Why are more adults being diagnosed with ADHD? With Russell Ramsay, PhD

For many years, ADHD was seen as a disorder of childhood. But in recent years, an increasing number of adults have been diagnosed with it as well. Clinician and researcher Russell Ramsay, PhD, discusses what’s driving the rise in adult diagnoses, what ADHD looks like in adults, how it affects people’s lives – including their work, relationships and health -- and what treatments are available. Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  This episode is brought to you by Indeed. You're ready to level up your business, but the pressure to find the right person to make that happen is intense. Indeed sponsored jobs can help carry the load. It boosts your job post to help it reach quality talent fast. Cut through the chaos with Indeed sponsored jobs. Get a $75 sponsored job credit at indeed.com/podcast. Terms and conditions apply. Hiring now? Then this is a job for Indeed sponsored jobs.

• 0:30Kim Mills?

  For many years, attention deficit hyperactivity disorder, or ADHD, was seen as a disorder of childhood. But in recent years, an increasing number of adults have been diagnosed with it as well. In 2023, more than 15 and a half million US adults said they had ADHD, and about half of those were diagnosed as adults, according to data from the National Center for Health Statistics. Now, as public awareness has grown, more people are coming forward to be tested, and researchers and mental health practitioners are developing new guidelines for diagnosing and treating adult ADHD. So what's driving the rise in adult diagnoses?

• 1:14Kim Mills?

  Is ADHD becoming more common, or is it just recognized more often? How do the symptoms differ between adults and children? What treatments are available for adults with ADHD? How does ADHD affect people's lives in adulthood, from relationships to work to physical health? And if you suspect you might have ADHD, where can you go for diagnosis and support? Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills.

• 1:52Kim Mills?

  My guest today is Dr. Russell Ramsey, the founding co-director of the Penn Adult ADHD Treatment and Research Program at the University of Pennsylvania Pearlman School of Medicine, from which he retired in 2023. He's authored numerous peer-reviewed scientific articles and six books, including the APA book, Rethinking Adult ADHD: Helping Clients Turn Intentions Into Actions, and the Adult ADHD and Anxiety Workbook: Cognitive Behavioral Therapy Skills to Manage Stress, Find Focus, and Reclaim Your Life. Since retiring from academia, Dr. Ramsey has transitioned to a telepsychology practice treating patients with ADHD. Dr. Ramsey, thank you for joining me today.

• 2:36Speaker 02

  Kim, it's a pleasure and an honor to be here with you.

• 2:39Kim Mills?

  Well, let's start with the first question I posed in the introduction. What do you think is causing the rise in adult ADHD diagnoses? Is it becoming more common? Or are people just becoming more aware of it?

• 2:51Speaker 02

  You know what? As one of my colleagues said, there were no headlines years ago about where are all these adults with ADHD? So part of it, I think the first answer, a large part of it is a correction. And I think especially with the pandemic and lockdown, with the loss of the scaffolding of everyday life, going to school, going to work, having to self-organize at home, both children learning at home and adults working from home. As one of my clients said, now the world is getting to understand what every day of my life has been like for me, trying to manufacture this motivation and the structure. So a big part of it is a correction. And I also think with that

• 3:34Speaker 02

  and the increased attention and seriousness with which mental health issues were addressed over the pandemic, I think it got more people talking about it. And the credible information out there with ADHD was helping a lot of people to seek out assessment and treatment for adult ADHD. And with the loosening of the state-by-state licensing restrictions for telepsychology and cross-state practice, I think it gave Greater access to people like myself who are familiar with the diagnosis and treatment of adult ADHD.

• 4:13Kim Mills?

  What do ADHD symptoms look like in adults? I think we have an idea of what it's like for kids where they can't focus, they act out in classrooms, things like that. I think we may have that image, but how does it present in adults? How is it different from what happens with kids?

• 4:29Speaker 02

  Right. You know what? The criteria are the exact same 18 symptoms in the DSM, now the DSM-5 TR. And the most persistent symptoms are the inattentive symptoms. The distractibility, the difficulty sustaining, initiating and sustaining focus and getting back on track after distraction. Everybody can get distracted, but individuals with ADHD have a hard time re-engaging in whatever the focus was. Interestingly, impulsivity is relatively persistent, but it looks different in adults, whereas with children, it might be impulsively speaking out in school, speaking out of turn, if you will.

