ADHD: Do We All Have It?

ADHD is all over the internet, with people saying that it’s way different than we thought it was — and that tons of us might have it without even knowing it. Influencers are telling us that ADHD can cause all sorts of things, like hyperfocused states, serious emotional dysregulation, even something called rejection sensitivity dysphoria. So — is all this true? Plus, when you do have ADHD — what’s going on inside your brain? And what are the best ways to cope with it? We talk to Prof. Maggie Sibley, Prof. Philip Shaw, and Dr. J. Russell Ramsay. This episode does mention depression. Here are some crisis hotlines: United States: US National Suicide Prevention Lifeline Dial 988 (Online chat available); US Crisis Text Line Text “HOME” to 741741 Australia: Lifeline 13 11 14 (Online chat available) Canada: Canadian Association for Suicide Prevention (See link for phone numbers listed by province) United Kingdom: Samaritans 116 123 (UK and ROI) Full list of international hotlines here Find our transcript here: https://bit.ly/ScienceVsADHD Chapters: In this episode, we cover: (00:00) Is ADHD everywhere?? (02:45) How do you really know if you have ADHD? (09:05) Is hyperfocus legit? (12:50) What’s up with ADHD and emotional issues? (18:05) ADHD in women and people who menstruate (20:07) So do is ADHD really everywhere? (21:34) ADHD in the brain (26:21) Meds, Therapy, Body Doubling?! This episode was produced by Rose Rimler, with help from Wendy Zukerman, along with Meryl Horn, Michelle Dang, and Ekedi Fausther-Keeys. We’re edited by Blythe Terrell. Mix and sound design by Bobby Lord. Fact checking by Erica Akiko Howard and Marlowe Starling. Music written by Peter Leonard, Emma Munger, So Wylie, Bumi Hidaka, and Bobby Lord. Thanks to all the researchers we spoke to for this episode, including Dr. Robert Rosenthal, Dr. Miguel Garcia Pimenta, Prof. Michelle Martel, Dr. Maedbhe King, Dr. Edward Modestino, Prof. Edmund Sonuga-Barke, and Dr. Ashley Halkett. Again, big special thanks to all the listeners who called in and told us about their ADHD experiences! Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

• 0:00Wendy Zukerman?

  Hi, I'm Wendy Zukerman and you're listening to Science Versus.

• 0:05Wendy Zukerman?

  Today, we're pitting facts against focus as we look at ADHD.

• 0:15Wendy Zukerman?

  Lately, it seems like more and more people are saying, "I've got ADHD." And if you're pondering your ADHD status, there are plenty of TikTok listicles out there to help you out.

• 0:28Speaker 01

  Top 10 signs of ADHD.

• 0:30Speaker 02

  Five things that are ADHD that I had no idea were ADHD.

• 0:34Speaker 03

  The six surprising signs that could be signs that you too have adult ADHD.

• 0:40Wendy Zukerman?

  Six signs? 10 signs? According to the internet, ADHD goes way beyond those classic symptoms of having trouble paying attention or being fidgety. We're hearing that it includes stuff like...

• 0:53Speaker 04

  Hyper-focus, you get so engrossed that you sort of lose track of time. You might forget to eat, or sleep, or go to the bathroom.

• 1:00Speaker 05

  I have trouble regulating emotions, mood swings 24/7.

• 1:04Speaker 02

  Having ADHD feels like you're on an emotional roller coaster. Either everything is great, or everything is absolutely terrible.

• 1:12Wendy Zukerman?

  But some aren't so sure about all these new so-called ADHD symptoms. They're worried that this ballooning definition of ADHD is making a bunch of people think that they have this condition when they don't. There are all these headlines screaming that we're over-diagnosing ADHD, medicating people for ADHD when we shouldn't be. One British politician called it "a fashionable disorder", and said, "A lot of people who have it aren't actually sick at all." You hear this kind of thing a lot.

• 1:43Speaker 02

  There's a lot of people who are self-diagnosing. And I'm like, "No, she's just late, and she's a pain, and when I arrange to have a coffee with her, she needs to turn up and not tell me, 'Oh, it's my ADHD.' No, you're late, mate."

• 1:58Wendy Zukerman?

  So today, we're asking, when it comes to ADHD, what's real and what's just hype? We'll also find out what is going on in the ADHD brain. There's all these videos online saying that if you've got ADHD, you can blame your dopamine levels. But is that really true? The cutting-edge neuroscience on ADHD will give it to you. Plus, for people who have this condition, we'll find out some tips and tricks that can help you out. When it comes to ADHD, there's a lot of...

• 2:27Speaker 02

  No, you're late, mate.

• 2:28Wendy Zukerman?

  But then, there's science.

• 2:32Wendy Zukerman?

  Science vs. ADHD is coming up just after the break.

• 2:42Speaker 06

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• 4:12Wendy Zukerman?

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• 4:55Wendy Zukerman?

  Welcome back. Today on the show, ADHD. Tell us all about it is Rose Rimmler, senior producer here at Science Vessos. Hi, Rose.

• 5:04Speaker 07

  Hi, Wendy.

• 5:04Wendy Zukerman?

  Do you think you have ADHD?

• 5:07Speaker 07

  Uh, no, I don't think so, no. Do you ever suspect that?

• 5:11Wendy Zukerman?

  Oh, whether you have ADHD. Not me personally, but I have had quite a few friends who have recently been diagnosed with ADHD. It definitely feels like it's everywhere right now.

