What is adult ADHD and how to treat it – The Conversation Weekly podcast transcript


This is a transcript of The Conversation Weekly podcast episode: Adult ADHD: What it is, how to treat it and why medicine ignored it for so long, published on May 12, 2022.

NOTE: Transcripts may contain errors. Please check the corresponding audio before quoting in print.

Dan: Hello and welcome to The Conversation Weekly.

Mend Mariwany: This week, we’re exploring ADHD in adults, what it is and why it’s been under-diagnosed in the past.

Tamara: So often people with ADHD develop secondary anxiety and depressive disorders, and those are the things that frequently get identified, but it doesn’t fix it because the underlying issue is ADHD.

Dan: And we find out how it’s diagnosed today and what therapies can help support adults with ADHD.

Laura: So I often say metaphorically, meds sort of treat the disorder from the inside out; therapy, I think really is treating the disorder from the outside in.

Dan: I’m Dan Merino in San Francisco. And today I’m joined by Mend, our wonderful producer who’s usually sitting behind the scenes.

Mend: Hello. I’m Mend Mariwany in Mexico City and you’re listening to The Conversation Weekly, the world explained by experts.

Dan: ADHD stands for attention deficit hyperactive disorder. It’s a neurological condition that affects children and adults alike. And Mend, you actually have ADHD, right?

Mend: Yes, I do have ADHD.

Dan: And how long have you known about it?

Mend: Well, I’ve known this pretty much all of my life, but it’s only within the last five years that I was able to get an official medical diagnosis and you know what, it was surprisingly difficult to get diagnosed.

Dan: Why was it so hard for you to get diagnosed?

Mend: Well, I grew up in Germany and when I went to school in the late 1990s and the early 2000s my teachers and child psychologists really just thought I was a rowdy boy.

Dan: That’s very interesting given that ADHD has been a subject of study for a very long time.

Laura: It’s been more than 200 years ago in the literature that a condition like ADHD was described, mostly in children at first and kids who had difficulty with hyperactivity, but also basically with self-regulation.

So my name is Laura Knouse and I am an associate professor of psychology at the University of Richmond. My area of both research and clinical expertise is in attention deficit hyperactivity disorder, specifically in adults. And as a clinical psychologist by training, the main things that I’m interested in within ADHD are behavioural treatments or specific forms of therapy for adults with ADHD.

Dan: Back when clinicians were first studying it, they had a very different idea of what ADHD was.

Laura: It was a person in Germany, Melchior Adam Weikard, who first described this.

Dan: Some of the earliest descriptions of attention disorders are from 1775. A German physician, Melchior Adam Weikard, published some observations in a textbook. He was describing some children who showed signs of being inattentive. And in his words were “unwary and careless”.

Laura: And then you saw it appearing again in the child clinical literature. So it used to be known as hyperkinetic reaction of childhood, minimal brain dysfunction and then of course, ADD – attention deficit disorder – and now ADHD, which often get used interchangeably.

Dan: How was ADHD historically viewed? What was the perception of people who had it or were suffering from it?

Laura: So I think that the perception there leading up and through the 1990s even was that the prototypical person with ADHD was a child. And usually a boy. And usually the most defining feature was the hyperactive and disruptive behaviour and seeing that as the core of the disorder. And then in the 1980s, some folks doing work to define ADHD, more brought up this idea of the inattentive piece of the disorder, being a really important part of how we describe and understand ADHD.

And around that time in the 1980s, into the 1990s, the idea that ADHD is not just a childhood-limited condition really started to gain momentum and gain traction. It was sort of assumed for many years that yes, maybe there’s some people that continue to have symptoms into adulthood, but really most kids are going to grow out of this. It’s a time-limited problem.

Dan: The Diagnostic and Statistical Manual of Mental Disorders, or the DSM, is basically the definitive guide on mental disorders for healthcare professionals in the US and much of the world. Since the 1980s, it’s provided clinicians with diagnostic criteria for ADHD, but it wasn’t until 2013 that it updated its definition of ADHD to include adult ADHD.

Laura: I think the issue there was because we were defining the disorder in terms of what it looks like in children, we missed what the disorder actually looks like in adulthood and it looks a little bit different, you know?

Dan: So we’ve heard from Laura about how ADHD was viewed historically. And we’re going to hear more from her a little bit later, but first let’s dive into what ADHD actually is – both in the brain, as well as how it manifests in the symptoms – in children, as well as in adults.

