All About ADHD - Part II

Everything you ever wanted to know about ADHD...continues! WOOHOO! Go back and check out Part I, or start here to learn more about what's happening in the brain, how to use environments to cue ourselves, how debate and manufactured fights can be ways to help you focus, and more! The things that are easy, hard, and all the myths and misperceptions that exist about what is really not a deficit, but rather an abundance and variety of, attention. The second part in a series from David, who has lectured as an expert and advocate on this subject nationally, and assisted by Isabelle, who is eagerly sponging up the information. A neurodivergent and neurotypical blend of friends Christina, AJ, Gabe, and Isabelle's husband, Bobby, sit in to ask questions. (Part II of David’s Lecture Series)---(Part II of David’s Lecture Series) Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the first part of this talk, please see episode 4, David’s Lecture: All About ADHD!).  We talk about Auditory Processing Disorder (APD) which often also exists alongside ADHD; however, they are two different things. ADHD can make you more prone to distraction when you hear sounds, no APD (see definition below).  ADHD can also coexist with Autism Spectrum Disorder (ASD). David gets nerdy about how blood flow to certain parts of our brain connects to distraction, and how our environment can also cue us to shift blood flow to the forebrain (prefrontal cortex). Gabe notes that sports served as an important accommodation. David makes the comparison that it’s like having an energy bar in a video game, and if you don’t use it during your day, it will become anxious rumination at night. David and Bobby get distracted by Bobby’s audio equipment (or Bobby tweaking his audio settings) and David points out that being oppositional rewards us with dopamine. Debate as a dopamine booster. As a parent, how do you get out of power struggles. Talking about ADHD as too much gas (hyperactive) and too much brakes (inattentive); combined type is both, and environmentally cued (the more comfortable you are, the more gas; the less comfortable you are, the more brakes).  What about ADHD on vacation? We can get more irritable or more chill, and it can be because we have uprooted our accommodations: the structure we have in place at home that helps us get along. So we can start to manufacture structure (including undertaking vacation-only projects, getting into a predictable arguments, reading a book in a day, etc.). When we understand how ADHD impacts us (for example, starting to write a book on vacation to cleverly avoid interactions we don’t want to have, plus building in structure…but not finishing because we didn’t factor in the response cost of it) we can work with it.Click here for slides from David’s lecture.How genetically loaded is ADHD?Pretty loaded. For more on this, check out this article in Nature (prepare for science!)On a related note, this article also points to ADHD being more of a spectrum than previously thought; as the article mentions:"Accumulating evidence from family, twin, and molecular genetic studies suggests that the disorder we know as ADHD is the extreme of a dimensional trait in the population. The dimensional nature of ADHD has wide-ranging implications. If we view ADHD as analogous to cholesterol levels, then diagnostic approaches should focus on defining the full continuum of “ADHD-traits” along with clinically meaningful thresholds for defining who does and does not need treatment and who has clinically subthreshold traits that call for careful monitoring. The dimensional nature of ADHD should also shift the debate about the increases in ADHD’s prevalence in recent years. Instead of assuming that misdiagnoses are the main explanation for the increased prevalence, perhaps researchers should explore to what extent the threshold for diagnosis has decreased over time and whether changes in the threshold are clinically sensible or not.”In other words, ADHD is part of a set of traits that live along a spectrum, and since we tend to diagnose ADHD when those traits/behaviors/experiences are read as a problem, we lump it into it’s own bag, when really it might turn out to be a neurodivergent branch of the same tree. And so those with ADHD can exist all along a spectrum, too! Hence: calling it attentional variability rather than a deficit.DAVID’S DEFINITIONS:Auditory Processing Disorder (APD): a hearing disorder and has to do with how the brain processes auditory information. APD can impact attention as well, but it’s not ADHD. Note: ADHD can make it harder to hear certain sounds, for example a person’s voice in a noisy setting, but the mechanism behind why it’s hard is different than APD. Autism Spectrum Disorders (ASDs): a group of developmental differences (AKA neurodiversity or differences in the brain) that can cause increased sensitivity to stimulation, social, communication and behavioral challenges.  Prefrontal Cortex (PFC): also known as the forebrain, is a part of the brain that, through dopamine, is linked to executive functioning, or the skills (check out the list below) that help you pay attention, curb your impulses, take in memories (working memory), and play with different scenarios and outcomes (cognitive flexibility), for starters. For further reading, check out this super science-y article. Forebrain skills that are harder for folks with ADHD (no matter the type): Response Cost - neurological skill that helps you know the consequences of your actions later on down the road Delay of Gratification - receiving the reward or win, well after the behavior occurs.Black and White Thinking - believing or acting as if there are only two ways of thinking right or wrong. Black and white thinking makes it harder to see middle paths during an argumentTime and Organization Skills - knowing how long tasks will take, planning transition times into tasks, appropriately guessing how long something will take, or all parts of time and organizational skills.-------cover art by: Sol Vázquez