• 5:23Speaker 07

  Yeah, I talked about that idea, that it feels like it's everywhere right now, with a professor and ADHD researcher. She's named Maggie Sibley. She's at the University of Washington. And she says there's a lot of reasons for this. One thing we talked about was these online quizzes about ADHD that have popped up.

• 5:41Wendy Zukerman?

  Oh, yeah.

• 5:42Speaker 07

  The worst for me are the ones that say things like, "Experiencing indecision, you might have ADHD. Having trouble keeping up at work, you might have ADHD. Come take this five-minute quiz to see if you do."

• 5:53Wendy Zukerman?

  What'd you think when you saw that?

• 5:55Speaker 07

  Well, as somebody who has spent decades doing research trying to show that you cannot diagnose ADHD with a five-minute quiz, it definitely activated me a little bit.

• 6:04Wendy Zukerman?

  Yes, I've totally seen, I've seen so many of these quizzes and been tempted to do them, but haven't. So what are the symptoms for sure of ADHD?

• 6:17Speaker 07

  Well, to find out, I thought you and I could take a brief quiz, actually.

• 6:24Wendy Zukerman?

  Rose.

• 6:26Speaker 07

  Which sounds bad, but really, really what I have for you is this is a valid, science-backed questionnaire. It doesn't diagnose you with ADHD. It's more of a checklist to see if you're at risk of having it. And this questionnaire has Ben's blessing. And it basically maps onto the main symptoms of ADHD.

• 6:45Wendy Zukerman?

  Oh, OK, great.

• 6:47Speaker 07

  So I'll send here's the link.

• 6:48Wendy Zukerman?

  Wow, here we go.

• 6:49Speaker 07

  Yeah, put it, put an X if it's never, rarely, sometimes, often, or very often.

• 6:54Wendy Zukerman?

  OK.

• 6:54Speaker 07

  For all these symptoms.

• 6:56Wendy Zukerman?

  All right, so. How often do you have trouble wrapping up the final details of a project once the challenging parts have been done?

• 7:07Wendy Zukerman?

  Sometimes.

• 7:08Speaker 07

  How often do you have difficulty getting things in order when you have to do a task that requires organization? I'm gonna say sometimes.

• 7:16Wendy Zukerman?

  I'm gonna say never, almost to the point where I don't understand the question.

• 7:23Wendy Zukerman?

  How often do you have problems remembering appointments or obligations?

• 7:30Speaker 07

  I never do. I would say never. What about you?

• 7:33Wendy Zukerman?

  Rarely. I will often forget that I've arranged to meet with my mom.

• 7:38Speaker 07

  That one specifically?

• 7:40Wendy Zukerman?

  That one specifically.

• 7:43Speaker 07

  Let's not look too deeply into that.

• 7:44Wendy Zukerman?

  Thank you. Love you, mom.

• 7:46Speaker 07

  How often do you feel overly active and compelled to do things like you were driven by a motor?

• 7:51Wendy Zukerman?

  How often do you have difficulty concentrating on what people say to you even when they are speaking to you directly?

• 7:57Speaker 07

  What?

• 7:59Speaker 07

  Just kidding. How often do you find yourself talking too much when you are in social situations?

• 8:04Wendy Zukerman?

  When you're in a conversation, how often do you find yourself finishing the?

• 8:09Speaker 07

  Sent to the people you're talking to? How often do you have difficulty waiting your turn in situations when turn-taking is required? Never.

• 8:18Wendy Zukerman?

  I don't like waiting in line, that's for sure.

• 8:22Wendy Zukerman?

  So Rose, how'd you do? How'd you do?

• 8:24Speaker 07

  All right, OK, I'm ready. What'd you get, Wendy?

• 8:26Wendy Zukerman?

  OK, I got five.

• 8:28Speaker 07

  OK.

• 8:29Wendy Zukerman?

  What'd you get?

• 8:30Speaker 07

  I got two.

• 8:31Wendy Zukerman?

  Uh huh, so what is, what does this mean?

• 8:34Speaker 07

  Well, a few years ago, researchers gave this checklist to a sample from the US population. And they found that the average person got about a two.

• 8:44Wendy Zukerman?

  Oh.

• 8:45Speaker 07

  And five or more is like, maybe you should get evaluated for ADHD.

• 8:50Wendy Zukerman?

  Really?

• 8:52Speaker 07

  Yeah, yeah.

• 8:53Wendy Zukerman?

  Whoa.

• 8:54Speaker 07

  Wow.

• 8:56Wendy Zukerman?

  That's so funny.

• 8:58Speaker 07

  Yeah, I mean, so if you get this higher score, that's when you would probably want to go to the doctor and get checked out.

• 9:04Wendy Zukerman?

  Mm hmm.

• 9:04Speaker 07

  But what we can see from this questionnaire is that the symptoms that we're looking for with ADHD, it's still basically this classic picture that we probably have in our heads. So for some people, it's largely about having a hard time staying focused. For other people, and especially when they're younger, it's more about being hyperactive. And there are people who have both. And these core symptoms, they really haven't changed recently.

• 9:28Wendy Zukerman?

  OK, OK.

• 9:30Speaker 07

  And, you know, it is stuff that a lot of us might experience from time to time.

• 9:33Wendy Zukerman?

  Yeah.

• 9:34Speaker 07

  But when doctors are trying to figure out if someone has ADHD or not, what matters is how severe it is. How much does it impair your life? Does it get in your way?

• 9:42Wendy Zukerman?

  Yeah, so I said, you know, I often have trouble waiting my turn.

• 9:47Speaker 07

  Right, and if you had so much trouble that you were like cutting in line at the pharmacy, that the pharmacy banned you from the store, like, that's the kind of, uh, the kind of problem.

