We know that there is a genetic factor, but it's not that people with ADHD have different genes to any of the illness. It just means that certain genes are on maximum volume. Three core characteristics are inattention, hyperactivity, impulsivity. They manifest in myriad ways. Managing ADHD is not just about taking medication which lasts for eight hours. The reality of it is that pills don't teach skills. We've had such a great response to the podcast and so many of you have been in touch asking what you can do to help. It's really simple. Just follow, subscribe, wherever you get your podcasts. That way we can reach more people and that way we can celebrate these great minds that think differently. So we've got a bit of a different episode today. I've invited previous guest, Dr. Tony Lloyd, CEO of ADHD Foundation, the neurodiversity charity, to come and sit and talk and answer your questions all about ADHD. So we've canvased a lot of questions, Tony, from the audience. I actually thought I'd take the Selfish Opportunity to start with the first question being my own. What are the nine traits of ADHD? And I've got a list of symptoms here written that I'd like your reaction on. Impulsiveness, disorganisation and problems prioritising, poor time management skills, problems focusing on a task, trouble multitasking, excessive activity or restlessness, poor time planning, low frustration tolerance, poor executive functioning. You don't need to display all of those characteristics in order to have ADHD. For example, we know some people are not inattentive. They have good retention, good focus, but are impulsive and hyperactive. So your three core characteristics are inattention, hyperactivity, impulsivity. And context often determines whether or not they manifest at all. So all of those things are characteristics of ADHD, which in and of themselves sound quite trivial, but actually when you look at how they can manifest, you know, being disorganised can make your life very stressful, you know, low frustration tolerance, impatience, you know, can make life very difficult for you and other people around you. Do you need to be all three to be diagnosed ADHD? No, two of those three, but it's about how they manifest in terms of presentation, how they impact on your life on a day-to-day basis in a pervasive way. And not, for example, not just in work, but also at home. But we know that context matters. So you might find that ADHD is not as much of a problem when you're at home as it is in work or in school, for example. But it does need to be evident in some way in more than one domain. But you can have what's called inattentive ADHD, for example. We know that most girls and women don't present as hyperactive. So again, it's about how the three core characteristics manifest and they might all be described as executive functioning skills, for example. So, you know, emotional regulation is the same as saying frustration tolerance. Emotional overwhelm is often presents like low frustration tolerance, anxiety. It can also exacerbate your ability to remember things and plan and organise your life. So it becomes quite a complicated matrix, really, of how three core characteristics of ADHD manifest in a number of other characteristics. But when undertaking a diagnostic assessment, you will be looking at those nine primarily. So what it isn't is I forgot my keys and put my homework in the dishwasher? No, because anybody can do that, it needs to be pervasive. So your three core characteristics in the diagnostic manual are inattention, hyperactivity and impulsivity, and on their own, they sound fairly trivial. But actually, they can manifest in ways that if you don't know you've got ADHD and you don't know how to manage it well and live with it well, then they really can sort of undermine the quality of your life and compound on each other. Absolutely, yeah. And so those three are the top three. What are the other other three that you would be looking for? Poor executive functioning skills. So for example, executive functioning skills include the ability to plan and organise. So some of us have whiteboards, flip charts, lots of reminders on our phone, tick screenshots of things on our phone to remind us not to forget. Planning and organising, self-monitoring, they all kind of come together. So with poor executive functioning skills, which is common, not in everybody who has ADHD, because not everybody who has ADHD has poor memory and this is where good memory is often associated with a linear autistic kind of neurotype because of that overlap, you do have some people who have really good memory. But with executive functioning, poor executive functioning is almost the manifestation if you like of how impulsivity, hyperactivity and inattention actually look like, you know, in terms of human interaction. So poor executive functioning is a key factor with ADHD. One of the biggest challenges for people with ADHD, they'll often tell you is anxiety, pervasive levels of anxiety. And we know that when you have pervasive levels of anxiety, you have slumps of energy because you're overutilising stress hormones like cortisol and adrenaline. If you're worried about something, you stay busy because it stops you worrying, but what happens then is it's a bit like driving the car with one foot on the accelerator, one foot on the brake. So you have slumps of energy and then you crave sweet things to give