Tamara: Basically for people who have this condition, the brain sort of develops differently and it affects the way our executive functions work. So executive functions are things like how we pay attention, how we moderate ourselves, how we plan and organise, time management, how we switch attention. So they have some difficulties doing these kinds of activities.

I’m Dr. Tamara May. So, I work as a psychologist in Melbourne, Victoria, Australia, and I also work as a senior research fellow at Monash University in Victoria. I mostly work with adults with attention deficit hyperactivity disorder, or ADHD.

Dan: Tamara explained to me that clinicians today distinguish between three sub-types of ADHD. The first sub-type is one where inattention or attention deficit is the dominant trait and hyperactivity is much less pronounced or even not there at all.

Tamara: So those with the inattentive presentation, a lot of it, you can’t actually see in observable kinds of behaviours. So it might be them reading a book and they read the first sentence and they read the first paragraph and they don’t take any of it in. The brain gets distracted, focuses on other things and can’t take in that information.

So a child or a young person reading, you’re not going to notice that happening, it’s an internal process. The inattentive symptoms are not always obvious in that regard. So they include things like forgetting, issues with time management, being late all the time. In childhood and adolescence, if you think about it at school and with parents, a lot of scaffolding happens. So parents are reminding us “Alright, have you remembered your lunchbox today?” So if a kid is in a really supportive environment, you might not notice the depth of their difficulties within attention.

Dan: What’s the second sub-type of ADHD?

Tamara: Yeah. Yeah. So the other stuff is hyperactivity, impulsivity. And so someone can have just only the hyperactive, impulsive presentation where they’re not necessarily inattentive, but they’re overly active, talkative, they butt in on things and they’re impulsive. So they act without always thinking things through, you know, that short-term kind of reward over the long-term.

So the hyperactive impulsive symptoms can be a little bit more obvious. You know, the kid climbing all over things, can’t sit still, standing up all the time, just moving about. You see that as a teacher or a parent, and it gets in the way a bit because: “No, Johnny, we’re eating dinner now – sit down!” Or at school, you know? “OK. We need to sit and do this work, you can’t stand up and be walking around the class.” And the third presentation is the combined type where you have both inattentive and the hyperactive impulsive symptoms.

Dan: Do you see any gender differences in how ADHD presents?

Tamara: Yeah and this is still an emerging area, I guess. Boys are more frequently affected in childhood. So the gender ratios in childhood and adolescence are like maybe three boys to everyone one girl.

Dan: Oh, wow! That’s pretty significant.

Tamara: As is the case for all the neurodevelopmental disorders like autism, etc. So boys are more frequently affected. But in adulthood, the interesting thing with ADHD is that studies suggest it’s more like 1:1. So we think some of that is due to hyperactivity symptoms reducing a bit or people at least finding ways to compensate for them.

Dan: Oh, interesting.

Tamara: Yeah. Rather than being like, you know, up in your chair, all over the place, moving around, as an adult that might just become, you know, tapping your foot or tapping your pen. And it’s an inner sense of restlessness rather than outwardly expressed. So that might mean though that you might not meet the strict criteria that the studies use to assess prevalence and such.

Dan: So, you might’ve been above the threshold as a child, but then you come down and below the threshold as you age or something.

Tamara: Yeah, Exactly. So, we think it’s probably due to those hyperactivity symptoms reducing a bit in boys. But also, I think girls are more likely to have the inattentive subtype, and that’s harder to detect. So I think they just get detected late. So it kind of balances out back to 1:1 in adulthood.

The ADHD symptoms themselves are not technically different. We still have exactly the same criteria, they apply equally well, but then we’ve got all that gender stereotypes and the socio-cultural impacts, which it’s OK for boys to be active, because they’re boys. But girls have to sit nicely and be quiet and stuff like that.

Mend: We’re taking a quick pause here to ask you a little favour. We want to know what you think about our podcast. The Conversation Weekly launched in February, 2021. And this is our 65th episode. We hope if you’re a regular listener, you’ve learned something along the way.

Dan: Whether you listen every week or if this is your first ever episode, we’d love to hear what you have to say about the show. Think it’s good? Think it’s bad? Any comments, critiques, anything. We’re doing a short listener survey and we’ve got a link to it in the show notes. It shouldn’t take you more than about five minutes.