• 5:11Speaker 02

  Grownups can still speak out of turn or over-talk situations as well as impulsive decision-making, impulsive spending. And a core feature of procrastination for everybody is impulsivity. I know I should be doing this, but let me just do this for a minute. That's impulsivity. But we don't think about it because it's very subtle, but it's still moving off and following the impulse. And the third of the big three, the hyperactivity, this generally gets more internalized for adults with ADHD, an internal sense of restlessness that may not show up in terms of getting

• 5:54Speaker 02

  up, moving around, obviously climbing on a chair. But generally, within reasonable lengths of time, such as a work meeting or something like that, many adults with ADHD will start to fidget around, tap their foot, maybe wagging their foot a bit. Maybe some of your listeners right now, listening to me, are fidgeting around, looking for something else to do. And interestingly, one of the, I'd say, the perceptions of ADHD in adulthood for women was that they were overrepresented of in the inattentive presentation without the hyperactivity. But some more recent reviews are finding that actually, the rates

• 6:34Speaker 02

  of the combined presentation, both the inattention and the hyperactivity, women actually manifest roughly the same levels of impulsivity and hyperactivity as males, but it's just manifesting in different ways. And in fact, one review looking at children, girls versus boys manifesting the same behaviors, it did not get categorized as hyperactivity and impulsivity in girls as much as it was in boys, even though independent raters were finding it about the same behavior. So there are some gender differences in how the symptoms were noted and attributed. And no surprise, with recent CDC data about the prevalence of adult ADHD in the United

• 7:16Speaker 02

  States, which reported that half of individuals with ADHD have been identified in adulthood, 18 years old or later, and of that group, 61% were females.

• 7:28Kim Mills?

  Right.

• 7:28Speaker 02

  So that's another correction going on, that the diagnosis in adults for women generally comes later, even though that may be changing now with the increased awareness.

• 7:39Kim Mills?

  So do we miss it when they're younger because of the stereotypes for girl behavior versus boy behavior?

• 7:45Speaker 02

  I'd say that's, to a large degree, true, even though I think, at least with adults, going back to children, for clinic referred children years ago, it was about a 10 to 1, boy to girl ratio. Now with adulthood, the differential is about 1 and 1/2 to 1, male to female. So with the increased understanding of the different manifestations, and one of the things to remember... ADHD is not caused by the environment, but it is certainly bound in the environment. Like, different settings requiring sustained attention, working on tasks for a long time without breaks, or some sort of acknowledgement, or reward,

• 8:28Speaker 02

  or something like that, are more difficult for adults with ADHD. But there might be other situations with working in teams, working hands-on work, where there's a lot of breaks, or more immediate feedback, or reminders to stay on task. There are situations where individuals with ADHD can do quite well, if not thrive.

• 8:52Kim Mills?

  If people are diagnosed with ADHD as adults, does it mean that they've always had it, and it wasn't diagnosed? Or can it develop later in life?

• 9:02Speaker 02

  ADHD is considered a neurodevelopmental syndrome. And so, it is generally, even if somebody is late identified in adulthood, part of the adult diagnosis is confirming childhood onset of symptoms. You don't have to have the diagnostic levels, or have been diagnosed before. That is not a requirement of the diagnosis. But part of the evaluation is confirming by the book whether there was symptom emergence, many symptoms showing up before age 12. Now, I follow DSM. However, there's some evidence to say that 16 years old is probably a better marker, because the 12-year-old, it misses those middle school years,

• 9:47Speaker 02

  where there's a developmental expectation for different levels of self-regulation with increased chronological age. Now, another part of the question was, can it develop de novo later? And a few years back, there were a lot of studies looking at the potential for adult onset ADHD. Now, that's different than late identified. Late identified is, yeah, you had symptoms in childhood, but you got through school okay. Maybe underperformed, maybe not. But they persisted and caused increased difficulties. Now that you're 21, 25, 35, 55, it's creating impairments. So, we can document that it was percolating before, but it wasn't till now that you got diagnosed.