you that energy boost. But that then also exacerbates the emotional dysregulation as well. So anxiety and depression is really common. And I think particularly when you consider that in childhood, if you're studying everyday in school and let's be honest, 250,000 years of human evolution didn't really design children for how we educate socialising and culture eat them now, your brain will produce stress hormones like adrenaline and cortisol to tearable charge your concentration. Now, in high-pressure situations, that's great, that's what it's there for. But if you're using stress hormones all day, every day in school, and you're not allowed to move around watch and you're not allowed to use or be taught by somebody who knows how to adapt the teaching in a way that makes it neuroinclusive. But if you spent your whole childhood in a state of pervasive anxiety, then of course by the time you get to puberty in this major growth space of the brain that happens, your brain's going to think, right, you need to be hyper vigilant. The environment you live in is stressful. So we'll really develop the wiring and the neuronal pathways that are about your fight or flight response. So you are almost conditioned and reprogrammed into an adult brain whereby you are more hyper vigilant, you are more aware of threat. And it's often been said, and this is anecdotal, Ben, that a lot of people related to you are very, very intuitive and very sensitive and very empathic. And some people have argued, well, that's possibly because, throughout childhood, because of this difference in communication where you live in a world where not everybody is growing where it's the same way as yours, that you need to descend and develop a greater acuity in reading non-verbal cues as a way of helping you understand the environment that you live in and the people that you're surrounded by. And presumably also help you fit in. Well, of course, we're a social species where in every social group we belong to, whether it's your classroom group, the football team, the netball team, the book club, the racing club, whatever it is, there are appropriate more ways of behaviour that enable us to belong to that group. And every human being needs to believe that not just that they are protected and safe in a social group, but that they add value that they belong. So a lot of people who talk about equality diversity inclusion, they now add the B letter. It's equality diversity inclusion and belonging because belonging is integral to human flourishing. The irony of what you've just said is that the outcome that we're actually seeking from equality and diversity and inclusion is belonging. Maybe we just need to replace it with belonging. That would be wonderful, wouldn't it? And this is the. I like the equation, but I'm lying. Hold on, we've got the solution, we've got the aim, it's belonging. We started talking about emotional overwhelm and emotional regulation in relation to our ability to connect with other human beings, be in relationship with other human beings, feel understood and understand other human beings. Integral to the human condition. And if you are emotionally dysregulated, then your ability to maintain relationships, manage conflict, overcome differences as we all have to do in our relationships. And then, you know, for somebody with ADHD, relationships can actually be a bit more of a mind field because of your sensitivity, if you like, which can be a positive, but also something that makes you rejection sensitive as well. So, you know, I would say number five is about rejection sensitivity and emotional overwhelm as a key, one of the key things that many people with ADHD struggle with. I've got a question from Dan. I think I might be ADHD, what do I do next? My advice Dan would be you need to get some good quality information about what is ADHD and what is it not because there's a lot of enduring myths out there about ADHD. You could be having a really stressful day and you'll be forgetful, inattentive, impulsive, hyperactive, all of these qualities, but they are a temporary state of being because they are a response to your environment. If you've got ADHD, these things are pervasive and they're there all the time. And the question you need to ask yourself is, in what way am I struggling? And how does this align with ADHD? Find out what ADHD is. Talk to friends, talk to maybe family members, but people have also known you as a child because we will be looking for evidence that it was there since childhood. So it is a genetic condition and that's really important that I feel is a myth that people are, oh, I'm suddenly being ADHD or I'm suddenly more ADHD in my 50s, 40s, 30s, whatever. Well, there's an element of truth to that in terms of people's perception. Then each time you can acquire ADHD is through brain injury, for example, so we know that a lot of people with epilepsy develop ADHD as a direct result of that. But for example, many women have been under diagnosed, 75% of women are just completely overlooked. And what a lot of women find is that they experience pre-menstrual tension because estrogen is a precursor to dopamine, their cognitive function is impaired, but a day is at a particular point in their menstrual cycle. And they put it down to, well, I'm just being emotional, it's just because I'm having a period, for example. Women in menopause, because of the very significant changes in