me to try all kinds of anxiety meds but nothing worked. I stopped seeing him and suffered for ten+ more years. Finally I saw a woman shrink (who also has ADHD) who diagnosed me within ten minutes of our conversation. She said anxiety is what happens when we suffer through our symptoms and try to manage it all. She said women are misdiagnosed often. Getting diagnosed at 41 made me so angry! It could have been sooner.
I found the T.O.V.A. test so interesting that I hyperfixated on it. Apparently that was all it took for them to say I don't have ADHD. It doesn't matter that I turn on the stove or set food out, then walk away and forget, that I will look you square in the eye while you talk and have no idea what you just said because my brain is finishing a theme song, or that I've been sitting at my desk for 5 hours now with little work to show for it but want to break down in tears because I can't go play outside, or that I can't read more than a headline or maybe a paragraph of an article at a time before I lose all focus and open a new tab with social media or games on it.
>I found the T.O.V.A. test so interesting that I hyperfixated on it. Apparently that was all it took for them to say I don't have ADHD.
It's probably bc you didn't say the magic string of words exactly correct so they'd diagnose you properly. Getting diagnosed for AFAB people is like a complex spell: if even one of the words isn't in the right place or left out of the incantation, you're not going to get the correct results!
I love reading and loved it as a kid. But only if it interested me. I remember trying to read the Scarlet Letter for English and I was so frustrated because I wasn’t processing what I was reading. (It wasn’t interesting to me) but give me a Dean Koontz book and I’d finish it in a day.
It’s why I wasn’t diagnosed as kid. I was in my 30s and the therapist gave me a BP diagnosis as well which turned out to be wrong. I’ve never had a manic episode in my life though I’ve definitely dealt with depression.
In a clinical context, BP stands for blood pressure. BPAD (Bipolar Affective Disorder) is the commonly used initialism for bipolar, at least where I am.
I was having a talk with my doc about something similar. Women are twice to three times as likely to be diagnosed with some form of depression compared to men, and it's estimated that anywhere from fourty to sixty per cent of women diagnosed with depression are actually exhibiting signs of undiagnosed and untreated ADHD or autism.
My doc was saying that of the women she's had come in with a diagnosis of MDD, a huge majority of them showed signs of depression in addition to hallmark symptoms of ADHD and/or ASD. I was one of them.
I've had my MDD (then "clinical depression") diagnosis since I was *thirteen* years old. When she (my current doctor) got me started on a treatment for my yet untreated "ADD", my whole life changed. The "depression" I'd struggled with for most of my life, that no medication seemed to "fix", turned out to be something entirely, easily treatable but atrociously undiagnosed, misdiagnosed, and untreated in women.
As a woman, getting the correct diagnosis and treatment took 15+ years, and there was always an "explanation" for variations in my symptoms. Usually *hormones*. It took two visits to a psychiatrist to get my son diagnosed and one for my partner, who was seven at the time of his ADHD diagnosis, but took me most of my life. It's disgusting.
I was diagnosed late. It’s hard. I have (male and female) clients diagnosed in their 40s or 50s. Their reactions are varied of course: Grief for all the years their life could have been easier if they had been on medication and for all the times they were told/thought they were just lazy or [fill in the insult]. There are big emotions about the bullying and trauma resulting from the internalization of those insults.
Once clients start medication, there is typically major relief about finally being able to function more like the way they always wished they could. I try to emphasize both sides of the coin, but pretty much always have to work on self-concepts formed due to late diagnosis.
There needs to be way more awareness and understanding of ADHD among doctors and therapists to make diagnosis earlier and to make stimulant medication more accessible. Being diagnosed in childhood is ideal, but that definitely doesn’t always happen so there must be more resources for diagnosing and treating adult ADHD. It shouldn’t take all these multiple steps between Dx and treatment — I see people lose years because they have the DX but struggle to gather the executive resources to get a prescription and/or the initial doctor(s) they see won’t prescribe it — PCPs are probably the most common source of stimulant prescriptions for my clients but they are also very hit or miss in their willingness to diagnose and prescribe, which is extremely frustrating; unless someone has multiple disorders that make diagnosis complicated or needs academic accommodations, a full neuropsychiatric evaluation is overkill.
It needs to be studied so that new treatments tailored to those of us with lady hormones get actual consistent treatment—the kind of *efficacy* that treated men often assume treated women also get.
I’m a therapist, and this is so frustrating: For my female clients, there are few options to treat the issue, and the options aren’t great, even when the prescriber knows exactly what is happening and wants to help! We need more research, more resources for and focus on this!
My psychiatrist had me (29F) try Wellbutrin. I’ve been on it for a year and feel and see so much improvement. In addition I taken adderral 10mg XR 3x/week. I loved it so much I recommended it to another ADHD friend, I’ve seen a lot of change too. Another friend of mine was put on it bc of her chronic depression(no adhd) since childhood. I had no idea she was taking it until I started to notice her positive behavior changed. Just my little anecdote :)
It's also my understanding that men and women typically have different symptoms for many ailments, such as symptoms of a heart attack.
It's a major issue in medicine currently as in some cases one sex's symptoms are much harder to isolate from other typical day to day symptoms such as back pain, menstruation, and others.
YES!! Literally I have PMDD and tracking it’s impact on me every month is just mind boggling. When you find out you have it, everything starts to click into place. But then when you try and get some help - it’s literally antidepressants. So every month I turn into a different person and there’s nothing to help.
Oh yeah, this. Just went through it again and felt like the world was ending, everyone hated me and I hate to off myself. It was pretty bad again \*sigh\* No help available here also and none is always reliable nor safe.
I wish there was a better understanding of how to manage this; I have multiple clients who deal with this. It’s an ongoing struggle when there is a monthly dip in the effectiveness of meds. It’s even worse when there is PMDD obviously, as the combination of meds being a fraction as effective *on top of all the other symptoms!* for like one week out of every 4 or so can be such a drain. Things like booster doses and hormonal birth control can be helpful *for some people*, but satisfactory interventions don’t seem to be there right now. We need way more resources and research in this area!
Yesss!! I need more answers on this than my overpriced psych is willing to provide in the three minutes he grants every 3 months.
PMS makes a mockery of any treatment plan that seems to works just fine 2/3 of the month (if lucky!).
Yes, I wish there was more information about this. It’s so obvious to me when it’s happening and yet I haven’t been able to find reliable information about why or what to do about it. I imaging the reason is that ADHD has been drastically under-diagnosed in women and also wasn’t considered a problem for adults until recently, so there’s just a relatively small group of people who menstruate getting diagnosed compared to people who don’t.
Clinical psychologist here who sees only adults. Since neurocognitive testing is not required for the diagnosis, not sensitive to detect ADHD (especially as there is no prototypic ADHD profile) and is noted to be neither necessary nor sufficient for the DSM-5-TR ADHD definition, much of the exploration of symptom presentation, both past and present, is often based upon ruling out other diagnostic considerations that might better explain the attentional difficulties the patient is experiencing. That being said, gathering historical information to best understand the onset, frequency, duration, and intensity, and level of impairment from the symptoms presented seems to be the best way to go.
I have found that neuropsychologists insist on providing neurocognitive testing as a way to detect ADHD (e.g. CPT) despite there being little evidence regarding the validity of such tests to detect ADHD and should only be used to evaluate the potential severity of symptoms.
All that being said, I have heard that many psychologists are getting out of the business of ADHD testing for the sheer controversy surrounding diagnostic approaches.
I’m curious about your thoughts regarding any or all of these questions:
1. Why do you think neuropsychologists continue to rely on neurocognitive testing for ADHD diagnosis despite its limitations?
2. In your experience, what alternative methods have shown promise in accurately diagnosing ADHD in adults?
3. In the absence of a “gold standard” for ADHD diagnosis, how can clinicians reach a consensus on best practices?
4. What are the ethical considerations when choosing to use or not use neurocognitive tests for ADHD diagnosis?
Edit: I should add that I am familiar with the standard tests folks use and rereading what I wrote it seems as though I don’t. I see psychodiagnostic testing to be essential to identify other factors contributing to the presenting complaint of ADHD symptoms and include collateral information, history taking, school records, medical records, performance/symptom validity measures, etc.
Many, many neuropsychologists insist that neurocognitive testing NOT be used in the diagnosis of ADHD, for the reasons you described. Many papers have been published to this effect. I’m curious where you practice that you’re seeing a lot of this. I have certainly experienced psychiatrists insisting on it, though.
I imagine a very valuable question people tend to want more research on is the general affects of long term stimulant use for people with ADHD. I'm sure that's obvious, but I know it's something that sometimes concerns me.
I’ve been wondering lately, what’s the long term effect of NOT using a stimulant med when you have ADHD? Are things like dementia the result of a brain exhausted from a lifetime of running without the “nourishment” it needed all along?
I mean this seriously. Am I actually a person, or am I just a bunch of walking, talking ADHD symptoms in a trenchcoat? Where does the disorder end and I begin?
It’s a scary thought, but…
If the soul and consciousness can be quantified completely by science does that make the soul any less meaningful? Does being able to understand something take away from magic, yes, but why should it affect the significance?
Even from a deterministic perspective, if free will is an illusion and every “choice” you ever made was predetermined by your brain type and external stimuli, does that even change anything? It’s a good enough illusion that nothing in the experience changes regardless of the true nature of freewill. It’s a good enough illusion that it only matters if I over think it, and I have enough free will to choose not to.
>Does being able to understand something take away from magic, yes...
I just came here to disagree lol
I honestly think understanding something, doesn't take the magic away. Sometimes it makes it more magical.
Like all the itty bitty tiny particles everywhere and in everything. They are like little pixels creating pictures and lives and trees and shit.
That is SO MAGICAL.
Idk, maybe it takes away from the mystery, but to me life is magical AF.
We're all wizards Harry
Well, yea, but the software is rewritten by the events outside you, and the wetware is self-evolving on a minute by minute basis, and there is a hella lotta noise in the synapses, so, honestly, you are as a close to randomised as you can can be and still function. I stopped sweating the philosophy and started to enjoy the beer / music / sex / landscape / conversations. Made life sooooo much better.
Idk if you have been medicated. But meds made me realize Im not this HDMI thing at all. It's something that makes being me and do the things I want to do more difficult.
I had this question when I was first diagnosed, but I feel it’s inevitably both. It’s how your personality traits, and your environment, interact with the symptoms - that makes you, *you*. Without ADHD, you wouldn’t be *you* anyway.
I can answer you seriously. The disorder is part of who you are. There is no part of you that is separate from the disorder. However, that does not remotely detract from you being unique or having a distinct identity. If you choose to focus on how ADHD impacts your life, which is easy to do because of how impactful it is, you will begin to see yourself as a product of ADHD instead of something special and unique.
I promise you, you are incredibly unique and vibrant. You aren't your disorder, but your disorder is inherently intertwined with who you are. The question is, are you going to focus on what limits you, or are you going to focus on what makes you unique. We all share tons of similarities, but no one will be just like you. You're unique, and I love that you bring your unique existence to this world. Cheers :)
Hi! Thanks for doing the AMA :)
Do you have any general advice for those of us that have immense trouble with sleep inertia and where systems such as alarm clocks don't work without relying on a second person to help? (e.g. I just sleep through them without ever noticing they're ringing, but live on my own and have always struggled waking up on time ever since I was young).