Mend: Thank you and now back to the episode.

Dan: You specialise in adult ADHD. So let’s define what adult ADHD is first of all. Is adult ADHD, adult onset ADHD? Or just ADHD that is diagnosed when someone is an adult?

Tamara: Yeah, it’s more the latter. ADHD is a neuro-developmental disorder, which means that changes are happening during that childhood, adolescent period to the brain.

Dan: During the developmental period….

Tamara: Yeah, exactly. During the developmental period. So there is some controversy in this area because there are some people as adults who we can’t find any sort of ADHD type symptoms in their childhood and adolescence, but it’s the minority, it’s a tiny amount I would say. Most of the folks just didn’t get identified in childhood and adolescence for a whole range of different reasons. And so the ADHD is only picked up once they’re in adulthood, but they’ve always had it.

Dan: What does it look like for someone who has ADHD as an adult?

Tamara: Just talking to someone, obviously, you can’t always tell that it’s not easy to detect, but if they have those hyperactive symptoms, they might talk quite quickly. You might see that they quickly jump from topic to topic as the idea pops into their mind. They might interrupt you because they want to quickly get out what’s in their mind because they’re worried they’re going to forget it. And it might be difficult to follow their rabbit trails or, you know, as they’re jumping all over the place with their ideas.

Dan: And time management, is this a thing that happens a lot?

Tamara: Absolutely. So it’s part of that attention, you know, when we don’t have ADHD, we’re thinking about the future. We’re thinking about the things we’ve got going on. We’re self monitoring and checking and folks with ADHD don’t have that function sort of going on. So they might put something in their diary for tomorrow, an appointment, but when tomorrow comes, they’re not doing that checking, “what have I got on today?” and it doesn’t kind of get stuck in their mind, so they could just as easily forget that, even though they got a reminder for it yesterday.

Dan: What are some other kinds of classic adult ADHD symptoms?

Tamara: So forgetfulness is one of the other classic ones. You know, keys, wallets, phones etc., and resulting in lots of time spent looking for things. And again, beating yourself up, forgetting things, you know, locking your keys in your car, those kinds of classic sort of forgetfulness symptoms.

Read more: ADHD looks different in adults. Here are 4 signs to watch for

When they sit down to do a task or, I’m going to do the dishes, they might realise they have to get a tea towel from the cupboard in the other room and they’ll go to the other room and then they’ll get distracted by something in the other room and the dishes never get done. So that kind of distraction. And then the procrastination is a huge issue for folks. “Right, I’ve really got to do this piece of work or I’ve got to do the dishes.” But it’s unpleasant and there’s nothing … it’s going to be hard, it’s going to hurt my brain to do it. And so I really don’t want to do that.

So next minute, they’re on their phone. They’re just scrolling through, you know, socials or whatever. And you get little dopamine hits from doing that, but doing the dishes you probably don’t. So a lot of life activities can get neglected, huge impacts on study, of course.

Dan: But this sounds like stuff that everyone goes through to a certain extent. How do you differentiate between the normal trials and travails of being a human with a forgetful brain and we all make mistakes and etc, etc, where do you separate that from clinical ADHD?

Tamara: I mean, that’s a really good question. And often when people with ADHD tell others that they have ADHD, they’ll be told, oh, I’ve got, you know, everyone’s forgetful like that. Of course. And it’s really the severity of symptoms and that, you know, all of these symptoms are occurring together. So it’s not just forgetfulness. With the inattentive symptoms it has to be being distracted, not being able to focus on what you want to do, not being able to sustain your attention. That happens in all aspects of your life and has a significant impact. It means that you really underachieved academically at school, you had to drop out. It means that your interpersonal relationships are impacted, you can’t maintain friendships. You’re heavily relying on a partner to do all your organising, etc. So it’s that severity of the functional impairment.

Dan: What triggers someone to come in and say: “I think I have adult ADHD”. Is that something that really happens?

Tamara: Yeah. Well, what seems to happen is a lot of folks into secondary school or high school or whatever country you’re from and how you term that, the demands get greater and greater for becoming more independent and doing independent study. So, by the time you get to the late years of high school, you need to actually do independent homework and you need to work on assessments and assignments and things by yourself. And that’s when difficulty starts to appear.