female hormonal production, that also then impacts on dopamine. So we have a lot of women who are now being diagnosed in middle age, who are perimenopausal, menopausal, who are experiencing acute difficulty with cognitive functioning. Also, it's about the job that you do and the lifestyle that you have. So I know lots of people who've had ADHD and they've been coping reasonably well, but only went for an adult diagnosis because a series of life events just knocked them for six. And then their ability to recover from that suddenly really brought into focus the fact that actually, it was ADHD all along, I think often people come to the realization they've got ADHD and adulthood because they didn't identify with the stereotypes and the stigma. So one thing we've got to remember here, and I think this is something I'd really like everybody who's watching the podcast to understand, we all went to school and we're all inculturated into believing that if you weren't achieving in class, you were low ability, or you were lazy, or there was something wrong with you. And for the teacher and no disrespect to teachers have been married to a teacher or my life is a lovely guy. There was never the question, well, if you're not achieving it, it can't possibly be because of the way I teach. It's because you're either not bright, you're not trying, or there's something wrong with you. And there was this shame and stigma. So even if you thought you had dyslexia or ADHD or autism or dyspraxia or dyscalculia, you would never want it to be seen or known about because you didn't want to be ostracized from the social group you needed to belong. So to be seen to think differently, wasn't just actively discouraging, it was filled with shame and stigma. And I think for many people who've come to the realization in adulthood that they're ADHD, it's because they finally sort of realized that, okay, maybe that was me. And now I'm hearing more and more about people who are like me who are being open and honest about their ADHD and not ashamed of who they are and don't see themselves as disorders. And here and more about the research that sort of says, estimated 30% of entrepreneurs and people who are self-employed, for example, have ADHD. We know that university graduates of ADHD are twice as likely to start their own business, for example, that you'll find people with ADHD in every profession, everywhere they've always been there, hiding in plain sight. So what should, if Dan reads a bit more bit of self-reflection and Dan thinks, hey, I'm ticking some boxes here, I feel like I do want to progress with an assessment. What should he do? His options are to go to his GP and ask the GP to explain to the GP, bring evidence along, especially if they've got copies of your school reports, for example, to go along and have a series of notes written down, don't be afraid to take a pad with you where you've said, you know, you've spoken to parents, to former teachers, maybe, to friends who've known you a long time, that these are the ways that you think ADHD is really impacting on your life and affecting your mental health and your employability. For example, your relationships and that you'd really like to have an assessment and a diagnosis. Now, managing ADHD, living successfully with ADHD is not just about taking medication which lasts for eight hours. It is about a series of lifestyle changes that will enable you to play to your strengths. If you do manage to get a diagnosis, the only thing you're going to be offered is a prescription. But the reality of it is that pills don't teach skills. And while I'm a great believer in medication, especially for children, because actually the data on the life chances of children who would identify a daily and offered medication are just phenomenal. And they will not just save a great deal of unnecessary suffering and educational achievement and dependency, but actually really improve people's life chances. It makes good economic sense for people to get a diagnosis and support if they need it. But medication isn't for everybody. It shouldn't be used in isolation. So Dan, be informed, speak to people who you know well and who've known you since you're a child, and then go and get a comprehensive assessment from an expert. Thank you. Sean has a question. Is there a link between ADHD and hyperthyroidism? That question has come up a lot. A correlation, not cause is all I'm prepared to say on that. I think when we have ADHD, when you are exhausted and tired, you're immune suppressed. So we know that when you're immune suppressed, you're more likely to catch illnesses. We know that ADHD and autism correlate with an increased propensity for inflammatory illnesses. So we know that things like irritable bowel syndrome, Crohn's disease, allergies, asthma, exma. We know that children who are undiagnosed have twice as many visits to the GP and accident emergency. So another good financial reason, as well as a moral reason, to intervene early. And we know that if you have high levels of stress, which impede your immune system, it just predispose you to poor health. So the link between hyperthyroidism at the moment is I think correlation, not cause. And you know, you can have hyperthyroidism and ADHD, but it doesn't necessarily mean to say that one causes the other, even if sometimes the presentation can appear similar in terms of hyperactivity. What are other conditions that