This is a Global Player original podcast. I'm doing well, and I'm really interested to speak to our guest today, because one of the things we were talking about last time is how I don't really understand what ADHD is, and I want some answers. I'm excited about this, getting stuck in and actually having it explained to us in a way that I can understand by somebody who has ADHD and who really is an expert in this field. We've got just a man today, Dr.
Tony Lloyd, head of the ADHD Foundation. Great to have you, Tony. Thanks very much, Dan. Good to be with you.
I think one of the things that I struggle with, even now that I've been diagnosed, I was diagnosed a couple of years ago, is that people will say to me, in all sincerity, you know, what does that mean? And honestly, I can't really explain it very well. If somebody were to say that to you, on the basis that you've had lots more experience telling people about this, what would you say is ADHD? ADHD is a difference in neurocognitive functioning, a difference in how your brain processes information.
It's been around for as long as human beings have. It affects one in 20 people. The acronyms ADHD don't really describe it very well, because it's kind of best understood by most people as having three core elements of hyperactivity, inattention, and impulsivity. And in and of themselves, Sam, that sounds a bit trivial.
We can all be a bit hyperactive and impulsive, and inattentive can't be, depending on the context. But for people with ADHD, their neurology works in a slightly different way, and it means that there are some things that they might find more difficult, particularly in a certain context, but then there are other ways in which their brain can excel. So I always say to people, you know, I'm exceptionally good at some things and exceptionally poor as others. But I think we need to frame ADHD in the context of, we know that there are lots of people with ADHD in every profession in the world who live very happy, healthy, and successful lives.
But we also know there are a lot of people with ADHD who are more vulnerable to things like anxiety, depression, PTSD, eating disorders, particularly more likely to underachieve at school and experience pervasive levels of later anxiety in school each day, which we know is going to impact on people's mental health. So ADHD in and of itself, it's not a mental illness, it's not a behavioral disorder, it's a neurodeveloped mental condition. It can affect people in a variety of ways, and often it's the context that we find ourselves in that determines whether or not ADHD can be really disabling and impairing or not. So for some people, depending on their life events and their lifestyle, ADHD can be really, really challenging.
But it is, in effect, a neurology that affects learning, memory, to some extent, motivation, and there are lots of acronyms around it. It's a Ferrari brain with bicycle brakes, or it's like watching six televisions all at once, but you're trying to focus on one and you can't because the other five are drowning out your ability to focus. So it's not so much an attention deficit, so much as an attention surplus, you can't actually filter out a lot of other information. And many people with ADHD say, well, their brain makes it 100 miles an hour, and that can be quite exhausting.
So I think we have to recognize people, it affects different people in different ways, but we know what the core elements of it are. So what exactly is going on in the brain of somebody with ADHD? Well, from a neurobiological point of view, Paisley, we know that there are two major neurotransmitters that work differently. One is called dopamine, which is a reward-based hormone that's involved in learning, memory, and another is called noradrenaline.
And we know that the regulation and synthesis of those two neurotransmitters works differently in people with ADHD. But, you know, it affects one in 20 people, and that means that out of seven and a half billion people on this planet, everybody who has a brain as unique as their fingerprint, if one in 20 even beings have an ADHD brain, then there's got to be an evolutionary reason as to why. So I question the notion of disorder. That's not to deny that it can be difficult.
I think it's a naturally occurring difference, but I think it's one that often, particularly in modern lifestyle, and particularly for young people when they're at school, and for some people in the workplace, where it can be a real challenge. But when we understand what it is, and we learn the strategies of how to manage it sort of successfully, then we can reduce a lot of those challenges. And there are, you know, there's some research evidence that says that they present to leaders and executives who have ADHD or dyslexia, or both, that university graduates are twice as likely to start their own business if they've got ADHD. There can be some pluses to it, but I think we need to understand ADHD as one of a whole umbrella collection of different neurodevelopmental conditions, like dyslexia, which affects one in 10, and 40% people with ADHD also have dyslexia.