Often what happens though is, those ADHD symptoms of inattention still might not be picked up and the people start to wonder why they can’t get their study done. They’re sitting down, they’re trying to do their assessment, but they can’t. And they start to internalise a lot of that, get really anxious about the work and start to feel really bad about themselves. And so that can result in secondary anxiety and depressive disorders. And those are the things that frequently get identified and that’s what they get treatment for.

And they’ll get the standard treatment for anxiety and depression, you know, your cognitive behaviour therapy or whatever it is, but it doesn’t fix it because the underlying issue is ADHD. So they’ll continue to seek services potentially in adulthood. And then often people are just reading something or there’s a lot of social media and stuff now about ADHD and they’ll see something and they’ll connect with that. And then finally, they might get a diagnosis.

Dan: So it talks about, as you mentioned, all these executive functions, that’s what it presents as. What is our current understanding of actually what’s happening, neurologically speaking?

Tamara: So there’s been a lot of studies of the brain trying to work out, you know, are there structural differences? Are they functional differences and are there differences in neuro-transmitters? And the evidence suggests that there are differences in the brains of people with ADHD compared to those without. And some of these are structurally related so that the frontal cortex and related functions are slightly different in people with ADHD. Some of them are functional. So when our brains are working, the brains of people with ADHD might not light up or activate in particular areas, relative to people without ADHD. And also in neurotransmitters. So there’s a reduced amount of dopamine available in the brain of people with ADHD, which means they’re kind of seeking things to increase that amount of dopamine. And so that relates more to some of those hyperactivity impulsivity symptoms.

Dan: Interesting …

Tamara: Yeah, so people with ADHD can be seeking short-term sort of rewards and not thinking about those longer term consequences.

Dan: I know there’s a lot of genetic components. How has that kind of understanding evolved recently? How much genetic component is at play here?

Tamara: Yeah look, it’s pretty high. It’s towards 80% hereditary, so due to genetic factors. There are some small sort of environmental influences. So things that might relate to pregnancy and birth – things like very low birth weight, very early birth. So those factors are risk factors for ADHD. But the vast majority is these genetic influences. So ADHD runs in families and often almost always when we’re seeing folks with ADHD, we can link to other family members who also have ADHD.

Dan: It sounds like ADHD can be a real struggle in many cases. Did any of what Tamara talked about resonate with you, Mend as someone who has ADHD?

Mend: Oh yeah. It made me think it would have been so much easier navigating school as a young person with teachers, just being more conscious of ADHD.

Dan: It sounds like having an environment that was supportive, might’ve been really helpful. And this is something that Laura Knouse was keen to emphasise.

Laura: This is such an important thing I think to understand about ADHD, or any disorder, is that when people experience a condition or disorder like ADHD, it’s always an interaction between their behaviour and the nature of the environment that they’re in. The environment has a huge role to play, in terms of the extent to which people’s symptoms are actually causing problems. Like for example, you could think of a person with two different types of jobs, right? Like I am an accountant and I sit at a desk and I do desk-oriented work versus something like a ski instructor and those two people could have the very same level of ADHD symptoms – they’re going to experience more impairment.

Dan: Sure.

Laura: So that’s something that I think is really important. A disorder is always an interaction between symptoms and the environment.

Dan: So how many adults are dealing with ADHD in some way, shape or form at this point?

Laura: The best estimates we have come from some big studies, some in the US and some world wide. So approximately 3.55% to 4.5% people in the population will meet criteria for ADHD when you’re using all of the criteria for ADHD. So the symptoms, the onset, and before age 12 and the degree to which somebody is impaired, because any disorder requires impairment, you know, to be a disorder. I think what you see though, is if you did a survey of people in the community and just ask, have you been diagnosed with ADHD? You would get a different number, because not all clinicians are using the same methods to diagnose the disorder.

Dan: How is ADHD diagnosed today? If someone walks into a practising clinician and says: “Hey, do I have ADHD?” What do you do? What does that process look like to check or diagnose that? Given access to care.

Laura: Yeah, so a lot of information gathering. So the clinician should do a really thorough history to try to get as much information, obviously about childhood and adolescent functioning as possible. If they can get records from back then, that’s great. If they can interview parents that’s even better, but really trying to establish the developmental trajectory of the disorder is really important.