• 10:32Speaker 02

  The late onset, there were individuals who were described as not having ADHD in childhood, but then it's showing up in adulthood. Now, a couple of the studies, the adults were 19, 20, and that's a fuzzy diagnostic line between childhood, adolescence, and adulthood. And in some of the cases of the studies tracking children into adulthood, including children without ADHD, who were a control group for some childhood studies, when individuals were showing up in adulthood, in their twenties with ADHD, not having had it before, it was usually normal cognitive difficulties with attention in new circumstances, or maybe substance use problems,

• 11:16Speaker 02

  or an emergent mood or anxiety disorder. So there was usually another explanation for the quote unquote, "attention problems." Like, one quote I love, "all that glitters is not gold, and all that is distracted is not ADHD." It can have, because, you know, attention problems are a nonspecific symptom, like a fever in medical practice. You go to your family doctor with a fever, could be the flu, could be an infection, it could be malaria, you need more information. And likewise, within attention problems, that's why a thorough evaluation is really important to verify the diagnosis.

• 11:49Kim Mills?

  What effects can ADHD have on people's lives in adulthood, on their relationships, or their work lives, or even their physical health?

• 12:00Speaker 02

  Right. That's a great question. You know, I mentioned how ADHD is neurodevelopmental, and my thumbnail definition, it's a neurodevelopmental syndrome of impaired unfolding and execution of self-regulation skills. So, these are what are also known as the executive functions, which we all have. And they unfold in a relatively predictable pattern. And these are what, if we wake up to an alarm today, that's your executive functioning, setting an alarm. If you set something by the door, so you don't forget it on the way out in the morning, that's an executive functioning. There's virtually no area of life in which we don't rely on

• 12:40Speaker 02

  executive functions. So, what generally drives people for an evaluation, with children and adolescents, usually school problems. And maybe some behavioral problems in the classroom. And similarly, for like with our ADHD program at Penn, our first year or two, it was a lot of college students, first or second year beyond the adjustment period, having difficulties managing on their own without the scaffolding of home or teachers in high school and whatnot. So those were still where the difficulties were the most prominent. But with adults, it can also turn into financial difficulties, overspending despite knowing or not tracking or not saving for retirement

• 13:25Speaker 02

  or whatever, workplace, ongoing academics, driving. And increasingly, we're seeing the effects on physical health. There was one longitudinal study tracking children from eight years old to mid twenties, twenty seven. And the health profiles at twenty seven years old predicted more than a decade's lowered estimated life expectancy at age twenty seven, based on the behavioral profile at that time. Now, one of the encouraging things in these very discouraging findings is a lot of the elements are behavioral and can be targeted with all the evidence-supported treatments for ADHD

• 14:08Speaker 02

  and also making it part of a behavioral treatment plan. Then what is self-regulation as we think about it with ADHD? Organizing behavior across time towards a future focus, a larger later goal, rather than a smaller sooner payoff. This is why we we save for retirement. But also, these investments in behavior, such as exercise, watching diet, follow-through with medication regimens, physical therapy, whatever it may be. But it certainly can affect personal health. And some people, including Russell Barkley, have said, thinking about ADHD as a public health issue. But also relationships of all sorts, or you can think of them as an endurance

• 14:52Speaker 02

  race, including committed relationships, co-parenting relationships, and think about the self-regulation demands of being a parent. And there's no end of the school year in adult life. That's one of the things working with adults. You don't get to start, okay, new semester, new marking period, new teacher. No, it's cumulative. And so difficulties within relationships, the reciprocity, and keeping up with responsibilities within a relationship. And these could be roommates, where everybody has to pay rent, but somebody's always late with rent. Like I said, a co-parenting, committed relationship, where there's some expectation of reciprocity. And if it's not there, the attribution's often in relationships,

• 15:37Speaker 02

  if you cared about me, you would remember to pay the bills or keep the promises. But we're talking about a neurobiologically driven syndrome that gets in the way of that happening. Now, that being said, one of the lines in my field is ADHD is not your fault, but it is your responsibility. So there are accommodations that can be helpful at school or at work, but they're not infinite. There are some measures that require coping, changes, making use of treatments, other things to navigate. That can help with all these domains of potential impairment across somebody's life.

• 16:13Speaker 00

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• 17:12Kim Mills?

  There are guidelines for diagnosing and treating ADHD in children, but they don't apply to adults. Is that correct? And that there's a need for adult guidelines at this point?