often co-occur with ADHD? From a neurotype perspective, we know that 43% of people with ADHD also have dyslexia, which is another reason why they were often put in the special needs class and written off. Depending on which research paper you read, 29% of people with ADHD also meet the diagnostic criteria for autism, but some papers would argue that it's as high as 80%. But again, autism like ADHD are these huge spectrums that represent this phenomenal diversity of human neurocognitive capability and potential and flourishing. And we don't necessarily have everything attached to every one of them. And I would say that, you know, dyspraxia, dyscalculia, dysgraphia, autism ADHD, all often co-occur. You can have all of them, even. You can have traits of some of them, all of them. It's at what point something becomes impairing that it constitutes a diagnostic entity that represents an impairment, if you like. And then what about non-neurotypes in terms of co-occurring conditions? We do know that for women, for example, I've mentioned that there's impairments in cognitive functioning, a particular point in the menstrual cycle and during menopause. And it's kind of the default things that happen. So for example, if you overeat because you're craving dopamine, that can lead to being overweight, which can create other health problems. So we've got to be really careful here that people in to understand correlation is not cause. And that having a healthy lifestyle and living a successful life with ADHD involves a whole range of strategies that include decent nutrition, good sleep, poor sleep is a particular issue in terms of people with ADHD. Your circadian rhythms work in a slightly different way. So you poor sleep, we know, affects your physical health, affects your ability to concentrate. Anybody who's been a peer, it knows what it's like to know what poor sleep can do to your physical health and your mental health. But again, it's understanding how these things can kind of impact on your life and your lifestyle and that then collectively they start to impact on your physical and mental health as well. Makes sense. Jade has asked, why does ADHD get diagnosed in women so much less than other disorders like anxiety and depression. She goes on to say, I've had anxiety in low mood on my medical records now for 18 years, been on and off medications all that time, but no one including my GP and an NHS psychiatrist will take me seriously. When I said, I think the underlying issue is I have ADHD and that's because it's classed as trendy at the moment. Right. No one will take it seriously, not even my partner. In a nutshell, pure and simple gender bias, because when ADHD was first identified as a diagnostic entity, the research was based on samples of boys, not girls, because we noticed the boys because the boys were hyperactive. So in a sense that the core data was flawed and girls were more likely to be labeled as lazy or dizzy or chatterboxes or tomboy's or whatever it might be. We know that many women have been treated for years with antidepressants and we know that SSRIs don't work particularly well on people with ADHD. And the effect size of an SSRI like Prozac is about 0.3 out of a maximum of one. The effect size of ADHD medication is 0.9. They do what they say on the tin. But they're not a neurological El Gerardo. They didn't change their personality. They don't undo a lifetime of trauma or anything else like that. They just improve your cognitive functioning for the eight hours that they're active. But we've seen, I think, a very cynical response from some clinicians, from some politicians in relation to what they're calling this trend of ADHD. The World Health Organization said that there is a 6% global prevalence of ADHD. That's at least one in 20 people. The UK, out of an estimated 2.8 to 3 million people who have ADHD, only 225,000 children and adults have a diagnosis and use medication. That's 11% of adults, 12% of children. It is significantly still significantly underdiagnosed, under-medicated in the UK, even though it's twice what it was five years ago. And you've seen these headlines, 400% increase, etc. Well, percentage of nothing is still nothing. The reality is it's still underdiagnosed and it's under-treated. And there has been a lot of cynical comments and some cynical articles by journalists dismissing ADHD. But the reality of it is that there are many GPs who work very hard and care about their patients, but they don't know their general practitioners. They're not specialists in youth developmental conditions, point number one. Point number two, ADHD wasn't even part of the psychiatry curriculum until three years ago. So a lot of psychiatrists didn't know. There's a long history of women who've been diagnosed as bipolar, when in fact it was ADHD all along. Is therefore anxiety a symptom of undiagnosed ADHD? It could be a symptom of diagnosed ADHD. Yes. I mean, the research data says that 43%, 42% to 43% of people with ADHD also meet the diagnostics threshold for what's called anxiety disorder. Where the anxiety becomes impairing to your day-to-day life. I'm still selfishly slightly reeling from the fact that there wasn't neurodivergence piece of, I don't know, module, etc. within the psychiatry manual or education system. Because I've seen eight psychiatrists from when I was eight years old, you know, right up to in my 20s. And I'm not sitting here