They’re going to look a lot at what the areas of impairments are. So not just symptoms, but what are the problems that you’re having in your life in each area? And then we would maybe go to symptoms and say, are these symptoms the best explanation for these problems that I’m experiencing? And does ADHD seem like the most, the best explanation for what’s going on. And I guess my worry as both a clinician and a researcher is: that level of rigorous diagnosis is maybe not what’s happening or what’s available to folks out in the community. Yeah. So that’s the thing where my field needs to do a lot better, I think, in terms of evidence-based assessments.

Dan: Do you see any disparities in who gets diagnosed in the US, at least?

Laura: I think there’s good evidence that in some demographic groups and populations, the rate of diagnosis is higher than the rate of prevalence. If you look at upper-class white areas, probably you’re going to see a much higher rate of diagnosis, but on the other hand, in lower-income populations. Specifically in Hispanic and Latinx populations and Black African-American populations, there’s good evidence that they’re underdiagnosed and undertreated. I think it’s really important to realise the effect of those disparities on who gets diagnosed and who gets treated.

Dan: OK. I want to move on to treatments now. So, drugs. What kind of drugs are available to someone who’s got ADHD?

Laura: Yeah. So back at the beginning of the last century, it was discovered by accident that stimulant medications can be useful for ADHD. This always happens in medicine and a lot in psychiatry, we just discover by accident that certain things are effective. And so medications in the stimulant class. So listeners will probably be familiar with things like Adderall and Ritalin really pretty early on we’re one of the first line treatments for the disorder and remain so today in terms of effectiveness. In fact, of all the kinds of psychiatric drugs that we have, they’re some of the most effective for a given condition which is good news. They’re not perfect, but they are definitely an important tool in the toolbox.

Read more: ADHD in adults is challenging but highly treatable – a clinical psychologist explains

If side-effects are going to show up, they’re going to show up right away, usually, and get a little bit better over time, potentially as your body gets used to them. You’re looking at depressed appetite, difficulty sleeping. If you’re taking it too late in the day, there can be weight loss related to the appetite, but also their stimulant medications, meaning that they’re stimulating particular parts of the brain in terms of increasing certain neurotransmitter chemicals in the brain. But they also are stimulants in the sense that they’re going to raise heart rates slightly. And so if a person has a cardiac issue, that might be a reason that those medications are counter-indicated.

So then if a stimulant doesn’t work or is ineffective or can’t be used, there’s another non-stimulant medication Atomoxetine, brand named Strattera. And basically, I would just say to back up all of these medications work somehow by elevating the availability of a particular group of neuro-transmitters. So it’s either going to be your dopamine or your norepinephrine.

Dan: So your research focuses on behavioural therapy for people with ADHD. Can you first explain what behavioural therapy is and what it means for someone to go through behavioural therapy?

Laura: I would love to. This is in my wheelhouse and something I’m very passionate about. What’s interesting was that as adult ADHD became a thing that people recognised, a couple of studies came out that showed that adults with ADHD, when they went to traditional therapy, like just, we would say supportive therapy where you know there aren’t specific goals, it’s just come in and talk about your problems and, you know, maybe we’ll work on them. There was a really influential paper that showed that these folks were not doing well in their traditional therapy. And it’s because the ADHD was getting in the way – they would be late for appointments, they would miss their appointments. And then the therapist, if the therapist didn’t recognise the ADHD, they might have been making assumptions about patient X’s resistance to treatment. It’s like: no, they just have ADHD.

Dan: Talk about getting in the way of social relationships.

Laura: Exactly. Therapeutic social relationships, for sure. So very early on, it was sort of recognised that like, if you have depression or anxiety or you have other life problems you want to work on, supportive therapy is not gonna hurt your ADHD, but it’s probably not going to be helpful for the ADHD itself.

Dan: And when we’re talking about therapy – are we talking about how to change your lifestyle, how to make habits … like that kind of thing?

Laura: That’s a really good question. I would say we’re mostly dealing with the second one, how to basically develop your systems and structure your life and structure your environment back to the whole environment thing and structure your social relationships too. Right? People around us are part of our environments. So that, basically to reduce the impact of the symptoms on your life. So I often, metaphorically, like meds sort of treat the disorder from the inside out, therapy I think really is treating the disorder from the outside in.