We know that there's a strong genetic overlap with autism, so it's estimated that more than half people with autism also meet the diagnostic criteria for ADHD, similarly with dyscalculia, dyspraxia. These things very rarely travel alone, and, you know, we have, I think, historically seen any child who didn't conform the way we wanted to as being somehow abnormal or disordered, but I think we're moving away from that now. I think that's a really interesting point, because, you know, we talk about neurodivergence, it's the idea of a, what you said there, it's the idea of one way of being amongst lots of ways of being. I suppose, perhaps the question to that, I was playing devil's advocate, it's the question we get all the time, is you'll say, you know, I'm not motivated, or sometimes I feel like I can't concentrate, and people will say, but how is that different to the way that a, you know, quotation marks normal person behaves?
So are we talking about... You're just being lazy. Yeah, or you're just being lazy. So how do we identify someone who has ADHD and someone who doesn't?
Okay, well, there are very well-established metrics, Sam, that we use, including computer-based cognitive functioning screening tools like QB test and QB check, and what we call rating scale interviews, where we can actually measure, statistically, the extent to which these naturally occurring cognitive abilities present in a different way. It's the extent to which they then become impaired. So we can all be inattentive, we can all be hyperactive, we can all be impulsive. For people with ADHD, that is a more pronounced and more constant kind of presentation than for the majority of people.
It's what we call a dimensional diagnosis rather than a classical one. It's not like you've got a specific thing that nobody else has got. It just means that some of your genes, your neurology, that everybody has the same, but yours presents in a slightly different way, and in a slightly more extreme way when it comes to certain cognitive functions. Does that mean then that with ADHD there's a spectrum?
So in the sense that some people might experience it in a certain way, and some people in others? Absolutely. As is dyslexia, autism, dyscalculia. It's the extent to which it is impairing that determines whether or not you get a diagnosis.
But unfortunately, a lot of the metrics that we use when we devise these diagnostic protocols were based on these examples that were just about boys. So we know that 75% of girls with ADHD are completely missed, because they don't fit that sort of enduring stereotype of a fidgety, naughty boy. But what a lot of people don't realise is that the fidgeting and the movement of hyperactivity is the brain's way of getting you to produce more dopamine naturally to support your cognitive functioning. So when we're telling children to sit still in school, it's actually counterintuitive.
It's better that they're moving because it improves their cognitive function. So yes, I think we've got to be careful here that we don't define people and see them purely through the lens of an ADHD diagnosis. We're a very sophisticated species, and each individual is the sum of their life experience, their talents, their interests, their aspirations, and yes, ADHD is a part of it. But when we're introducing people, we don't introduce people and say, this is Tonya, he's got ADHD.
I do now. That's really interesting. Really? Really?
I'm interested in that whole labelling concept about whether or not that can be a problem. Can that lead to somebody switching off and giving up and maybe not no longer looking for the strategies that might once have been helpful to them or looking for new ways of dealing with their ADHD? Can that be an issue? It's a really good question, Katie.
I think you will have all, we would have all gone to school, wouldn't we? And we were all inculcated when we were into thinking when we were at school that if you were one of those special needs kids that you weren't very bright, you weren't employable, you were probably trouble or you were weird and you were put in a porticabin at the back of the school's portal and you didn't really belong in the school. But the reality is that ADHD, dyslexia, dyslexia, dyslexia, it's got nothing to do with low IQ at all. It was just this idea that, well, if you don't learn the way we teach, if you don't write with your right hand, then we'll make you sit on your left hand, which is what we used to do 50 years ago.
This idea that if you don't learn the same way, that you don't belong here or you're not able. And I think labels, particularly labels that have the disorder rate on the end, you know, I think we have disabled people by defining them by what they can't do. And let's be honest, the kind of cognitive skills and abilities that we value in society in the 2020s, the kind of cognitive skills and abilities and talents you need in the workplace in the 2020s are completely different from what they were 50 years ago, because they were computers. So having a great memory was great to pass 300 exams 50 years ago in school, but now it doesn't matter because we've all got smartphones to access to the internet.
