ADHD: Do We All Have It?

Summary

Science Vs Podcast Episode Summary
Title: ADHD: Do We All Have It?
Host/Producer: Rose Rimler & Wendy Zuckerman
Release Date: April 3, 2025
Presented by: Spotify Studios

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Introduction

In this episode of Science Vs, hosted by Rose Rimler and Wendy Zuckerman, the duo delves into the increasing prevalence of ADHD diagnoses. With the surge of self-diagnosis through online quizzes and social media, the hosts investigate whether ADHD is genuinely becoming more common or if it's simply gaining attention in popular discourse.

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Perception vs. Reality of ADHD Prevalence

Key Points:

• The perception that ADHD is rampant is fueled by online content, such as TikTok listicles and viral quizzes.
• Historical data shows a modest increase in ADHD diagnoses over the past two decades.

Notable Quotes:

• Wendy Zuckerman [00:00]: "As we look at ADHD lately, it seems like more and more people are saying, 'I've got ADHD.'"
• Rose Rimler [21:08]: "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."

Statistics:

• 2003: 4.4% of adults diagnosed with ADHD (CDC).
• 2023: 6% of adults diagnosed with ADHD (CDC).

Analysis: While the numbers have increased from 4.4% to 6% over 20 years, the exponential rise often portrayed in personal anecdotes and online narratives is not supported by empirical data. This increase can be attributed to heightened awareness and better diagnostic practices rather than an actual surge in ADHD cases.

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Understanding ADHD: Symptoms and Misconceptions

Key Points:

• ADHD symptoms extend beyond inattention and hyperactivity to include phenomena like hyperfocus and emotional dysregulation.
• The DSM (Diagnostic and Statistical Manual of Mental Disorders) outlines core symptoms, but popular media often exaggerates or misrepresents these.

Notable Quotes:

• Wendy Zuckerman [01:00]: "I have trouble regulating emotions, mood swings."
• Rose Rimler [09:07]: "Like forgetting phone calls. I've lost important documents. I mean, it feels like it's trying to hold water in a strainer kind of situation."

Classic vs. Extended Symptoms:

• Classic Symptoms: Inattention, hyperactivity, impulsivity.
• Extended Symptoms: Hyperfocus, emotional rollercoasters, mood lability.

Expert Insights:

• Professor Maggie Sibley [04:18]: Emphasizes that self-diagnosing ADHD via quick online quizzes is unreliable and often inaccurate.
• Philip Shaw [04:31]: Highlights the pitfalls of oversimplified diagnostic tools like five-minute quizzes.

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The ADHD Brain: Beyond Dopamine

Key Points:

• While dopamine dysregulation is a cornerstone in understanding ADHD, recent research points to a more complex neurological landscape.
• Alternative theories involve the Default Mode Network and disruptions in executive function pathways.

Notable Quotes:

• Rose Rimler [24:31]: "ADHD is caused by a dopamine deficiency."
• Philip Shaw [25:03]: "Oh, if it was as simple as dopamine, we'd probably have figured it out by now."

Neurological Theories:

1. Dopamine Deficiency: Traditionally linked to attention and motivation deficits.
2. Default Mode Network Imbalance: Difficulty suppressing daydreaming phases when focusing on tasks.
3. Executive Function Disruptions: Problems with information processing loops essential for attention and cognition.

Expert Commentary:

• Professor Maggie Sibley [25:50]: Suggests that ADHD may manifest differently across individuals, leading some researchers to refer to it in the plural—ADHDs.

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ADHD and Emotional Dysregulation

Key Points:

• Emotional dysregulation, including mood swings and heightened sensitivity to criticism, is increasingly associated with ADHD.
• There is debate among professionals about whether these emotional aspects are intrinsic to ADHD or stem from comorbid conditions like anxiety and depression.

Notable Quotes:

• Rose Rimler [14:31]: "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."
• Philip Shaw [16:07]: "And we also ask questions about that, and you see that that story just fits this kid."

Comorbid Conditions:

• Approximately 60% of individuals with ADHD have another diagnosis, such as anxiety or depression, which can complicate symptom presentation and diagnosis.