So, the kinds of approaches that look like they’re helpful for ADHD, at least according to the studies we have so far, really can fall under this umbrella of something we call cognitive behavioural therapy (CBT). I like to simplify that and just say a skills-based treatment, a treatment that’s going to help you figure out how to structure your environment, how to structure your time. What are the strategies that you’re going to need to make your goals real, even in the presence of having ADHD in your life? The cognitive behavioural label is saying that we’re going to look at how your thinking patterns, the way you look at the world, what your beliefs are about your own capabilities or your capacity to change, how that’s going to interact with the actual strategies you’re using and then how that’s going to interact with your emotional life.

Most CBTs for adult ADHD and the ones that have the most evidence so far that they’re effective, really start with the bedrock of organisation, time management and planning skills. The truth is that when you have ADHD symptoms, it’s harder to implement these things and stick with them. So the focus isn’t, “Oh, let’s just sit in the room and talk about theoretically, how we would do this.” We gotta get out there and try this. Like, we might have to try three different planner systems until we find the right one. And to get that person where using that skill is such a habit that they can’t remember what it was like not to use that skill.

And here’s the thing that I just want to really emphasise is I think sometimes my clients come in and they think, oh, if I didn’t have ADHD, I wouldn’t have to use these tricks to self-regulate. It’s like, no, the best self regulators are using so many tricks to make themselves do things they don’t want to do. Everybody, to reach their goals in life, needs to figure out how to hack their own brain in their own environment to get what they want.

Dan: So we talked about kind of time management skills. What are some of the other major skills you’re teaching in CBT?

Laura: So there’s that motivation, procrastination stuff. So taking everything and deploying it at this problem of procrastination. And that’s a lot about how you structure the task. So I would say to my students, like if you sit down and the item on your task list is to “write a history paper”. No one in the history of the world is ever going to sit down and be like “Yay, that’s a thing I want to do.” But using something called the Premack principle, which is where I’m going to do low-frequency non-preferred activity, and then allow myself to do the preferred activity. And the preferred activity doesn’t have to be like playing video games. Like literally it could be cleaning your room if that’s preferred to the thing you don’t want to do.

So if you can get, take little teeny tasks and just like alternate stuff you don’t want to do with stuff you do you want to do, again, like tricking yourself. And then this is another area I get jazzed about because I’ve been studying it for a little bit is the thought patterns, like how the way we think about, the assumptions we make about the future, the interpretations we make about this environment can change your motivation. And traditional therapy, CBT for depression and anxiety, of course, there’s a lot of focus on overly negative thinking, right?

A person who’s depressed when an event happens, they’re more likely to interpret that as here’s yet another example, it’s my fault. Why do I even try? We actually see in some of the research I’ve been involved with, adults with ADHD, even when they don’t meet criteria for depression and anxiety, do tend to have a little bit more of these patterns of negative thinking.

But what’s really interesting is when folks like myself started doing this work, we started noticing that adults with ADHD also tend to have what I would call overly positive or overly optimistic patterns of thinking that can get them into trouble. I made it one time through all of the Boston traffic in 20 minutes, you know, that sort of thing. And it’s a thing that I think every human probably recognises in themselves from time to time.

But the work that I’ve done so far, it’s really cool. Like we’ve with my colleagues, we created a questionnaire or rating scale to try to get at how often this is happening. It’s where on your cell phone, our participants, several times a day, get a text message and they fill out this little survey and the survey is: how are you feeling right at this moment? And then we measured, we said, how, what degree are you putting off doing something you’re supposed to be doing? And so it’s not published yet, but we basically have found that yeah, people with more ADHD symptoms are reporting more of these overly positive thoughts. When people are reporting these overly positive thoughts, they’re a little bit more likely to be avoiding something.

Dan: Are there new things coming down the pipeline, either behaviourally or pharmacologically that you’re excited about?

Laura: Yes. So I think on the pharmacological side, they’re going to continue to be more studies in adults of things that we know have worked for kids. So working out how to make medications last longer, how to make the side effect profiles better and that sort of thing. The other piece of work that I’m starting to do that I’m really excited about is I’ve been doing some work with an app company that is trying to pull in cognitive behavioural therapy principles and spin them into an app for people with ADHD. So there’s another way, like anything we can do to get those skills outside of the office visit and like into the actual environment. As I talked about earlier, there’s such disparity in terms of people’s ability to access these treatments. And while apps are not going to totally fix that, they’re going to really lower the barrier, I think.

Dan: Laura, thank you so much for sharing your time with us. It’s really been a pleasure.