• 9:58Wendy Zukerman?

  Yeah, right, it's not, I just find it frustrating to wait.

• 10:00Speaker 07

  But you can, and you do.

• 10:02Wendy Zukerman?

  Yes.

• 10:02Speaker 07

  Or thinking about that question about missing appointments. We all forget appointments now and then. But Nagy told me this example of a patient of hers that kept forgetting to pick her kid up from school over and over. That's a bigger problem, right?

• 10:14Wendy Zukerman?

  Yes, yeah, that's a totally different level.

• 10:17Speaker 07

  And we actually asked listeners with ADHD to call in and tell us about their experiences. And a lot of what they talked about was pretty hard stuff. Um, like this listener.

• 10:26Speaker 04

  Just trying so hard not to mess up and not trying to forget things or miss things. Um, I've been fired from jobs because of it. Um, I, it's impacted friendships, I forgot phone calls, I've, um, lost important documents. I mean, it's, um, feels like it's trying to hold water in a strainer kind of situation.

• 10:48Wendy Zukerman?

  Right, OK. So then- Those are the kind of classic symptoms of ADHD still around. But then more and more, we're hearing people saying that their experience of ADHD, it's manifesting in all of these different ways.

• 11:05Speaker 07

  Yeah.

• 11:05Wendy Zukerman?

  Like that they experience hyperfocus or that they can't control their emotions. So what's going on here?

• 11:12Speaker 07

  OK, so let's start with hyperfocus. So this is the idea that for some people with ADHD, when they are able to focus, they can do it really intensely and they can work on something for hours and hours. People tell stories about forgetting to eat or go to the bathroom.

• 11:29Wendy Zukerman?

  Do you know, I, this, this is something I absolutely relate to.

• 11:34Speaker 07

  I can get. You know, I thought of you, actually. Because I remember back when we worked in the office together, you would just like power through, like for hours. It was crazy.

• 11:43Wendy Zukerman?

  I would have never thought of this as a symptom, though. I love it. I love this part of my personality.

• 11:48Speaker 07

  Yeah, a lot of people who experience hyperfocus say they really like it. Some people who called in said that this is their superpower. Like, one listener told us that when they're in this hyperfocused state, they can do something in a few hours that it would take other people days to do.

• 12:03Wendy Zukerman?

  It's sort of funny because it feels so counterintuitive to the other symptoms of ADHD.

• 12:08Speaker 07

  Right.

• 12:08Wendy Zukerman?

  That you're fidgety and you can't pay attention, but then you can pay attention on one particular task that you've been sucked into.

• 12:16Speaker 07

  Yeah, exactly. It seems like a paradox. And the going hypothesis that I've been hearing from scientists is that maybe what's going on with ADHD is they have problems with the control of their attention. So not just like problems with attention, but problems with how to control it. So to Maggie, it wouldn't be a paradox at all.

• 12:36Wendy Zukerman?

  It does make intuitive sense that if ADHD is a disorder of dysregulated attention, you're going to experience both sides of that coin. So the distractibility, you know, it means that you're.

• 12:48Speaker 07

  Unable to focus on something usually that's not holding your interest. And then the other side of that coin is that you can focus well when things are holding your interest. So the same thing that makes it hard for someone to stay on task might make it hard for them to move on to other things that should be now taking their attention. Like, you know, I was saying earlier, people forget to go to the bathroom. You should be aware, like, I have a full bladder, I should go to the bathroom.

• 13:14Wendy Zukerman?

  Aha. Do you, oh my god, oh my god, Rose.

• 13:19Speaker 07

  Yeah.

• 13:21Wendy Zukerman?

  Oh my god.

• 13:22Speaker 07

  Are you having a, another, yet another Ratatouille moment?

• 13:25Wendy Zukerman?

  Yes.

• 13:28Wendy Zukerman?

  I just had this memory of when I was at uni and I was studying in the library and I really wanted to finish studying.

• 13:37Wendy Zukerman?

  And I paid myself.

• 13:40Wendy Zukerman?

  I paid, yeah. I just really wanted to finish it and it was the upstairs library. Like, you had to go down a bunch of stairs to get to the toilet. And I was like, I just really wanted to finish it. And I paid myself.

• 13:51Speaker 07

  Oh my god.

• 13:51Wendy Zukerman?

  I know, I know.

• 13:54Speaker 07

  You know, it makes me think that some people do say that hyper-focus is a problem. It's not necessarily a superpower. It can mean that you get way too focused on the wrong thing or at the wrong time.

• 14:04Wendy Zukerman?

  So, I know, so, so is this really an ADHD thing?

• 14:08Speaker 07

  Well, it's not in the DSM, which is, you know, the psychological bible.

• 14:11Wendy Zukerman?

  Uh huh, it's not.

• 14:12Speaker 07

  Yeah, it's not part of the diagnosis of ADHD.

• 14:14Wendy Zukerman?

  Uh huh.

• 14:15Speaker 07

  So officially, no, but there has been a little bit of research on this and it has given us some clues. We have a couple of studies that have found that people who score higher on that questionnaire that we just took, they were more likely to experience hyper-focus.

• 14:31Wendy Zukerman?

  Right, so what do you make of it? Like, that's not the strongest evidence that this is definitely part of ADHD.

• 14:39Speaker 07

  But it just, it really hasn't been studied very much at all. So, right now, it seems like it's plausible that people with ADHD experience a state of hyper-focus more often and maybe differently than people without ADHD. We just don't have a lot of research, one way or the other, on it.

