← ADHD Experts Podcast
ADHD Experts Podcast
580- Debunking Myths and Misperceptions of ADHD: How to Influence Naysayers
01:10:58
To kick off ADHD Awareness Month, William Dodson, M.D., presents an overview of ADHD's history, complexity, and persistent myths and stigma — and shares ways to correct lingering misperceptions about the condition. ADHD Myths and Misperceptions:...
Loading summary
Transcript22 lines
- [00:04]
A
Welcome to the Attention Deficit Disorder expert podcast series by Attitude magazine.
- [00:14]
B
Everyone. I'm Carol Fleck and on behalf of the Attitude team, I'm delighted to welcome you to a very special event to kick off ADHD Awareness Month. We're very fortunate to have Dr. William Dodson here. He'll be giving today's ADHD experts presentation on a very timely topic, Debunking myths and misperceptions of ADHD. How to influence naysayers. Dr. Dodson is a board certified psychiatrist who has been instrumental in advancing the field's understanding of adhd. He was among the first practitioners to specialize in treating adults with adhd more than 25 years ago. He is also widely recognized for his work involving one of ADHD's most impairing features, rejection sensitive dysphoria. Dr. Dodson has spent his career as a passionate advocate and defender of the importance of ADHD treatment. He was named a Life Fellow of the American Psychiatric association in recognition of his contributions to the field of Adult ADHD. So without further ado, I'm so pleased to welcome Dr. William Dodson. Thank you so much for joining us today and kicking off ADHD Awareness Month with us.
- [01:33]
C
My pleasure to be here. Thank you for asking me. We're here today to talk about ADHD and how it affects individuals. There's a lot going on with thugs and make America healthy again and we're not going to have any influence on that. Nothing direct. So it's one of those things. We have to control our own lives. I was just looking back over a presentation by Neil DeGrasse Tyson and he was talking about the fact that he was looking at life expectancy going all the way back to cavemen 100,000 years ago. And back then the life expectancy was 30 years and most of the children would die in their first year of life. Then you look at 1840, which is at the beginning of the modern era. The Industrial Revolution hadn't changed much. Life expectancy was 35 years. And still half of children died before their first birthday. If you jump forward to today, life expectancy on average in fully developed countries is 78, more than double. And it's exceedingly rare to hear of a child dying early in childhood. He said, what made the difference between 1840 and now? He says it wasn't governments, it wasn't churches, it wasn't the environment. It was one thing. It was science. Science has been what has made us the whole planet livable. It has helped us double our life span and also our lifestyle. We have the best medicine in the world. So it's important that when science in general and medicine in specific gets attacked that we respond. And it's going to have to be each and every one of us individually responding, because right now the whole medical system is in jeopardy. ADHD as a diagnosis is no longer controversial. It has not been controversial for more than 25 years, although you would never believe that to listen to some of the stuff that's out there. Back in 1998, the American Medical association put out a council report about ADHD to help inform people about the controversies that were there. And what they wrote was, debate over ADHD within the research and medical communities has been mild and mostly concerned with nuances in the diagnosis and treatment paradigms. By contrast, highly inflammatory public relations campaigns and pitched legal battles have been waged. These attacks are abstract, distorted and mendacious. If you're like me, you have to go to the dictionary to find out what mendacious means and it's mean spirited. And I think that's a very good description of what we're dealing with right now. So today we're going to try and prepare you to know all the data that's out there and why ADHD.
- [04:53]
B
Is.
- [04:53]
C
Being attacked and what you can do about it. Everybody, somewhere in their lives has a person who goes through life constantly telling everybody else they're wrong. Now they are described in my family as often in error, but never in doubt. Now, our goal today is not that you're ever going to win an argument or change minds. This is going to be entirely for the benefit of yourself and your children and family. When people who are attacking ADHD, or indeed anything else, when you present them with facts and reality, they don't say, oh, thank you for that insight. They usually double down and become even more outlandish in their claims. Now, the goal is for you to be able to separate that which is realistic and that which is intended to mislead you by increasing doubts and fears. So one of the first things they do is they say, well, ADHD doesn't even exist. There are two people, two types of people that you're going to run into out there. Many of them are going to be the truly curious person who's new to adhd, just like you and I were at some point in our lives. And it's usually because either the person's been recently diagnosed or a family member has been recently diagnosed and they are genuinely looking to become educated about what's going on. The second group are those who are merely provocative and Argumentative. You know, this is your Uncle Fred that nobody wants to invite to Thanksgiving dinner because all he does is pick fights. These argumentative people are self appointed experts who know nothing. So if you find somebody who just basically is pontificating about it, just walk away if you can. Sometimes you can't though. And so my first piece of advice about handling, how to handle this is ask them how do you, what do you know and how do you know it? So it puts them on the defensive of how to show that they actually know nothing. They just enjoy arguing. They don't know the decided science that has been there for years. If that doesn't work, the next thing I ask is what would it take to, for you to open your mind and try to take in some new information. These argumentative people will then double down and they'll say there's no reason for me to know anything else I know at all. And I sort of thing. So you know then that to try and even have a conversation with such people is a waste of your time and will only lead to your frustration. ADHD as an entity and the first line stimulant medications have been accepted by every professional organization and regulatory agency in North America and the European Union. And the stimulants have been accepted as the treatment of choice for more than 70 years. Even so, it's the nature of science to be constantly improving what we know, going for more depth, more nuance. But that doesn't mean that what came before was wrong. We're just doing a better job of it. One of the problems that makes people attack ADHD is not existing is that indeed there is no blood test for adhd. There's nothing on the physical exam, there are no psych drugs or scans or anything like that that show the proof of adhd. But then again, there's not for a lot in medicine, no psychiatric diagnosis has a blood test or a scan or anything like that. It's diagnoses in psychiatry or neurology, where headaches, for instance, don't have any markers or scans or anything like that, you, you make the diagnosis because of a consistent observation and experience that ADHD is the same, it doesn't change. And that if two people, one doctor from Bangkok and one from Denver, Colorado interviewed the same patient, we would come up with the same diagnosis, that it's consistent. These factors that we look to as diagnostic criteria are the same everywhere you go, is not laziness, is not an attempt to escape responsibility. Indeed, it's the exact opposite. Once the diagnosis is made and confirmed more is expected from people, not less.