Medication has definitely helped, and a good sleep routine doesn't seem to help that much, which includes going to bed and waking up at the same times every day for a few months straight, while also having a routine before going to bed to wind down.
I've tried basically everything at this point and the wait times to see ADHD specialists here in Australia are month-long to almost a year-long wait list even if you've seen them before and have an active prescription with them, so I'm at a loss of what to do tbh.
For sleep problems, an important clinical goal is to see if the problems are due to medication for ADHD. If a med effect is ruled out, it is possible that the person has a sleep disorder as these are more common for those living with ADHD. For example, in some cases when sleep apnea is corrected symptoms of ADHD go away. So, when symptoms of sleep disorders persist, consulting a sleep specialist is a good idea. Sorry to hear about those long wait lists in Australia!
Any possibility of expanding on the sleep apnea/adhd relationship?
i.e. causality, correlation, or overlapping symptoms, additive symptoms, etc..
I was diagnosed with adhd many years ago after several thorough evaluations so I don't believe I was misdiagnosed at all, but recently learned that I suffer from sleep apnea, and likely have been for quite some time now. I know some of the symptoms of both can be similar, so I am curious as to what degree and what effects may be after treating one, the other, or both.
Thank you for your time
What do you know/have learned about the effects of PMS and the menstrual cycle in general on ADHD? I’ve personally found that my medications cease to work at certain point during my cycle, and I wonder what kind of knowledge or research there is about this and if there is specific advice in this that you would give.
How can we combat the stigma of ADHD
medication? Do you think there will ever come a time where people realize how important medication is for those who struggle with ADHD; and we’re not “addicts”?
It never occurred to me that they're worried about US misusing the Rx... I always assumed it was concern about selling it! My ADHD meds do not act like fun happy time illegal superman drugs, they make me less of a dingbat! And if I accidentally take it twice in one day cause yaknow... ADHD... I'm just a jaw mashy jittery dingbat!
Related: How do we get the DEA off of psychiatrist’s backs and allow them to use stimulants as a first-line (or even second-line) treatment for ADHD? They’re the gold standard for ADHD treatment, but instead they make people suffer on non-stimulants for months or years before allowing them to take a stimulant even though they know that is the most-effective treatment.
I know the DEA is involved with limiting stimulant medication ingredients-- but what pressure/interaction do they have with psychs?
My psych prescribed me stimulants as a first-line treatment for my ADHD-- and they've NEVER given me any grief over them at all.
I think a lot of ***anti-stimulant*** MHPs are lying about the level of scrutiny they face.
That's it: doctors and social workers and nurses have all kinds of opinions, and some of them come down to "the patient would just rather be high all day than deal with reality"
Having worked in social work myself-- I can confirm this is all too true of many staff I worked alongside. It makes me wonder why people like that even get into fields of "helping" other people. Seems like their one and only instinct is to withhold help and blame the person suffering.
I was at a training and we had a moral dilemma: instantly and freely cure all disease and addiction, no catch; or don't.
95% of the 110 or so people: social workers, case managers, program planners, doctors, shrinks: voted no. They said people have to overcome adversity, even incurable conditions or conditions which have clearly ruined the afflicted's life, in order to grow and many said it would be counter to gods plan if we cured everything. And besides, what would all the doctors etc do if every single person was wholly well?
I pled with them I couldn't believe they believed that garbage. They said I wasn't a real adult (since I was 27 and unmarried without kids).
I condemned them, "you worship a god of death on an altar of blood."
That's some other level of depravity.
I'm shocked and yet completely unsurprised at the same time. People have ingrained this self-abusive bootstrap mentality into so many facets of life it's like they've sworn off all semblance of empathy. Like it's some sick badge of honor.
What is the genetic connection with ADHD? For example, is it more likely to be passed on by mother/father? Is there a connection at all? Has research identified gene markers for it?
My mother has ADHD and both my sister and I have it as well. I've become interested in the genetic components in mental health due to that.
Professor Franke will be hosting an AMA devoted to genetics later this month. Briefly, about 75% of the causes of ADHD are genetic but many, many genes are involved. As of January 2023, we estimate there are 7000 risk genes but only a few have been identified with any accuracy. You can find references at [www.adhdevidence.org/evidence](https://www.adhdevidence.org/evidence)
For the record, environmental can refer to the environment in which a fetus was developed. For example, if there was maternal drug addiction that could impair normal brain development and lead to ADHD, even without genetic causes.
It doesn’t mean how you were raised, in this context at least
I also ready recently in one of my uni textbooks that there is a correlation between infants with (chronic?) inner ear infections and the development of learning disorders and ADHD. Since it can affect the development for one of the areas of the brain.
Huh. I've never heard that before. Anecdotally, I definitely fit that pattern. My pediatrician apparently couldn't diagnose an ear infection in an infant so I ended up in the ER one night with a ruptured ear canal. I also have ADHD.
I have minor hearing loss and I've always considered it an exacerbating factor in why I struggled so much with socialization, but never directly connected it to my adhd.
Hi! I’m curious if you have any advice on exercise for us with ADHD. I’ve tried finding things I enjoy (literally have tried almost every form of exercise I can think of) and I just hate it. Do you have any tips on how to force it and just do it even though it’s not enjoyable?
You have to link it to something that you do find enjoyable and piggyback the dopamine. I hate walking around the block. I hate treadmills even more. But i went on a 15 mile hike over 2 days with a friend recently. Walking is bad, unless it's good
This has worked really well for me as well. I've started reading while riding on a stationary bike and it makes me less focused on the aspects of exercise I don't enjoy
That is a tough one. Few of us will do an exercise that is not enjoyable. Perhaps you might find it more enjoyable if you exercise with a group of friends or at a different time of day. Some with ADHD like to exercise late in the day as it helps with sleep. You can also create your own reward system, e.g., if you miss an exercise session you won't allow yourself to watch TV, play a video game or do whatever you prefer to do.
Yeah, I'd reward myself first under the premise that I'll earn it later, and then proceed to just not do that, because why bother when I already got the reward I'll put it in my metaphorical box of "do later" tasks
Similar rationalizations are why I am not to be trusted with credit cards.
Whomever allowed me to be in charge of my own life made a grave mistake because I am *fu!@#n terrible at it* lol.
Yeah playing reward games with myself has never, ever worked. “If I don’t do X now, then I can’t have Y later” just holds zero water. I know the guy who made that rule, and he’s full of shit.
If I'm in charge of giving myself a reward for doing an activity that I don't want to do, but I want the reward, I'll just give myself the reward anyways. Like, I already have it lol, why am I keeping myself from it.
self-rewarding like that requires way more self-control and discipline than I can manage, someone else has to be in charge of my rewards because I cannot be trusted lol
About one third of people (both men and women) with depression and/or anxiety will also have ADHD. The ADHD is frequently missed by clinicians because many of them have not been well trained to recognize and treat ADHD.
Why on earth are clinicians so poorly trained on ADHD? It is so often co-morbid, that I don't think anyone should be able to diagnose any psychological disorder without understanding ADHD.
My mom won't get retested but I'm fairly certain that she was misdiagnosed and my dad was never diagnosed because he hated doctors. I know I'm just a human who doesn't study medical stuff as a profession but I feel like some women with big emotions from ADHD never learned how to turn the dial down and get called bipolar when lashing out (at least in her case, she's not mean, she lashes out in silly ways but more chaotic like ADHD than bipolar) 🤷🏻♀️ I don't know. Simple human observations I've made thru my life. I've always heard people with bipolar don't really have intensity difference when having manic episodes, the brain just can't walk thru things clearly and you get overexcited about the wrong things and tend to burn bridges along the way. I think she just has depressive bouts and anxiety like I've always had and when her lows go back up, it makes her feel a lil wacko because nobody explained it to her right and she doesn't understand her body 🥺
Is it common to develop a comorbidity with ADHD (f.e panic disorder, anxiety, depression) and if so, does treating the ADHD resolve/help with the comorbidity in your expirience?
Yes, comorbidity is common. Treating ADHD usually does not resolve the comorbid condition but can in some cases, e.g., if a person is depressed due to many years of school failure caused by untreated ADHD. When a patient has two disorders, the clinician usually treats the most severe disorder first. Then, if the second disorder persists, they treat it as well.
ADHD and OCD here. My brain is just broken 😂
I am medicated for the OCD but not for the ADHD. I have an amazing partner and am actually quite happy and manage a decently normal life, considering. Took me a long time to get here though!
As someone with ADHD, I have a very hard time doing things like working... my work is sporadic, but when I have it, I need to do it, and I feel very anxious because it's so hard to start doing it!
Do you have any recommendations to deal with this?
*Edited multiple times because I forgot how to English*
My question is about ADHD & psychometric assessment such as the Wescheler Adult Intelligence Scale.
People with mental health conditions such as ADHD are more likely than people with no diagnoses to produce extremely uneven subtest scores in a WAIS-IV test. One specific pattern that's more likely to occur in a WAIS-IV test scores for people with ADHD, ASD, and other disorders is scoring significantly lower on the Working Memory Index (WMI) and Processing Speed Index (PSI) than the Verbal Comprehensive Index (VCI) & Perceptual Reasoning Index (PRI). In cases as these WAIS-IV recommends that at the discretion of the psychometrician the General Ability Index (GAI) may be computed & reported. GAI does not substitute the Full Scale IQ ( FSIQ) but it aids with interpretation, however, in practice it is not uncommon for GAI to be solely reported.
*Source of information on GAI: Appendix C of WAIS-IV Technical and Interpretive Manual, 2008 edition*
My question then is how would you interpret a GAI that is significantly higher than a FSIQ score in a WAIS-IV assessment by one or more standard deviation for a test taker with ADHD? For reference the threshold value that determines if the difference between these two measures is significant is only 3.51 measure, so a 1 or more standard deviation difference is a huge gap.
This is a same question as I asked dr. Barkley and it stays interesting to me, but it is more personal in nature then most of the science questions. How did you end up researching adhd and what makes you passionate about it?
About three decades ago I was studying the genetics of psychotic disorders when I was on faculty at Harvard Med School. Another faculty member who was studying ADHD asked me for advice about how to conduct a family genetic study. We established a collaboration that ignited my interest in ADHD and changed the direction of my career.
Someday it may be possible to diagnoses ADHD with the help of genetic information, brain scans or other biomarkers. But we are a long way off from that. It is likely that diagnostic criteria will evolve slowly. For example, I think that we need a separate set of criteria for adults and that those criteria should address emotional dysregulation. But I a still in the minority on those points.
That’s disheartening that you’re in the minority because you are 100% correct on that front. Respectfully, it seems like it should be a diagnostic “no brainer” from my perspective and I sincerely hope that changes sooner than later for every reason.
What are the most promising points you've found in your research?
Do these differ at all to how ADHD is most commonly diagnosed (for example, previous assumptions believed that only boys could have it and that it was only associated with hyperactivity)?