• 14:55Wendy Zukerman?

  That's interesting. All right, so the next one can we look at is the emotional. Emotional stuff that people were talking about, that it's like really hard to control your emotions when you have ADHD. This is something I had, I'd never really associated with ADHD before.

• 15:12Speaker 07

  Yeah, it doesn't sound like it has anything to do with that profile we were talking about earlier, like the typical ADHD set of symptoms, which are all about, you know, attention and focus. But a lot of people are sharing stories about being emotionally overwhelmed, dysregulated, very reactive, very sensitive. Here's one listener who called in. That Pixar Disney movie Inside Out. Imagine if all the emotions took steroids. That's basically what I experienced. I have extreme highs, extreme lows.

• 15:41Wendy Zukerman?

  I don't like to admit this, but I often freak out or just kind of have meltdown over small things. And then I end up feeling a little dumb just because I'm like, why did I overreact so much? So is, is this a part of ADHD or something else?

• 15:57Speaker 07

  This is tricky. I looked into it. It, it's like it's almost in the diagnosis. The, the DSM does say that low frustration tolerance, irritability and mood-ability, that's, that's basically moodiness. It says that all of those are associated with ADHD. And there is a study that found that people who scored higher on that test that we just took, they also scored higher on a test that measures emotional dysregulation, which suggests there might be some connection here.

• 16:27Wendy Zukerman?

  And do we know why?

• 16:29Speaker 07

  I talked about this with Maggie and other scientists, and they think it might be tied to impulsivity, which we know is, is common in people with ADHD. So we know that some people with ADHD have trouble regulating their behavior. Maybe this also applies to emotions, like they could have a tough time regulating emotions like they have a tough time regulating behavior. So it's not the emotions themselves that are unstable, but your cognitive ability to put the brakes on the emotion? Maybe.

• 16:57Wendy Zukerman?

  Mm hmm. Okay, right.

• 16:59Speaker 07

  But some people are taking this a step further and they're saying that people with ADHD have this particular emotional problem where they are really sensitive to criticism. Like their mood totally plummets if they feel like they're being rejected or criticized.

• 17:13Wendy Zukerman?

  Mm hmm.

• 17:13Speaker 07

  And some doctors have even named this. They call it rejection sensitivity dysphoria.

• 17:19Wendy Zukerman?

  Oh.

• 17:19Speaker 07

  This is an idea that the internet has really caught hold of. But I looked into it. There's hardly any evidence for it. There's really just one paper, which is about four patients.

• 17:30Wendy Zukerman?

  Oh, man.

• 17:31Speaker 07

  And when I talk to academics about this rejection sensitivity thing or the emotional dysregulation thing, they said it might be a part of ADHD. But for some people, something different might explain what's going on. So maybe they have ADHD, but they also have another condition on top of that. That's very common. We know a lot of people with ADHD also have a mental health diagnosis or they're neurodivergent in some other way, like they have autism. Studies pin it at at least 60% of people who have ADHD have another diagnosis. And anxiety and depression are some of the most common ones, which, you know, could also be associated with being really sensitive to being criticized or perceived rejection.

• 18:16Wendy Zukerman?

  Mm hmm. And so what's the concern here? The, I guess the problem would be that if you're putting all of these new symptoms into an ADHD bucket, emotional dysregularity, trouble with rejection, like, and you start saying, oh, everything's ADHD, and then you could miss a diagnosis of depression or anxiety. Is that the fear?

• 18:38Speaker 07

  Pretty much. And like, you know, the point of getting a diagnosis, ideally, is to get treatment and help for what's wrong. And so if you get the wrong diagnosis, you might get the wrong treatment. And so it's important to get the right diagnosis. And Maggie gave me an example of this. She told me about a teenager that she was evaluating. This kid had got referred to her by his school because he had a lot of problems paying attention in class. But as Maggie was talking to this kid, she realized there was other stuff going on here.

• 19:04Wendy Zukerman?

  You know, he grew up in a neighborhood with a lot of violence and he had a lot of home instability. And as you like just unpeel the layers of everything this, this boy had experienced in his life and you open the DSM to the PTSD criteria and you understand a little bit about how that can also manifest and you also ask questions about that.

• 19:25Speaker 07

  And you see that that story just fits this kid. Maggie said that trauma can affect how your brain works and affect your coping skills in a way that can affect how you pay attention. And she realized that that was explaining his symptoms. And so she diagnosed him with post-traumatic stress disorder. I didn't give him an ADHD diagnosis, even though at quick glance, somebody definitely would have. And that matters because you don't treat PTSD the same way you treat ADHD. So you don't just give someone stimulants to help them process their trauma, right?

• 19:54Wendy Zukerman?

  Right, uh huh. So, so what do you think? Do you think emotional dysregulation is part of ADHD?

• 20:02Speaker 07

  I don't know, it could be, but I think the takeaway is that if you really struggle with this, don't assume it's just your ADHD. Something else could be going on for you.

• 20:10Wendy Zukerman?

  That makes sense.

• 20:13Speaker 07

  There's another thing that's all over the internet that's worth talking about. It's this idea that women and girls aren't getting diagnosed properly.

• 20:19Wendy Zukerman?

  Yes, seen a lot on this.

• 20:21Speaker 07

  They get missed as children.

• 20:22Wendy Zukerman?

  Yeah.

• 20:23Speaker 07

  And they only figure out that they have ADHD if they ever do, much later in life as adults. And this does seem to be true to some extent. So data from the CDC found that 61% of women with ADHD were diagnosed as adults compared to 40% of men.

