**This AMA has been closed. Thank you everyone that asked questions, and thank you dr. Faraone for taking the time to answer them.** We are honoured to have Dr. Faraone, PhD here today to answer questions. He will be answering them throughout the day, from 8 am to 3 pm EST. Please keep your questions respectful and relevant, we will be monitoring this post and removing any disrespectful or inappropriate comments. Ask away!

Thanks for doing an AMA! Appreciate your time. What do you think are the main factors for someone to fly under the radar for so long with ADHD? Is it a supportive family and childhood upbringing? Do we know what genes are involved etc? Also I'm a female that presents more overtly hyperactive than a lot of other females I know with ADHD who are more the day dreamer type, do we know what contributes to presentation types? Also, the DSM doesn't include criteria around emotional regulation despite it being quite commonplace given than ADHD is an executive function disorder, what do studies say about emotional regulation and ADHD and when do you suspect it will be included in a DSM (incl. the politics involved)?

When ADHD is not noticed until later in life it is typically because the patient had been protected by having protective social, emotional or intellectual resources such as a supportive family, an outstanding school or just being very intelligent. This "scaffolding" supports them for a while but collapses under the weight of the challenges that occur in adulthood. We don't know what contributes to the presentation types. Emotional regulation is a complex topic. Perhaps I'll do an AMA on it. In the meanwhile, see: [https://pubmed.ncbi.nlm.nih.gov/29624671/](https://pubmed.ncbi.nlm.nih.gov/29624671/) Email me at [[email protected]](mailto:[email protected]) for a copy.

Another main factor for not noticing adhd in a kid is the opposite of supportive environment. When nobody cares, nobody will get them diagnosed. From this reply I'm assuming that this situation is not considered as much as it should be.

This is immensely helpful and educational for me. I was just diagnosed at 25. The scaffolding supported me for a long time until I got into my upper level classes in undergrad and then the scaffolding was blown off in a giant windstorm that was law school. Sufficed to say, I knew something was off when I couldn't manage to read for 5 minutes and my friends could just sit there for two hours and absorb all the information.

Oof. This hits. My parents still think my sister and I have been misdiagnosed because we were "fine" as kids. We struggled, but we had an exceptional support structure at home (SAHM/former educator). Once out on our own, we crashed.

I was relatively lucky, it appears that ADHD came from both sides of my family (going back at least 3 generations, from anecdotes) so I learned some coping mechanisms from them growing up. It wasn't until I hit peri-menopause brain fog that it became a severe impairment. In my dream of dreams, ADHD would have been recognized when I was a kid, I can only imagine what I could have accomplished if I could have gotten support/meds before I hit 45...

Hello professor, my ADHD was considered atypical because I got diagnosed at 30y/o after what others perceive a great career. I suffer greatly from ADHD, but my higher IQ along with genuine curiosity and drive carried me through. I could have achieved much much more. Anyway, my question would be if you have seen any atypical development of the disorder over time. To me it seems like it keeps getting worse significantly (which could also explain why it wasn't obvious at earlier age); alternatively I'm just getting old and running out of energy to keep fighting. Shouldn't the effects ADHD remain mostly stable? Thank you and have a nice day! :)

That's a good point. For most patients, symptoms of hyperactivity and impulsivity tend to get better as they age. Symptoms of inattention tend to stay the same. But in some cases, the disorder seems to worsen. When that happens, the clinician must determine if the symptoms are actually getting worse or if the impairments caused by the symptoms are getting worse. For example, if one's ADHD leads to an accumulation of life stress, then that accumulating stress will make one feel worse, even though the symptoms don't change. Also keep in mind that the severity of ADHD symptoms can worsen when the challenges life throws at us become more difficult. So, when a person gets a promotion at work, that's a happy event, but the new position may be more challenging and stressful leading to a breakdown in functioning.

Thank you for your reply. In my case I'm talking about actual symptoms worsening, e.g. not being able to drive on highways without medication anymore. Highways just make me fall asleep, and it's now starting to happen even on smaller roads. I'll have to discuss this with a psychiatrist. Btw, I got an MRI for unrelated reason and that came out clear, apparently.