- [10:14]
D
This show is brought to you by BetterHelp. BetterHelp therapists have helped more than 5 million people worldwide on their mental health journeys. That's millions of stories and behind every one is a therapist who showed up, listened and helped someone take a step forward. This World mental health day, BetterHelp is honoring those connections and the therapists who make them possible. World Mental Health Day is a great time to speak up about the benefits of therapy such as personal validation and empathetic strategies for change and accountability along the way. The right therapist can change everything and BetterHelp has more than 12 years experience in matching people to the right therapist. BetterHelp therapists are fully licensed in the US and work according to a strict code of conduct. Begin with a short questionnaire that helps identify your needs and Preferences and BetterHelp does the initial matching work from its network of more than 30,000 therapists. If you aren't happy with your match, switch to a different therapist at any time from their tailored recommendations and the success rate is high with an average rating of 4.9 out of 5 for a live session based on 1.7 million client reviews. This World Mental Health Day, we're celebrating the therapists who have helped millions of people take a step forward. Forward. If you're ready to find the right therapist for you, BetterHelp can help you start that journey. Our listeners get 10% off their first month at betterhelp.com attitude that's BetterHelp H E-L-P.com attitude.
- [12:01]
C
The next thing people will say is that ADHD doesn't exist. It's really just two things. It's either bad parents or bad kids or both or it's pathologizing normal behavior. And really what this kid needs is a good spanking. We know that this is not true because the multimodal treatment study, the mta, one of its arms was what they called maximum dose behavior management. It was 14 months, five days a week, two hours every afternoon. The parents went twice a week for two hours to get parental training. It was delivered by the people who developed these behavioral techniques. So they were getting the best treatment from the best people in the world. And what they found out was it didn't work. So in their report they write, the notion that ADHD is just normal behavior labeled by uninformed parents or overwhelmed teachers appears not only implausible, but preposterous. The whole notion is being over diagnosed as just social ills or excuses. There's just no evidence for that intensive maximum dose intervention did nothing. So what does ADHD look like? It's important to know that ADHD remains the same throughout the lifespan. We are what changes as life goes on. We get more and more demands, we have to work harder for longer, we have to pick up skills and things like that. So as we develop from ages 0 up to about 18, we're constantly having to be challenged to pick up new skills. And that doesn't stop as we grow older, because we constantly have to be adapting to a new stage in life. The 18 features of the diagnostic criteria are stable, they're verifiable, and ADHD is the same. It's in the same prevalence wherever you go in the 58 countries where the prevalence has been studied. The one problem we're dealing with now is that the description of women has been fairly woefully inadequate. And they are working for both adult criteria and especially for women, not just adults. So yes, everybody has had at least one or probably all of the 18 criteria. It's just part of life. Yes, I've misplaced my keys, yes, I've been late to meetings. All 18 I've done at some time in my life. But that doesn't make it a disorder. In order for these 18 criteria to rise to the level of being, a problem is that they must be persistent, lifelong in every situation. But most of all, they must be impairing. These are more than just lovable little traits or parts. They actually have to cause significant impairments in every area of life for as far back as your memory goes. It will also continue to be impairing for the rest of your life. So right now, the 18 criteria that we have are based on 6 to 12 year old children. And so consequently they are based on observable behaviors. Researcher could see it, count it and do statistics on it. And so our criteria are almost entirely behavioral. But that's going to be changing because now we recognize that some of the more impairing parts of ADHD are not behavioral. Emotional regulations probably the most impairing. So behavior is really not the problem with adults about the age of 15. The two most impairing features are the inattentive component of ADHD, daydreaming, drifting off, being inefficient, and struggle with emotional control. In the literature it's called emotional dysregulation. It really is just being able to control your own emotions in the moment. This is one of the reasons why so many people get misdiagnosed as being anxious and depressed is because they have trouble controlling their emotions. So little boys have what we call noisy adhd. They're loud, they're impulsive, they're reckless, they're obnoxious, you can't miss them. But little girls have what we call quiet ADHD because they have the poorly noticed inattentive subtype of ADHD where they sit in the back of the room and daydream. They are usually missed due to over compensations. So girls, adolescents, grown women, the elderly, doesn't really matter. ADHD is their lifelong but it is missed. Most women with ADHD have a history of being clearly distressed their entire lives but nobody figured out what the cause was. No one also seen what it took for them to succeed. Now women also are much smarter than the general population. The best statistic