• 20:39Wendy Zukerman?

  Okay, do we know why?

• 20:41Speaker 07

  So one hypothesis to explain this is maybe girls hide, push down their symptoms in order to fit in socially because there's a lot of pressure to do that. That's also a possible explanation for why autism is diagnosed later in life in females. We also know that women with ADHD are more likely to get diagnosed with depression and anxiety than men are. And so maybe they're getting treated for that and then their ADHD gets missed.

• 21:09Wendy Zukerman?

  Rose, while we're on this topic of how vaginas and penises experience ADHD, I have seen stuff about how periods can affect ADHD. Have you looked into this?

• 21:22Speaker 07

  Yeah, we're just starting to get some research on this. It looks like ADHD symptoms might actually fluctuate throughout the course of your cycle, if you get a menstrual cycle. So there's one study that found that mid-cycle, people's impulsivity symptoms seem to get worse, and at the end of their cycle, they got sadder and they were less able to cope with stuff. And we also have research that found that women with ADHD suffer more postpartum and during perimenopause.

• 21:53Speaker 07

  So there might be something going on with estrogen levels changing in the brain combined with ADHD in the brain. That's basically like a double whammy. That's actually how some of these researchers put it.

• 22:05Wendy Zukerman?

  OK, that's really news you can use if you're, if you menstruate and you have ADHD, that you're something to be aware of. Your symptoms really might be fluctuating.

• 22:14Speaker 07

  And Wendy, just to cap off this part of the episode, we started out by saying, gee, doesn't it feel like ADHD is everywhere?

• 22:21Wendy Zukerman?

  And it does.

• 22:22Speaker 07

  I have some stats I have not yet told you. And yeah, I have kind of a reveal here. It's really not that wild. It's not everywhere.

• 22:31Wendy Zukerman?

  Oh.

• 22:31Speaker 07

  So if you look at about 20 years ago, in 2003, the CDC put out data finding that among adults, 4.4% of people said they'd been diagnosed with ADHD.

• 22:42Wendy Zukerman?

  OK, so 20 years ago, 4.4% had ADHD.

• 22:47Speaker 07

  Fast forward to 2023, that number had gone up to 6%.

• 22:54Wendy Zukerman?

  Wow. Oh, it's not that. It's really feels like it's gone from 1% to like 50%.

• 23:02Speaker 07

  But, right.

• 23:03Wendy Zukerman?

  You know, when you look at some friendship groups.

• 23:07Speaker 07

  But it's not, it's not that extreme. It's really not.

• 23:10Wendy Zukerman?

  It's not that extreme. It has been going up. But that could easily be explained by more awareness from both doctors and patients.

• 23:19Speaker 07

  Yeah.

• 23:22Wendy Zukerman?

  After the break, what is an ADHD brain? Yep, it's your brain on ADHD and what you can do about it.

• 23:41Speaker 01

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• 24:41Wendy Zukerman?

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• 25:29Wendy Zukerman?

  Welcome back today on the show. Rose is telling us all about the science of ADHD.

• 25:35Speaker 07

  Hey Wendy, so I'm ready to talk to you about ADHD in the brain.

• 25:38Wendy Zukerman?

  Yeah, tell me about dopamine. What's it doing?

• 25:41Speaker 07

  Yeah, I mean, that's what you hear online, that ADHD is caused by a dopamine deficiency. And this comes from the fact that dopamine is a chemical in the brain that helps us pay attention and feel motivated to do things. And we know that stimulants like Adderall work by increasing the availability of dopamine and other neurotransmitters in the brain.

• 26:02Wendy Zukerman?

  Okay, so ADHD brain. Dopamine is out of whack?

• 26:07Speaker 07

  No, not so fast.

• 26:08Wendy Zukerman?

  Well, okay.

• 26:09Speaker 07

  Wendy, there's more here. Scientists are pretty sure now there's a lot more going on.

• 26:13Speaker 01

  Oh, if it was as simple as dopamine, we'd probably have figured it out by now.

• 26:17Speaker 07

  I talked about this with Philip Shaw. He's a professor of developmental psychiatry at the King's Maudsley Partnership.

• 26:24Speaker 01

  You know, it really is so incredibly complicated. It's breathtaking, like it's.

• 26:30Wendy Zukerman?

  Magnificent, and it's a challenge. Like, I think there's no way it's all just one big thing. Wow, Philip's like dopamine, more like nope-amine.

• 26:39Speaker 07

  The British don't talk like that, but yes.

• 26:44Wendy Zukerman?

  Isn't he Irish?

• 26:45Speaker 07

  Yeah, but my point still stands. So there are other things going on in the brain that could help explain ADHD. And Philip and I talked about some of his favorite explanations. Yeah, there's two that I'm particularly taken by.

• 27:00Wendy Zukerman?

  Tell me about this dalliance with two other theories around the ADHD brain.

• 27:07Speaker 07

  So the first one has to do with the default mode network. Have you heard of this?

• 27:12Wendy Zukerman?

  I have.

• 27:12Speaker 07

  I think you have. It's come up before.

• 27:14Wendy Zukerman?

  Yes, it's the, it's the part of your brain when you are sort of daydreaming, when you're not particularly thinking about a thing, but it's just like, what's going on in there on the default?

• 27:24Speaker 07

  Exactly.

• 27:25Wendy Zukerman?

  Just the mind drifting, that sort of feeling, you know?

• 27:28Speaker 07

  If you're a bit bored, you know, probably after I go on for five minutes, everyone's brain will be in this state. He's being modest, he's actually very interesting.