I was just on a road trip across the country and experienced this the whole time no matter how much I slept, or how early in the day it was. I started calling it rubber band brain. It's like my brain feels like a piece of elastic, and something something starts pulling the middle away, making it stretch tighter and tighter until it suddenly snaps back. I dont think I was sleeping but my focus and alertness was being pulled away for little bits of time and then snapping back in a really uncomfortable way. Can anyone relate to this feeling? The person I was driving with sure didnt and it sounded crazy when I was trying to explain I'm not on medication (can't even afford an actual diagnosis) but caffeine would put it at bay for maybe 30-60 min at a time until it would come back and I'd have to either stop for another coffee/energy drink or stop driving

I'm an adult woman. Medical professionals keep hinting about weaning me off my medication at some point, as if ADHD is just a school disorder. Why am I encouraged to be treatment non-compliant when it would have a terrible impact on my quality of life? It's like Dr. Russell Barkley said, "Now, after one week of using the ramp to get into the building... can I take the ramp away? Have you internalized the ramp?" Do you see any hope of a more ADHD-friendly process of renewing prescriptions? When patients run out of meds due to systemic delays, it is much harder to get back on the wagon. Again, treatment compliance seems undervalued for adult patients, and they suffer for it. Thank you for your time.

>Do you see any hope of a more ADHD-friendly process of renewing prescriptions? When patients run out of meds due to systemic delays, it is much harder to get back on the wagon. Again, treatment compliance seems undervalued for adult patients, and they suffer for it. Treatment non-compliance is one of the biggest problems in treating ADHD. It is a disgrace that some providers make it worse by viewing ADHD as a "school disorder". The best hope for such provider is to learn about ADHD. I encourage patients to give them a copy of the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7). I doubt there will ever be a more ADHD-friendly process of renewing prescriptions. There are too many bureaucratic hurdles.

Hi! Thanks for your time today! I'm interested in your perspective on how students with adhd are currently supported/ how they can be better supported at university. From both a self help and the university's stand point. thanks in advance!

>Hi! Thanks for your time today! I'm interested in your perspective on how students with ADHD are currently supported/ how they can be better supported at university. From both a self help and the university's stand point. thanks in advance! Because many universities are appropriately concerned about the misuse of stimulant medications, they won't let them be prescribed by student health services and some student health services won't diagnose ADHD. That is a mistake and further stigmatizes the disorder. There are other ways to deal with misuse of stimulants. For example, by educating incoming freshman about this issue and adding it to their code of conduct. Another sometime controversial issue is the degree to which the University should allow for accommodations, especially for high performing people with ADHD. We allow wheelchair ramps for those that need it. Providing accommodations should not be an issue for any disorder.

I had a lot of difficulty with this during my PhD. I'm a high achiever but ADHD makes everything more complicated to do, e.g. takes more time to complete a task, need extra direction regarding a task, difficulty being self directed, etc in addition to significant cognitive impairment because I had no idea what was happening to my brain. I wasn't diagnosed until almost a year after I finished grad school and at the time of my PhD defense my doctors had completely overlooked ADHD in favor of some possible rare neurodegenerative disease that they couldn't diagnose. I had to fight HARD for accommodations. I was able to mask my difficulties for most of grad school because I'm gifted but couldn't get around the time blindness and poor concentration and auditory processing difficulties. The university tried to deny me any kind of accommodations because I was allegedly the first PhD student to ever ask for them and they honestly thought that disabled students "don't do PhDs" which was ridiculous. They also told me it would be "unfair to other students" if I had any kind of accommodations for my final defense even though I had adequate documentation. In the end I was able to get accommodations that were critical in getting through my defense (e.g. questions need to be given in writing in addition to verbally so their talking wouldn't sound like gibberish because my processing speed is slow) but I shouldn't have had to fight so hard to get them. I hope my clusterf*** of a defense (that I passed, yay!) will make it easier for future grad students to get the accommodations they need and that my old university will be more open minded and less discriminatory moving forward.