Concerns:

• Over-attributing emotional dysregulation to ADHD may lead to misdiagnosis, potentially overlooking other treatable conditions like PTSD.

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Gender Differences in ADHD Diagnosis

Key Points:

• Women and girls are more likely to receive an ADHD diagnosis in adulthood rather than childhood.
• Societal pressures may cause females to mask or compensate for ADHD symptoms, leading to underdiagnosis in younger years.

Notable Quotes:

• Rose Rimler [18:57]: "They get missed as children. Yeah. And they only figure out that they have ADHD if they ever do much later in life as adults."
• Wendy Zuckerman [19:17]: "It's not that extreme. It has been going up, but that could easily be explained by more awareness from both doctors and patients."

Statistics:

• Women: 61% diagnosed as adults.
• Men: 40% diagnosed as adults.

Implications:

• Delayed diagnosis in females can result in untreated ADHD during critical developmental periods, impacting education, career, and personal relationships.

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Impact of Menstrual Cycle on ADHD Symptoms

Key Points:

• Emerging research suggests that hormonal fluctuations during the menstrual cycle can exacerbate ADHD symptoms in women.
• Phases like perimenopause and postpartum periods are particularly challenging.

Notable Quotes:

• Rose Rimler [20:00]: "ADHD symptoms might actually fluctuate throughout the course of your cycle if you menstruate."
• Wendy Zuckerman [20:43]: "That's really news you can use if you're menstruating and you have ADHD, that your symptoms really might be fluctuating."

Research Findings:

• Increased impulsivity mid-cycle and heightened sadness toward the end.
• Challenges during postpartum and perimenopausal periods due to estrogen level changes.

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Treatment Modalities for ADHD

Key Points:

• Medications: Stimulants like Adderall are effective for many but come with side effects and accessibility issues.
• Therapies: Cognitive Behavioral Therapy (CBT) shows promise, especially when combined with medication.
• Alternative Strategies: Techniques like body doubling and listening to white noise or music can aid focus.

Notable Quotes:

• Rose Rimler [28:25]: "It's a slight shift in how the brain functions or talks to itself or is connected."
• Maggie Sibley [34:00]: "CBT with medication seems like the best supported stuff to try."

Specific Treatments:

1. Stimulant Medications:
   • Wendy Zuckerman [29:09]: "Stimulants help lots of people."
   • Effectiveness: 65% improvement with Adderall vs. 20% placebo ([29:43]).
   • Side Effects: Sleep disturbances, appetite loss.
2. Cognitive Behavioral Therapy (CBT):
   • Helps with motivation and combating procrastination.
   • May be most effective when paired with medication.
   • Maggie Sibley [35:08]: Notes the discrepancy between clinician-reported and self-reported improvements.
3. Body Doubling:
   • Involves having a companion present while performing tasks to increase accountability.
   • Rose Rimler [35:53]: "It sounds so sci-fi, but we'll get to it."
4. Environmental Adjustments:
   • Listening to white noise or music to enhance focus.

Cautions:

• Lack of robust evidence for non-traditional treatments like body doubling.
• Supplements and dietary changes lack convincing support, especially in adults.

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Concluding Insights

Key Takeaways:

• ADHD diagnosis has modestly increased, likely due to better awareness rather than an actual rise in cases.
• Symptomatology is broader and more nuanced than traditionally understood, encompassing aspects like hyperfocus and emotional regulation.
• The ADHD brain is complex, with multiple neurological pathways involved beyond just dopamine.
• Effective treatment often requires a multifaceted approach, combining medication with therapy and behavioral strategies.
• Gender differences and hormonal influences add layers of complexity to diagnosis and treatment.

Notable Quotes:

• Wendy Zuckerman [38:10]: "So if you get this higher score, that's when you would probably want to go to the doctor and get checked out."
• Rose Rimler [38:05]: "Medicine, therapy. Those are the best tools that we have for treating ADHD."

Final Thoughts: While societal narratives may sensationalize ADHD, scientific understanding underscores the importance of accurate diagnosis and personalized treatment. As research continues to evolve, so too does the approach to managing and supporting individuals with ADHD.

