Hello there, welcome back to Seeker+ and our series on ADHD. I'm your host Julian and this is our third and final
episode on the topic and once again we’ll be joined by Alie and Micah Caldwell, a neuroscience/clinical
counseling super couple who wrote the book Brains Explained and have been explaining
the ADHD brain for two episodes now. If you missed them be sure to go back and have a
look because we cover how the ADHD brain is structurally and functionally different, and
all the myriad symptoms these differences can create. Though be warned, there are multiple
disorders that can have similar symptoms and so for our final episode we’re going to
talk about how ADHD is diagnosed and treated. Now it would be great if people with ADHD --or any
mental health condition for that matter-- could have their brains scanned and the results
would illuminate a flashing neon sign that definitively diagnosed the condition like
a Family Feud answer going up on the board or something. But of course it’s never that
simple. Yes, research indicates the ADHD brain looks and behaves differently from neurotypical
brains, but imaging technology like CT scans, PET scans, or MRIs can’t be used to diagnose
it, in part because they’re not sensitive enough yet to work on a case-by-case basis
or differentiate between other possible causes. So a brain scan is out, but what about some
type of test? Is there a written questionnaire that someone seeking a diagnosis can fill
out? There are tests like that, right? Where it's sort of the Likert scale, one through
five, how much do these things affect you? And you just go through and you answer according
to the best of your ability, but there are also interview questions, where you actually
do open ended questions rather than, something that has a number attached to it. With kids
typically what'll happen is it is very much observational since they can’t necessarily
have the insight to provide a lot of information. And so typically there will be kinds of structured
activities that you engage in with kids to sort of gauge attentiveness and activity level.
So it can run the gamut. Now are any of these tests required for an ADHD diagnosis? There
are a wide malady of tests that can be given, but frankly, you don't even need any tests
necessarily to diagnose it, right? It could be diagnosed through observation, interview,
that sort of thing. So there is no one, like you got to pass this one test to get ADHD.
Yep, often it just comes down to the observations of a trained medical professional like a psychiatrist,
psychologist, or pediatrician. Which, to be totally clear, I am not any of those things,
and neither are most people on the internet. These doctors are aided by guidelines in a
manual, though specifically which manual is a question of geography. If they’re in the
US they’ll use the American Psychiatric Association’s Diagnostic and Statistical
Manual, fifth edition, better known as the DSM-5. Outside the US doctors will probably
reference the World Health Organization’s International Classification of Diseases,
or ICD, which is similar to the DSM. The DSM-5 lays out symptoms associated with the three
subtypes of ADHD we talked about before: inattentive, hyperactive / impulsive, and combined. To
meet the criteria for a diagnosis the symptoms have to negatively impact work, school, or
social functioning, be persistent for at least 6 months and in at least two settings like
at school and at home, and they have to appear before age 12. Patients under 17 must have
at least 6 symptoms, and those 17 and up must show at least 5. Still, even detailed guidelines
applied by medical professionals don’t guarantee an accurate diagnosis. I know people who basically
their doctor was like it's either anxiety or ADHD, so we're going to try a stimulant
medication, and if that makes it worse, it's anxiety, if that makes it better, it's ADHD.
Which brings us to what is probably the most hot button topic around ADHD: how it’s treated
once it's diagnosed. Two common medications are Adderall and Ritalin, which are both stimulants.
Adderall is an amphetamine, which for some might conjure images of Walter White in an
RV out in the desert cooking up blue meth, but to be clear, while methamphetamine and
amphetamines are related, they are distinct. I think that this contributes somewhat to
why some people don't really want to believe that ADHD is a real condition because of this
fear of abusing these stimulant drugs that obviously have real risks if they're used
inappropriately. Especially in kids. There's like, "Oh no, the children." Yeah. And I think
it is fair to have conversations about medicating children at too young of an age just to get
them to be chill in a classroom. But yeah, it's a real challenge for people who do experience
ADHD, right? Because it can be a total life changer to have access to medication. And
I think a lot of it is because we were talking about earlier that we know. So speaking
of this from the more neuroscience side, we know that there are these changes in dopaminergic
and norepinephrine signaling. And these are signaling pathways that are affected by stimulant
drugs. So if you have a lower level overall of signaling in those circuits, in your brain,
and now you add a stimulant, now you are basically helping your brain compensate for that lower
level of signaling. So these stimulants can get inattentive and hyperactive people to
a baseline that most other people are at, which explains the paradox of how a “stimulant”
can have a calming effect. But what if someone’s already got plenty of dopamine or norepinephrine
in their thinky meats already? If you're a neurotypical person and you are taking these
stimulants, you're boosting it above and beyond that normal level. And that's part of why
these drugs are abused as study drugs, because it essentially allows you to create that hyper
focus that normal people don't have, and ADHD people definitely don't have when it comes
to doing some of these less exciting daily tasks. Studies show that for about 80% of
people with ADHD stimulants effectively treat their symptoms. But even though Addreall isn’t
cooked up by Heisenberg in a lab under Los Pollos Hermanos, Adderall and Ritalin can
still come with a high potential for misuse and can be addictive if not taken as prescribed.