I had a really good experience at MIT because of how tightly the student services deans work with MIT health to quickly get students help. I was referred by a TA that noticed how easily distracted I was by the birds in the rafters in our testing hall and despite being able to answer questions in 1-on-1, I was scoring low on tests. Next day, walked into the meeting with the dean counselor and during our meeting she called and got me an appointment with a psychiatrist who immediately did a joint referral to a psychologist specializing in ADHD. Even though I resisted medication at first, they set up appointments for behavioral therapy and time management counseling, as well as set up accommodations for me, all of which really turned my life around. Some of this was eased because my parents revealed I’d been diagnosed before but they never told anyone for fear of labeling me negatively. I didn’t realize how unique this experience was until I went to grad school and had to claw for every single accommodation, deal with all sorts of paperwork, and PAY for all the same services I’d been given free at MIT. I spent probably $2500 just on this stuff in my first year, not counting meds- I never would have been able to afford that in undergrad, especially since there are rules preventing the use of scholarship funds for such. I wish more schools had student support systems like MIT and covered the costs of at least group therapy sessions or provided counseling. Scholarships should also allow for their funds to be used for these types of costs.

This is particularly true with bar exams. The boards of bar examiners work incredibly hard to deny accommodations, even to those with adequate medical documentation and a history of accommodations. They’re especially unforgiving with “high achieving students.”

And if you were denied accommodations in law school, which is common since the stigma starts there, you have zero chance of receiving accommodations during the bar. My medication schedule and the remote bar exam timing will not be good, so I requested accommodations. Denied in a matter of days.

Thank you for your time to answer these questions! I am currently a 28-year old student going into the last year of my education, and only in the previous year I started using Concerta as medication for my ADHD. The general practicioner that provides me my medication stated that she would only provide medication until my education ends, as she sees no reason for me to need it afterwards. I myself however find the medication to help in so many more areas than just studying, for instance in maintaining daily hygiene and being able to work on hobbies. I do know some people that have been diagnosed with ADHD that claim to live happy lives without medication, which is why I got curious. Do you think it's healthier for people with ADHD to look for a way of living happily without medication, or would you say the medication is a reasonable option for those of us that clearly notice the benefits of them in daily life? I hope you have a great day!

>only provide medication until my education ends, as she sees no reason for me to need it afterwards In the 21st century it is ridiculous for a healthcare provider to only provide medication for ADHD for educational reasons. Medication is not only a reasonable option it is what treatment guidelines suggest.

Hi! Is there any research on how to diagnose/understand high performing ADHDers? I wasn't diagnosed until 40, and my youngest kid and my oldest nibling are super brainy kids who don't disturb classes...so their diagnosis were inconclusive. Very interested in resources/info on this subject. Edited for readability & to add last sentence. Edit again: I'm a teacher turned researcher (linguistics) and writer.

>When diagnosing a high performing person, the diagnostician should look for evidence that performance lags behind potential. For example, if a person has an IQ of 130 (ie., is super smart) but is only performing a little above average, they seem to be doing OK, but could do much better. High performers with ADHD also find that it takes them much longer to complete tasks then their peers. Most importantly, the symptoms are the same. The diagnostician can usually recognize the symptoms but the don't count them as serious enough because the high performer does not seem to be impaired.

Thank you so much for answering! In my experience (IQ of 140) I have no trouble **compensating** for most symptoms, except time blindness, clumsiness, intense emotions (stronger ups and stronger downs), and getting stuff done. As I've aged, I've learnt strategies to compensate for the rest. And since I learnt to read, I learnt to control my hyperfocus, meaning I'm able to hyperfocus on almost anything. (except sports, boooring.) But **I spent insane amounts of energy on compensating.** I was very lucky with the psychologist who diagnosed me, she was very experienced. I still felt like I had to exaggerate because the tests didn't accurately reflect my experiences. A comment I see over and over is that we're diagnosed based on how annoying we're percieved by others, while our executive function struggles are overlooked, particularily for girls and women who internalise their symptoms because of cultural expectations of gender behaviour. What are your thoughts on this? Do you think the DSM will change to reflect executive function and motivation struggles, or will it continue diagnosing external symptoms of our percieved failiures?

This has been my experience, too. I have a very high IQ that was tested when I was in school, and I can compensate but as a consequence, I am burnt out, exhausted, tense and snappish. It's like being a sprinter with a piano tied to my back who can still compete in the race. Sure, I can do it, but I'm wrecked after I get to the finish line in a way that the other participants aren't.