• 17:24Speaker 02

  Right. And there are, right now, the first set of US guidelines are being put together by the American Professional Society of ADHD and Related Disorders. Colleagues, and I'm a member of that organization, I'm not participating on that side, but they are reviewing the evidence for assessment. And I think one of your previous guests and somebody I admire greatly, Dr. Margaret Sibley, is leading the review team for the assessment. But she's also had some wonderful papers, some of which, the findings I already mentioned here. But she has a very nice paper looking at the recommended diagnostic guidelines for a first-time adult ADHD diagnosis. So they're out there.

• 18:06Speaker 02

  And I'm part of a parallel group, a consortium under the rubric of CHADD, Children and Adults with Attention Deficit Hyperactivity Disorder, probably the largest grassroots organization, where we're going to take the guidelines and turn them into clinical toolkits for different professions. And I'm the psychologist on the team for that. But there have been international guidelines, the European guidelines, the NICE guidelines in the UK, Australian. And it actually works out well because after the US guidelines are out there for a while, another country, another region will come up with theirs, and it'll be this iterative process.

• 18:42Speaker 02

  We have good guidelines already, but hopefully with the US guidelines, there'll be more focus on dissemination.

• 18:49Kim Mills?

  Well, let's talk about treatment for a minute. You've got a clinical practice treating adults with ADHD. What kind of treatments are available, both in terms of drugs and behavioral treatments?

• 18:59Speaker 02

  Right. The two evidence-supported treatments are medications for ADHD predominantly, but not exclusively. And I'm not a prescriber and I'm not a psychiatrist, so I'm just talking about research and what's available, i.e. don't sue me. But predominantly, the stimulant medications, even though there are many non-stimulant medications approved for adult ADHD for people who don't respond to the stimulants or have intolerable side effects. And based on meta-analyses, and again, I get no funding from pharmaceutical companies, for adults, the ideal starting points, based on the literature reviews, is the amphetamine-based. And for children and teens, it seems to be the methylphenidate-based medications, at

• 19:42Speaker 02

  least as a starting point. And then, in terms of psychosocial treatment, therapy, the cognitive behavioral therapy has emerged as the evidence-supported treatment. And as dire as some of the life outcomes of a lifetime diagnosis of ADHD, of different impairments, not everybody has everything, but there's virtually no area of adult life that can hide from ADHD. It can affect any, like I said, driving, a whole host of other things. But there's also some of the most effective treatments that we have in all clinical psychiatry and psychology, including the combination of medications. So there's a lot of options out there.

• 20:24Speaker 02

  Again, there's a lot of great cognitive behavioral therapists. However, not all of them, or maybe qualify that, not many of them have had direct experience with adult ADHD. In fact, there was a study in the UK within the past several months, looking at client experiences going through cognitive behavioral therapy for adult ADHD, completing questionnaires, and a handful got interviewed afterwards. And the initial reading of the results were awful because clients were saying it didn't seem my therapist understood ADHD or understood the difficulties folks with ADHD have. So that was the complaints of many clients. Now, one of the interviewees reported that their therapist

• 21:09Speaker 02

  was very versed in ADHD, in adult ADHD, and described treatment as transformative. I felt understood and I felt I could understand my brain and work with it rather than against it and felt they made a lot of progress. Now, those are the two evidence-based treatments. There are a host of others that maybe have some studies behind them, like some mindfulness-based groups for ADHD adapted for adult ADHD. ADHD coaching is another one. It's been around for about 25 years now. It started off as a metaphor in the book Driven to Distraction, where Ned Halliwell and John Rady said something like, what adults with ADHD is something akin

• 21:49Speaker 02

  to a coach that can help them keep on track and implement skills. And so it became this ADHD coaching and there are some very good training programs, but it is not a licensed profession yet, but it does have some empirical research. So it's still gathering research. But I mentioned how the coach analogy that people need help with implementation. I think that's, that's an important description of ADHD across the board, but especially for adults. It is not a knowledge problem. It's a performance problem. It's not knowing that you should start earlier to get things done, or that you should be on time or anything

• 22:32Speaker 02

  like that. People know that, but it's difficulty putting it into play. The seven-year-old with the worst ADHD knows they should raise their hand and wait to be called on, but in the moment, I know the answer. I know the Declaration of Independence was not all signed on July 4th, but when was it signed? July 4, 1776, and then the arm goes up. It's the sequencing. They know it, but it doesn't manifest in the way we need it to. Now, that's a very innocent example, but then later on in adulthood. And I've had people miss job interviews, failing a class, not because they didn't do well on the test, but because they didn't hand in assignments or they violated the attendance policy,

• 23:16Speaker 02

  even though the quality of the work is good. And that's the insidious nature of ADHD, how it can undermine these things, including, as I mentioned, in relationships. You're a great person. I trust you, but I can't trust that you'll pay the bills on time or that you won't go out and overspend or things like that. And that's, that's what can even erode committed relationships.