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Additional Resources

• Show Notes & Transcript: Available via the link provided in the episode's show notes for detailed references and citations.
• Follow Us:
  • Instagram: sciencevs
  • TikTok: @Wendy Zuckerman

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This summary encapsulates the key discussions, insights, and conclusions from the Science Vs episode on ADHD. For a comprehensive understanding and nuanced details, listening to the full episode is recommended.

Transcript

[Wendy Zuckerman]

Hi, I'm Wendy Zuckerman and you're listening to Science versus Today. We're pitting facts against focus. As we look at ADHD 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.

[Rose Rimler]

Top 10 signs of ADHD 5 things that are ADHD that I had no idea were adhd.

[Maggie Sibley]

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

[Wendy Zuckerman]

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 hyperfocus. You get so, so engrossed that you.

[Maggie Sibley]

Sort of lose track of time.

[Rose Rimler]

You might forget to eat or sleep or go to the bathroom.

[Wendy Zuckerman]

I have trouble regulating emotions, mood swings.

[Rose Rimler]

24 7. Having ADHD feels like you're on an emotional rollercoaster. Either everything is great or everything is absolutely terrible.

[Wendy Zuckerman]

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, 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. 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.

[Rose Rimler]

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.

[Wendy Zuckerman]

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, we'll 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 no, you're late, mate. But then there's science. Science versus ADHD is coming up just after the break. This episode of Science Versus is presented by Amazon. The last thing you want to do when you're sick is go to the pharmacy to pick up a prescription because then you're standing in a long line with a whole bunch of sick people and everyone is sick of being sick around other people who are sick. Amazon Pharmacy will deliver right to you fast so you can get meds without congregating amongst the contagious. Healthcare just got less painful. Amazon Pharmacy McDonald's meets the Minecraft universe with one of six collectibles and your choice of a Big Mac or 10 piece McNuggets with spicy nether Flame sauce.

[Rose Rimler]

Now available with a Minecraft movie meal.

[Maggie Sibley]

And participating McDonald's for a limited time.

[Rose Rimler]

A Minecraft movie only in theaters.

[Wendy Zuckerman]

Welcome back. Today on the show adhd. Tell us all about it is Rose Rimler, senior producer here at Science Versus. Hi, Rose.

[Rose Rimler]

Hi, Wendy.

[Wendy Zuckerman]

Do you think you have adhd?

[Rose Rimler]

No, I don't think so. No. Do you ever suspect that.

[Wendy Zuckerman]

Oh, whether you have adhd? No, not me. 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.

[Rose Rimler]

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.

[Wendy Zuckerman]

Oh yeah.

[Philip Shaw]

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.

[Rose Rimler]

What'd you think when you saw that?

[Philip Shaw]

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.

[Wendy Zuckerman]

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?

[Rose Rimler]

Well, to find out, I thought you and I could take a brief quiz actually. Raz, Raz. 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 magnus blessing and it basically maps onto the main symptoms of adhd.

[Wendy Zuckerman]

Oh, okay, great.

[Rose Rimler]

So I'll send. Here's the link.

[Wendy Zuckerman]

Wow. Here we go.

[Rose Rimler]

Yeah. Put an X if it's never. Rarely, Sometimes, often, or very often for all these symptoms?

[Wendy Zuckerman]

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

[Rose Rimler]

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.

[Wendy Zuckerman]

I'm gonna say never. Almost to the point where I don't understand the question. How often do you have problems remembering appointments or obligations?

[Rose Rimler]

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

[Wendy Zuckerman]

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

[Rose Rimler]

That one specifically.

[Wendy Zuckerman]

That one specifically.

[Rose Rimler]

Let's not look too deeply into that.

[Wendy Zuckerman]

Thank you. Love you, mom.

[Rose Rimler]

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

[Wendy Zuckerman]

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

[Rose Rimler]

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

[Wendy Zuckerman]

Situations, when you're in a conversation? How often do you find yourself finishing.

[Rose Rimler]

The sentence of people? How often do you have difficulty waiting your turn in situations when turn taking is required? Never.

[Wendy Zuckerman]

I don't like waiting in line, that's for sure. So, Rose, how'd you do? How do you do?