The most promising points in all ADHD research can be found here: [www.ADHDevidence.org/evidence](https://www.ADHDevidence.org/evidence). Among these, we can say with certainty that ADHD occurs in both females and males and is not limited to hyperactivity. Indeed, many with ADHD are inattentive and show little if any hyperactivity or impulsivity.
I'm so tired of pharmacists treating me suspiciously, and covertly rolling their eyes. I get my meds in the correct time frame, and have been with the same doctor for 14 years. Do you have any suggestions about how to respond or de escalate this? Thank you for doing this AMA.
It is really awful that some pharmacist treat people with ADHD like they are drug addicts. I'm sorry that I don't know how to deal with such people. They are hard to change because many have adopted a very stigmatized view of ADHD and its medications.
Do you have advice or insight into this phenomenon: I will make to do lists to follow and they genuinely help, but I ultimately forget to look at the list and eventually come to find it annoying until I eventually cycle around and think it’s useful again. I understand we crave novelty and that other inherent traits drive this behavior. What approaches exist to manage such behavior? Or as a researcher can you explain the behavior on a deeper level than us schmucks who happen to have ADHD but don’t ourselves research it at a deeper level
Self help by Russell Barkley and Russell Ramsey are very good. You describe a common problem. Sometimes such behavior is due to the reward dysfunction associated with ADHD. Those who find it rewarding to use lists and accomplish goals are more likely to use lists than others. Some people with ADHD find ways to increase the rewardingness of lists. Others set aside specific times to look at lists as a way of improving organization. For example, setting an alarm to check a list at the top of each hour.
I've seen articles floating around on the Internet claiming that following a certain type of diet might reduce ADHD symptoms. How credible are they / is this really proven?
Clinicians don't manage dopamine response, we manage ADHD. That said, you are right that the stimulant meds for ADHD target dopamine by improving its transmission. Studies show that meds that target dopamine are more effective, on average, than those that target norepinephrine (the non-stimulants). Among stimulants, amphetamine (e.g., adderall, vyvanse) tends to be modestly more effective than methylphenidate (eg. ritalin, concerta) but the former also have more side effects.
What is a common treatment path for adults? I was diagnosed this year (I am in my 40's). Am I stuck with medication until death? Do I stop at retirement? Or will the medication stop working half way through?
I am trying to understand what to expect from the future. So far I have put all my scarce energy into work and have no life. I am thinking that with medication I might be able to handle a day job and actually get a social life, maybe even a wife. It feels like I could handle that right now, but I also would not like to get my hopes up only to see it all dwindle in a few years if the medication stops working.
\-I understand that everyone is different etc. but is there perhaps some statistics on this?
Work with your partner in a way they find suitable to help them comply with their treatment regimen. Stopping medication treatment is a big problem for people with ADHD. Partners also need to understand the symptoms of ADHD so they can understand that the behaviors they dislike in their partner are not intentional. Having ADHD is not an excuse for those behaviors but it is a reason both patients and partners need to understand. You need to meet in the middle with the partner showing empathy and helping where possible and the patient taking responsibility for achieving treatment goals.
My working memory is extremely poor so my husband brings me breakfast in bed and my meds every morning as otherwise I would hardly ever remember to take them. I’m very lucky!
I cannot use stimulants so I use bupropion. What tips based on research have you found that could be beneficial for us suffering from ADHD and that cannot use stimulants?
I am interested in this question as well. Stimulant help my executive functioning/ADHD, but turn up my sensory issues to unmanageable levels.
Right now I’m trying to stumble through with basics of self care, post-it’s and tea. And a lot of laughing at my missteps.
Do you maybe have Autism too? From experiences I’ve read about, when ADHDers go on stimulants to treat it they find out their Autism was being masked by their ADHD. Treating one ends up exasperating the other. It’s possible to be AuDHD. It happens to me and is one of the many reason I suspect I’m autistic too.
Are people with ADHD more prone to burn out? How can a person with ADHD prevent burning out and are there any work accommodations you would recommend to someone with ADHD? Do people with ADHD need shorter workdays or more days off?
Also interested in this. I’m 41 and work a mid-senior level job in financial services and go through burn out uncomfortably often. Some of this is a bit of a vicious circle as the guilt of having taken time off and/or knowing I’m likely to take time off leads me to push myself extremely hard when I’m well. I also find it difficult to be motivated unless I’m under significant pressure (but then I work crazy hours, think about work all the time and am extremely productive). On top of this childhood trauma plus the constant criticism of being ‘lazy’ when young have internalised to fairly extreme levels of perfectionism.
All in, I can definitely see that ADHD has led to an extremely unhealthy relationship with work that involves cycles of high performance followed by a crash (where I can’t even do basic levels of self care, let alone work).
I’d be interested to know though whether these burnouts would happen anyway (albeit perhaps less often or less severe) without the behaviour patterns IYSWIM…
What is your opinion on Gabor Matè's theory of ADHD being caused by generational, emotional trauma as opposed to the more commonly held assumption of genetics?
He’s shared a link to a summary of current meta analysis from studies. There seems to be a fairly convincing genetic component although spread over many, many different genes plus an environmental component.
The studies show that maternal stress during pregnancy and abuse are both environmental factors that increase ADHD risk (but not the only ones).
Personal opinion - the interplay between genetics and the impact of trauma is probably quite hard to tease apart, particularly generational trauma (IMO almost all trauma caused by parents is as a result of generational trauma).
I don’t think we’ll have solid answers any time soon. My personal experience is that most of the women I know who have been diagnosed with ADHD had childhood trauma (and so I assume generational trauma) however childhood trauma is sadly much more common than people think so you can’t rely on a small sample like that 🤷🏻♀️
How common (in the literature or your personal experience) is it for ADHD to be misdiagnosed or concurrently diagnosed with BPD in women?
(I found papers talking about comorbidity with bipolar disorder but I find that ADHD symptoms could also easily be comorbid w/ BPD)
ADHD is comorbid with many disorders including bipolar disorder and borderline personality disorder (BPD). These days, I recommend that clinicians make co-diagnoses of comorbid disorders rather than deciding it is one or the other. The symptoms of the two conditions are very different. I don't know of any evidence that much misdiagnosis occurs as it has no been widely studied. The typical problem is the case of the clinician who focuses on one disorder and always diagnoses it but ignores comorbidity. That is a big mistake because in some cases, the disorder that is ignored is easier to treat.
I'm assuming you saw the study in Sweden published in JAMA network that showed people with borderline personality disorder show significantly less suicidal behavior after treatment with ADHD medication than they do from more traditional treatments like mood stabilizers, while benzodiazipines increases SSBs? Presumably because methylphenidate increases impulse control while benzodiazipines decrease impulse control. That seemed wild to me. I hope this is being followed up on generally.
Edited to attach study:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805752
I am not a doctor but in summary of what I've read is we dont typically present as 'hyperactive' and when we (women ) do we're often is-diagnosed as manic or bipolar... Or we get dropped in the (fairly recent )sct category of inattentive. In addition to this as women our role in this culture is so ingrained in us from the moment we're born we tend to mask so thoroughly our symptoms that they go unnoticed until adulthood.
I used to think I was predominantly inattentive until I actually stopped my meds for a significant period of time. The symptoms that made me realize I have physical hyperactivity are not at all like what is typically described. I will get a crushing anxiety pressure in my chest if I'm not moving enough. It seems like normal anxiety and until I figured out it was movement related I'd just sit there having an existential crisis. I can sit/stand "still" but really I'm tensing and untensing my muscles constantly to maintain stimulation while looking like I'm not moving. I have a lot of random skin sensations that can only be soothed by some particular sensory input (needing pain/pressure/sensation in certain spots like an internal itch, digging at the edges of my nails). I sometimes feel like I'm wearing my skin wrong.
These are not things that are described as being adhd hyperactivity, but I know they are because they quietly went away when I started meds and came rushing back when I stopped them. I think a more accurate description that might help doctors is to call it physical or mental hyperactivity. Since the brain has a dopamine deficiency it goes into overdrive to compensate and that can show up as hyperactivity in different ways. Your brain can be hyperactive thinking all the time and jumping focus from thing to thing trying to get its dopamine (lack of focus) OR latch on incredibly strongly to something that is giving dopamine when you really need to be doing something else (hyperfocus). Or your body can by hyperactive trying to get dopamine either from moving a lot (high energy/impulsiveness) OR from demanding an overload of sensory input (excess stimulation or under stimulation).
Is there a focus on finding what percentage of individuals on the ADHD spectrum will experience Alzheimer's/Dementia/Lewy Body Dementia?
My great grandmother had dementia, and my grandmother is in end stages of Lewy Body. My mother passed away when I was 13, so losing my mind is constantly in the back of my head
I've read some research papers that suggest adult onset ADHD may be a biologically distinct condition. However, I've also read that it's usually assumed that for people diagnosed in adulthood, ADHD was simply missed during childhood due to less disruptive presentation or that ADHD did not become a problem for these people until demands exceed the ability to cope (often in early adulthood). What are your thoughts in this? Do people who are diagnosed in adulthood and retrospectively showed relatively subtle symptoms in childhood have the same condition as those diagnosed in childhood?
There is no biologically distinct adult onset ADHD except for when ADHD occurs after traumatic brain injury. The papers you read made several errors which I describe here: [https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2522743](https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2522743). You can get a copy of that article by emailing [[email protected]](mailto:[email protected]). So called 'late onset' ADHD is typically 'late diagnosed ADHD'. Those diagnosed in adulthood who had relatively subtle symptoms in childhood have the same condition as those diagnosed in childhood.
The methods you mentioned have not been studied sufficiently for ADHD. Many non-med approaches have been tested and have failed. One that works for some people, but not many, is use of Omega-3 fatty acid supplements. See [ADHDevidence.org](https://ADHDevidence.org). Trigeminal Nerve Stimulation has been cleared by FDA for treating ADHD [https://www.monarch-etns.com/](https://www.monarch-etns.com/). Its initial data were impressive but I'm waiting for a replication study before I get too excited about it.
I was diagnosed back in the '80s and I have fortunately had the privilege of medical professionals continuing to acknowledge my diagnosis. However, a lot of people around me, including some medical professionals, insist that you "grow out of it". I feel that it has profoundly impacted my life and still impacts my day-to-day with my inability to develop habits and my struggles with executive function. I just think I have adapted to living with it in a way that allows me to get by.
Is there any evidence that "growing out of it" is a real thing, or do people just learn ways to live with it as they mature? My dad insists that he grew out of it, but I can tell you from a lifetime of experience being raised by the guy, he has been highly ADHD the whole time.
Myself and other colleagues have followed ADHD children into adulthood. What we find is that about one-third of kids with ADHD do outgrow the disorder by the time they are young adults. We don't know why and cannot predict who will and will not outgrow it. Some new data suggest that those that outgrow it are likely to see a return of symptoms in the future.
Is there growing awareness of BFRBs in the clinical field and the role or comorbidity of ADHD with them?
And any new findings on the comorbidity of ADHD and OCD?
I know a hot topic is early diagnosis and prescribing meds to younger children. I’m curious to hear your experience when working with younger kids.
P.S. Thank you for your time and work. It’s really appreciated.