• 23:37Kim Mills?

  So how would coaching in this instance work? Because it sounds like people, adults who have this need like a constant reminder. It's not like once a week or every two weeks, you can see your therapist and get coached there. So how do you, on a daily basis, get that little impetus?

• 23:55Speaker 02

  Well, you know what, within some studies of CBT, now this has worked into studies. There have been some approaches where they would augment the weekly sessions and maybe having calls in between, like every couple of days to check on homework. And you know, some old school therapy approaches might say, well, you don't do that. But if there's between-session summary of the homework assignments or inviting people to check in if they need to double check like what they're working on within my therapy with them or scheduling more frequent sessions. Now, within the field of ADHD coaching, it's not necessarily every day, but they might set up more frequent phone check-ins or even things like site visits if somebody's working on an organization.

• 24:39Speaker 02

  Now, again, this is where ADHD coaching's been around for a while. It had remote sessions before the pandemic. That was part of follow-up texts, phone calls. So they, they were much more agile. And in terms of training of coaches, there are some things about sort of training expectations and the wide variety of quality you can get because it doesn't have the same controls as say, and I'm biased, but like a graduate program in clinical psychology and then the postdoctoral training and the licensing. But it does have a foothold and I think it filled the need where the cognitive behavioral therapist or other psychologists or whatnot, there weren't as many of them available. Whereas ADHD coaching, that's what it's designed for.

• 25:24Speaker 02

  They get trained in ADHD.

• 25:27Kim Mills?

  And for for most adults, I mean, there's the most effective treatment, a combination of either CBT or some kind of therapy and drugs? Or can you do just one or the other?

• 25:41Speaker 02

  Right of self determination. So sometimes individual for various reasons, but overall, it seems like the combined is the best. And actually, there's recent research looking at how the medications are very helpful with the core symptoms. The attention, the motoric hyperactivity and impulsivity, restlessness, sustained focus. But you can focus really well and procrastinate on something else or be disorganized but well focused. And that's where the psychosocial treatments, I'll say the cognitive behavioral therapy can come in. And also with that, the executive functioning coping skills. But a couple of things there.

• 26:22Speaker 02

  One, living with a lifetime of ADHD can lead to some negative self beliefs and negative cognitions because very often the experience of adults with ADHD, having lived with it, particularly if it's gone undiagnosed till adulthood, is you mean, I'm not stupid, lazy or crazy? That was the name of that. That was one of the first popular books on ADHD. But I think it resonates and why I keep citing it is because that would be the mindset. What's wrong with me? And it is a neurodevelopmental syndrome as well as one of the things that doesn't show up in the DSM criteria.

• 27:01Speaker 02

  But we're now appreciating, and one of the executive functions is emotional self-regulation, that emotions, the emotional piece of ADHD is part of the self-regulation. There's two factors, it's emotional impulsivity, the emotions come on unchecked. There's not that initial slowdown to say, whoa, whoa, whoa, what am I, what's going on here? It comes on quick and then it's harder to soothe it as efficiently. So that emotional impulsivity, then the deficient emotional self-regulation is the second layer we typically use, those are both problematic. And even going back to the 1970s, Paul Wender, one of the early experts in ADHD and one

• 27:43Speaker 02

  of the earlier professionals who identified adult ADHD, both at the time identified the role of emotions, including poor frustration tolerance, quick to anger. And also, he's since passed away, but his group headed by Fred Reimer, recently identified a two-factor model of ADHD. One was inattention, predominantly inattentive, but the second was emotional self-regulation. Now, it's only based on one or two studies by that group, but other groups have shown the relevance of emotions. And these are separate from the, and this is another part of treatment and how psychosocial and medications can work alongside each other.