[Rose Rimler]

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

[Wendy Zuckerman]

Okay, I got five. Okay, what'd you get?

[Rose Rimler]

I got two.

[Wendy Zuckerman]

Uh huh. So what is. What does this mean?

[Rose Rimler]

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. Oh, and five or more is like, maybe you should get evaluated for 80.

[Wendy Zuckerman]

Really?

[Rose Rimler]

Yeah. Yeah. Whoa.

[Wendy Zuckerman]

That'S so funny.

[Rose Rimler]

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. 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.

[Wendy Zuckerman]

Okay. Okay.

[Rose Rimler]

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

[Wendy Zuckerman]

Yeah.

[Rose Rimler]

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?

[Wendy Zuckerman]

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

[Rose Rimler]

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

[Wendy Zuckerman]

It's not. I just find it frustrating to wait.

[Rose Rimler]

But you can and you do.

[Wendy Zuckerman]

Yes.

[Rose Rimler]

Or thinking about that question about missing appointments. We all forget appointments now and then, but Maggie 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?

[Wendy Zuckerman]

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

[Rose Rimler]

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. Like this listener just trying so hard not to mess up and not trying.

[Wendy Zuckerman]

To forget things or miss things.

[Rose Rimler]

I've been fired from jobs because of it. It's impacted friendships, forgot phone calls. I've lost important documents. I mean, it feels like it's trying to hold water in a strainer kind of situation.

[Wendy Zuckerman]

Right. Okay, 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.

[Rose Rimler]

Yeah.

[Wendy Zuckerman]

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

[Rose Rimler]

Okay, 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.

[Wendy Zuckerman]

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

[Rose Rimler]

I can, 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.

[Wendy Zuckerman]

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

[Rose Rimler]

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 hyper focused state, they can do something in a few hours that it would take other people days to do.

[Wendy Zuckerman]

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

[Rose Rimler]

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.

[Philip Shaw]

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

[Rose Rimler]

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.

[Wendy Zuckerman]

Aha. Do you. Oh, my God. Oh, my God. Rose?

[Rose Rimler]

Yeah.

[Wendy Zuckerman]

Oh, my God.

[Rose Rimler]

Are you having yet another ratatouille moment? Yes.

[Wendy Zuckerman]

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. And I peed myself. 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, really wanted to finish it, and I paid myself.

[Rose Rimler]

Oh, my God.

[Wendy Zuckerman]

I know, I know.

[Rose Rimler]

You know, it makes me think that some people do say that hyperfocus 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, so. I know.

[Wendy Zuckerman]

So is this really an ADHD thing?

[Rose Rimler]

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

[Wendy Zuckerman]

It's not.

[Rose Rimler]

Yeah, it's not part of the diagnosis of adhd, so. Officially, no. But there has been a little bit of research on it, and it has given us some clues. We have a couple studies that have found that people who score higher on that questionnaire that we just took, they were more likely to experience hyperfocus.

[Wendy Zuckerman]

Right. So what do you make of it? Like, that's not the strongest evidence that this is definitely part of adhd, but it just.

[Rose Rimler]

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.

[Wendy Zuckerman]

That's interesting. All right, so the next one can we look at is the 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 never really associated with ADHD before.

[Rose Rimler]

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. I don't like to admit this, but I often freak out or just kind of have meltdowns over small things, and then I end up feeling a little dumb just because I'm like, why did I overreact so much?

[Wendy Zuckerman]

So is. Is this a part of ADHD or something else?

[Rose Rimler]

This is tricky. I looked into it. It's like it's almost in the diagnosis. The. The DSM does say that low frustration tolerance, irritability, and mood lability. That's. I said 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.

[Wendy Zuckerman]

And do we know why?

[Rose Rimler]

I talked about this with Maggie and other scientists, and they think it might be tied to impulsivity, which we know 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.

[Philip Shaw]

So it's not the emotions themselves that are unstable, but your cognitive ability to put the brakes on the emotion, maybe.

[Wendy Zuckerman]

Mm. Okay. Right.

[Rose Rimler]

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

[Wendy Zuckerman]

Oh.