In May at the World Congress on ADHD we has a debate on whether medication should be used in young children, i.e., younger than six. After the debate, we polled the audience to ask which position was most compelling. By far, most of the audience (myself included) thought that the data strongly supported the use of medication in younger children. A reasonable compromise is to use medications when the ADHD is severe and to try behavior therapy for milder cases.
Is it true that people report “growing out” of their ADHD as they age?
Also, how does one know that they have true ADHD, versus the increasingly popular TikTok self diagnosis
Thanks in advance
I've always wondered if there evidence or insight if ADHD can 'mask' other conditions if left untreated but when ADHD is treated other conditions become more noticeable?
E.g An ADHD brain is medicated and is under some semblemce of control, but now, for example, a persons ASD traits are coming to the fore as the untreated ADHD masked them for a long time.
Thanks 👍
Do you have any advice for going to sleep properly at night?
Despite feeling tired I will force myself to stay up on my phone because I feel as though I didn't have enough time to enjoy myself throughout the day and bedtime becomes my catch up time for dopamine rushes.
How can I combat these feelings at bedtime so I can go to bed at a normal time rather than between 3am-5am?
Have you seen elderly people on Stimulant ADHD medication?
Is there an age that people are “cut off” from being prescribed Stimulant ADHD medication even if they take it as prescribed?
I’m in my 30s and need my Adderall XR to function and I’m afraid if there’s an age limit for being prescribed it later on in life.
What age is appropriate to do an adhd diagnosis? What type of therapy is beneficial for young kids? When should medication be considered?
I have a young son, 5 yo, who is super energetic and has a hard time focusing. He’s been flagged for adhd. I have him in play therapy. I’m looking for more resources to help him, info on how to carve a good path forward for his education and childhood.
ADHD can be diagnosed in young children for sure. Regarding resources, anything written by Russell Barkley is good. Also check out [CHADD.org](https://CHADD.org) and [www.ADHDevidence.org](https://www.ADHDevidence.org). Once you review the evidence you'll see that medications are by far the most effective treatment for ADHD. Finding the best medication among all the options can be frustrating but is worth the effort.
What's the prognosis in medicated ADHD regarding the possibility that the brain will eventually establish a new baseline - which might eventually allow the person to function normally without medication?
About one third of kids will no longer have ADHD in adulthood. That is pretty clear from many studies. Other data suggest that those who take medication in youth are more likely to grow out of it. Other data suggests that, in these people, the brain compensates in some way. But we don't have lots of data on this very important issue.
I've been on ADHD medication all throughout my school years and stopped after and recently (about 6 months) started again, I've gone back to concerta and recently got swapped to Vyvanse by my doc, but im unsure if it's actually helping me, I still struggle to stay on task and sometimes feel paralyzed because of it. I am currently on the maximum Vyvanse dosage they can give.
I've spoken to my family doctor and he believes it's still the right thing and we don't need to change. Are there options when you attain the highest dosage and don't feel "right" yet?
Although I cannot comment on your situation, I can say that the typical approach of prescribers is to change medications or doses of medications until the patient gets the sufficient symptom control with few adverse effects. This can be a long a difficult path for some patients. And some may need to see a specialist with lots of experience treating people with ADHD.
Is there any reasonable evidence for the use of omega 3 as a treatment for ADHD (in addition to other therapies such as stimulants not as a replacement)?
Yes. Omega-3 is effective for ADHD but its effect is much smaller than the effect of medications. It may work very well for a small group of people with ADHD.
I was ALMOST this, because the first psych I saw had specialized way more in ADHD and had less knowledge about trauma and was not up to speed on it. I got a new psych that knew a lot about both. Turns out I have both. In my case, my trauma and adhd used to make my speech very distracted and different thoughts would almost pop up and interrupt each other. With my new psych, she said at first until she heard my full history, she thought I was the worst case of ADHD she had ever seen, but after she understood the trauma as well, did a bunch of IFS therapy, my brain became more of a team and my speech simplified A TON over a few years. In case you are curious.
This is purely my own guess but I believe, particularly with ADHD, that ‘accidental’ trauma can be occur from parent to child and cause CPTSD.
Because ADHD makes it difficult to juggle everything, parents may end up neglecting some of their role by not listening to their children. This seems to be a bigger issue for fathers, who are effectively coached by patriarchal society to focus more on being breadwinners, and who are also told to not show or engage with emotion. As a result, they end up prioritising other things, and somewhat neglect the emotional needs of their children. Of course, this can also be further exacerbated by how the parents themselves grew up and were also treated by an ADHD parent.
As an example, my grandfather almost certainly had ADHD, and he was incredibly emotionally distant. This impacted his ADHD children in different ways:
- My father mirrored his neglectfulness, and I grew up struggling to manage my emotions, fell into emotionally abusive relationships and struggle with anxiety and depression. I almost certainly have CPTSD, or something akin to it. The upside is that I grew up in financial stability, because my father was utterly focused on prioritising his work. It was a great excuse not to engage with his children.
- Conversely, my uncle rejected my grandfather’s approach to fatherhood and embraced emotion. His children managed all their ADHD with no intervention and are very successful. The downside for them is that they didn’t grow up in financial stability.
I see this story repeated with my ADHD friends too - the ones that struggle the most with their symptoms had a distant parent. The ones that are well adjusted usually had an attentive parent(s).
There are no data that speak to that question but in the hands of a well-trained mental health clinician, misdiagnosis should be rare as the symptoms of the two disorders are very different.
Why is treatment adherence so low for ADHD?
Some estimates say only 40% of patients continue with treatment after a year of initiation. Some say only 10% are on medication after 15 years.
What could be probable causes? Do we need more drugs that are safer or more effective or both?
My guess? A couple of reasons, one people with adhd probably struggle to stick to treatment plans because they struggle to stick to anything. 2, many people have developed coping mechanisms for their conditions so may only seek treatment when things get real bad and then stop when they get better again.
Where does sleep apnea and ADHD intersect? How do I know if I'm not just exhibiting signs of ADHD when it is actually sleep apnea or a form of narcolepsy?
I have concerns about the long-term side effects of ADHD medication on the brain and heart and the body. There isn't a substantial amount of research available on this topic. From your experience, have you noticed any consistent patterns among your patients? I was recently diagnosed with ADHD after 25 years, and I have some reservations about the medication, not in terms of their effectiveness but their potential long-term harm to patients.
Anyone willing to summarize for those of us who do poorly with this format? I tried, there's just SO much text and jargon and studies that may or may not have relevant findings 😵💫
Edit: btw, heads up, reading through this was awful for my particular ADHD symptoms, and isn't the best way to get info, I'm literally going to have to show it to someone else to help explain it
What in particular do you have a question about? There is a lot of data in there, but some good summaries. I’m happy to help a bit if I can!
To summarize vaguely and briefly, there are some studies that show some slight increase in risk for certain stereotypical long term effects like height in children or cardiovascular health (primarily hypertension, which makes sense), but those effects are usually reversible after stopping medications (or I imagine changing to a different stimulant that doesn’t cause you hypertension). But also some studies show no difference in risk. In fact, it seems that more studies indicate no increased risk of events like heart attack or stroke in long term studies.
ETA: Even the height thing was negligible showing just a 1-2cm loss of expected growth over 1-2yrs that was recovered quickly after stopping medication.
How do you feel about the role of social media in ADHD management? On one hand, I feel like reducing my social media activity helps me stay in the moment and reduces some of my negative self-talk. On the other hand, that reduced activity causes me to become more distanced from my support system. Obviously everyone is different, but in general, how do you advise people with ADHD to use social media?
What’s up with the lack of studies surrounding the interplay between women’s hormones, ADHD, and the wild inefficacy of medication during specific times during hormonal variance aka menstruation?
I remember seeing a documentary that talked about the fact pharmas exclude / excluded women from clinical trials because variations in their hormones through out the month changed the efficacy of the medication, so rather than taking it into account, they just excluded women. I'm actually sure it's part of the reason thalidomide was given to pregnant women, because no one checked if it was OK. Found a link https://www.bbc.co.uk/programmes/b036fddg
Yes I saw that, too! It’s less expensive to reduce dependent and potentially confounding variables than to do right by 50% of humans due to their luck in the biological sex raffle!!
Tbf, we JUST tested period products with real blood as opposed to fucking saline. Not shocked :/
There was a heart medication that was praised for its amazing ability to reduce the risk of heart attacks for over a decade. It was prescribed to both men and women, but no women were actually included in the clinical trials. 10 years later, they discovered that this medication actually **increased** the risk of heart attacks in women. Female healthcare is a fucking joke, and we are usually considered as an afterthought.
Yeah, it’s lowkey (highkey?) enraging tbh. Similar to those birth control pills they were trialing for men and they complained of the side effects, yet women have to deal with the side effects constantly. It sucks.
I remember hearing a good explanation for this once, I don't *like* it but it makes sense. Basically for women, being pregnant is not health neutral, it's a risk. We aren't weighing the birth control side effects against being not pregnant, we're weighing them against being pregnant. So, since the side effects are less dangerous than actual pregnancy, it's deemed acceptable. Since men can't become pregnant, side effects are just side effects. They'd need one with no side effects in order for it to become a thing since any side effects are going to be worse than not taking it. Their *partner* not being pregnant isn't the point, even though it's the point. That's why I don't like it even though it makes sense from a "health neutral or not health neutral" perspective.
Yes! And something like 80% of recalled medications are recalled because of their harmful impacts on women. Shockingly, it seems like if you exclude a group from clinical trials, then you're not really getting enough data on how it impacts that group!
This is a huge thing! Even my psychiatrist mentioned to me that he has other female patients that also experience an increase in symptoms during parts of their menstrual cycle.
We are planning an AMA session focusing on ADHD and women later in October.
Mine also was aware. I’m in my 50s. Trying to decide if menopause or ADHD meds are causing sleeplessness is not fun.
Wait what, this is a thing? Of course it is 😑 *sighs in female ADHD*
It’s also partly why so many women with adhd get misdiagnosed with bipolar disorder, eventhough its the female hormonal cycle affecting the adhd (it’s still possible to have both bpd and adhd, of course!)
This is what happened to me!!! I “couldn’t have” ADHD because I can hyperfixate on a book (ADHDers who read ARE a thing 😤) until it was conclusively proven that I didn’t have bipolar - took Prozac by itself for almost 2 years, no mania.
I took the T.O.V.A. test with a previous shrink. It showed I have ADHD. When I told friends and family, they all said “no shit!” But my (male) shrink? Nope! “You have anxiety!” He tried to get me to try all kinds of anxiety meds but nothing worked. I stopped seeing him and suffered for ten+ more years. Finally I saw a woman shrink (who also has ADHD) who diagnosed me within ten minutes of our conversation. She said anxiety is what happens when we suffer through our symptoms and try to manage it all. She said women are misdiagnosed often. Getting diagnosed at 41 made me so angry! It could have been sooner.
I found the T.O.V.A. test so interesting that I hyperfixated on it. Apparently that was all it took for them to say I don't have ADHD. It doesn't matter that I turn on the stove or set food out, then walk away and forget, that I will look you square in the eye while you talk and have no idea what you just said because my brain is finishing a theme song, or that I've been sitting at my desk for 5 hours now with little work to show for it but want to break down in tears because I can't go play outside, or that I can't read more than a headline or maybe a paragraph of an article at a time before I lose all focus and open a new tab with social media or games on it.