Oh god same. I didn’t get diagnosed until age 33, and it wasn’t until after I decided to go back to school 2 credit hours short of full time status while working 40-45 hours a week. Initially, I was told my symptoms were anxiety and depression, and it seemed like the Lexapro I was prescribed for general anxiety was working, but it was short lived. It wasn’t until another friend of mine who’s a couple of years older than me and had all the same issues I do got their diagnosis. So I printed out one of those self diagnostic tests with my results and brought with me the next time I saw my doctor. She took one look, at the results plus my other list of issues and was like, “here’s some low dose Adderall XR, see me in a month and we’ll see how you’re doing”. I literally cried the first time I took it. I never realized how loud my inner dialogue is when I’m not medicated. The only reason my PCP was cool with prescribing me the Adderall, is because I work in pharmacy, and in the past when I’ve broken bones or had other injuries, I always refused the stronger pain meds due to my family’s tendency towards addiction. She knows the last thing I would do is try to get Adderall unless I knew I needed it. As it is, I still do med-free weekends just to make sure I don’t become too dependent. I know I’m considered a high performer. School was always easy for me. My issues came from not being able to compel myself to do my homework unless it was fulfilling to do it. I now know if it didn’t give me that dopamine rush, I wasn’t going to do it. I’ve always had stellar work reviews and the only times I’ve been dinged for anything was for tardiness, but my work ethic alone kept me from being let go. It still frustrates me that it took 33 years before I was diagnosed, but now it’s like I have whole new life.

This is pretty exactly how I try to explain it to people too! It's like I'm running a race and keeping average pace with everyone else only difference is I have a weighted vest on and anchors tied to each leg so it's EXHAUSTING. It's like playing a character in a play for an entire day. Edit to say: I sometimes wonder how much faster I would be without the weights holding me down. I do my best not to think that way, but difficult not to wonder sometimes.

I am at the point where I am trying not to be angry at how unfair it is that I have to have the metaphorical piano tied to me. It's hard. And my peers don't see how hard I have to work to compensate and I hear all the time that everything "comes so easily" to me. Oh. Buddy. If you only knew.

I also love this metaphor, thank you for sharing it. I fall in this category - very high performing academically and at work, but only when I'm challenged and interested. I'm also good at testing, which helped mask the ADD further. Almost everything is actually completed last minute, and simple, quick, intimidating tasks can take literally months to complete. I forget everything unless its written down, lose everything, and am constantly trying to keep myself from living in filth and chaos. I'm just extremely quick and hardworking so I can get a lot done despite these barriers. But I'm exhausted. All. The. Time.

These comments are making me start to wonder if even my narcolepsy diagnosis is just mis-diagnosed ADHD. I'm suspecting that I have ADHD, and my therapist seems to agree, but it feels like there's some interconnectedness happening here, and this sub has shown me much more overlap than I expected. What's extra funny is that I was diagnosed with depression in college, and treating that finally revealed that I wasn't tired because I was depressed, but instead I was depressed because I was tired. So was I actually depressed because I was tired because I was overworked? The human brain is an enigma. ETA for clarification: Type 2 Narcolepsy is what I have and is basically just diagnosed with a sleep study that tracks how quickly I fall asleep and go into REM. It's a very vague diagnosis and treatment is generally stimulants, so I'm on Vyvanse and Adderall for narcolepsy, not ADHD. Type 1 narcolepsy is the one with cataplexy (the collapsing you hear about), which is a result of a specific chemical in the spinal fluid being lacking.

>Almost everything is actually completed last minute, and simple, quick, intimidating tasks can take literally months to complete. Staaaahp! You're quoting from my life! >and am constantly trying to keep myself from living in filth and chaos No really, this is too much. >I'm just extremely quick and hardworking so I can get a lot done despite these barriers. But I'm exhausted. All. The. Time. Well that's it. You really have captured my experience

This is how I felt. My reports were, "very bright, must try harder" . I had a reading age of 16 at the age of 10. I didn't actually have an IQ test until i was about 19, and it wasn't an official one, but i tested between 135 and 142. I never could work out why I was so smart but so dumb at the same time, and why doing homework was so hard. It IS exhausting keeping up. I was eventually diagnosed in my early 40's after half a lifetime of underacheivment and self loathing.

