Everyone gets bored at work or at school.
But for some folks, staying focused on a task is really difficult.
And it’s not because they’re lazy or not intelligent.
Sometimes, having a hard time focusing can be caused by an underlying neurological condition.
Like ADHD.
ADHD, or attention deficit hyperactivity disorder, is sometimes perceived as a “made up”
condition that lets doctors and parents overmedicate energetic little Jimmy to make him
easier to handle.
But ADHD has been around for a long time.
Its symptoms were first described in the early 1900s.
And it’s a real condition that affects a lot of people, including some of my friends!
My name is Steven Brown.
I'm a 36 year old Caucasian male.
I'm a microbiologist and bioinformaticist at UCSD.
I'm a postdoc right now.
Married to Cindy.
I'm Cindy.
I am 32.
I am a medical student at UC San Diego.
I'm in the last six months of my 8-year MD/PhD program.
And I guess I have ADHD.
Well, I don't actually know when I was first diagnosed.
I know when I was first diagnosed most recently that I've been treated for.
It was five or six years ago.
I had just switched to an academic postdoc position from a brief stint working in the
finance industry after graduate school.
And I felt like I was having trouble staying focused on what I was doing.
That I was kind of switching tasks a little too often.
Like, I could just stay focused and get one thing more done, but instead I would jump
between things.
I tried a few different systems where I would schedule half an hour, set a timer, work on
the thing for half an hour.
But I just kept finding that, even when I was trying to stay focused in that half an
hour, that I was fighting this really intense battle in my own head.
It was just much harder than it felt like it should be.
So, I made an appointment with a psychiatrist and he said, you know, based on just that
first conversation, that I had "garden vareity"ADHD.
Without the hyperactivity, so I guess it's the inattentive subtype.
So my reaction to the diganosis was, I was actually kind of excited about it because
if I did actually have ADHD, then it was something that I could maybe manage.
In addition to, you know, having trouble getting things done, it caused me a lot of stress
to not be getting those things done.
And, as a result, I had a lot of anxiety around that.
And so, to maybe have the possibility of treating that, I was just...
that was very exciting for me.
I was diagnosed three or four months ago.
The way it actually came up was that I had gone to my psychologist for what I thought
was a different set of things.
And I still don't really know how interrelated they are.
I had gone because I was applying to med schools.
And it was extremely stressful.
I was having a really hard time feeling confident.
And I thought it had gotten better that I could talk about it without this again.
Can I get you a tissue?
So I'd gone in for that and, while there, we were trying to pick apart why...
We were trying to pick apart why I felt so insecure about things in general.
I definitely never felt like I was as good as the other med students or as good as the
other grad students.
On paper, I can write the same thing, but I never feel like I earned it.
Like, I never feel like I put in nearly as many hours into studying for med school as
some other med students or that I spent nearly as much time in lab as some other grad students.
And I always attributed it to a lack of discipline.
I just can't focus for that long on a thing.
And so, like, when he heard that, he kind of latched onto this whole discipline thing.
Like, why does it have to be discipline.
You know, could it be an attention thing?
He's like, "I'm gonna refer you to a psychiatrist to be evaluated for ADHD.
What do you feel about that?"
My initial reaction was kind of like, "Yeah, what's new."
But I'm still trying to figure out how much it affects my day to day and how much of it
is personality and how much of it is something that I want to change or feel needs to change.
ADHD affects about 5% of the population.
And it’s more commonly diagnosed in boys than in girls at a rate of about three boys
for every one girl.
But that may be partially the result of the fact that it can be harder to recognize the
symptoms in girls.
Symptoms usually start to show up when kids are between 3 and 6 years old,
and can continue into adulthood.
Although some adults may outgrow it.
So I don't know if I was diagnosed as a child ever.
There were a couple of times where my parents were worried about me for reasons that I didn't
really understand or at least don't remember and I saw a psychologist.
But I don't remember any detailed conversations about it.
I do know that when I told my parents about it after I was diagnosed and started treatment,
that they didn't seem really surprised.
So I kind of wonder if this was something that they got hints of.
I used to do this thing where I'd blow spit bubbles with my mouth.
And the teachers found that really annoying.
And so what I kind of wonder is maybe I would do things to amuse myself because I wasn't
focusing on the lessons.