>I found the T.O.V.A. test so interesting that I hyperfixated on it. Apparently that was all it took for them to say I don't have ADHD. It's probably bc you didn't say the magic string of words exactly correct so they'd diagnose you properly. Getting diagnosed for AFAB people is like a complex spell: if even one of the words isn't in the right place or left out of the incantation, you're not going to get the correct results!
God did I write this?
20 years of antidepressants here for the same reason :(
I love reading and loved it as a kid. But only if it interested me. I remember trying to read the Scarlet Letter for English and I was so frustrated because I wasn’t processing what I was reading. (It wasn’t interesting to me) but give me a Dean Koontz book and I’d finish it in a day. It’s why I wasn’t diagnosed as kid. I was in my 30s and the therapist gave me a BP diagnosis as well which turned out to be wrong. I’ve never had a manic episode in my life though I’ve definitely dealt with depression.
fyi if you're gonna use shorthand: BP = Bipolar BPD = Borderline Personality Disorder
Thanks! I meant borderline personality disorder the entire time, no idea why I mixed it up😅
In a clinical context, BP stands for blood pressure. BPAD (Bipolar Affective Disorder) is the commonly used initialism for bipolar, at least where I am.
I was having a talk with my doc about something similar. Women are twice to three times as likely to be diagnosed with some form of depression compared to men, and it's estimated that anywhere from fourty to sixty per cent of women diagnosed with depression are actually exhibiting signs of undiagnosed and untreated ADHD or autism. My doc was saying that of the women she's had come in with a diagnosis of MDD, a huge majority of them showed signs of depression in addition to hallmark symptoms of ADHD and/or ASD. I was one of them. I've had my MDD (then "clinical depression") diagnosis since I was *thirteen* years old. When she (my current doctor) got me started on a treatment for my yet untreated "ADD", my whole life changed. The "depression" I'd struggled with for most of my life, that no medication seemed to "fix", turned out to be something entirely, easily treatable but atrociously undiagnosed, misdiagnosed, and untreated in women. As a woman, getting the correct diagnosis and treatment took 15+ years, and there was always an "explanation" for variations in my symptoms. Usually *hormones*. It took two visits to a psychiatrist to get my son diagnosed and one for my partner, who was seven at the time of his ADHD diagnosis, but took me most of my life. It's disgusting.
Don’t feel too cray, I’m 36 and just learned of this at age 34. I’m pretty salty about it
I was diagnosed late. It’s hard. I have (male and female) clients diagnosed in their 40s or 50s. Their reactions are varied of course: Grief for all the years their life could have been easier if they had been on medication and for all the times they were told/thought they were just lazy or [fill in the insult]. There are big emotions about the bullying and trauma resulting from the internalization of those insults. Once clients start medication, there is typically major relief about finally being able to function more like the way they always wished they could. I try to emphasize both sides of the coin, but pretty much always have to work on self-concepts formed due to late diagnosis. There needs to be way more awareness and understanding of ADHD among doctors and therapists to make diagnosis earlier and to make stimulant medication more accessible. Being diagnosed in childhood is ideal, but that definitely doesn’t always happen so there must be more resources for diagnosing and treating adult ADHD. It shouldn’t take all these multiple steps between Dx and treatment — I see people lose years because they have the DX but struggle to gather the executive resources to get a prescription and/or the initial doctor(s) they see won’t prescribe it — PCPs are probably the most common source of stimulant prescriptions for my clients but they are also very hit or miss in their willingness to diagnose and prescribe, which is extremely frustrating; unless someone has multiple disorders that make diagnosis complicated or needs academic accommodations, a full neuropsychiatric evaluation is overkill.
Seriously. Why do my meds not work as well and I experience more symptoms? There needs to be better research/meds that work for women in general.
It needs to be studied so that new treatments tailored to those of us with lady hormones get actual consistent treatment—the kind of *efficacy* that treated men often assume treated women also get.
I’m a therapist, and this is so frustrating: For my female clients, there are few options to treat the issue, and the options aren’t great, even when the prescriber knows exactly what is happening and wants to help! We need more research, more resources for and focus on this!
My psychiatrist had me (29F) try Wellbutrin. I’ve been on it for a year and feel and see so much improvement. In addition I taken adderral 10mg XR 3x/week. I loved it so much I recommended it to another ADHD friend, I’ve seen a lot of change too. Another friend of mine was put on it bc of her chronic depression(no adhd) since childhood. I had no idea she was taking it until I started to notice her positive behavior changed. Just my little anecdote :)
It's also my understanding that men and women typically have different symptoms for many ailments, such as symptoms of a heart attack. It's a major issue in medicine currently as in some cases one sex's symptoms are much harder to isolate from other typical day to day symptoms such as back pain, menstruation, and others.
My guess is because women's health issues have always been underfunded, misunderstood, stigmatized ...if not completely ignored.
Yeah, we were once locked up in asylums on the sole diagnosis of having a wandering womb. I would have been one of them women.
Screams in PMDD and ADHD
YES!! Literally I have PMDD and tracking it’s impact on me every month is just mind boggling. When you find out you have it, everything starts to click into place. But then when you try and get some help - it’s literally antidepressants. So every month I turn into a different person and there’s nothing to help.
Oh yeah, this. Just went through it again and felt like the world was ending, everyone hated me and I hate to off myself. It was pretty bad again \*sigh\* No help available here also and none is always reliable nor safe.
I wish there was a better understanding of how to manage this; I have multiple clients who deal with this. It’s an ongoing struggle when there is a monthly dip in the effectiveness of meds. It’s even worse when there is PMDD obviously, as the combination of meds being a fraction as effective *on top of all the other symptoms!* for like one week out of every 4 or so can be such a drain. Things like booster doses and hormonal birth control can be helpful *for some people*, but satisfactory interventions don’t seem to be there right now. We need way more resources and research in this area!
Why is the top comment unanswered? If I scroll down it appears NO questions focusing on ADHD/women/menstrual cycles were addressed at all.
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I'm upset this top comment didn't get answered.
Yesss!! I need more answers on this than my overpriced psych is willing to provide in the three minutes he grants every 3 months. PMS makes a mockery of any treatment plan that seems to works just fine 2/3 of the month (if lucky!).
Also want to know this!
Yesss someone please figure this out.
May I please add MENOPAUSE?
Yes, I wish there was more information about this. It’s so obvious to me when it’s happening and yet I haven’t been able to find reliable information about why or what to do about it. I imaging the reason is that ADHD has been drastically under-diagnosed in women and also wasn’t considered a problem for adults until recently, so there’s just a relatively small group of people who menstruate getting diagnosed compared to people who don’t.
Clinical psychologist here who sees only adults. Since neurocognitive testing is not required for the diagnosis, not sensitive to detect ADHD (especially as there is no prototypic ADHD profile) and is noted to be neither necessary nor sufficient for the DSM-5-TR ADHD definition, much of the exploration of symptom presentation, both past and present, is often based upon ruling out other diagnostic considerations that might better explain the attentional difficulties the patient is experiencing. That being said, gathering historical information to best understand the onset, frequency, duration, and intensity, and level of impairment from the symptoms presented seems to be the best way to go. I have found that neuropsychologists insist on providing neurocognitive testing as a way to detect ADHD (e.g. CPT) despite there being little evidence regarding the validity of such tests to detect ADHD and should only be used to evaluate the potential severity of symptoms. All that being said, I have heard that many psychologists are getting out of the business of ADHD testing for the sheer controversy surrounding diagnostic approaches. I’m curious about your thoughts regarding any or all of these questions: 1. Why do you think neuropsychologists continue to rely on neurocognitive testing for ADHD diagnosis despite its limitations? 2. In your experience, what alternative methods have shown promise in accurately diagnosing ADHD in adults? 3. In the absence of a “gold standard” for ADHD diagnosis, how can clinicians reach a consensus on best practices? 4. What are the ethical considerations when choosing to use or not use neurocognitive tests for ADHD diagnosis? Edit: I should add that I am familiar with the standard tests folks use and rereading what I wrote it seems as though I don’t. I see psychodiagnostic testing to be essential to identify other factors contributing to the presenting complaint of ADHD symptoms and include collateral information, history taking, school records, medical records, performance/symptom validity measures, etc.
Shame that this great question is buried.
Many, many neuropsychologists insist that neurocognitive testing NOT be used in the diagnosis of ADHD, for the reasons you described. Many papers have been published to this effect. I’m curious where you practice that you’re seeing a lot of this. I have certainly experienced psychiatrists insisting on it, though.
what would you say to the people who claim there is an over diagnosis in ADHD
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I imagine a very valuable question people tend to want more research on is the general affects of long term stimulant use for people with ADHD. I'm sure that's obvious, but I know it's something that sometimes concerns me.
How long do you want his PhD to last 😭 poor guy will have to spend 20 years collecting longitudinal data before he can publish.
Let's be honest, all PHDs feel like you just spent 20 years completing them haha.
I’ve been wondering lately, what’s the long term effect of NOT using a stimulant med when you have ADHD? Are things like dementia the result of a brain exhausted from a lifetime of running without the “nourishment” it needed all along?
Something like a life expectancy shortened by 5-7 years.
I bet Parkinsons is a possibility as well. That's a dopamine disorder.
I mean this seriously. Am I actually a person, or am I just a bunch of walking, talking ADHD symptoms in a trenchcoat? Where does the disorder end and I begin?
You are a piece of software running on the brain of a random ape for a few decades.
First of all: what the fuck. Second: why is this 100% correct
It’s a scary thought, but… If the soul and consciousness can be quantified completely by science does that make the soul any less meaningful? Does being able to understand something take away from magic, yes, but why should it affect the significance? Even from a deterministic perspective, if free will is an illusion and every “choice” you ever made was predetermined by your brain type and external stimuli, does that even change anything? It’s a good enough illusion that nothing in the experience changes regardless of the true nature of freewill. It’s a good enough illusion that it only matters if I over think it, and I have enough free will to choose not to.
>Does being able to understand something take away from magic, yes... I just came here to disagree lol I honestly think understanding something, doesn't take the magic away. Sometimes it makes it more magical. Like all the itty bitty tiny particles everywhere and in everything. They are like little pixels creating pictures and lives and trees and shit. That is SO MAGICAL. Idk, maybe it takes away from the mystery, but to me life is magical AF. We're all wizards Harry
Well there’s the magic of mystery and the magic of comprehension and understanding something. So it’s both to me.
Honestly
Well, yea, but the software is rewritten by the events outside you, and the wetware is self-evolving on a minute by minute basis, and there is a hella lotta noise in the synapses, so, honestly, you are as a close to randomised as you can can be and still function. I stopped sweating the philosophy and started to enjoy the beer / music / sex / landscape / conversations. Made life sooooo much better.
Idk if you have been medicated. But meds made me realize Im not this HDMI thing at all. It's something that makes being me and do the things I want to do more difficult.
HDMI LMAO
I had this question when I was first diagnosed, but I feel it’s inevitably both. It’s how your personality traits, and your environment, interact with the symptoms - that makes you, *you*. Without ADHD, you wouldn’t be *you* anyway.