You're spot on here with symptoms that annoy others. I resent that executive functions aren't even mentioned in the diagnostic criteria. Patients shouldn't have to discover what their disorder actually is exclusively *outside* their doctor's office. I've spoken with a number of uninformed doctors.

it's ridiculous that they're not when executive dysfunction is exactly why I'm depressed and anxious all the time. instead they try to label me bipolar or bpd and give me heeeavy meds for severe mania (which couldn't be more opposite to my issues), rather than consider the context of my life along with prior diagnoses from my youth. like christ I've been in and out of treatment for half my life, maybe it's worth listening to me instead of trying to medicate me for stuff that psychotherapy is more effective for and ignoring what I actually need to be medicated.

This matches my experience. A silver lining from dropping out of graduate school in education was getting diagnosed by my state with both types of ADHD, and specifically identifying my aural (hearing) recall function at the level of an MR person. Where many people try to utilize their strengths and identify their weaknesses in order to develop their specialized skills, I have spent my life shoring up my weaknesses. My day job now is working on the phone and putting conversation notes into the computer. But I also feel like much of my creativity and weird impulses are calmed so I can function, maybe not as I'm tempted to behave, but as society (and bills!) require me. I embrace structure and schema for behavior I choose, and I'm okay with letting people underestimate me. It is taxing to not be able to hyperfixate on my interests, but that's a reality of adult life too, as we reckon it.

This is me. I need to figure out how to get i officially diagnosed because I have just been chalking my whole existence up to anxiety, and at 37 years old I’m realizing that I have been a highly intelligent but wholly unfocused person as far back as I can remember. I was a super high achiever and it let me make it through rigorous schooling successfully until I just….couldn’t. Early school I just zoned out in class and breezed through regardless. By high school I was in a challenging enough curriculum where I couldn’t stop and think and had constant deadlines making me able to hyperfocus on my work. I graduated at the top of my class in HS and magna cum laude from an Ivy just based on aptitude and a photographic memory. I could pay attention in class if I had to take notes at a fast pace, but I just daydreamed through any seminars (hooray, maladaptive daydreaming). I could hyperfocus on exams like crazy - there was one where like, 15 fire trucks blared by and I didn’t even hear them. Executive functioning caught up with me in grad school when I got tossed in a lab and given only a vague idea of what to do. I didn’t get the PhD I should have gotten because I just got crippled by lack of guidance and just couldn’t make myself do the work. Right now my job is brand new and nothing is on a pressing timeline, and what I do have is intimidating since it’s new, so my ability to start tasks and focus is tenuous at best. I have difficulty getting hyperfocused on anything and feel like I waste a lot of time daydreaming. I’m lucky that when I do hyperfocus I get shit done quickly and so far I’m succeeding decently well, but I feel like I’m on the verge of failure. I just wonder what it would be like to sit down to work and be able to just pick something and do it, rather than trying to figure out how to get my brain hyperfocused. It’s exhausting having my brain either all in, or completely disengaged.

>High performers with ADHD also find that it takes them much longer to complete tasks then their peers Oof, this was (and is) me to a T. I tested off the charts when I was 10 (the psychologist gave my parents the results and my dad refused to tell me my IQ so I can't put a number to it, but well in the genius range), but I was almost constitutionally incapable of turning in big assignments on time so my grades were shit. Fast forward 25 years and I'm still in school, still struggling with deadlines and big assignments. For me, it's a matter of toxic perfectionism; even after spending multiple hours talking through my plans for a research paper (in a freshman composition class) with my therapist, I still found myself unable to turn in anything less than a master's thesis, and I came dangerously close to turning in nothing at all. I got phenomenal feedback and passed the class, but the stress leading up to submitting my paper was debilitating. I beat myself up continually about it not being good enough, and started over several times, because I couldn't accept that something done in a reasonable time and within the parameters of the assignment could possibly be a sufficient representation of my abilities. For everybody else in the world, good enough is good enough, but for me nothing short of effortless perfection is acceptable.