[Rose Rimler]

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.

[Wendy Zuckerman]

Oh, man.

[Rose Rimler]

And when I talk to academics about this projection 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.

[Wendy Zuckerman]

Mm. 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?

[Rose Rimler]

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.

[Philip Shaw]

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 unpeeled 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, and you see that that story just fits this kid.

[Rose Rimler]

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.

[Philip Shaw]

I didn't give him an ADHD diagnosis, even though at quick glance, somebody definitely.

[Rose Rimler]

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.

[Wendy Zuckerman]

Right, Right. Uh huh. So what do you think? Do you think emotional dysregulation is part of adhd?

[Rose Rimler]

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.

[Wendy Zuckerman]

You that makes sense.

[Rose Rimler]

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.

[Wendy Zuckerman]

Yes. Seeing a lot on this.

[Rose Rimler]

They get missed as children. Yeah. 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.

[Wendy Zuckerman]

Okay. Do we know why?

[Rose Rimler]

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.

[Wendy Zuckerman]

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?

[Rose Rimler]

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. 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.

[Wendy Zuckerman]

Okay. So that, that's really news you can use if you're, if you menstruate and you have adhd, that your something to be aware of. Your Symptoms really might be fluctuating.

[Rose Rimler]

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?

[Wendy Zuckerman]

And it does.

[Rose Rimler]

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.

[Wendy Zuckerman]

Oh.

[Rose Rimler]

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.

[Wendy Zuckerman]

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

[Rose Rimler]

Fast forward to 2023. That number had gone up to 6%.

[Wendy Zuckerman]

Wow. Oh. It's not that it really feels like it's gone from 1% to, like, 50%, but when you look at some friendship groups.

[Rose Rimler]

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

[Wendy Zuckerman]

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

[Rose Rimler]

Yeah.

[Wendy Zuckerman]

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

[Rose Rimler]

Spring starts with savings at the Home Depot. So if you're working on getting your yard spring ready, you'll need the right tools to get it done. Like the Ryobi One 18 volt cordless string trimmer, now only $129. Or the Ryobi One 18 volt cordeless blower, also for only $129. Save on cordless power during spring starts event at the Home depot, now through April 2nd. Um, I think I just won my taxes. Yeah, I just switched to HR block.

[Wendy Zuckerman]

In about one minute.

[Rose Rimler]

All I had to do was drag.

[Wendy Zuckerman]

And drop last year's return into H and R block, and bam. My information is automatically there so I don't have to go digging around for all my old papers to switch.

[Rose Rimler]

Nope.

[Wendy Zuckerman]

Sounds like we just leveled up our tax game.

[Rose Rimler]

Switching to H and R block is easy. Just drag and drop your last return. It's better with block. Hi, this is Jevon, your blinds.com design consultant.

[Wendy Zuckerman]

Oh, wow.

[Rose Rimler]

A real person.

[Wendy Zuckerman]

Yep.

[Rose Rimler]

I'm here to help with everything from selecting the perfect window treatments to. Well, I've got a complicated project. No problem. I can even help schedule a professional measuring install. We can also send you samples fast and free. Hmm. I just might have to do more. Whatever you need. So the first room we're looking at is for shopblinds.com now and save up to 45% site wide blinds.com rules and restrictions may apply. The PC gave us computing power at home. The Internet connected us, and mobile let us do it pretty much anywhere. Now, generative AI lets us communicate with technology in our own language, using our own senses. But figuring it all out when you're living through it is a totally different story. Welcome to Leading the Shift, a new podcast for Microsoft Azure. I'm your host, host Susan Ettlinger. In each episode, leaders will share what they're learning to help you navigate all this change with confidence. Please join us, listen, and subscribe wherever you get your podcasts.

[Wendy Zuckerman]

Welcome back. Today on the show, Rose is telling us all about the science of adhd.

[Rose Rimler]

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

[Wendy Zuckerman]

Yeah. Tell me about dopamine. What's it doing?

[Rose Rimler]

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.

[Wendy Zuckerman]

Okay, so ADHD brain, dopamine is out of whack.