• 28:23Speaker 02

  And comorbidity is the rule rather than the exception for adult ADHD, the top two being anxiety and depression. And anxiety, and I did the workbook on anxiety, one of the features of anxiety is the intolerance of uncertainty, in addition to the perception of risk. And for my money, ADHD is an uncertainty generator. Now, some people will do individual treatments, they might do fine just on medications. And with that, they're able to say, okay, now I can be on time, use my plan or whatever. And I've seen people individually for just CBT. There may be like a rare medical condition that does not allow them to take ADHD medications

• 29:06Speaker 02

  or that the side effects are intolerable, or a pregnant woman or breastfeeding woman. Now, some of the research on medications and pregnancy are equivocal, but usually prescribers and individuals might err on the side of caution, even though it's not a blanket prohibition, but people just being cautious. Or there's might be people say, you know what, I want to try it without medications first. And right of self determination, I always invited as an option, but it's just pretty much doubling down on the on the CBT and the implementation focused interventions.

• 29:38Kim Mills?

  You know, I read about a recent survey out of Ohio State University that found that 25% of US adults think they have undiagnosed ADHD.

• 29:48Speaker 02

  Right.

• 29:49Kim Mills?

  The research has speculated that some of the, the part of the reason might be the popularity of ADHD related content on social media. What's your take on this self diagnosis? Is, is this really a thing or people just reading so much about it and they think they've got it?

• 30:06Speaker 02

  I, I, I think it's part of all of them. So it's out there and in a way it's the part of the correction. So 10 years ago, ADHD would be the last thing after everything else got tried. And okay, maybe it's that, or maybe individuals brought it up and the, the provider might say, and I say this respectfully, might be going, why not check it out? We got nothing to lose. So some of it is now it's out there in the language and the culture a little more, especially over the pandemic and maybe on a shorter list of possibilities. Because one of the things about the symptoms of ADHD and the executive functions, they're

• 30:46Speaker 02

  a dimensional human trait, whereas something like, say bipolar disorder, where it has very clear onset and we could say it's a qualitative difference from, say, the typical range of mood most of us experience, but ADHD feels familiar for a lot of people. Oh yeah, I do that sometimes. I almost left my iPad on the plane the other day, or I, I lose focus, which is true. I think, like I said before, you had, you get the flu, your executive functioning will go down. You have a bout of insomnia, your executive functioning will go down. But if you don't have ADHD, as these

• 31:27Speaker 02

  Situations, conditions remit spontaneously or with treatment, your executive function will go back to a baseline. It's normative baseline. With ADHD, the baseline's a moving target. So there was a study of children. And it was a population study. So many of them did not have ADHD. A handful of them screened positive for ADHD as part of the study. And another group had been identified as already diagnosed. So what this study did, it was all parent ratings. Rate your child using this 18 item, ADHD rating scale, and also rate their quality of life. Pretty much a functioning schedule. So

• 32:12Speaker 02

  parents rating their children with zero or one symptom of ADHD. Very high well-being ratings. They're doing well. Two or three, really well. Maybe a smidge less well. Six, seven, eight out of 18, nine. Probably not diagnostic levels, but the ratings start, the well-being ratings start going down. But maybe not diagnosed with ADHD. And then we get up into the diagnostic levels. You know, 10, 12, 13, 14, 18. The well-being ratings go steadily down. Now, there's a lot of variation. It's not a one-to-one. But in the trend was the more symptoms of ADHD you had, at least rated by your parents, the lower your well-being.

• 32:56Speaker 02

  So my take on the Ohio State survey, the 25% guessing. I would say maybe a lot of those people, maybe they fall in that middle sub-threshold range. Where somebody goes, yeah, I have insomnia every couple of weeks for a day or two. But I don't need a sleep study or whatever. And sometimes I'm really stressed out and I'm not as well. But I usually rebound and I don't have the time or money or to go see this Ramsey guy or anybody else. But there might be like the two or three or four or five out of those where they self-diagnose, say, or at least self-screen. And I think self-diagnosis gets a bad rap. Because now somebody could go and say, oh, I must have ADHD then.

• 33:40Speaker 02

  Because TikTok told me I do. And there was a study saying, pretty much in a nutshell, 80% of TikTok content is unreliable, if not patently wrong.