Context really matters. And I think what we're seeing now with the neurodiversity movement is people with ADHD, also dyslexia, autistic people, this idea that we don't assume that because we have a brain that we're in the same way, that we can be defined by what we can't do, when actually the kind of skills and competencies that are really valued now are different to what they used to be 20, 20 years ago, but our education system hasn't quite caused up with that yet. Yeah, I mean, Sam and I disagree on this a little bit. I happen to think my ADHD is the reason why I do the job that I do.
I think I celebrate and absolutely embrace the ADHD part of my brain that makes me react to certain situations where I do not all of them helpful, necessarily. I do think it's the reason why I do the job that I do now. I think it's the reason why I stand on the job. I'm disagreeing with you.
It's just a journey, Katie. You said earlier that you talked about the evolutionary place that this might have in society, and that's really fascinating, isn't it? Because I've talked about this before. I fundamentally believe that long ago when we were all living in little villages in mud huts and we were all fighting the next door village, I believe it was the ADHDers who were sitting up all night keeping an eye out for threats and were able to do long-term planning and were able to...
Because I just think we think more laterally, we have more of a sense of 360 thinking, all of those wonderful things that maybe, as you say, school doesn't celebrate, but actually in a different kind of society would be massively celebrated. What is your sense of that as a sort of evolutionary thing? I agree with everything that you've just said, Katie. I think, again, it's a naturally occurring phenomenon.
I wouldn't identify personally as somebody who's disabled or disordered. If you'd have asked me, was I disabled or disordered in school, I would say absolutely, but not me as a person, disabled and disordered by the context of the school because they want to be able to think a certain way, learn a certain way, experience a way of a certain way when that's not how my neurology is. There is a reason why we have people who think differently, and just because you're on the edges of a standard distribution curve does not mean you're abnormal or disordered. And I think historically, we need to look at what it is about human beings where you've got to be like us in order to belong.
You've got to be white, you've got to be straight, you've got to learn like this, you've got to write with your right hand. And thankfully, we're moving away from that kind of narrow, almost tropeism, you know, you think about you have to be a certain way in order to belong. And I do think, and I think a growing number of people recognize that ADHD has had really bad press, and a lot of people have been really stigmatized and shamed and perceived very negatively because of a label. I mean, Sam, you mentioned before about labels.
I think labels are called labels, all the sort of things. The problem with labels is when they carry a lot of stigma. But I think, you know, if you think about if one in five of us have one of these different minds, and they're all spectrums, so there'll be lots of people who are subthreshold if they ever went for a diagnosis, but it doesn't mean they don't have traits, then, you know, what are we saying? Are we defining people by what they can't do?
And this is where the whole neurodiversity agenda takes a strength-based approach. I find that really encouraging, actually, because what Katie's driving at is that I am not particularly positive. I do feel disordered. I think I've always felt disordered.
The way I came to my diagnosis was because I suffered a lot with depression and, you know, what I now know is emotional dysregulation. And I think there is a sense that I've never quite worked properly. And OK, now I've got a reason why I don't quite work properly, but it certainly doesn't feel like a superpower. And to hear you say that, actually, makes me think, well, maybe there's a time where I'll start thinking of myself and how things work a different way.
I'm not so sure that I would call it a superpower. I know a lot of children do. I know that's where it came from, because, you know, bless them, that was their attempt to try and reclaim some sense of dignity because of the way they're perceived and spoken about in education, particularly. But I do think that it's a good thing that we're now reframing this whole conversation now, celebrating this naturally occurring diversity of human minds.
There's got to be a reason for it. There are, you know, somebody was saying to me the other day, there was a research book recently about, you know, creative thinking could be measured in five adults on average about 97%. But by the time you're 30, it's dropped to 3%. You know, and that's in the general population.