• 27:37Wendy Zukerman?

  Mm-hmm, right, remains to be seen.

• 27:40Speaker 07

  So if your mind is drifting, the default mode network is activated. We can see this in a brain scanner. But if you start thinking about something, like you start making dinner plans in your head, or you're thinking like, oh, I better sit down and do my taxes next week, or whatever, other areas of the brain light up. And in response, the default mode network kind of simmers down.

• 28:01Wendy Zukerman?

  Uh-huh.

• 28:01Speaker 07

  But what we see in people with ADHD, when researchers have gotten them into these scanners, is that the daydreaming network doesn't always simmer down when they're thinking about something else. It might kind of intrude. So every so often, the individual is doing something, and then the offline brain pops up and turns it off when it shouldn't do.

• 28:20Wendy Zukerman?

  So there's an imbalance between the offline and the online brain. Oh, that's so interesting. And that could totally help explain why it's hard to focus, right?

• 28:31Speaker 07

  Yeah. There's another explanation that has to do with another network in the brain.

• 28:35Wendy Zukerman?

  Okay.

• 28:36Speaker 07

  So basically, there are these pathways where different parts of the brain talk to one another. There are these fantastic information processing loops in the brain. You know, they go deep in the brain, and then they go to the surface of the brain.

• 28:49Speaker 01

  In the cortex and then they go back. And these information processing loops are what controls attention, cognition, everything.

• 28:58Speaker 07

  And some of these loops are really important for what's called executive function, which can help us decide what we pay attention to.

• 29:06Speaker 01

  And in ADHD, the thought is that they're a bit disrupted, that the flow of information sometimes goes a bit awry.

• 29:14Wendy Zukerman?

  And so how do all of these different ideas, the dopamine, brain looping, default mode network, are they all happening at once in an ADHD brain?

• 29:26Speaker 07

  So, no, not necessarily. What scientists are starting to figure out is that there are probably a bunch of different kinds of ADHD caused by a bunch of different brain changes.

• 29:36Speaker 01

  Gosh, just meet 100 people with ADHD. After meeting them, you're not going to think they've all got the same thing going on. You know, it's just not like that.

• 29:42Speaker 07

  Philip says that some of his colleagues are actually calling it ADHDs, not ADHD. So maybe for some people, dopamine is the main issue. For someone else, the imbalance with the default mode network is the main issue. For someone else, it's these loops that are important for executive function. Or there could be some combination of these things. And by the way, we should say that while these brain changes are meaningful, they're also small. It's a slight shift in how the brain functions or talks to itself or is connected.

• 30:14Wendy Zukerman?

  OK, so now can we look at treatments? What can people do if they're really struggling?

• 30:19Speaker 07

  Yeah, so as we've said in a previous episode, stimulants help lots of people. So there was a trial of about 400 adults with ADHD, gave them Adderall. And they found that 65% of people given Adderall got better. That's compared to 20% of people who took the placebo.

• 30:40Wendy Zukerman?

  OK.

• 30:40Speaker 07

  So that's why stimulants are kind of the first line medication for people.

• 30:45Wendy Zukerman?

  Yeah.

• 30:46Speaker 07

  But obviously, that's not everybody. Not everybody got better. And not everybody wants to take them or can take them or can get them, right? There's been a shortage.

• 30:54Wendy Zukerman?

  Yeah, there's also side effects, right? They can mess with your sleep.

• 30:57Speaker 07

  Yeah, they can mess with your sleep, your appetite. So there are non-stimulant medications that are also fairly effective. But there's a lot of other things you can try. I mean, online, you hear all these tips and tricks. Everything from body doubling to changing your diet.

• 31:12Wendy Zukerman?

  What is body doubling?

• 31:15Speaker 07

  It sounds so sci-fi. We'll get to it. I'm gonna leave you in suspense. But I called up a psychologist named Russell Ramsey to talk about this. And he does therapy for adults with ADHD. And he's like, a lot of his patients come in and they're like, I don't really know how therapy is gonna help me, especially with my main problem in life, which is like not getting stuff done that I need to get done, procrastination.

• 31:40Speaker 04

  They'll say, I know what I need to do, but I just don't do it. So what good is talking with you about it gonna do me? Or that I haven't read already? And my answer to that is, I think I'm pretty good at helping people understand how they don't do things. Not just, oh, you procrastinated again. Try harder next time not to procrastinate.

• 31:58Speaker 07

  So that's a lot of what Russ and I talked about. How to help a person with ADHD get motivated and avoid something called procrastivity. Can you guess what that means, Wendy?

• 32:09Wendy Zukerman?

  Sounds sexual.

• 32:12Speaker 07

  Are you thinking of the prostate perhaps?

• 32:14Wendy Zukerman?

  I was thinking of like procreation.

• 32:16Speaker 07

  Oh, no. Here's how he defines procrastivity.

• 32:19Wendy Zukerman?

  Procrastivity.

• 32:20Speaker 04

  Procrastivity is avoiding a higher priority, more important task by doing some lower priority task, a chore or whatnot. But that is self-defeating because then the more important task doesn't get done.

• 32:35Speaker 07

  So he gave me this example. There is a patient of his who, at the time, was a graduate student working at a lab. And she had to present a paper to her lab group the next week.

• 32:45Wendy Zukerman?

  Yeah.

• 32:45Speaker 07

  And so she knew that like this is gonna be a drag. And she talked about it in advance in therapy with Russ.