• 33:51Speaker 02

  But the most influential posts are personal stories. So even if they're wrong, they are compelling and believable. So there's a lot of misinformation. But the self screening, the self diagnosis, if that's followed up with, well, let me go get an evaluation that is familiar with ADHD and follows like for right now Maggie Sibley's advice, which will probably turn into a nice skeleton framework for the guidelines. As well as looking for things that could better explain what you think are ADHD.

• 34:30Speaker 02

  And I know some of my, the evaluations I'm most fond of are the ones where I was able to sit with somebody and say, yeah, you're rating the high on the ADHD scales, but here's a better explanation for what's going on. Because that's, you know, as practicing clinicians, that's what we're looking for. Is it depression? Is it anxiety? Is it trauma? Is it OCD and substance use and running through everything? And it might sound like, oh, my gosh, this is going to be like an eight hour evaluation. Well, no, if you, if you go through and you know what you're doing and I do a skid. So if you know the skip out questions on the skid and you get two no's in a row, it's like barring other information to the contrary, you can move on and be relatively efficient.

• 35:12Kim Mills?

  So finally, for our listeners who may be among the 25% of people wondering if they have it, how do you decide if it's worth getting tested and where should you go?

• 35:23Speaker 02

  You know what? A readily available reputable screening scale that is available for free is the World Health Organization Adult ADHD Symptom Rating Scale. And it's available with a quick internet search and you can download it. It's six items. Now, like any screening scale, like for diabetes or heart disease or depression, anything like that, screening scales cast a wide net because you want to catch the true positives and you'll put up with a couple of false positives in there for follow up evaluations. So that would be a way to screen. If you're in a relationship or, you know, somebody you're comfortable asking and say, yeah, I was wondering if I have ADHD and seeing what somebody else says.

• 36:05Speaker 02

  And I've had people say, other people have said to them, oh, I thought you knew already or something like that. Or I'm glad you brought that up in early. I was wondering about that too, but I didn't want to hurt your feelings or whatever. So that is a starting point. In terms of where do you go to find somebody? The main professional organizations, CHADD, Children and Adults with ADHD, the Attention Deficit Disorder Association, that one focuses specifically on adults. They will have find a helper, find a professional, find a therapist features on their websites. AppSard, I'm not sure, I don't think they have a find a professional yet because it is more of a professional organization.

• 36:49Speaker 02

  But here's advice I've been giving people looking, if they're from a state I'm not, I don't know anybody in or other region. I say, look at the board of directors or the professional advisory boards of the ADHD organizations and see what the academic affiliations are and maybe reach out to people to say, oh, I see you're at the University of wherever. Do you know of any referrals in the state or nearby or things like that? So it's a little bit of a six degrees of separation approach to getting there. But authors of books, I think Ned Halliwell, many of his books, he'll have lists in the back of people he knows who provide services. I know in a couple of my books, I had some listing of colleagues who had programs around.

• 37:30Speaker 02

  But the, one of the things professionally and personally, my experience has been the ADHD community, the adult ADHD community has been very giving, like in terms of, oh, can I use your questionnaire and my evaluations and giving within professionals and wanting to make sure people get the help they need. And I think the forthcoming US guidelines are an expression of that, a love letter to adults with ADHD in a way in the US, hopefully.

• 37:57Kim Mills?

  Well, Dr. Ramsey, I want to thank you for joining me today. This is a lot of useful information. Thank you.

• 38:02Speaker 02

  Kim, it was a pleasure and an honor to be asked.

• 38:06Kim Mills?

  You can find previous episodes of Speaking of Psychology on our website at speakingofpsychology.org, or on Apple, Spotify, YouTube, or wherever you get your podcasts. And if you like what you've heard, please subscribe and leave us a review. For those of you who want to know more about psychology and the work of APA, you can join us as a supporter. You don't have to be a psychologist. The benefits include a subscription to our award-winning magazine, Monitor on Psychology, as well as discounts on our books and other publications. So if psychology is your passion, or you just want to know more about the science, you can become a supporter by visiting at.apa.org/speaking.

• 38:47Kim Mills?

  That's at.apa.org/speaking. If you have comments or ideas for future podcasts, email us at [email protected]. Speaking of Psychology is produced by Lee Weinerman. Thank you for listening. For the American Psychological Association, I'm Kim Mills.

• 39:46Speaker 04

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