I've seen is the average IQ for a woman with ADHD is 123. That's all the IQ a person needs to do anything they want. But that doesn't protect them from shame, from knowing that they're not like everybody else and that they have very low self esteem because they're never sure whether they're going to be able to get access to their abilities when they need them. And so they view themselves as unreliable failures or frauds. They see themselves as, you know, they're not what the people don't see how really impaired they are. Also one of the big problems is that women at all ages have intentionally not been studied. Women girls were not included in an ADHD study until the year 2000. They were completely ignored. In my training I was taught that women did not get adhd so we just never even looked. So again here in half the population ADHD is missed. It's not being over diagnosed. And in general all of the studies of diagnosis around the world have shown that half of children with ADHD or are missed, they never had it mixed into them. So when you ask what is ADHD like? The answer is going to almost always be well it depends. This is an important concept. ADHDers are inconsistent but in a very consistent way. They can get engaged when they're in a hyper focus or they also can be often their own thoughts and la la land. They can act impulsively or be be paralyzed by procrastination. They can be very empathic or they can be socially inept. And from the outside it looks like these ability to get their strengths or not do something. From the outside it looks as if it's a conscious choice, but it rarely is. So one of the first things I ask new patients is this question, I'd like for the people who are out there right now to ask it about themselves, if they have adhd, or ask it about their family member who has adhd. Here's the question. Take time to formulate your answer. Look back over your entire life. If you've been able to get engaged and stay engaged with literally any task of your life, have you ever found something you could not do? The answer from virtually every patient I've seen is, they'll stop, they'll think, and they'll go, no. You know, if I can get started and stick with it, I can do anything. This changes everything. It's a radical question. It's not the person, it's the situation the person's in that determines how well the ADHD nervous system works, how well it gets engaged, how well it gets access to its abilities. And you can really see this when people have the sort of ultimate of this we call a hyper focus, during which time the term that you'll see is coming up in the literature now is people can be omnipotential. They quite literally can do anything. Executive functions are sometimes deficit, sometimes deficit. But only 50% of children have a detectable executive function deficit. As such, executive function deficits are neither required to make the diagnosis nor sufficient to make the diagnosis of ADHD, although it's been the dominant theory for 20 years. This coming and going based on whether or not you're engaged explains the inconsistency that we see with adhd. Why sometimes they can function better than anybody else and sometimes they can't even get started. It depends on the situation. Therefore, it's coming to me that ADHD is not being seen as someone being damaged or deficit or whatever you want to call it. ADHD is much more being seen as a second type of nervous system that sometimes, if the situation's right, works perfectly well, but it works by its own set of rules and methods. This is where we're beginning to hear much more about the term neurodiverse, which is a fancy way of saying that you're merely different from the majority of people who are called neurotypical. Now, in the neurotypical world, people with ADHD are seen as deficit, broken, damaged, deficient. And so this would mean that you have to manage two parts of the ADHD nervous system in order to really manage adhd. The first one we're used to. The medications do a wonderful job of helping us get engaged and stay engaged. The stimulants especially, there are other medications that handle other aspects of adhd. When primarily people start with stimulants. But the second thing is that they have to know what works for their ADHD nervous system and what doesn't. If you look at most of the non medication based therapies that are out there, they are all some variation on Try again harder. They make a list of all the things that people struggle to do and then demand that they do them. And we don't see any futility in that, which is why the non medication based therapies have had such poor outcomes.
- [24:56]
D
This show is brought to you by Hyperfocus with Ray Jacobson. October is ADHD Awareness Month and unfortunately there's no shortage of myths and misinformation to challenge and correct this year. Attitude reports the truth about adhd and we hope that's why you're here listening. It's why you might like another podcast too. It's called Hyperfocus with Ray Jacobson. Each episode Ray speaks with a different expert, whether they're a scientist, doctor or researcher, to dive into some of the big questions and headlines around ADHD and mental health. They talk about things like how ADHD affects women's hormones and vice versa, how ADHD might impact postpartum depression, how to manage ADHD and your career and more. I especially liked two recent episodes in which a clinical psychologist and a researcher break down what parents need to know about the Maha report and how misleading analysis of scientific research tells a false narrative about adhd. To listen to Hyperfocus with Ray Jacobson Search for Hyperfocus with Ray Jacobson in your podcast app. That's Hyper Focus with Ray Jacobson.