But, like, sitting in class wasn't a thing where I was learning a lot.
It was reading the book and working the exercises where I learned.
And it was only later when I got into more unstructured jobs when I started to run into
some trouble.
So, did I have it as a kid?
Was I diagnosed as a kid?
I can certainly see how my behavior patterns as a child would fit with what later became
as I know it to be ADHD.
I kind of always had the idea that perhaps I might have ADHD.
I think my parents also, when I was younger, thought that I had ADHD.
They never felt the need for me to go see a psychologist or to be medicated because
I was getting good grades.
I had friends.
I kept out of trouble.
But I talked a lot.
And I got in trouble for that a lot.
And I was always trying to run around and climb on things and jump on things.
So when I was actually diagnosed, it wasn't really that surprising.
ADHD is a complex condition, with a lot of different symptoms.
But most of them are related to issues with “goal-oriented behaviors”.
Things like paying attention, staying focused, and seeing tasks through to the end.
There are three different subtypes of ADHD, and each is defined by their primary symptoms.
People with the primarily inattentive subtype tend to be easily distracted and forgetful.
They lose track of time and have a hard time focusing on tasks.
This subtype can be more difficult to identify and diagnose.
And, related to what I was saying earlier, girls are more likely to have this kind of
ADHD.
People who are primarily hyperactive-impulsive, on the other hand, are often fidgety and impatient,
have a hard time controlling their impulses, and are very talkative.
In adults, this kind of ADHD can appear as an “inner restlessness”
rather than outward movement.
And the third subtype is the combination subtype, with a mixture of
inattentive and hyperactive symptoms.
All three of these subtypes can include other symptoms of ADHD, including difficulty managing
anger and poor handwriting.
And sometimes ADHD can result in developmental delays or it can co-occur with other neurodevelopmental
conditions like epilepsy, Tourette’s Syndrome, OCD, and autism.
For me, I definitely have more of the hyperactive- impulsive type of ADHD than the inattentive type.
We were getting ingredients for pizza and Steve was like, "Should I clean the house
while you go to the grocery store or do you want to clean the house while I go to the
grocery store?"
I'm like, "You go to the grocery store because you'll actually come back with the things
I tell you to bring back."
If I go, I'm going to get distracted and come back with a whole bunch of other things.
That happens a lot.
In social situations, before I started taking the medication, I could not remember people's
names to save my life.
I would be introduced at a party.
"Hi, I'm Bob."
"Hi, I'm Steve."
And I would forget in the next sentence what their name was.
I was just not...I was just...it just couldn't.
And it would be this really intense conversation right up til the end and I would go to say
goodbye and I couldn't remember their name and it...
so it was like, very kind of stressful for me.
And I think kind of awkward for a lot of people involved!
Like so many other complex neurological conditions, it’s not totally clear what causes ADHD.
But there seems to be some kind of genetic component.
Siblings of kids with ADHD are 3 to 4 times as likely to have it themselves compared to
families without ADHD.
Genome-wide association studies, which use big data sets to look for patterns across
the entire human genome, have found a relationship between genes involved in dopamine transmission
and ADHD.
Dopamine is commonly known as one of the “reward molecules” of the brain.
But it’s important for lots of other things too.
Like controlling decision making, movement, and motivation.
There are environmental factors that play a role, too.
For example, fetal alcohol syndrome, exposure to certain chemicals, and particular types
of infections, like the measles during pregnancy or early childhood can all increase the likelihood
of an ADHD diagnosis or cause ADHD-like symptoms.
One of the reasons we know that ADHD is a real condition is that doctors have been studying
it for a while now.
Using fMRI research, which studies brain activation by measuring blood flow, scientists have found
changes in a bunch of different brain regions.
One of the most well-known changes is that kids with ADHD have reduced activation in
the inferior fronto-striatal circuit compared to kids without ADHD during
motor inhibition tasks.
This means that kids with ADHD had less activation in the circuit that helps us prevent motion.
Many other brain regions show decreased activation, too.
Including a bunch of regions associated with controlling movement.
Like the supplementary motor area, the anterior cingulate cortex, the right striatum, and
the left thalamus.
People with ADHD also showed reduced activation in the right dorsal attention network, which
could be a key part of the inattentive type of ADHD.