I guess now would be a good time to mention that about 15% of adults with ADHD also have
difficulties with substance abuse. So for people who don’t react to stimulants, or
that have coexisting conditions like anxiety or substance abuse that might rule them out
as a treatment option, there are other possible medications. The antidepressant Wellbutrin
for example can treat ADHD by preventing brain cells from reabsorbing dopamine and norepinephrine
they’ve emitted, so they hang out hitting that “focus” button on the neighboring
neuron longer. There are also non-pharmaceutical options like cognitive behavioral therapy
that can help people with ADHD adjust their behavior and develop skills to keep their
symptoms manageable. Alright I’ve spent a very long time talking about ADHD but one
statistic I haven’t mentioned is just how many people have it. According to the CDC
a little under 10% of children have been diagnosed with ADHD, though that number is probably
a bit low because girls are likely underdiagnosed. For adults fewer than 5% have ADHD. So it’s
not super common, but it’s not incredibly rare either. That’s not the impression one
might get from social media sites like Twitter or TikTok. Lately it seems like the conversation
about ADHD has exploded and tons of people on the platforms are talking about what it’s
like to have it. There could be a few reasons for this. I saw this tweet the other day that
was making a joke about somebody said that there's so many people with ADHD on Twitter
and it's like, "Hmm. I wonder why so many people with ADHD love the dopamine slot machine."
Yeah an endless feed of algorithmically curated content can be a strong draw for anyone even
if you don’t have a dopamine-starved brain. But it’s also important to consider the
time we’re in right now. Stress can highly exacerbate ADHD, and in the time of COVID
many adults who had undiagnosed ADHD may be finding their coping strategies are starting
to break down. And then there’s our collective attitude towards issues surrounding mental
health. The conversation among younger people is becoming more open and less stigmatized,
leading many of them to seek care. Which could cause a peculiar phenomenon. This has been
a big topic for us actually recently. So I work as a therapist, right. And I work with
college students primarily. It has become harder to know, in part because of the pandemic,
right? Because it's such a change in our normal life that some of the difficulties that people
are facing can look like ADHD symptoms, but also strangely ADHD has become a sort of like
trendy topic on TikTok and sort of the narrative that's given is you have ADHD, you just don't
know it, right. And as such, it pushes a lot of people to self-diagnose and then to misdiagnose
their anxiety or their depression as ADHD. And then they go to their doctor or whoever
and say, "I have ADHD, because here's what I have." And they've sort of been given this
script by someone else. Still, an open conversation around mental health can be a net positive
for many people. It was for me. Last year I was diagnosed with ADHD, and I only sought
professional help because so many people shared experiences that I realized were remarkably
similar to my own. If you’re like me and you think you could benefit from professional
help, just remember the brain, as a topic, and as an organ, is kind of squishy. You may
notice that your story is a lot like one you saw on social media, but like we’ve said
over and over ADHD symptoms can have a lot of overlap with depression, anxiety, or other
disorders. Do your best to give your doctor honest insights about your own experiences,
and remember that most people on TikTok or Twitter or YouTube do not have Ph.Ds in neuroscience
or are licensed to professionally counsel others on their mental health, including me.
So with that said, if you’re still interested in seeking a diagnosis because you may think
you have ADHD, I’ll let Dr. Alie Caldwell have the last word. I think it's also good
to think about why are you looking into this? And what are you hoping to better understand
about yourself? Because ultimately, like we said, whether it's a pathological condition
or just a difference in the brain, it's just about figuring out how you can interact with
the world in the way that works best for you. And that helps you feel productive and happy
and fulfilled. Once again a huge thank you to our guests Alison Caldwell and Micah Caldwell.
I’d love to have them both back on again soon but if you can’t wait that long be
sure to visit their Neuro Transmissions YouTube channel or check out their book Brains Explained:
How They Work and Why They Work That Way. If you liked this topic let us know over on
twitter @seeker and we may just poke around the brain some more! And as always don’t
forget to subscribe. I’ll see you for the next Seeker+!