thinking, well, if they'd have known. I think the problem for a lot of psychiatrists was they couldn't understand that you could be hyperactive and depressed at the same time, because we often associate depression with indolence, don't we? Yes. But the reality is that you can. So I mean, it might be that some people are bipolar. We know that if you've had ADHD and you've experienced a life of a lot of trauma and you've never managed the ADHD and remember the trajectory of where your mental health goes, that you could have both, for example. But we know from the data that women have more likely been diagnosed as depressive or bipolar and that ADHD has never even been considered. I see that here. That is a story that comes back to us. 50% of all new adult diagnoses are women. But in childhood, we still diagnose three boys to every one girl. Up until 10 years ago, it was four boys to every one girl. But in adulthood, what we're seeing now, it's the same number of women who are being diagnosed in adulthood as men. This is an anonymous question, Tony. Do you have to disclose a diagnosis to a workplace? No, you don't. You're not obliged to disclose any medical condition to your employer. This is another anonymous question. I'm ADHD and I've always struggled to keep friends. How does ADHD impact my ability to maintain friendships? I think the question I would ask myself if I was struggling with friendships would be to speak to somebody I trust or even a therapist and explore the reasons why that could be for a whole host of reasons why your relationships are breaking down. It might also be partly because of your communication skills and particularly if you've got autistic traits, for example, a lot of people with autism and combined ADHD autism have a very literal interpretation of the spoken word. Neuon's humor might, you know, sarcasm, things that might be completely lost on them and that can be incredibly isolating. Sometimes it's about our interpretation of it. So I would say, you know, talk to a therapist and explore the reasons why because there are lots of people with ADHD who enjoy really good friendships, relationships. But I would argue it's because they've learned how to and they've learned how to create and maintain relationships through the lens of understanding of, well, this is me and my ADHD means that this is how I experience the world and how I process information and that that might be different to other people. Next question. What are the scientifically proven origins of ADHD, including the roles of genetics, environmental factors such as childhood trauma, theories like the hunter gatherer hypothesis? ADHD is genetic in origin or rather we know that there are gene variants involved in ADHD in the same way that we know that there are gene variants involved in autism and dyslexia. Variants doesn't necessarily mean disordered or something wrong, let's be clear about that. So we know that there is a genetic factor, but it's not that people with ADHD have different genes to anybody else. It just means that the certain genes are on maximum volume and the presentation is therefore slightly different. And context matters a lot, doesn't it? We're the most successful species on this planet, arguably the most intelligence and people might not agree with that, but we're the most successful species because we have learned to adapt our environments to suit us and from a genetic perspective, we have evolved, our genome has evolved and our genetic makeup has changed over hundreds of thousands of years of evolution in order for us to thrive and flourish. And throughout life, every experience you have, your diet, everything affects your genome, which is then passed on to your children, so this theory of epigenetics that we are constantly evolving and adapting. So what you have as a roadmap isn't necessarily exactly how things are going to work out across your lifespan because we interact with our environment, our brains are only half programmed when we're born for that very reason, we need to be an adaptable species. So genetics are possibly environmental factors are significant, so I would say it's the environmental factors that determine whether ADHD is an asset or an impairment, ADHD is probably an impairment in school, but it can be an asset in all the parts of your life. Another question is ADHD actually real? Absolutely, unequivocally. Why aren't people taking it seriously? Why is that even a question? I think people are taking it seriously now. I think as a society, as a culture, we're evolving, we know that human beings are no less human beings because of their sexual orientation, the colour of their skin. What kind of job they do, how they dress, whether they're dyslexic, autistic, so what? That's what makes humanity so successful in many respects, nature, likes, difference. And I think we're recognising that ADHD is a neurotype. Yes, we all know somebody who's dyslexic or ADHD or autistic, that is part of life. I think what we're doing now is we're stripping away the shame and stigma that was instilled in us in children and more people are accepting it. I don't think the acronyms with these in them, like deficit and disorder help. ADHD is not an attention deficit. If anything, it's an attention surplus. It's watching six televisions all at once, but trying to watch one programme and you can't, because you can't filter out the other five, we need to get away