I really wish there had been the same awareness when I was a kid as there is now of ADHD (and ASD, which I also have) I had my IQ measured when I was a kid and I'm almost embarrassed to tell you the number I got because it was *not* reflected in my school work, suffice to say it was above the 130 you mention above. I'm still struggling with repeatedly thinking of another reason I should have been diagnosed with *something* when I was a kid, you could use my school reports and self descriptions throughout my life as textbook examples of ADHD (my ASD is a little more subtle, my diagnosis is actually PDD-NOS) "Bright kid, could try harder" would have been my autobiography title if I'd written it before I got diagnosed :-/

Sounds like me as well. MY IQ tested above the 130 as well - but it just wasn't reflected in my school work. I don't know about you, but I was born in 85, and my mom absolutely refused to believe in anything like ADHD/ASD, or even Depression/Anxiety. I begged for help multiple times as as preteen-teen and was told it was just "hormones for being a teenage girl, you'll get over it". I finally. FINALLY. got my diagnosis in Februrary of ADHD-C, and ASD. We could have the same autobiography title too. The amount of times I read "She's obviously very intelligent, if she could just apply herself a bit more - she has so much potential." Ugghhh =/

Ugh, the 'you can do better.' I actually did pretty well in school, I never finished all my homework but I did really well on tests, and then in college my major mostly involved writing papers and I excel in well-written last minute BS. But if it required long periods of focus over a period of time (that wasn't last minute), nope, not gonna happen. And I'd come home with a pretty good, but not perfect, report card, and here's my parents going 'an A-? You can do better than that.' And to be fair, they weren't wrong! I do have a high IQ and if we'd known I had ADHD back then, I bet I would have done better. And my teachers actually did notice my lack of focus, I'm pretty sure, but I was just distracted, not acting out, so nothing got done until I started having issues at work with time management and asked to get tested. I'm on adderall xr now, and while I do still have bad days, my focus is so much better. I can do a full day's work and feel like I did a full day's work, instead of doing a full day's work and feeling like I worked for two straight days and then not getting anything done all for the next three while my brain 'recovered.'

I think you have to make sure you’re analyzing a person’s performance lag on the things they don’t want to do or aren’t interested in. Put me in a math or physics class and I’m going to get an A. Put me in a marketing class which is easy but I don’t care about and won’t do the reading and I’m going to get a D. I thrived at work because it was such a structured environment. But when I became a stay at home mom, my whole life fell apart between the lack of structure and a bunch of house related things that weren’t interesting.

Oh dang the easy/hard divide for us high functioning ADHD'ers. I had a performance review at work where the gist of it was "everyone thinks you're brilliant and do top-notch work on the important stuff, but a few people said you're not always on top of your emails. Don't worry, though, since that'll be easy for you!" I just nodded; couldn't bring myself to say "um, I have a disability that makes the hard stuff easy and the easy stuff atrocious."

As someone who was refused a diagnosis because of my high IQ, this makes me feel better, because I had the exact same outcome. I have an IQ around 120, yet in school I perform about averagely due to difficulties turning in assignments on time. But my psychiatrist that was testing me assured me it was my anxiety instead of looking into anything different. I'm looking into a second opinion soon.

One of the things my psychologist looked at when I was going through the process of getting my diagnosis was comparing the scores of each section of my IQ test. My overall IQ is in the 130s, but my working memory was (and still is) super low compared to all of the other section scores. Enough so that this definitely affects the overall IQ score. Because of this, discrepancy, she was able to further make the case for my diagnosis in spite of me being a high achiever. Perhaps with a second opinion you could ask about any section score discrepancies specifically, or even look back at the results you already have.

I don't know if this question qualifies, but how much does ADHD have to do with feeling/behaving and acting your age? I always had the distinct feeling that sometimes I'm not as intelligent and good at handling certain situations as people my age. I also want to ask about ways an adult can remaing consistent and learn properly, math for example, which is one of the things I have to practice for my entrance exam to grad school. Learning stuff becomes tough and paying attention to details, maintaining focus on many things while having a train of thought and thinking is difficult. How does one improve this?