Yeah, do we have to think the same way that everybody else does kind of thing? But I do think that it is something that we should celebrate. I think there are a lot of enduring myths. I think this whole idea that, you know, oh, it's, you know, this moral failing about naughty boys, thankfully, that's beginning to disappear.
I think there's been some very negative and harmful journalism in the past. But also this idea, isn't it, that, you know, if you don't do as I tell you, or be as I tell you you should be, therefore you are less than, delinquent, less intelligent, less able, whatever it might be. And I think we've just got to recognise something that some people think differently. And again, we need, you know, you go into a university, there are lots of science faculties where you have an accordance with people who are autistic.
If you go into school faculties, you'll have an abundance of people with dyslexia or dyspraxia. I wonder whether Einstein and Leonardo da Vinci and Mozart would be excluded from school if they went to one of our schools now. So I think, you know, the conversation is changing and that's got to be a good thing. It can be difficult to live with at times.
But, you know, Sam, I hope that you get to a point where you just say, you know, this is who I am. It's not always an easy thing to deal with. But actually, when we understand it and we understand how it affects us as an individual, with all our unique personal characteristics and life experiences, and we employ all those different strategies and tools to help us, and for some people that includes medication. I use medication still, it's an important part of my toolkit.
But, you know, pills don't teach skills. It's generally played to our strengths. You're not allowed to do that as a child in school. There are some people who, because of their circumstances, have maybe not been given the opportunity to really work and have a career or an occupation in a field that plays to their strengths.
So context, again, is really important, isn't it, in terms of how we perceive ourselves as fitting in. How much of a problem do you think is the under-diagnosis or the lack of available access to diagnosis that we keep hearing about at the moment? It's a huge problem. It's a massive problem.
It's very significantly under-diagnosed. And again, some of the comments in the media, from certain parts of the media, you know, over 8 million people are on antidepressant medication in the UK. Only 190,000 are on ADHD medication. Good Lord, that's a statistic.
That's extraordinary, because you would think it was the opposite way around, considering why it's reported. Yeah, yeah. So we've got to ask ourselves, what is this about? Where is this coming from?
And why is it that some people are dismissive and say harmful things about the fact that people, you know, some people think differently? I think we do need to understand that we know undiagnosed, unmanaged ADHD makes you more likely to experience anxiety and depression as you have, sir. You're more likely to experience other mental health problems, more likely to underachieve at school, which means you're less likely to be employable or more likely to be in a lower socioeconomic group. And those trajectories start very early in our childhood.
And, you know, this is where I think we maybe need to change the narrative around this and fit that victim narrative and also not encourage people about ADHD to see themselves as deficient. One of the things that I've read is that people, perhaps it's an old way of thinking, that people could grow out of ADHD. What is the difference in terms of being a child or being an adult? Is it all just masking or is it that some of the traits become less pronounced?
What happens to some of the ADHD as they grow older? Your brain doesn't reach all maturity until they're in their 20s. And we know that in the brains of children with ADHD, there is a developmental delay in certain parts of the brain. So this is where this idea of immaturity comes from, as opposed to bad behaviour.