from words like disordered and abnormal, and recognise that they belong in the 18th century. When we used to have this notion that some people were intellectually superior to others, and we used that to justify the way we treated black people or gay people, or anybody who wasn't like us. I agree, there is a lot of change happening and those barriers and walls of stigma and stereotyping and myth, etc, are starting to be broken down. But why do I have this increasing sense that the sections of society or institutions that are actually threatened by ADHD? I think we've seen some cynicism in the medical profession because a lot of people think that. Well, I think some people are offended by the fact that people are looking on the internet. It was four million searches, wasn't it, last year, the second most Google item in the UK, and that people are going in, and GPs saying, "Well, these people are coming in and they've been looking on the internet." And I'm saying, "Well, in the absence of any decent quality public health information from the National Health Service or decent quality information about different neurotypes in our education system, of course they're going to go looking to find out. They want to understand themselves. That's integral to their human condition." But that's where everybody looks when they have to learn something regardless of their divergence or not. And if I can't get an appointment with you for four weeks, then of course I'm going to look in the meantime, and a lot of people have realised that GPs don't know everything, and how can they? It's an unrealistic expectation. And I think that certain MPs and certain journalists have written disparaging things about ADHD, but I think that's also about the fact that they don't want to say, "Well, actually, we've not resourced this properly in order for you to find out where you've got ADHD and help you learn how to manage ADHD, or if you need medication to provide medication for you." And rather than acknowledge the fact that our health service is under resourced, and sometimes not very efficient, because we know, for example, that the top five performing NHS trusts in the UK, see the same number of patients with ADHD, as the bottom five would see twice the number for the same amount of money, as the bottom five, so it's not just about resources either. It is about, you know, we all need to learn, and we all need to have a little bit of humility, including those of us who are so-called experts and say, "Well, you know what, we've got this wrong. We've looked at it carefully. We recognise that it makes not just good moral sense, but good economic sense to help people live healthily and understand themselves. And we can't continue to, you know, throw these stigmatising tropes out as the reason for why we justify and rationalise why we discriminate against some people in terms of their access to an education or their access to health services." And change is difficult, isn't it? I've got three last quick fire questions that are all anonymous. Is everyone ADHD? No. Does sugary food cause ADHD? Absolutely not. Does screen time cause ADHD? Absolutely not. What I will say about screen time, though, is there is some research evidence that says that since, you know, the advent of technology, we are that used to absorbing massive amounts of information. That we're often in a state of cognitive overload. I think, particularly with smartphones, is that we do scroll and we do look for sound bites. And we are drawn to dopamine stimulating sound bites of information, because we need to filter out. And we're drawn to things that are of interest to us. You know, I would say to anybody who thinks they've got ADHD, you know, be proud of who you are. Don't necessarily view yourself as disordered. I don't think that ADHD is, you know, is a superpower. But I do know there are a lot of people who have, because of their ADHD, experienced a great deal of success in their lives. That doesn't mean to say that it's everything about their lives is a success, but that they've learned who they are and how to live their best life in a way that is unique to them. And I think that's something to be proud of and something to celebrate. Thank you, Tony. If people want to find out more because they've listened to you and gone, ooh, I want to read up more. Which website, where do they go? ADHDfoundation.org.uk has a vast amount of resources that are free to download, including comic books for children, booklets for teachers, booklets for adults, booklets for teenagers. There's also a website called
[email protected], which is specifically for girls and women. There is a series of videos by people with ADHD talking about ADHD on a website called Candid.nhs.uk/ADHD. Legend. Thank you, Tony. Thanks very much. Thank you. You've been listening to the hidden 20%. If you're still knocking about, then let me introduce you to the band. First up, main man on the mic, host Ben Branson. Our wonderful producer, Belenio. And the man who'll probably try and cut this bit, video editor James Griffin. Not forgetting our wondrous theme tune by Jackson Greenberg. For lovers or haters we want to know, so be sure to leave a review wherever you're listening. For the lovers amongst you, you'll find us on TikTok and Instagram at hidden20podcast or over on hidden20.org where you can join our mailing list.
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