[Rose Rimler]

No, not so fast. Well, okay, honey, there's more here. Scientists are pretty sure now there's a lot more going on.

[Unknown Speaker]

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

[Rose Rimler]

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

[Unknown Speaker]

You know, it really is so incredibly complicated. It's breathtaking. Like, it's magnificent. And it's a challenge. Like, I think there's no way it's all just one big thing.

[Wendy Zuckerman]

Wow. Philip's like dopamine. More like nopamaine.

[Rose Rimler]

The British don't talk like that. But yes.

[Wendy Zuckerman]

Isn't he Irish?

[Rose Rimler]

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.

[Unknown Speaker]

Yeah, there's two that I'm particularly taken by.

[Wendy Zuckerman]

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

[Rose Rimler]

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

[Wendy Zuckerman]

I have.

[Rose Rimler]

I think. You have.

[Wendy Zuckerman]

I have.

[Rose Rimler]

It's come up before.

[Wendy Zuckerman]

Yes. 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?

[Rose Rimler]

Exactly.

[Unknown Speaker]

Just the mind drifting, that sort of feeling, you know, if you're a bit bored, you know, probably after I go on for five minutes, everyone's brain will be in this state.

[Rose Rimler]

He's being modest. He's actually very interesting.

[Wendy Zuckerman]

Right. Remains to be seen.

[Rose Rimler]

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.

[Wendy Zuckerman]

Uh huh.

[Rose Rimler]

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.

[Unknown Speaker]

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. So there's an imbalance between the offline and the online brain.

[Wendy Zuckerman]

Oh, that's so interesting. And that could totally help explain why it's hard to focus. Right?

[Rose Rimler]

Yeah. There's another explanation that has to do with another network in the brain. Okay, so basically there are these pathways where different parts of the brain talk to one another.

[Unknown Speaker]

There are these fantastic information processing loops in the brain. They go deep in the brain and then they go to the surface of the brain, the cortex, and then they go back. And these information processing loops are what controls attention, cognition, everything.

[Rose Rimler]

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

[Unknown Speaker]

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

[Wendy Zuckerman]

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?

[Rose Rimler]

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.

[Unknown Speaker]

Gosh, just meet a hundred 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.

[Rose Rimler]

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.

[Unknown Speaker]

It's a slight shift in how the brain functions or talks to itself or is connected.

[Wendy Zuckerman]

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

[Rose Rimler]

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. Okay, so that's why stimulants are kind of the first line medication for people. Yeah, 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.

[Wendy Zuckerman]

Yeah. There's also signs, side effects. Right. They can mess with your sleep.

[Rose Rimler]

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.

[Wendy Zuckerman]

What is body doubling?

[Rose Rimler]

It sounds so sci fi, but 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 adh. And he's like, a lot of his patients come in and they're like, I don't really know how therapy is going to help me, especially with my main problem in life, which is, like, not getting stuff done that I need to get done. Procrastination.

[Maggie Sibley]

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 going to 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.

[Rose Rimler]

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?

[Wendy Zuckerman]

Sounds sexual.

[Rose Rimler]

Are you thinking of the prostate perhaps?

[Wendy Zuckerman]

I was thinking of like procreation.

[Rose Rimler]

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

[Wendy Zuckerman]

Procrastivity.

[Maggie Sibley]

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.

[Rose Rimler]

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

[Wendy Zuckerman]

Yeah.

[Rose Rimler]

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

[Maggie Sibley]

I think that day, or like the day before, we said, okay, so how are you going to do this? She said, I got a long day in lab, I'm going to come home, I have the article. I just need to read through it, do a couple 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.

[Rose Rimler]

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?

[Maggie Sibley]

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

[Wendy Zuckerman]

No.

[Maggie Sibley]

She had been what? She liked cooking shows. I'm gonna bake a cake.

[Rose Rimler]

Don't do it. Read the article. She didn't read the article. She baked a cake.

[Maggie Sibley]

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.

[Wendy Zuckerman]

Okay. Classic prac tivity. Proctivity.

[Rose Rimler]

Procrastinativity.

[Wendy Zuckerman]

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

[Rose Rimler]

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 tasks 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.