You have to be exactly like your year group and not every child develops at the same rate. We know that our developing brains are affected by the environments that we're brought up in. So if we experience a lot of trauma in childhood, including pervasive levels of later anxiety every day in school, for example, that's going to impact on how our brain develops and how our brain wires itself as we transition into adulthood but i think we do need to recognize that our potential and our talents and our abilities are such that ultimately we're an individual i don't think we can be defined by a diagnostic label and i think it's not good for us to see ourselves as a person who is defined by a diagnostic label we are unique complex individuals and we are the sum of many many factors and many life experiences and you know we all have adhd but we all have different tastes in music in clothes probably all do different jobs you know there's a common denominator you mentioned trauma earlier and one of the big theories about the cause of adhd at the moment is trauma in childhood now i'm skeptical because i come from a family where certainly i've been diagnosed with it two generations down one generation down two months my family got it i think my mother probably has it so for me it feels genetic it feels like an inherited condition where does that claim about trauma sits for you oh right okay well we know that it's highly heritable so we know that the likelihood of having adhd is influenced by whether you have a parent who has adhd bearing in mind that many of them would never have been screened or diagnosed that the majority of people have adhd are never referred for a diagnosis in school unless they're behaving badly because adhd is supposed to be about naughty boys isn't it which is the reason why we miss girls trauma can exact there is no question the research proves trauma exacerbates adhd and makes you more vulnerable to a particularly negative impact from traumatic events makes you more vulnerable to ptsd for example can make you more vulnerable to addiction what about the trauma of having undiagnosed adhd absolutely but people don't see how we can traumatize children by not recognizing their strengths and their vulnerabilities and supporting them in a more holistic way you know education is not quite the sausage factory that it once was but for many children who think differently it is still very very stressful trauma really can exacerbate adhd but there are we know that there are over 70 gene variants that are commonly associated with adhd but i don't want us to fall into that trap of what causes adhd is if it's something that should be cured i don't think we should be writing off you know six percent of the human race because they have adhd i think there's an evolutionary reason why you know absolutely but you know look at some of the remarkable contributions and achievements that people with adhd have made to our lives to our economy to our culture to become the artists adventurers risk takers there's a lot of people who work in the city for example who have adhd you'll find people with adhd in every walk of life and yeah it's not always an easy thing to live with but again learning to understand what is and how to play to our strengths can really impact on the extent to which it might be an asset in saving areas of all that oh without doubt i know we work in radio and this building is full of i know obviously there are bright lights that's a great one but also having to think about lots of different things at the same time and most importantly of all there's no project work involved you know we come in we do a shift we burn very brightly and then we go home exhausted and shattered and spent but we don't have any homework and for me that was the major draw for this job was that it was shift based turn brain on for eight hours yeah yeah yeah and run around like a lunatic without a lunch break but ultimately you get a chance to come home and go to sleep without struggling to go to sleep because you haven't done the homework for the next day and i knew from my school experience that i was no good at that so that was the draw for me but there are definitely jobs and environments where people with adhd thrive and i think that's the conversation that we should be having isn't it is how do we take people with adhd and find the place where they can use this wonderful aspect of their brain in the best possible way yeah i think we've got to be telling children yes and enabling children you know because i know that in the uk for example there's this idea that you know within the department of education that they really want more than 15% of school children identified as what they call especially educational needs and disabilities it doesn't encourage dependencies on the country i think we're going to tell children throughout their lives about what they can't do why they're not good enough why they're not able and write them off in in terms of you know a particular model of intelligence or concept of intelligence which let's or behavior in the class yeah um you know that our understanding of neuroscience of human anthropology and human beings in general has moved on so much and i think how we measure people's ability and worth and it's so narrow and often that in itself is quite disabling um there are 72 genomes we have billions of genes you know there are 72 involved in adhd why should that define us yeah yeah here here seems like a place to leave it funny i really appreciate that's been that has certainly set me thinking about all sorts of things i really appreciate your time thank you you're very welcome great talking to you thanks a lot well i'm gonna be honest i actually i found that completely mind-blowing so much of that made me feel like i'm part of a community i didn't realize there were so many of us there are hundreds of thousands of us one in 20 sam that's amazing it's a lot to think about i think it raised some it raised more questions to be honest but i think there are some real answers in there and things to chew over amazing next time we're going to talk about diagnosis because there's lots of questions out there for people who are looking to be diagnosed wondering if they've got it how do they get diagnosed what's the process like we're going to dig into all of that we're going to speak to adhd uk and find out exactly how you're going about getting diagnosed that's everything from us for today you can listen to you're wrong about adhd for free on global player download it from the app store www.globalplayer.com see you next time you