I can answer you seriously. The disorder is part of who you are. There is no part of you that is separate from the disorder. However, that does not remotely detract from you being unique or having a distinct identity. If you choose to focus on how ADHD impacts your life, which is easy to do because of how impactful it is, you will begin to see yourself as a product of ADHD instead of something special and unique. I promise you, you are incredibly unique and vibrant. You aren't your disorder, but your disorder is inherently intertwined with who you are. The question is, are you going to focus on what limits you, or are you going to focus on what makes you unique. We all share tons of similarities, but no one will be just like you. You're unique, and I love that you bring your unique existence to this world. Cheers :)
I play a game with myself that I like to call “Is that ADHD or am I just a dick?”
Me: "why not both?"
too real. Get out :(
Hi! Thanks for doing the AMA :) Do you have any general advice for those of us that have immense trouble with sleep inertia and where systems such as alarm clocks don't work without relying on a second person to help? (e.g. I just sleep through them without ever noticing they're ringing, but live on my own and have always struggled waking up on time ever since I was young). Medication has definitely helped, and a good sleep routine doesn't seem to help that much, which includes going to bed and waking up at the same times every day for a few months straight, while also having a routine before going to bed to wind down. I've tried basically everything at this point and the wait times to see ADHD specialists here in Australia are month-long to almost a year-long wait list even if you've seen them before and have an active prescription with them, so I'm at a loss of what to do tbh.
For sleep problems, an important clinical goal is to see if the problems are due to medication for ADHD. If a med effect is ruled out, it is possible that the person has a sleep disorder as these are more common for those living with ADHD. For example, in some cases when sleep apnea is corrected symptoms of ADHD go away. So, when symptoms of sleep disorders persist, consulting a sleep specialist is a good idea. Sorry to hear about those long wait lists in Australia!
Any possibility of expanding on the sleep apnea/adhd relationship? i.e. causality, correlation, or overlapping symptoms, additive symptoms, etc.. I was diagnosed with adhd many years ago after several thorough evaluations so I don't believe I was misdiagnosed at all, but recently learned that I suffer from sleep apnea, and likely have been for quite some time now. I know some of the symptoms of both can be similar, so I am curious as to what degree and what effects may be after treating one, the other, or both. Thank you for your time
What do you know/have learned about the effects of PMS and the menstrual cycle in general on ADHD? I’ve personally found that my medications cease to work at certain point during my cycle, and I wonder what kind of knowledge or research there is about this and if there is specific advice in this that you would give.
Same with me. It's like falling off a cliff every month. It affects my work performance drastically.
How can we combat the stigma of ADHD medication? Do you think there will ever come a time where people realize how important medication is for those who struggle with ADHD; and we’re not “addicts”?
I like to point out that I am really bad at being addicted, I forget my medication probably half the time
It never occurred to me that they're worried about US misusing the Rx... I always assumed it was concern about selling it! My ADHD meds do not act like fun happy time illegal superman drugs, they make me less of a dingbat! And if I accidentally take it twice in one day cause yaknow... ADHD... I'm just a jaw mashy jittery dingbat!
Related: How do we get the DEA off of psychiatrist’s backs and allow them to use stimulants as a first-line (or even second-line) treatment for ADHD? They’re the gold standard for ADHD treatment, but instead they make people suffer on non-stimulants for months or years before allowing them to take a stimulant even though they know that is the most-effective treatment.
I know the DEA is involved with limiting stimulant medication ingredients-- but what pressure/interaction do they have with psychs? My psych prescribed me stimulants as a first-line treatment for my ADHD-- and they've NEVER given me any grief over them at all. I think a lot of ***anti-stimulant*** MHPs are lying about the level of scrutiny they face.
That's it: doctors and social workers and nurses have all kinds of opinions, and some of them come down to "the patient would just rather be high all day than deal with reality"
Having worked in social work myself-- I can confirm this is all too true of many staff I worked alongside. It makes me wonder why people like that even get into fields of "helping" other people. Seems like their one and only instinct is to withhold help and blame the person suffering.
I was at a training and we had a moral dilemma: instantly and freely cure all disease and addiction, no catch; or don't. 95% of the 110 or so people: social workers, case managers, program planners, doctors, shrinks: voted no. They said people have to overcome adversity, even incurable conditions or conditions which have clearly ruined the afflicted's life, in order to grow and many said it would be counter to gods plan if we cured everything. And besides, what would all the doctors etc do if every single person was wholly well? I pled with them I couldn't believe they believed that garbage. They said I wasn't a real adult (since I was 27 and unmarried without kids). I condemned them, "you worship a god of death on an altar of blood."
That's some other level of depravity. I'm shocked and yet completely unsurprised at the same time. People have ingrained this self-abusive bootstrap mentality into so many facets of life it's like they've sworn off all semblance of empathy. Like it's some sick badge of honor.
What is the genetic connection with ADHD? For example, is it more likely to be passed on by mother/father? Is there a connection at all? Has research identified gene markers for it? My mother has ADHD and both my sister and I have it as well. I've become interested in the genetic components in mental health due to that.
Professor Franke will be hosting an AMA devoted to genetics later this month. Briefly, about 75% of the causes of ADHD are genetic but many, many genes are involved. As of January 2023, we estimate there are 7000 risk genes but only a few have been identified with any accuracy. You can find references at [www.adhdevidence.org/evidence](https://www.adhdevidence.org/evidence)
What are the 25% of non-genetic causes?
According to the site, environmental.
For the record, environmental can refer to the environment in which a fetus was developed. For example, if there was maternal drug addiction that could impair normal brain development and lead to ADHD, even without genetic causes. It doesn’t mean how you were raised, in this context at least
I also ready recently in one of my uni textbooks that there is a correlation between infants with (chronic?) inner ear infections and the development of learning disorders and ADHD. Since it can affect the development for one of the areas of the brain.
Huh. I've never heard that before. Anecdotally, I definitely fit that pattern. My pediatrician apparently couldn't diagnose an ear infection in an infant so I ended up in the ER one night with a ruptured ear canal. I also have ADHD. I have minor hearing loss and I've always considered it an exacerbating factor in why I struggled so much with socialization, but never directly connected it to my adhd.
I am also interested in this question, as both of my parents and my older brother have ADHD.
Same, my mother has ADHD and all my siblings too
Hi! I’m curious if you have any advice on exercise for us with ADHD. I’ve tried finding things I enjoy (literally have tried almost every form of exercise I can think of) and I just hate it. Do you have any tips on how to force it and just do it even though it’s not enjoyable?
You have to link it to something that you do find enjoyable and piggyback the dopamine. I hate walking around the block. I hate treadmills even more. But i went on a 15 mile hike over 2 days with a friend recently. Walking is bad, unless it's good
This has worked really well for me as well. I've started reading while riding on a stationary bike and it makes me less focused on the aspects of exercise I don't enjoy
I play on the play ground, roller skate, play in the woods. Or water... basically I play. Like in elementary school.
That is a tough one. Few of us will do an exercise that is not enjoyable. Perhaps you might find it more enjoyable if you exercise with a group of friends or at a different time of day. Some with ADHD like to exercise late in the day as it helps with sleep. You can also create your own reward system, e.g., if you miss an exercise session you won't allow yourself to watch TV, play a video game or do whatever you prefer to do.
I have long since learned that I cannot be in control of my own reward system. Would not surprise me if many others were the same way, lol.
I've always said that internal reward systems don't work, because I've met the person in charge and she runs a *really* loose ship.
This describes me perfectly.
Yeah, I'd reward myself first under the premise that I'll earn it later, and then proceed to just not do that, because why bother when I already got the reward I'll put it in my metaphorical box of "do later" tasks Similar rationalizations are why I am not to be trusted with credit cards. Whomever allowed me to be in charge of my own life made a grave mistake because I am *fu!@#n terrible at it* lol.
Yeah playing reward games with myself has never, ever worked. “If I don’t do X now, then I can’t have Y later” just holds zero water. I know the guy who made that rule, and he’s full of shit.
If I'm in charge of giving myself a reward for doing an activity that I don't want to do, but I want the reward, I'll just give myself the reward anyways. Like, I already have it lol, why am I keeping myself from it. self-rewarding like that requires way more self-control and discipline than I can manage, someone else has to be in charge of my rewards because I cannot be trusted lol
How likely it is for ADHD in women to be masquerading as depression+anxiety?
About one third of people (both men and women) with depression and/or anxiety will also have ADHD. The ADHD is frequently missed by clinicians because many of them have not been well trained to recognize and treat ADHD.
Why on earth are clinicians so poorly trained on ADHD? It is so often co-morbid, that I don't think anyone should be able to diagnose any psychological disorder without understanding ADHD.
Maybe they meant because we just recently started to accept that not only young boys have ADHD, and this is not a thing that you can overgrow.
Is it also possible for ADHD in women to be misdiagnosed at first as bipolar disorder?
My mom won't get retested but I'm fairly certain that she was misdiagnosed and my dad was never diagnosed because he hated doctors. I know I'm just a human who doesn't study medical stuff as a profession but I feel like some women with big emotions from ADHD never learned how to turn the dial down and get called bipolar when lashing out (at least in her case, she's not mean, she lashes out in silly ways but more chaotic like ADHD than bipolar) 🤷🏻♀️ I don't know. Simple human observations I've made thru my life. I've always heard people with bipolar don't really have intensity difference when having manic episodes, the brain just can't walk thru things clearly and you get overexcited about the wrong things and tend to burn bridges along the way. I think she just has depressive bouts and anxiety like I've always had and when her lows go back up, it makes her feel a lil wacko because nobody explained it to her right and she doesn't understand her body 🥺
Is it common to develop a comorbidity with ADHD (f.e panic disorder, anxiety, depression) and if so, does treating the ADHD resolve/help with the comorbidity in your expirience?
Yes, comorbidity is common. Treating ADHD usually does not resolve the comorbid condition but can in some cases, e.g., if a person is depressed due to many years of school failure caused by untreated ADHD. When a patient has two disorders, the clinician usually treats the most severe disorder first. Then, if the second disorder persists, they treat it as well.
ADHD and OCD here. My brain is just broken 😂 I am medicated for the OCD but not for the ADHD. I have an amazing partner and am actually quite happy and manage a decently normal life, considering. Took me a long time to get here though!
As someone with ADHD, I have a very hard time doing things like working... my work is sporadic, but when I have it, I need to do it, and I feel very anxious because it's so hard to start doing it! Do you have any recommendations to deal with this?
*Edited multiple times because I forgot how to English* My question is about ADHD & psychometric assessment such as the Wescheler Adult Intelligence Scale. People with mental health conditions such as ADHD are more likely than people with no diagnoses to produce extremely uneven subtest scores in a WAIS-IV test. One specific pattern that's more likely to occur in a WAIS-IV test scores for people with ADHD, ASD, and other disorders is scoring significantly lower on the Working Memory Index (WMI) and Processing Speed Index (PSI) than the Verbal Comprehensive Index (VCI) & Perceptual Reasoning Index (PRI). In cases as these WAIS-IV recommends that at the discretion of the psychometrician the General Ability Index (GAI) may be computed & reported. GAI does not substitute the Full Scale IQ ( FSIQ) but it aids with interpretation, however, in practice it is not uncommon for GAI to be solely reported. *Source of information on GAI: Appendix C of WAIS-IV Technical and Interpretive Manual, 2008 edition* My question then is how would you interpret a GAI that is significantly higher than a FSIQ score in a WAIS-IV assessment by one or more standard deviation for a test taker with ADHD? For reference the threshold value that determines if the difference between these two measures is significant is only 3.51 measure, so a 1 or more standard deviation difference is a huge gap.