• 32:50Speaker 04

  I think that day or like the day before, we said, okay, so how are you gonna do this? She said, I got a long day in lab. I'm gonna come home. I have the art. I just need to read through it, do a couple of slides. It doesn't have to be anything big. And if I do it right away when I get home, I'm good for the next day.

• 33:05Speaker 07

  So some time passes. She comes back for her next session. Russ follows up and he asks, so how did it go? Did you read the paper and make the presentation?

• 33:15Speaker 04

  And she said, you know what? I got home and I thought about doing it. But my first thought then was, I'm gonna bake a cake.

• 33:23Wendy Zukerman?

  No.

• 33:24Speaker 04

  She had been, was she like cooking shows? I'm gonna bake a cake.

• 33:27Wendy Zukerman?

  So do it. Read the article.

• 33:30Speaker 07

  She didn't read the article. She baked a cake.

• 33:33Speaker 04

  And then she said, and I'm diabetic. I can't eat the cake. I wanted to make it, I knew it. But it wasn't like I had a neighbor to give it to or a nephew. It's just, I wanted to do it, but it makes no sense that I did that instead of, and probably took longer doing that.

• 33:51Wendy Zukerman?

  Okay. Classic proctivity.

• 33:54Speaker 07

  Proctivity.

• 33:57Wendy Zukerman?

  Yeah. Okay, so how does Russell get his patients to read the science report?

• 34:04Speaker 07

  So one thing Russ has noticed is that a lot of people are opting for a task that's sort of broken into steps, like baking the cake. There's a recipe. So it's like, do this, then this, then this. And so he has found it can be really helpful for his patients to break their task down into kind of a recipe. And he likes to use what he calls if then statements. So like for the cake baking scientist, he told her like, okay, so next time, tell yourself, if I can sit down at my computer when I get home from work, then I can open the document. If I can open the document, then I can read the abstract.

• 34:44Wendy Zukerman?

  Wow.

• 34:45Speaker 07

  If I can read the abstract, then I can.

• 34:47Wendy Zukerman?

  Little instructions, one by one. Ah ha, ah ha, ah ha.

• 34:52Speaker 07

  It's like the first step is like, that wasn't so bad. Maybe I can do the next step. That wasn't so bad. Maybe I can do the next thing. And before you know it, you're actually doing it. He also asks his patients to remind themselves of the bigger picture. Like, why am I doing this annoying task? How does it matter for my life or the goals you want to accomplish?

• 35:08Wendy Zukerman?

  Ah ha, and he finds this is helpful for his patients.

• 35:11Speaker 07

  Yeah, he does. So Russ practices a form of therapy that's called CBT. And there are studies on CBT for people with ADHD that find that it can really help. A lot of these studies are looking at CBT plus medication. And so it seems like what works fastest is CBT with medication. People improve the fastest with that combination.

• 35:31Wendy Zukerman?

  Okay.

• 35:32Speaker 07

  But for some people, CBT on its own, maybe could work. So we have one study that found that they eventually caught up to the people who were also taking meds.

• 35:41Wendy Zukerman?

  Wow, that's impressive.

• 35:43Speaker 07

  Yeah, I mean, there is a caveat here. So very recently, there was this big meta-analysis of treatments for ADHD. And when it came to CBT, they said that mostly these results were shown in clinician-reported ratings. So like, your doctor says, my patient's getting better or not. And it didn't really show up for self-reported ratings. So people were saying like, I'm not doing that much better on average, people in CBT. So like, the positive results are mostly coming from the doctors saying, this is working for my patient.

• 36:15Wendy Zukerman?

  Oh.

• 36:17Speaker 07

  So that's interesting.

• 36:18Wendy Zukerman?

  Get that Kate Baker into the studio. Let's ask her how she feels.

• 36:24Speaker 07

  I mean, maybe people are improving in their coping skills, but this doesn't show up when asked about their core symptoms. Or maybe the improvement is subtle enough that the people themselves aren't noticing it as much as like an outside observer might be noticing it.

• 36:39Speaker 04

  Let's just say, right now, you procrastinate four times out of five. And if we can get that to three out of five, you're still procrastinating. But if we invented a medication with those results, we're billionaires. Most people will get better. Yeah, some people not as better as they would have hoped to have been.

• 36:54Wendy Zukerman?

  Mm-hmm. Okay, so therapy, medication, some things that can help. What else we got?

• 37:03Speaker 07

  Well, I promised you I would tell you what the hell body doubling is.

• 37:06Wendy Zukerman?

  Oh, yeah.

• 37:07Speaker 07

  It sounds so weird. It just means having someone else there with you, even virtually.

• 37:12Wendy Zukerman?

  And so what is this person supposed to be doing?

• 37:15Speaker 07

  Well, they're, they might, so let's say you are working on, you're a student, you're working on your homework. Having a friend in the room is also working on their homework. It's kind of like keeping you accountable.

• 37:26Wendy Zukerman?

  Okay.

• 37:27Speaker 07

  But Russ was like, yeah, yeah, sure.

• 37:30Speaker 04

  That is something I would view as credible. Now, has there been a randomized controlled design saying, hey, we tried this and not? No, but this is one of these, if you will, commonsensical that it can help anybody. Yeah, I think.

• 37:42Speaker 07

  It's probably the basis of personal training at a gym. Oh, I should be able to walk in here and do all the machines. But if Lars over here tells me to get on the treadmill, I do.

• 37:52Wendy Zukerman?

  I love that you use Lars. That's such a personal trainer name.

• 37:54Speaker 07

  I don't know why. Yeah, it just sounds like one.

• 37:57Wendy Zukerman?