- [26:20]
C
So why are people, more people being diagnosed with adhd? There are a lot of people out there who, for their own reasons, want to see something nefarious going on, that people are scamming doctors to get medications or they're drug addicts or something like that, where there's actually no evidence for that. What has happened is that people are much more aware now and recognize much more frequently the purely inattentive subtype, the quiet ADHD that otherwise goes unnoticed. It's the squeaky wheels that have gotten the grease for 50 years. Also, more people have an awareness that what they've been told in horror stories and fake opinions and things like that just isn't true. They have a personal experience of the kid down the street who was just a horror show, terribly behaved, a menacing community, but who started on ADHD medication and is now just a delightful kid. They find that all of these scares and tactics just weren't true. Because they saw it with their own eyes. Probably the big one about why people, more people are being diagnosed are that females are finally being recognized and diagnosed. So half the people with ADHD in the world were not recognized at all. So now that we are beginning, and we're only just beginning to recognize women with ADHD that doubles the number of people who are out there being diagnosed and getting medication. It is not people trying to get a little system is that we're doing a better job of recognizing it. There's also a lot less social stigma to seek treatment. ADHD is extremely common everywhere in the world. And everywhere in the world that they look for ADHD they come up with about the same problems again, something that shows that ADHD is pretty consistent all the way through the world. ADHD is the second most common neuropsychiatric condition, not just in kids, we're definitely by far the most, but at all ages with substance use disorder being the number one most frequent. This whole notion about being over diagnosed, there's no evidence for that. There are a couple of papers that show that there's small pockets around the country where the, the prevalence and number of prescriptions is much higher than the rest of the country. But in all cases it's a rural physician who's the only person who diagnoses and treats adhd. So that's what he gets, everybody goes to him or her and so he ends up writing more prescriptions. There's a study done by the National Institute of Mental Health of five US cities. Actually one of them was San Juan, Puerto Rico. And what they found was that half of children and adolescents with ADHD were missed. Again, it wasn't over diagnosed. It was a 50% failure rate to diagnose. It was so bad that the study recommended a national program to educate prescribers of all types how to recognize ADHD and treated because we were missing so many people. Now there's another study of which I was the lead author, but I didn't earn that at all. I'm basically an lead author because I want to bet the study was eight board certified adult psychiatrists who they the least amount of time they'd been out in practice was seven years and they looked at 13 patients and they videotaped every moment of interchange between the doctor and the patient looking for what it was that would trigger the thought in the clinician's head I need to consider adhd. I just need to think of it. I won the bet because I met them and said look guys, at the end of this we're not going to have any data because an American psychiatrist is not ever going to think of adult adhd. Well, I won in a big way because not only did not a single psychiatrist recognize ADHD in nine out of the 13 patients, even when the doctors were told, this is a study of adult ADHD and that's all it is, that's all these people is. Nine times they said, no, this person has a mood disorder, usually bipolar. And they refused to accept that ADHD was even a possibility. No, psychiatrists do not over diagnose it. The National Comorbidity Survey replication is a huge study, 10,000 subjects looking at the prevalence of all psychiatric conditions. It's supposed to be done every 10 years. It's done about every 15 to 20. But it's trying to figure out what demands are we going to have on the mental health system for services that Congress has absolutely no intention of funding. And what they found was, by the way, this was the first time the National Comorbidity Survey replication was bothered to include ADHD in their subjects. So it had been neglected the previous three times. They found about the same prevalence, 5.2%. If they added one thing that you didn't have to have evidence of impairments prior to the age of 12, that jumped up to 8.3%. So almost exactly what kids had. But these people were not doing well in life. 42% were in active psychotherapeutic activities. Virtually every one of these people had first been misdiagnosed with anxiety and depression. ADHD was not recognized when they looked at the people who were diagnosed. Depending on which center you looked at, somewhere between 11 and 13% of those who were diagnosed with ADHD had received any ADHD treatment in the previous 12 months. So more than a 50% miss rate and even then 80% non treatment. Again, there is nothing to believe or support the fact that the assertion that ADHD is either over diagnosed or over treated, everything points exactly in the other direction, dramatically. So now it should be incredibly easy to get people to consider giving a try to ADHD medications. First of all, the most effective medication in all of psychiatry, we measure effectiveness by what we call an effect size. An antidepressant, for instance, has an effect size of about 0.5. Just about everything in medicine is between 0.4 and 1. The stimulants, if they're fine tuned to the unique individual, get an effect size of 1.88. In other words, triple the effectiveness of antidepressant medications. They are the most thoroughly studied Medications with last now more than 8,000 studies, they're safe. These medications have been around for 80 years. They're approved down to age of three. They're approved for use in pregnant women. They are the treatment of choice in every standard of care in the world. Unfortunately, they're usually treated as a treatment, last resort. And yet people, parents especially, agonize over the decision of whether or not to try medication for years. So why should somebody try it? Well, ADHD is a serious condition. I had one colleague refer to ADHD as an optional disorder. As far as he was concerned, it was optional whether you looked for it, and if you found it, it was optional whether you treated it. On average, a person with untreated ADHD lowers their life expectancy in general 12.7 years, almost 13 years less life. To put that in perspective, that's about the same loss of life expectancy that you see in type 1 diabetes. ADHD is a very serious, potentially