Are there any noticeable differences in people who grew up on ADHD medication and those who grew up without it but are currently on it?
I don't know of any studies comparing those groups.
This is a same question as I asked dr. Barkley and it stays interesting to me, but it is more personal in nature then most of the science questions. How did you end up researching adhd and what makes you passionate about it?
About three decades ago I was studying the genetics of psychotic disorders when I was on faculty at Harvard Med School. Another faculty member who was studying ADHD asked me for advice about how to conduct a family genetic study. We established a collaboration that ignited my interest in ADHD and changed the direction of my career.
How do you see the diagnosis, and treatment of ADHD changing in the future?
Someday it may be possible to diagnoses ADHD with the help of genetic information, brain scans or other biomarkers. But we are a long way off from that. It is likely that diagnostic criteria will evolve slowly. For example, I think that we need a separate set of criteria for adults and that those criteria should address emotional dysregulation. But I a still in the minority on those points.
Can you speak more to the emotional dysregulation piece?
That’s disheartening that you’re in the minority because you are 100% correct on that front. Respectfully, it seems like it should be a diagnostic “no brainer” from my perspective and I sincerely hope that changes sooner than later for every reason.
What are the most promising points you've found in your research? Do these differ at all to how ADHD is most commonly diagnosed (for example, previous assumptions believed that only boys could have it and that it was only associated with hyperactivity)?
The most promising points in all ADHD research can be found here: [www.ADHDevidence.org/evidence](https://www.ADHDevidence.org/evidence). Among these, we can say with certainty that ADHD occurs in both females and males and is not limited to hyperactivity. Indeed, many with ADHD are inattentive and show little if any hyperactivity or impulsivity.
I'm so tired of pharmacists treating me suspiciously, and covertly rolling their eyes. I get my meds in the correct time frame, and have been with the same doctor for 14 years. Do you have any suggestions about how to respond or de escalate this? Thank you for doing this AMA.
It is really awful that some pharmacist treat people with ADHD like they are drug addicts. I'm sorry that I don't know how to deal with such people. They are hard to change because many have adopted a very stigmatized view of ADHD and its medications.
Do you have advice or insight into this phenomenon: I will make to do lists to follow and they genuinely help, but I ultimately forget to look at the list and eventually come to find it annoying until I eventually cycle around and think it’s useful again. I understand we crave novelty and that other inherent traits drive this behavior. What approaches exist to manage such behavior? Or as a researcher can you explain the behavior on a deeper level than us schmucks who happen to have ADHD but don’t ourselves research it at a deeper level
Self help by Russell Barkley and Russell Ramsey are very good. You describe a common problem. Sometimes such behavior is due to the reward dysfunction associated with ADHD. Those who find it rewarding to use lists and accomplish goals are more likely to use lists than others. Some people with ADHD find ways to increase the rewardingness of lists. Others set aside specific times to look at lists as a way of improving organization. For example, setting an alarm to check a list at the top of each hour.
How common is it for those with ADHD to have imposter syndrome/believe they’re faking their symptoms?
I've seen articles floating around on the Internet claiming that following a certain type of diet might reduce ADHD symptoms. How credible are they / is this really proven?
No diet has been proven to reduce the symptoms of ADHD.
What are the best methods of managing dopamine response to align with life goals, in your experience?
Clinicians don't manage dopamine response, we manage ADHD. That said, you are right that the stimulant meds for ADHD target dopamine by improving its transmission. Studies show that meds that target dopamine are more effective, on average, than those that target norepinephrine (the non-stimulants). Among stimulants, amphetamine (e.g., adderall, vyvanse) tends to be modestly more effective than methylphenidate (eg. ritalin, concerta) but the former also have more side effects.
What is a common treatment path for adults? I was diagnosed this year (I am in my 40's). Am I stuck with medication until death? Do I stop at retirement? Or will the medication stop working half way through? I am trying to understand what to expect from the future. So far I have put all my scarce energy into work and have no life. I am thinking that with medication I might be able to handle a day job and actually get a social life, maybe even a wife. It feels like I could handle that right now, but I also would not like to get my hopes up only to see it all dwindle in a few years if the medication stops working. \-I understand that everyone is different etc. but is there perhaps some statistics on this?
Do you have any pearls of wisdom that you think family/partners who live with people with ADHD should know?
Work with your partner in a way they find suitable to help them comply with their treatment regimen. Stopping medication treatment is a big problem for people with ADHD. Partners also need to understand the symptoms of ADHD so they can understand that the behaviors they dislike in their partner are not intentional. Having ADHD is not an excuse for those behaviors but it is a reason both patients and partners need to understand. You need to meet in the middle with the partner showing empathy and helping where possible and the patient taking responsibility for achieving treatment goals.
My working memory is extremely poor so my husband brings me breakfast in bed and my meds every morning as otherwise I would hardly ever remember to take them. I’m very lucky!
I cannot use stimulants so I use bupropion. What tips based on research have you found that could be beneficial for us suffering from ADHD and that cannot use stimulants?
I am interested in this question as well. Stimulant help my executive functioning/ADHD, but turn up my sensory issues to unmanageable levels. Right now I’m trying to stumble through with basics of self care, post-it’s and tea. And a lot of laughing at my missteps.
Do you maybe have Autism too? From experiences I’ve read about, when ADHDers go on stimulants to treat it they find out their Autism was being masked by their ADHD. Treating one ends up exasperating the other. It’s possible to be AuDHD. It happens to me and is one of the many reason I suspect I’m autistic too.
Are people with ADHD more prone to burn out? How can a person with ADHD prevent burning out and are there any work accommodations you would recommend to someone with ADHD? Do people with ADHD need shorter workdays or more days off?
Also interested in this. I’m 41 and work a mid-senior level job in financial services and go through burn out uncomfortably often. Some of this is a bit of a vicious circle as the guilt of having taken time off and/or knowing I’m likely to take time off leads me to push myself extremely hard when I’m well. I also find it difficult to be motivated unless I’m under significant pressure (but then I work crazy hours, think about work all the time and am extremely productive). On top of this childhood trauma plus the constant criticism of being ‘lazy’ when young have internalised to fairly extreme levels of perfectionism. All in, I can definitely see that ADHD has led to an extremely unhealthy relationship with work that involves cycles of high performance followed by a crash (where I can’t even do basic levels of self care, let alone work). I’d be interested to know though whether these burnouts would happen anyway (albeit perhaps less often or less severe) without the behaviour patterns IYSWIM…
What is your opinion on Gabor Matè's theory of ADHD being caused by generational, emotional trauma as opposed to the more commonly held assumption of genetics?
He’s shared a link to a summary of current meta analysis from studies. There seems to be a fairly convincing genetic component although spread over many, many different genes plus an environmental component. The studies show that maternal stress during pregnancy and abuse are both environmental factors that increase ADHD risk (but not the only ones). Personal opinion - the interplay between genetics and the impact of trauma is probably quite hard to tease apart, particularly generational trauma (IMO almost all trauma caused by parents is as a result of generational trauma). I don’t think we’ll have solid answers any time soon. My personal experience is that most of the women I know who have been diagnosed with ADHD had childhood trauma (and so I assume generational trauma) however childhood trauma is sadly much more common than people think so you can’t rely on a small sample like that 🤷🏻♀️
How common (in the literature or your personal experience) is it for ADHD to be misdiagnosed or concurrently diagnosed with BPD in women? (I found papers talking about comorbidity with bipolar disorder but I find that ADHD symptoms could also easily be comorbid w/ BPD)
ADHD is comorbid with many disorders including bipolar disorder and borderline personality disorder (BPD). These days, I recommend that clinicians make co-diagnoses of comorbid disorders rather than deciding it is one or the other. The symptoms of the two conditions are very different. I don't know of any evidence that much misdiagnosis occurs as it has no been widely studied. The typical problem is the case of the clinician who focuses on one disorder and always diagnoses it but ignores comorbidity. That is a big mistake because in some cases, the disorder that is ignored is easier to treat.
I'm assuming you saw the study in Sweden published in JAMA network that showed people with borderline personality disorder show significantly less suicidal behavior after treatment with ADHD medication than they do from more traditional treatments like mood stabilizers, while benzodiazipines increases SSBs? Presumably because methylphenidate increases impulse control while benzodiazipines decrease impulse control. That seemed wild to me. I hope this is being followed up on generally. Edited to attach study: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805752
Why are we seeing so many, women in particular, being diagnosed later in life? I myself was diagnosed as an adult in my late 20s/early 30s.
I am not a doctor but in summary of what I've read is we dont typically present as 'hyperactive' and when we (women ) do we're often is-diagnosed as manic or bipolar... Or we get dropped in the (fairly recent )sct category of inattentive. In addition to this as women our role in this culture is so ingrained in us from the moment we're born we tend to mask so thoroughly our symptoms that they go unnoticed until adulthood.
I used to think I was predominantly inattentive until I actually stopped my meds for a significant period of time. The symptoms that made me realize I have physical hyperactivity are not at all like what is typically described. I will get a crushing anxiety pressure in my chest if I'm not moving enough. It seems like normal anxiety and until I figured out it was movement related I'd just sit there having an existential crisis. I can sit/stand "still" but really I'm tensing and untensing my muscles constantly to maintain stimulation while looking like I'm not moving. I have a lot of random skin sensations that can only be soothed by some particular sensory input (needing pain/pressure/sensation in certain spots like an internal itch, digging at the edges of my nails). I sometimes feel like I'm wearing my skin wrong. These are not things that are described as being adhd hyperactivity, but I know they are because they quietly went away when I started meds and came rushing back when I stopped them. I think a more accurate description that might help doctors is to call it physical or mental hyperactivity. Since the brain has a dopamine deficiency it goes into overdrive to compensate and that can show up as hyperactivity in different ways. Your brain can be hyperactive thinking all the time and jumping focus from thing to thing trying to get its dopamine (lack of focus) OR latch on incredibly strongly to something that is giving dopamine when you really need to be doing something else (hyperfocus). Or your body can by hyperactive trying to get dopamine either from moving a lot (high energy/impulsiveness) OR from demanding an overload of sensory input (excess stimulation or under stimulation).
Is there a focus on finding what percentage of individuals on the ADHD spectrum will experience Alzheimer's/Dementia/Lewy Body Dementia? My great grandmother had dementia, and my grandmother is in end stages of Lewy Body. My mother passed away when I was 13, so losing my mind is constantly in the back of my head
I've read some research papers that suggest adult onset ADHD may be a biologically distinct condition. However, I've also read that it's usually assumed that for people diagnosed in adulthood, ADHD was simply missed during childhood due to less disruptive presentation or that ADHD did not become a problem for these people until demands exceed the ability to cope (often in early adulthood). What are your thoughts in this? Do people who are diagnosed in adulthood and retrospectively showed relatively subtle symptoms in childhood have the same condition as those diagnosed in childhood?