Overall, most of the changes seen in the ADHD brain are decreases in signaling in circuits
that are important for controlling impulses and in networks that help control attention.
A lot of the problems seem to be related to the communication between the frontal lobe,
which is the brain’s executive processing center, and the regions responsible for coordinating
various behaviors.
All of these results are based on meta-analysis of large sets of research studies.
But it’s always important to remember that fMRI research can’t tell us everything.
Like it doesn't tell us exactly which neurotransmitters are involved.
Also, this work has focused primarily on kids.
Only a few studies have looked at adults with ADHD.
But the studies that do look at adults have found similar results.
Now, ADHD is treated a couple of different ways.
Micah will talk about clinical therapeutic approaches in another video.
So for now I’ll just say that therapy can be effective in mild to moderate cases.
Particularly when it comes to helping folks with ADHD learn strategies to stay organized
and helping patients recognize their own behavioral patterns to help mitigate the effects.
Medication is another effective treatment for ADHD.
Though of course it’s not without its controversy.
Most folks have heard about popular ADHD medications like Adderall or Ritalin because they’re
sometimes abused.
Often by students who are just trying to boost their studying skills.
These drugs are not some sort of Limitless drug that unlocks your brain’s capacity.
They’re actually just stimulants, which seems like a weird thing to give to a person
with a hyperactivity problem.
But, if you look at the brain rather than the behavior, it makes a lot of sense.
Scientists think these drugs increase the availability of norepinephrine and dopamine
in the brain.
Since part of ADHD is thought to be related to problems in dopamine signaling, it makes
sense that these drugs might help.
So I'm on a very small dose of ritalin.
Like, it's 5mgs.
It's about as small as you can get.
For me, I don't feel like it's a stimulant in that I don't feel like I have more energy.
For me, it kind of just makes the anxiety tone down a little bit.
He put me on 20 milligrams of extended release adderall.
And I take that every morning.
The biggest difference I've noticed is that I'm far more relaxed.
My approach to conversations at social events is much more focused.
Adderall and Ritalin both have similar effects, in that they help improve focus and reduce
impulsive behavior.
But they aren’t without their side effects, which can include difficulty sleeping, loss
of appetite, nervousness, headaches, and more.
When I first started taking the medication...actually, the first day that I took it, I very distinctly
remember being in the car and suddenly there was this intense rush of all these things
that I could be doing, right?
And it almost felt like it was exacerbating it.
And I felt like, "Oh my gosh.
Maybe this is just going to make things worse."
And that first day was a little weird, not gonna lie.
But what I've been told was that you have to kind of adjust to it.
And so there's these immediate effects, but then you keep taking it and sort of the immediate
effects don't really have the same impact as they once did.
And it was really remarkable.
On the second day, that didn't happen.
And it hasn't actually ever happened since.
Sometimes other medications are prescribed, too.
Especially when the ADHD is comorbid with something else, like depression or anxiety.
Ultimately, it’s up to the person affected by ADHD and their families to decide what
approach is best for them.
The debate is ongoing as to the true prevalence of ADHD, and how it’s best treated.
And since ADHD medications are stimulants that can be easily abused, there’s a real
concern regarding overprescription to children.
Parents might not want to give their child stimulants.
Or people have observed that maybe ADHD isn't so much a disease as it is a product of the
social environment and the economic environment that we live in.
I'm kind of fascinated by that as a possibility.
Maybe this isn't a disease so much of me, here and now, as it is a change in the way
that humans are expected to be in the world just because of, I don't know, industrialization
and all this other who-knows-what.
It's fun to talk about, but it's also not something I can do much about.
And it's okay.
It's fine.
Everybody's got their problems.
I feel really lucky in my life.
I've got a lot of good things that I'm very grateful for.
And if that's the cross I have to bear, cool.
We're good.
Totally fine.
Researchers are working to better understand the biological underpinnings of ADHD so they
can develop more targeted therapies.
But however it’s treated, it’s a real condition.
And it’s important that people with ADHD have access to the resources and medications
they need to succeed.
Do you have thoughts or feelings about ADHD and how it’s viewed by society?
Let us know in the comments.
Huge thank you to our friends Cindy and Steve for their help with this video.
We’re always so inspired by the willingness of our friends to share their experiences.
Until our next transmission, I’m Alie Astrocyte.
Over and out.