lethal entity. So what are the biggest risks out there? Well, substance use disorder is a big one. The diagnosis of substance use disorder is 400% higher in people with untreated ADHD than in the general population. Next comes serious injuries, injuries severe enough to have produced a hospital record, and that goes up fourfold. And accidents are the leading cause of death. Until you're 44, I'm not sure that I would want my kid quadrupling his risk of a serious accident, especially if he's driving my car. Another big one is involvement in the justice system, especially the juvenile justice system. Somebody with untreated ADHD is five times more likely to be arrested. If they are arrested, they are nine times more likely to be convicted and incarcerated. Now, this is mostly due to oppositional defiant disorder, which also significantly improves with stimulants. Treatment of ADHD in prison makes a huge difference. In one study that I know of personally here In Colorado, the 3 year recidivism rate, in other words, they're released from prison, but they're back incarcerated again within the next three years, dropped from 56% to 13%. This makes a huge difference in how well people with ADHD do after they are released from prison. Now, we all know about the problems with schools. You triple your rate of being retained in grade, you quadruple your risk of being suspended, but it's the dropout rate, 32% versus 0%. And we all know that if you don't have a high school diploma, the best jobs you can get require you to say, do you want fries with that? Retreating also is equally Important is the effect that untreated ADHD has on making and keeping friendships. McConnell's work looked at third graders and what he found was that 70% of children with ADHD untreated ADHD reported that they did not have a single friend. As adults, people with ADHD have twice the rate of separation and twice the rate of divorce. When I have parents cry in my office, it's not because the kids flunking out, it's because they were never invited to a birthday party. You can get an education anytime in your life, but it's in these early years where you're learning how to get along with other people and whether other people like you that you can't go back and do over again. So it's important for children, if only for their ability to learn social skills and get friendships that enough all alone enough for me to recommend getting on medication and staying there. In terms of sexual lives, I have a longest running study. The Milwaukee study looked at ADHD versus controls. People with ADHD had two and a half times as many sexual partners, almost 10 times more pregnancies, most of which were unplanned. They had four times as many sexually transmitted diseases. And of the 42 children born to study subjects, 41 were born to the ADHD group, only one was born to the control group. What's most disturbing is that 22 of the children, half had already been removed from the parents custody. ADHD is a disorder that affects not only the person who has it, but everybody in the family. So this is one of the things I really want to emphasize is that the impairments of ADHD continue throughout childhood and into adult life. ADHD does not go away. But what happens is that while the impairments continue, the consequences of those impairments get worse and get worse for more people. For instance, multiple injuries. An 8 year old who rides his bicycle into a tree is going to have consequences, but a 28 year old who drives his car into that same tree is going to have more severe consequences or for more people. Self medication, experimentation, substance use disorders get progressively worse when they're untreated and so on. So this is not something that you should wait for it to go away. It's only going to get worse. ADHD is a genetic disorder and since no other genetic disorders go away with age, it is foolishness of the first rank to think that ADHD is going to go away with time. So what makes it so hard to consider just trying an ADHD medication? The problem is baseless fears almost entirely. And there are four Major sources. First one is not accessing reliable information. There's a nice article looking at TikTok, which is one of the main sources of information for adolescents of every age. And what they found was that half of the postings on ADHD were wrong, completely wrong, and another fourth were termed misleading. In other words, they had the facts in there, but they draw the wrong conclusion. So we really need for many reasons to guide our children away from bad sources of information such as TikTok. They have fears about problems with the medication. They're real, but they are also correctable problems. There are no side effects of ADHD medications that can be fixed today. We also have to deal with intentionally false information. And there are still bad actors out there that do that with a really big one. The stubborn clog in the pipe is the lack of medical training. Half of all pediatricians admit that they were not prepared to treat adhd. They did not feel prepared to handle even an uncomplicated case of ADHD. When you look at adult psychiatry training programs, 93% do not mention ADHD. They just don't acknowledge its existence. I know my residency didn't. Consequently, we have plenty of patients. We have plenty of good medication treatments. The stubborn clot in the pipe are the prescribers, or rather the lack thereof. It's very, very hard to find somebody who knows what they're doing. So we're all out there being forced to balance what are the risks of treating ADHD versus not. So let's do the low hanging fruit medication side effects different. What we'll call the rule. The right molecule at the right dose for that unique individual should normalize behavior without significant side effects. Now, if you're having side effects, the dose is too high or it's the wrong molecule. You or your child's personality should not change. The goal is always to find the best version of you. You'll get better at what you're doing. Just about every international standard of care agrees. The two minor stimulant class medications, amphetamine and methylphenidate, are the treatment of choice, period. And a wavering about that and that both should be tried before moving on to a second or third line agent. Unfortunately, nothing predicts in advance which one a person is going to get their best response from. It doesn't run in families. So you can have one child on an amphetamine product and the parent on a methylphenidate product. You just have to try the medications to see which one works best for that unique individual. Side effects are well known there's the Starbucks syndrome. Imagine what somebody would look like if they rolled out of Starbucks after five double espressos. They'd be revved up. They'd be jittery, restless, irritable, have nausea, et cetera. There's the reverse autonomy