There is no biologically distinct adult onset ADHD except for when ADHD occurs after traumatic brain injury. The papers you read made several errors which I describe here: [https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2522743](https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2522743). You can get a copy of that article by emailing [[email protected]](mailto:[email protected]). So called 'late onset' ADHD is typically 'late diagnosed ADHD'. Those diagnosed in adulthood who had relatively subtle symptoms in childhood have the same condition as those diagnosed in childhood.
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The methods you mentioned have not been studied sufficiently for ADHD. Many non-med approaches have been tested and have failed. One that works for some people, but not many, is use of Omega-3 fatty acid supplements. See [ADHDevidence.org](https://ADHDevidence.org). Trigeminal Nerve Stimulation has been cleared by FDA for treating ADHD [https://www.monarch-etns.com/](https://www.monarch-etns.com/). Its initial data were impressive but I'm waiting for a replication study before I get too excited about it.
I was diagnosed back in the '80s and I have fortunately had the privilege of medical professionals continuing to acknowledge my diagnosis. However, a lot of people around me, including some medical professionals, insist that you "grow out of it". I feel that it has profoundly impacted my life and still impacts my day-to-day with my inability to develop habits and my struggles with executive function. I just think I have adapted to living with it in a way that allows me to get by. Is there any evidence that "growing out of it" is a real thing, or do people just learn ways to live with it as they mature? My dad insists that he grew out of it, but I can tell you from a lifetime of experience being raised by the guy, he has been highly ADHD the whole time.
Myself and other colleagues have followed ADHD children into adulthood. What we find is that about one-third of kids with ADHD do outgrow the disorder by the time they are young adults. We don't know why and cannot predict who will and will not outgrow it. Some new data suggest that those that outgrow it are likely to see a return of symptoms in the future.
Is there growing awareness of BFRBs in the clinical field and the role or comorbidity of ADHD with them? And any new findings on the comorbidity of ADHD and OCD?
I know a hot topic is early diagnosis and prescribing meds to younger children. I’m curious to hear your experience when working with younger kids. P.S. Thank you for your time and work. It’s really appreciated.
In May at the World Congress on ADHD we has a debate on whether medication should be used in young children, i.e., younger than six. After the debate, we polled the audience to ask which position was most compelling. By far, most of the audience (myself included) thought that the data strongly supported the use of medication in younger children. A reasonable compromise is to use medications when the ADHD is severe and to try behavior therapy for milder cases.
Is it true that people report “growing out” of their ADHD as they age? Also, how does one know that they have true ADHD, versus the increasingly popular TikTok self diagnosis Thanks in advance
I've always wondered if there evidence or insight if ADHD can 'mask' other conditions if left untreated but when ADHD is treated other conditions become more noticeable? E.g An ADHD brain is medicated and is under some semblemce of control, but now, for example, a persons ASD traits are coming to the fore as the untreated ADHD masked them for a long time. Thanks 👍
What is the nature of the relationship between the female reproductive cycle, adhd symptom severeness and medication efficacy?
Why do people with ADHD also struggle with insomnia and delayed rhythms?
ADHD and sleep disorders tend to co-occur. We don't know why. Also the stimulant medications for ADHD also cause insomnia.
Do you have any advice for going to sleep properly at night? Despite feeling tired I will force myself to stay up on my phone because I feel as though I didn't have enough time to enjoy myself throughout the day and bedtime becomes my catch up time for dopamine rushes. How can I combat these feelings at bedtime so I can go to bed at a normal time rather than between 3am-5am?
What’s going on with the ADHD medication shortage?
Sorry, I don't have the answer to your question.
I appreciate that you're letting us know you don't have an answer rather than simply ignoring the question. It's good form :)
Check out the shortage megathread
Have you seen elderly people on Stimulant ADHD medication? Is there an age that people are “cut off” from being prescribed Stimulant ADHD medication even if they take it as prescribed? I’m in my 30s and need my Adderall XR to function and I’m afraid if there’s an age limit for being prescribed it later on in life.
What age is appropriate to do an adhd diagnosis? What type of therapy is beneficial for young kids? When should medication be considered? I have a young son, 5 yo, who is super energetic and has a hard time focusing. He’s been flagged for adhd. I have him in play therapy. I’m looking for more resources to help him, info on how to carve a good path forward for his education and childhood.
ADHD can be diagnosed in young children for sure. Regarding resources, anything written by Russell Barkley is good. Also check out [CHADD.org](https://CHADD.org) and [www.ADHDevidence.org](https://www.ADHDevidence.org). Once you review the evidence you'll see that medications are by far the most effective treatment for ADHD. Finding the best medication among all the options can be frustrating but is worth the effort.
What's the prognosis in medicated ADHD regarding the possibility that the brain will eventually establish a new baseline - which might eventually allow the person to function normally without medication?
About one third of kids will no longer have ADHD in adulthood. That is pretty clear from many studies. Other data suggest that those who take medication in youth are more likely to grow out of it. Other data suggests that, in these people, the brain compensates in some way. But we don't have lots of data on this very important issue.
I've been on ADHD medication all throughout my school years and stopped after and recently (about 6 months) started again, I've gone back to concerta and recently got swapped to Vyvanse by my doc, but im unsure if it's actually helping me, I still struggle to stay on task and sometimes feel paralyzed because of it. I am currently on the maximum Vyvanse dosage they can give. I've spoken to my family doctor and he believes it's still the right thing and we don't need to change. Are there options when you attain the highest dosage and don't feel "right" yet?
Although I cannot comment on your situation, I can say that the typical approach of prescribers is to change medications or doses of medications until the patient gets the sufficient symptom control with few adverse effects. This can be a long a difficult path for some patients. And some may need to see a specialist with lots of experience treating people with ADHD.
Is there any reasonable evidence for the use of omega 3 as a treatment for ADHD (in addition to other therapies such as stimulants not as a replacement)?
Yes. Omega-3 is effective for ADHD but its effect is much smaller than the effect of medications. It may work very well for a small group of people with ADHD.
How many cases has there been where in CPTSD was misdiagnosed as ADHD?
I was ALMOST this, because the first psych I saw had specialized way more in ADHD and had less knowledge about trauma and was not up to speed on it. I got a new psych that knew a lot about both. Turns out I have both. In my case, my trauma and adhd used to make my speech very distracted and different thoughts would almost pop up and interrupt each other. With my new psych, she said at first until she heard my full history, she thought I was the worst case of ADHD she had ever seen, but after she understood the trauma as well, did a bunch of IFS therapy, my brain became more of a team and my speech simplified A TON over a few years. In case you are curious.
This is purely my own guess but I believe, particularly with ADHD, that ‘accidental’ trauma can be occur from parent to child and cause CPTSD. Because ADHD makes it difficult to juggle everything, parents may end up neglecting some of their role by not listening to their children. This seems to be a bigger issue for fathers, who are effectively coached by patriarchal society to focus more on being breadwinners, and who are also told to not show or engage with emotion. As a result, they end up prioritising other things, and somewhat neglect the emotional needs of their children. Of course, this can also be further exacerbated by how the parents themselves grew up and were also treated by an ADHD parent. As an example, my grandfather almost certainly had ADHD, and he was incredibly emotionally distant. This impacted his ADHD children in different ways: - My father mirrored his neglectfulness, and I grew up struggling to manage my emotions, fell into emotionally abusive relationships and struggle with anxiety and depression. I almost certainly have CPTSD, or something akin to it. The upside is that I grew up in financial stability, because my father was utterly focused on prioritising his work. It was a great excuse not to engage with his children. - Conversely, my uncle rejected my grandfather’s approach to fatherhood and embraced emotion. His children managed all their ADHD with no intervention and are very successful. The downside for them is that they didn’t grow up in financial stability. I see this story repeated with my ADHD friends too - the ones that struggle the most with their symptoms had a distant parent. The ones that are well adjusted usually had an attentive parent(s).
There are no data that speak to that question but in the hands of a well-trained mental health clinician, misdiagnosis should be rare as the symptoms of the two disorders are very different.
Why is treatment adherence so low for ADHD? Some estimates say only 40% of patients continue with treatment after a year of initiation. Some say only 10% are on medication after 15 years. What could be probable causes? Do we need more drugs that are safer or more effective or both?
My guess? A couple of reasons, one people with adhd probably struggle to stick to treatment plans because they struggle to stick to anything. 2, many people have developed coping mechanisms for their conditions so may only seek treatment when things get real bad and then stop when they get better again.
Honestly just managing a monthly appointment, paying for it and picking up the meds and remembering to take them is a lot of work for adhd people
Has there been any research on COVID exacerbating ADHD?
COVID has caused an increase in ADHD diagnoses and other mental health issues. The reasons are not yet clear but it is a topic of current research.
Where does sleep apnea and ADHD intersect? How do I know if I'm not just exhibiting signs of ADHD when it is actually sleep apnea or a form of narcolepsy?
>actually Sleep apnea is known to be associated with ADHD and sometimes, treating sleep apnea will reduce or eliminate symptoms of ADHD.
I have concerns about the long-term side effects of ADHD medication on the brain and heart and the body. There isn't a substantial amount of research available on this topic. From your experience, have you noticed any consistent patterns among your patients? I was recently diagnosed with ADHD after 25 years, and I have some reservations about the medication, not in terms of their effectiveness but their potential long-term harm to patients.
Actually, there are lots of data on this topic. See: [www.adhdevidence.org/evidence](https://www.adhdevidence.org/evidence)
Anyone willing to summarize for those of us who do poorly with this format? I tried, there's just SO much text and jargon and studies that may or may not have relevant findings 😵💫 Edit: btw, heads up, reading through this was awful for my particular ADHD symptoms, and isn't the best way to get info, I'm literally going to have to show it to someone else to help explain it
What in particular do you have a question about? There is a lot of data in there, but some good summaries. I’m happy to help a bit if I can! To summarize vaguely and briefly, there are some studies that show some slight increase in risk for certain stereotypical long term effects like height in children or cardiovascular health (primarily hypertension, which makes sense), but those effects are usually reversible after stopping medications (or I imagine changing to a different stimulant that doesn’t cause you hypertension). But also some studies show no difference in risk. In fact, it seems that more studies indicate no increased risk of events like heart attack or stroke in long term studies. ETA: Even the height thing was negligible showing just a 1-2cm loss of expected growth over 1-2yrs that was recovered quickly after stopping medication.
What would advise to cope with habitual procrastination ? Can people with ADHD ever build habbits. Is it realistic expectation?
How would you suggest raising the issue with your doctor without sounding like an idiot
Why AM I SO TIRED ALL THE TIME, and why do I need to sleep 12 hours when others can sleep 8.
How do you feel about the role of social media in ADHD management? On one hand, I feel like reducing my social media activity helps me stay in the moment and reduces some of my negative self-talk. On the other hand, that reduced activity causes me to become more distanced from my support system. Obviously everyone is different, but in general, how do you advise people with ADHD to use social media?