  It totally does.

• 37:58Speaker 07

  Yeah. Another thing people talk about a lot online is listening to music or white noise. And there are some studies that get people with ADHD to do a task while listening to white noise or music and find that people do better when they have this sort of noise.

• 38:13Wendy Zukerman?

  Oh, that's cool.

• 38:17Wendy Zukerman?

  All right, on to diets and supplements. People love to offer these.

• 38:21Speaker 07

  Yeah, so people have looked into this somewhat, mostly in kids. Stuff like taking vitamins and minerals, omega threes, omega sixes. But it's pretty iffy. Just a couple of years ago, there was a big Cochrane review that kind of just poured cold water on the omega supplements, helping kids with ADHD. And I didn't find anything in adults that would convince me that there are any supplements to take or diets to try or foods to avoid or eat to improve your ADHD.

• 38:50Wendy Zukerman?

  So watch out for those influencers online promising the world.

• 38:54Speaker 07

  Seems like really, right now, the best supported stuff to try, medicine, therapy, those are the best tools that we have for treating ADHD. And then some of this other stuff, body doubling, listening to white noise or to music, there's no, there's not really any harm to trying that. So if it works for you, that's great.

• 39:16Wendy Zukerman?

  All right, Rose, we've come to the end of our ADHD episode.

• 39:20Speaker 07

  Yeah.

• 39:21Wendy Zukerman?

  Hopefully listeners rebels of focus for long enough to get to here. If you tuned out for a hot minute or two, let me sum up. All right, so when it comes to the symptoms of ADHD, while perhaps ADHD might manifest in emotional stuff or hyper focus, we're still kind of working that out. But based on those two symptoms alone, do not be diagnosing yourself with ADHD. The main symptoms are still. Still having difficulty focusing and also being a little bit hyperactive.

• 39:57Speaker 07

  Yeah.

• 39:58Wendy Zukerman?

  The ADHD brain is complicated. It's not just dopamine, but it is also a little bit dopamine. And if you are looking for treatments, there's no magic diet or supplement. You can go on, but medication and therapy might help.

• 40:14Speaker 07

  Yeah.

• 40:14Wendy Zukerman?

  How do I do?

• 40:15Speaker 07

  That sounds good. You might need a little help. You could enlist a really hot muscular guy named Lars to work on this with you. And if you choose to do that, you have our blessing here at Science Versus.

• 40:28Wendy Zukerman?

  Thanks, Rose.

• 40:30Speaker 07

  Thanks, Wendy.

• 40:33Wendy Zukerman?

  And Rose, Rose, Rose, Rose, Rose.

• 40:35Speaker 07

  Oh, yeah, I'm still here. I'm still here.

• 40:36Wendy Zukerman?

  How many citations are in this week's episode?

• 40:39Speaker 07

  Um, 61 this week.

• 40:41Wendy Zukerman?

  61. And if people want to see them in all of their glory, where should they go?

• 40:45Speaker 07

  They can click the link to the transcript and that link is in our show notes.

• 40:49Wendy Zukerman?

  That's right. So if you want to read more about any of the studies that Rose told us about, just head to the show notes. Also, if you want to come say hello and let us know what you thought about this episode, we are on Instagram, science underscore V S. I am on TikTok, at Wendy Zukerman.

• 41:06Speaker 07

  Yeah, and I just wanted to call out here, like, we had so many listeners call in, leave voicemails, send us voice memos, email, comment on Instagram, and tell us about their experiences with ADHD. And I listened to every one of those voice memos and read all those comments. So even if you didn't hear yourself in the episode, it was really important for me to hear from everybody. And I thank everyone for sending all that stuff in. It was super helpful.

• 41:34Wendy Zukerman?

  Yeah, thank you so much. We love, we do love, love, love, love hearing from you. Um, also, as a little thing, Emma Munger, who used to sound engineer our show, has a new album out. Did you know this, Rose?

• 41:49Speaker 07

  No, I didn't know that.

• 41:50Wendy Zukerman?

  She doesn't just score podcasts. She also makes beautiful, beautiful, beautiful music. And I was listening to the album last night. It's really lovely. So you can find her on Spotify. The album is called Pattern. Her name is Emma Munger.

• 42:05Speaker 07

  It's M U N G E R, because not M U N G A, because of your accent.

• 42:10Wendy Zukerman?

  No.

• 42:12Wendy Zukerman?

  No. Thanks, Rose.

• 42:14Speaker 07

  Thanks, Wendy.

• 42:22Speaker 07

  This episode was produced by Rose Rimler with help from me, Wendy Zukerman, along with Merrill Horn, Michelle Dang and Akenny Foster Keys. We're edited by Blythe Terrell. Mix and sound design by Bobby Lord. Fact checking by Erica Akiko Howard and Marlo Starling. Music written by Peter Leonard, Emma Munga, So Wiley, Bumi Hidaka and Bobby Lord. Thanks to all of the researchers that we spoke to for this episode, including Dr. Robert Rosenthal, Dr. Miguel Garcia Pimenta, Professor Michelle Martel, Dr. Maeve King, Dr. Edward Modestino, Professor Edmund Sonuga-Bark and Dr. Ashley Hawke. Again, a huge thanks to all of our listeners who called in and told us about your ADHD experience. Thank you. Science vs. is a Spotify Studios original.

• 43:07Speaker 07

  Listen to us for free on Spotify or wherever you get your podcasts. And if you want to know when new episodes come out, if you're listening on Spotify, you can follow us and tap the bell icon. I'm Wendy Zukerman. Back to you next time.