syndrome. Loss of facial expression. They're lost initially. They're just sort of bland. They're no longer disruptive, but they're also not there. Both of these are caused by the dose being too high. All of the stimulant side effects are minor, harmless. But the most important thing is they are reversible within just a few hours. Why should this matter? It's an important distinction to make. It's not that these medications are inherently difficult or hard to use. The problem is that establishment medical education has done virtually nothing to teach physicians how to use these medications. They're actually very easy medications to use with virtually no side effects. If you have been trained on how to do them, it's not the fault of the medications. Unfortunately, it is hard to find somebody. So we need to go through the major FDA warnings because they are the FDA probably biggest source of bad information that I can think of. It's very rare that the FDA gets anything right. For instance, 25 years ago, they put a black box warning on all the stimulants, even though they had no evidence that they were dangerous for cardiovascular diseases. And despite the fact that their advisory committee voted unanimously not to do it, they basically did it because they had a baseless fear that somehow ADHD medications were dangerous for the cardiovascular system. And they acted on that baseless fear. And what they did was they scared people away. The risk of cardiovascular problems is due to the ADHD itself. If you have adhd, your risk of having anything wrong with your heart is determined almost entirely by the adhd, whether it's treated or not. Consequently, all this fear mongering by the FDA has left in people's minds a very odd belief that it's the treatment of ADHD that is dangerous and not the disorder itself. There are also fears of misuse, abuse, addiction and diversion. Yes, there is substance abuse. If you have untreated ADHD, your risk of at some time being diagnosed is 60%. The risk is out there. But use of ADHD medications does not increase that risk. In some reports it actually lowers it. So what makes people think it's abusable? It beats me. Amphetamine was first synthesized 148 years ago. Methylphenidate was synthesized in 1939, 86 years ago. So these are not unknown to us, we know these medications. For the first decades they were over the counter medications. You could just walk in and buy them in treatment of asthma. And there was no significant notable misuse or abuse. So they were used a minimum of 20 years with no trouble at all. Then in the late, in 1958, they made them a C4, which is the least restricted category, so they can monitor them. It was more than 20 years after that, in 1978, that the country suddenly discovered cocaine and methamphetamine, which is a real public health problem. And the DEA just arbitrarily, without asking anybody, lumped the ADHD medications into the same class as cocaine. It was not that these medications were a problem or being abused. It was just an administrative poor decision. So many studies, the majority of studies show that adhd, if it's being treated with stimulant medications, usually the stimulation, the substance use gets much better because the substance use was really self medication and usually trying to medicate the impulsive hyperactive component. There are some studies that found neither protection nor increased later use, but there have been no studies to show that the ADHD stimulants made it worse. Now we all should have known this just from common sense. In my practice when I was talking to parents about this, I would go up to the whiteboard and I would tell mom, dad, tell me what you know about drugs of abuse. And they would give me that list on the left pretty much every time. People take them to feel good, get high, users crave the drug. There's a large and ready market out there for them and it's a struggle to get their kids off of these medications. Good mom and dad, tell me what you know about the medications for adhd. Well, you feel nothing or you feel bad if the dose is even just a little bit too high. The biggest problem is patients commonly forget to take the medications. They don't like how they feel if the dose is too high while they are readily available because they're out there. Long term use is very low, less than a half of 1%. And it's a struggle to get kids to take the medications. So once you literally see the handwriting on the wall that the medications for ADHD are exactly the opposite of drugs of abuse, you start wondering exactly why they ended up that way and continue to be that way. So think for yourself on this. Do drugs that are described this way really have a high potential for abuse and dependence? There really is very little evidence for that because there was very little evidence for putting him in category Two, and they were put there strictly for political reasons. The DEA felt like they had to be doing something. And it's also why they're going to remain controlled substances, because nobody's going to expend any political capital to do the right thing and put them in Schedule 4, where they began. Once again, ADHDers pay the ADHD tax. They pay a penalty for the misbehavior of others. So let's real quickly go through the other baseless fears so we have time for some questions. One of the big ones is retardation of growth. That one's been around since 1970 and it really depends on what your training is. If you can prescribe medications, you tend not to find ADHD loss of growth, and if you can't prescribe medications, you tend to find it every time. Even if the growth problems were real, they would be inconsequential compared to the massive risks of not trying medications. The loss in all the reported studies that said there was one was less than 2 centimeters. That's less than the width of your index finger. Nobody is going to notice less than 2 cm. Whereas the risk of not taking ADHD as we just talked, is huge. There was the Adduce study, ADHD drugs used in chronic effects in Europe. It was a two year study and what they found was that methylphenidate especially was not associated with any effects on growth and development. This study also looked at a whole bunch of other things and it was interesting. What they didn't find. They didn't find any neurological problems. They didn't find any developmental problems. They didn't see an increase in psychiatric symptoms or problems. There was no increase in seizure disorders. The only thing they found was extremely minor changes in blood pressure and pulse. We're talking about 4 millimeters of mercury and 2 beats per minute. In other words, something that is not even noticeable. A lot of people worry to wring their hands. We don't know what these drugs are doing to a developing nervous system. The answer is yes, we do. These medications have been around for a long time and we've kept