E (8:42)
Bingo, Bingo. That's the right way to think about it. Nail in the head. Okay, like let's, let's put aside advantage disadvantage for a second. If we're not going to call it a disorder and say you're broken, let's not suggest any superiority, let's just try to be neutral here because like evolution doesn't have an opinion of these types of things. Right. And I can relate to the negative side of that. I was diagnosed with what was, we used to call learning disorder at the time and some earlier probably back when it was ADD only as a separate disorder. I was diagnosed with that I wasn't treated and I developed a very negative self esteem issue around that. And it was even reinforced by the psychiatric community. I had a psychiatrist, I was a teenager who said to me, you don't have adhd. You don't have these dyslexia thing or whatever. I said, what do you mean? I've been told this for years. I wasn't treated, but I was in special ed classes and things like that, so they were working with me. No, no, you're too smart for that. And by your age now, if you had it, you would have outgrown it. Those are wrong. Those are just like myths we have about it. Right. But my core to this was that I had this negative aspect that I was thinking about it. Well, so, you know, what if we think of it in a more sort of neutral manner? What if we think about the idea that we all have attention systems and they operate in different ways? So let's connect this to the science that we know early on in the research about adhd, which by the way is probably the most neuroscience biologically grounded of all the psychiatric conditions. And one of the things that support that it's efficacy with medication. The particularly. We're just talking about stimulants. Yeah. The stimulic conditions are rock stars at improving adhd. We don't have another class of medications for another condition that does anywhere. Well as that. So all you guys at home with ADHD like be really grateful for that because depression, anxiety, schizophrenia, do not have that. And part of it is that we really seem to think that there is a neurobiological underpinning. So by having a drug that changes your basically your neurochemistry, like you are really targeting the thing that is creating a struggle for you, let's call it. Whereas things like depression are more complicated. And so you have this system of attention. We know early on that they used to do EEGs on kids with ADHD. They were trying to figure out the biology of it. And EEG is normally used for things like seizures. They would notice slow waves. It seems to be the kind of stuff that's associated with not being so awake. Like it's asleep, but you're not like awakened alert. And you think those ADHD kids, when they're not paying attention, they just seem to be sort of like their mind is wandering, they're sort of not very engaged. We even used to confuse it with absence seizures and things like that. So it's this thing where their attention isn't as strong that you would imagine that. Okay, so then we think about another thing that we've seen, which is that the brains of those with ADHD on average. Right. Like not fortunately, we're not going to scan anyone's brain and get any help. I don't care how good a neuro imaging doctor you are. We know that when you lump a lot of brain scans together and you average them, that there are things we see that are different about the brain. Right. Like prefrontal cortex is part right here. That is maybe the most recently added version of our brain from an evolutionary point of view, you know that the activity in that area seems to be lower on average in those with HD seems to be developed a little bit less. And that's interesting too, because we've always noticed that these ADHD kids seem to be like three to four years behind their peers, especially when they're growing up. Yeah, that's why we call the neurodevelopmental condition. It's also why we mistakenly thought that it didn't exist in adulthood because a good number of them get better. Epidemiology data would say maybe a third don't meet criteria anymore, though almost everyone still has some kind of symptom. We have these trends with this neurobiology that there's something different about their brain. And I think one of the most compelling things is if it's such a problem, why is it so reliably common and it appears at such a young age? And doesn't it seem like if it was really that problematic evolution, natural selection. Natural selection is not friendly, it's not sentimental. You don't get to reproduce. Right. So why is it being conserved? And you have to say, well, maybe because it isn't always a problem. And so let's think about how life is different. Certainly in the last 150 years, since the Industrial Revolution, life has changed a lot, very fast, sometimes within generations. I'm old enough that I remember having a landline phone. My sister's younger than me and I don't think she remembers that. Things have really, really, really changed. And one of the things that have changed particularly is that what are our days like? And our days are significantly more structured than they were before and require you to sit quietly and do things that require sustained attention and are repetitive and boring. We all know that people with ADHD are not good at that. Whereas in an ancestral time, right. That ADHD kid that gets really easily excited can go run after on a hunt. You know how stimulating that is? It's going to pump up their dopamine. We know from the neurobiology that when you give them meds, for instance, their dopamine levels look similar in that front of the brain as they do to the ones that don't have adhd. Maybe they're going to be the individual that instead of picking from one berry and obsessively finishing every little berry on there, they say, oh, borders, I'm going to go check another berry tree. And so they don't move it around. And that may actually be a more efficient strategy. Right. There's diminishing returns the longer you try to do something. Maybe those are going to be the ones that are going to push their tribe to sort of go out on an adventure and check out a new area, which are opportunity also risks. Right. We know those with ADHD have a higher risk tolerance. Their whole dopamine system seems to be different, which is why they're so predisposed to substance use. There's a paper that, you know, one of the earliest papers I wrote on ADHD where you saw the comorbidity and, you know, even in teens, the comorbidity with substance use is much higher. Because whatever's going on in their neurobiology that maybe, let's say was useful, let's use the word useful in some other time period, feels a little less useful now. But also predisposes them to a reward system, a thing that is going to hit their reward system, which is one of the main problems of addiction. That's the kind of work that I do now. Maybe their system is just more predisposed to getting pulled into that. Yeah.