[Wendy Zuckerman]

Wow.

[Rose Rimler]

If I can read the abstract, then I can.

[Wendy Zuckerman]

Little instructions, one by one. Aha, aha, aha.

[Rose Rimler]

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?

[Wendy Zuckerman]

And he finds this is helpful for his patients.

[Rose Rimler]

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.

[Wendy Zuckerman]

Okay.

[Rose Rimler]

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.

[Wendy Zuckerman]

Wow, that's impressive.

[Rose Rimler]

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 the positive results are mostly coming from the doctors saying, this is working for my patient. So that's interesting.

[Wendy Zuckerman]

Get that cake baker into the studio. Let's ask her how she feels.

[Rose Rimler]

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 an outside observer might be noticing it.

[Maggie Sibley]

So 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. You know, some people not as better as they would have hoped to have been.

[Wendy Zuckerman]

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

[Rose Rimler]

Well, I promised you I would tell you what, what the hell body doubling is. Oh, yeah, it sounds so weird. It just means having someone else there with you, even virtually.

[Wendy Zuckerman]

And so what is this person supposed to be doing?

[Rose Rimler]

Well, 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.

[Wendy Zuckerman]

Okay.

[Rose Rimler]

And Russ was like, yeah, yeah, sure.

[Maggie Sibley]

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

[Rose Rimler]

I love that you use Lars. That's such a possibility.

[Maggie Sibley]

I know why.

[Rose Rimler]

Yeah, yeah.

[Maggie Sibley]

It just sounds like one.

[Rose Rimler]

It totally does. 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.

[Wendy Zuckerman]

Oh, that's cool. All right, Onto diets and supplements. People love to offer these.

[Rose Rimler]

Yeah. So people have looked into this somewhat, mostly in kids stuff like taking vitamins and minerals, omega 3s, omega 6s, but it's pretty iffy. Just a couple 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.

[Wendy Zuckerman]

So watch out for those influencers online.

[Rose Rimler]

Promising the world 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. Just. There's not really any harm to trying that. So if it works for you, that's great.

[Wendy Zuckerman]

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

[Rose Rimler]

Yeah.

[Wendy Zuckerman]

Hopefully listeners rebel to 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 are still having difficulty focusing and also being a little bit hyperactive. 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.

[Rose Rimler]

Yeah. How'd I do that? Sounds good. You might need a little help. You could enlist a. 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.

[Wendy Zuckerman]

Thanks, Rose.

[Rose Rimler]

Thanks, Wendy.

[Wendy Zuckerman]

And Rose. Rose, Rose, Rose, Rose.

[Rose Rimler]

I'm still here.

[Wendy Zuckerman]

How many citations are in this week's episode? 61.

[Rose Rimler]

This week.

[Wendy Zuckerman]

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

[Rose Rimler]

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

[Wendy Zuckerman]

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 wanna come, say hello and let us know what you thought about this episode, we are on Instagram sciencevs. I am on TikTok. Wendy Zuckerman.

[Rose Rimler]

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.

[Wendy Zuckerman]

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

[Rose Rimler]

No, I didn't know that.

[Wendy Zuckerman]

She doesn't just score podcasts. She also makes beautiful, beautiful music. And I was listening to the album last night.

[Rose Rimler]

It's really lovely.

[Wendy Zuckerman]

So you can find her on Spotify. The album is called Pattern. Her name is Emma Munger.

[Rose Rimler]

It's M u n g e r. It's not M u n g A because you're.

[Wendy Zuckerman]

No, no.

[Rose Rimler]

Thanks, Rose. Thanks, Wendy.

[Wendy Zuckerman]

This episode was produced by Rose Rimler with help from me, Wendy Zuckerman, along with Meryl Horn, Michelle Dang and Akenny Foster. Keys were 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 Munger 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 Martell, Dr. Maeve King, Dr. Edward Modestino, Professor Edmund Sanaga Bark, and Dr. Ashley Hawkett. Again, a huge thanks to all of our listeners who called in and told us about your ADHD experience. Thank you. Science Versus is a Spotify Studios original. 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 Zuckerman. Back to you next time.