registries for more than 50 years. Unfortunately, all of these registries, without exception, lumped the use of ADHD stimulants in with drug abuse studies. But even when you do that, they can't find any problems with pregnancy, not with getting conception, birth defects, delivery or post delivery have ever been found. They seem to be utterly neutral. Consequently, even the FDA says it's a decision that is left up to the parents and their doctor. We don't Know what these medications do over a lifetime? Yes, we do. The longest data we have is for people who've taken amphetamine for narcolepsy. It's been the drug of choice for narcolepsy for 85 years and thus far no problems have been found with long term use. So these are medications that millions of people take every day, all day, with a lot of success. The longest study, the longest study was now out 57 years. The subjects are now in their mid-60s. All the life problems these people experience were from not taking the medication, not from taking it. Appetite suppression. Adults do not complain of appetite suppression. And you'll hear it from about 30, maybe 40% of children. They just won't be eating as much, but they won't have any clinical significance. They may not be eating as much, but they're not losing weight, not failing to gain weight, et cetera. The only time it has clinical significance, if somebody fits the slide, it just disappeared. The only clinical significance of it was that it was found in about 6% of kids. And these were kids who started off being real thin to begin with. There we go. So there are things that you can do. A lot of ducks will switch molecules 40% of the time. People have appetite suppression on one molecule, will not have it on the other. Also supraheptadine, which is an antihistamine medication designed for children. It's been around since I was a child, works about 90% of the time at the very lowest dose of 4 milligrams, half to one tablet, about 30 minutes before the meal. Its benefits last for about six hours. And it works like a charm for the vast majority of people. And you can stop it every once in a while to see if the child has become used to it. If that doesn't work, we then go to mirtazolepine. A lot of people worry, since anxiety is the most common coexisting condition, that adding stimulant will make anxiety worse. There's a nice study of studies that found that looked at 23 studies where people who were already anxious had a stimulant medication added. And what they found was that in 22 of the 23 studies it dramatically lowered the level of anxiety and that higher stimulant doses tend to lower anxiety more than lower doses. So this turns out just not to be a problem. So in summary, ADHD is a seriously impairing neurologic and genetic condition. It's their lifelong. It's not going to go away if you do nothing that everyone, adults Parents, clinicians should base their decisions on decided science, the things about which there is no ambiguity, and not on their fears, their ignorance or disinformation. Virtually all of the adverse risks, 99%, come from not treating ADHD. There's virtually no problem with a trial of ADHD medication, just to see what they have to offer and then making your decision based on real information. Also, treatment is protective against later impairments, and the earlier you start the treatment, the better. So I hope this has been helpful. We're going to have some discussion now, but there are a lot of things on the Attitude website, which is, in my opinion, the very best source of information on ADHD that's out there and available to the general public. It's also real helpful if you advocate for yourself with your physician. Remember that you will probably know more about ADHD than your doctor does, and they are not. Many doctors are not going to go out and spend the time getting up to speed with adhd. But you can print things off from Attitude especially and thrust it into their hands and say, I want you to read this. It is important to me because it's important to my child. It's important for you to know this for my child and for everybody else. You also need to help them see you are already treating ADHD. Statistically speaking, the average physician will see 40 people every day with ADHD. Now, they may not recognize it, but they're there. And they can't just walk away and pretend that it's not there. If you're a mental health professional, 20 to 25% of the people that walk into your office every day is going to have adhd. And so you need to confront your doctors because remember, psychiatrists are just as poorly trained as anybody else. You have to say, look, I want you to evaluate me for adult adhd, and if you can't do it, refer me to someone who can. You must advocate for yourself because no one will do it for you. Passive people get bad medical care. That's an axiom I've never seen the exception to. So with that, we'll open things up and Carol will come back on.
- [62:06]
B
Thank you, Dr. Dodson. Thank you so much. Many people have commented on how validating this presentation has been. Thank you for that. Of course, we got lots of questions. The first is, my son is on a low level of Adderall and it's helped his impulse control, but his RSD still needs to be addressed. What can I do about this?
- [62:32]
C
Rejection, sensitivity, dysphoria is that doesn't respond very well, to the stimulants, if you look at the three aspects that are universally agreed on, inattention, impulsivity and hyperactivity, the stimulants do a marvelous job with the inattention. Now once you get engaged, it keeps you from being distracted, but it doesn't do that good a job with impulsivity or hyperarousal. And for that we have used a class of medications called alpha agonists. And there are two of them, guanfacine and clonidine. They are old blood pressure medications. The response rate, the dramatic life changing response rate to either one is about 30%, which is disappointing, but it's a different 30% for each one. So that if the first one doesn't work, you try the other one. And together when you try both, you have about a 60% very robust life changing level of response. And there are several articles about the use of medications for RISD on Attitude magazine. They're very simple medications to use. And again, originally, when they were brought on the market in the 1960s, they were blood pressure medications. Now they're almost exclusively used for adhd.
- [64:05]
B
We have quite a few questions, variations on the same question, which is how do I respond to relatives who doubt the validity of ADHD because I'm so good at masking, or how to explain to folks that my symptoms are from a disorder, not lack of discipline. How do I talk to teachers who don't understand the condition and its challenges? So there are variations of how do I help people to understand that this is real and impairing in these different situations?