Laura: Sure, you’re welcome!

Mend: I really appreciate that researchers like Laura are working to make new technologies and information more widely available. I think both people with ADHD and the people around them can benefit from that.

Dan: It’s also refreshing to hear Laura talk about how therapies are becoming more tailored to people with ADHD, because the needs seem to be really specific.

Mend: Absolutely. But you know, Dan, with all of this talk of ADHD as a condition that can cause difficulties. I also think it’s important to mention that there are lots of positive experiences that people with ADHD often associate with the condition.

Dan: And Mend, your input was very important on this episode and I actually got to ask Tamara about these kinds of benefits.

Tamara: I guess the research is only emerging in this space and there needs to be a lot more of it. And certainly we’re trying to focus all our efforts and interventions and so forth on a strengths-based sort of approach, but there’s so many strengths. Someone with ADHD can be, you know, if they have that hyperactivity, that bubbliness, they can be the life of the party. They can be just making all these connections between things. So they can be very fun to be around.

In working pursuits and so forth they can be very creative because the brain is always so busy and thinking so many thoughts, they can be great at things like risk management, because their brain will go down all the different paths of things that could potentially happen. So stuff like that, or coming up with ideas that other people haven’t thought of because they’re linking so many thoughts and ideas together at once. So there’s a lot of strengths there and it’s important that when we work with people with ADHD on how to help them, that we really focus on the things they’re good at.

Dan: Would you say that some people dislike it when they go on the drugs? And do they feel their personality change? Is that something that happens?

Tamara: Yeah, occasionally folks can feel that way, but for most people, the medication treatments, so stimulant medication is the frontline most effective treatment established through many large randomised controlled trials all across the world, showing that 70-odd% of people, children, adolescents, adults will have a really good response to the medication. And sometimes people will describe it as you know, tuning into a radio station in their mind. So before there’s all this business fuzziness, etc, and then taking the medication just helps them tune in and focus.

Dan: How has the social perception of ADHD changed? Are people being able to cope with ADHD or live with ADHD better, due to changes in the social perception of it?

Tamara: Yeah, I think it’s something that’s slowly changing and there’s certainly like a whole neurodiversity movement now. So we’re focusing more on what we would call neuro-affirming treatments that celebrate the differences of having a different brain and helping people with the things that they struggle with, but using a strengths-based approach. So sort of empowering the person to, you know, be in control of what help they want, etc. Rather than just imposing, right, you’ve got all these deficits, we need to fix all these deficits. Yeah. So there’s this huge change in the culture and that’s across other neuro-developmental disorders, particularly autism, as well.

It’s slowly filtering through to the general population and that’s still going to take time, but there’s just so much more awareness. So much more social media, just media generally about ADHD and how it affects adults. Because if we think about 20 or 30 years ago, the common belief by most people was that ADHD symptoms didn’t continue into adulthood. So now we’re really recognising, actually they don’t go away and they have significant impacts on folks. And if we can treat them, we can really help them with all of their outcomes.

Dan: Mend, as someone living with ADHD, have you ever been on any of these treatments or done any of these treatments?

Mend: Yeah, I did try medication as a child, but the side effects just put me off. But hearing Laura talk about new advancements in behavioural therapy and medication is making me want to try a treatment again.

Dan: If you want to find out more about adult ADHD, you can read articles by Laura and Tamara on theconversation.com. We’ll put links to those as well as some further reading in the show notes.

Mend: That’s it for this week. Thanks to all the academics who’ve spoken to us for this episode. And thanks to Amanda Mascarelli, Lucy Beaumont and Stephen Khan. And thanks to Alice Mason who runs our social media.

Dan: And Mend, thanks to you for sharing your insights on this episode. You can find us on Twitter @TC_Audio, on Instagram at theconversationdotcom or via email. And you can also sign up to The Conversation’s free daily email. There’s a link in the show notes. And if you’re enjoying The Conversation Weekly, please leave a review or rating wherever you can.

Mend: The Conversation Weekly is co-produced by Gemma Ware and me, Mend Mariwany with sound designed by Eloise Stevens. Our theme music is Neeta Sarl.

Dan: I’m Dan Merino. Thank you for listening and we’ll talk to you next week.

Neither Laura Knouse nor Tamara May work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and they have disclosed no relevant affiliations beyond their academic appointment.