- [64:38]
C
Once again, you have to divide into people who really want to know, who just haven't been exposed to it and just don't get it, and people who their goal is to blame somebody. They don't want anybody to get out the door without being punished for their behavior or their failures. The people who really want to know you can say you don't know what it took for me to get this far with no help at all. School didn't help, Congress didn't help, you didn't help. You know, I've done everything on my own where I meet the criteria. The medications are life changing. Believe me, it's there. And it's a genetic disorder. So that means that half of our first degree genetic relatives are also adhd. So look at cousin, so and so look at, you know, my grandson or whatever, you know, do you accept that they have adhd? You choose somebody who's, you know, pretty hyperactive and disruptive or somebody who's you know, failed to keep a job ever. And you say there, you sit there because it's a genetic disorder, it doesn't go away. And half of the people in the family are going to be adhd. They may not know it, but if you give that checklist, the Vanderbilt checklist is the one that's in the public domain, what you're going to find is there's a lot of ADHD in the family. Now there's a bunch of people who just like to blame people for two reasons. One is that if it's your fault, you, you've done something wrong, then they don't have to help you, you're at fault. Why should they help somebody who's lazy or no self control? And so it absolves them from helping. Conversely, it also they believe absolves them from any responsibility for being mean, nasty, demeaning to calling you names. You're lazy. You know, again, they're looking to blame somebody because it gives them a, what they think is a socially acceptable way of being mean and vicious to other people because it's their fault. These are people who are confused. They confuse fixing the blame and fixing the problem. To them they're one in the same. So these are people, people who enjoy going around and finding where everybody did it wrong. These are people who are not going to change. They like hurting other people so much they're not going to give it up. So the first thing you do is if this person genuinely open to new information. Again, one of the first things I suggest people do is ask the person, is there anything I can do? What would it take for you to listen and be open to new information? And I will tell you right then. Now people who are genuinely open will say, oh, I really like them no more because of, and usually somebody else in the family. Other people will just repeat their accusations that have no basis. So you can separate out. There's one group you can spend your time with and the other one you need to avoid at all costs at all times.
- [68:20]
B
Someone writes, my son thinks ADHD is something you can power through. How can I persuade him that medication might make his life easier?
- [68:33]
C
You're not going to persuade anybody. I mean, he doesn't want to, he just rather want to take medication. And so he's saying without any knowledge it's not going to help me. So again, he doesn't know? No, he's just saying that because you, you can't convince him otherwise because he doesn't want to hear it. So it makes a huge difference I mean, all those statistics I went through about the terrible damage that ADHD does if left untreated. And so you have to wait for the right time, a time in which ADHD has really sabotaged their life. You can't force them to take it now. They have to see that ADHD is a factor and that you can't just power through it again. That's why all of the therapies failed, is they're just variations on try the same thing that failed, only try it harder and longer. It doesn't work. So if they don't want to take the medication, bite your time. Now life gets harder and ADHD is going to impair them more and more. If it's an adolescent boy, I'll just point out that his ADHD keeps him from getting dates. That's the thing that's going to motivate an adolescent boy.
- [70:09]
B
Our last question is, my husband refuses to believe my son has ADHD and anxiety. So he's suffering because I'm his only advocate. Do you have any suggestions?
- [70:25]
C
This is a situation you see very often in divorced families where one spouse knows that the ADHD is there, but they're denying care to the child just to defeat and frustrate the other parent. I won't admit this, but that's the primary motivator. And so this is a speech that I usually give to these folks. And it's fair. It's failed only once in 50 years of practice. What I'm saying is, mom, Ed, I know that you have the very best interests of your child at heart, and whatever you decide, I can certainly accept that. But you need to know that five or ten years from now, your child is going to come to you and ask you the following question, and you need to be prepared to answer it. They're going to say, mom, dad, let me get this straight. Back in 2025, you knew or you had reason to know that I had adhd. It was impairing and anxiety. It was impairing my life, my sleep, my friendships. I was uncomfortable in my own skin. I struggled with academics, I was dabbling with drugs to self medicate. And let me get this straight. You did nothing. You didn't even let me try. What that does is it shifts because the parent knows that that day is going to come and they're going to have to bear the blame for what happened to their child. Most parents, in order to avoid that, will at least okay a trial on medication to see what it has to offer and deal with the reality of what the medications are rather than a hidden agenda of getting back his ex or defeating his spouse. That speech works almost all the time. The one time it did, the guy was an utter psychopath, but that's another story.
- [72:43]
B
Well, Dr. Dodson, that has to be our last question because we're out of time. But thank you so much for joining us today to kick off ADHD Awareness Month. We appreciate you.
- [72:54]
C
I thank you very much. I hope it was helpful.
- [72:57]
B
Well, everybody says it was extremely helpful. Of all the comments we got, and we got hundreds. And thank you to today's listeners. If you would like to access the event resources, visit attitudemag.com and search podcast 580. The slides and recording are posted a few hours after each live webinar. If you're listening in replay mode, simply click on the episode description. Please know that our full library of Attitude webinars is available as a podcast. It's called the ADHD Experts Podcast and it's available on most streaming platforms. Please make sure you don't miss future Attitude webinars articles or research updates by signing up to receive our free email newsletters@attitudemag.com thanks everyone. Have a great rest of your day.
- [73:49]
A
For more Attitude Podcast and information on living well with attention deficit, visit attitudemag.com that's a D D I T U D e m a g.com.
- [74:08]
E
AI agents are everywhere, automating tasks and making decisions at machine speed. But agents make mistakes. Just one rogue agent can do big damage before you even notice. Rubrik Agent Cloud is the only platform that helps you monitor agents, set guardrails, and rewind mistakes so you can unleash agents, not risk. Accelerate your AI transformation@rubrik.com that's R U B R-I K.com.