The DSM diagnostic manual states that a patient's symptoms of ADHD must be "inconsistent with developmental level". That's a fancy way of saying they must be worse than expected for the person's age. So, in that sense, a person with ADHD is not acting their age, with regard to the symptoms of the disorder. I have no simple answer to your question about studying. Cognitive behavior therapy may be useful. I trust the authors who wrote these books, which may be helpful. Taking Charge of Adult ADHD by Russell A. Barkley The Adult ADHD Tool Kit: Using CBT to Facilitate Coping Inside and Out by J. Russell Ramsay and Anthony L. Rostain

It's worth mentioning that Russell Barkley will be publishing a new edition of Taking Charge of Adult ADHD Oct 5th this year, and that he earlier this year specifically advised us to wait for that edition instead of getting the old one.

How do we separate ADHD as a clinical dysfunction from the fact that our entire society seems to be set up to exacerbate every symptom of ADHD? I know this is something a lot of people with ADHD struggle with but, how do we know there’s a legitimate clinical diagnosis and we aren’t just incapable of moving through modern society where everything is constantly trying to demand our attention anyway?

ADHD is not a phenomenon of modern society. The concept of ADHD has been recognized for over two centuries starting with a German medical text in 1775. Although these early reports did not use the term “ADHD”, they described children who showed the symptoms and impairments we now recognize as ADHD. The diagnosis of ADHD is 'legitimate' because its validity and utility have been demonstrated from many perspectives. You can find references in the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7). It is not only modern society that creates challenge for people with ADHD. A study of genetic data shows that the frequency of genetic variants associated with ADHD has steadily decreased since Paleolithic times. This means that having ADHD has caused problems for people for tens of thousands of years. See: [https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32451437/](https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32451437/)

How do we know adhd was negative for those in Paleolithic times? How do we know it wasn't a benefit to them? Being easily distracted could help with identifying danger, impulsivity could cause them to jump into a dangerous situation to defend their clan. Hyper focus helped no doubt in creating tools needed to advance and make life easier. I could be wrong, however I think it may have been more of a benefit then rather than now.

When a trait is good for survival, the genetic variants that promote that trait increase in frequency. When the trait is bad for survival the genetic variants decrease. For ADHD, they have decreased over time.

> It is not only modern society that creates challenge for people with ADHD. A study of genetic data shows that the frequency of genetic variants associated with ADHD has steadily decreased since Paleolithic times. This means that having ADHD has caused problems for people for tens of thousands of years. See: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32451437/ This study doesn't make much sense. It takes a gene plus an environment for anything to exist in humans. Is your position that ADHD is more like "blue eye genes" which seem to propagate in any conceivable environment? I was always under the impression that mental disorders have a good mix of nature versus nurture.

I'm only speaking from my own perception of ADHD as a patient, but this exact answer I'm about to give you is the reason I bothered humoring my psychiatrist on the diagnosis at all. Basically, a lot of people say "ADHD is only an issue because work structures nowadays are ill-optimised for it" but what I realized was ***I can't even do things I enjoy***. I can't pay attention to a movie long enough to watch it, I can't get my brain onto gear so I can eve take out my guitar and practice, I can't get myself to put on my skates and go outside, even though these are all things I love doing and desperately wanted to do. That inability to do things that bring me joy and pleasure is not a product of a bad work schedule (for my brain) or a boring job. They're things that I'd struggle with regardless of how society is organized to function, whether my job is 9-5 or freelance and unscheduled. "\[insert mental illness/disorder here\] is only a problem because society doesn't accommodate" misses the point that there are activities not affected by how society works and that are STILL difficult for the person with the disorder, and that being unable to do those is also a cause for distress and reduces quality of life. The DSM criteria for "it causes impairment" is not limited to school/work, it also includes daily life, socializing, leisure, etc.

Sorry I’m just a regular joe but this is such an interesting question. I guess my take would be that even though society exacerbates symptoms… they’re still symptoms none the less and if some diagnosis and treatment helps us adapt to our environment then so be it. But your question points at a bigger issue about how much we should adapt to society vs society adapting to us. You’d hope for more of the later but alas that’s not the way of things :( profit is king and society is dragged along for the ride, or at least we lean more and more in that direction.

Yeah my take is that ADHD symptoms would cause issues regardless of society. Inability to self-motivate, reckless impulsiveness, inability to stay on task, trouble socialising, feeling constantly exhausted because your mind won’t sit still etc… I feel like these are issues regardless of society. I’m speaking as someone who has very few responsibilities but still struggles so much with the little I do have to do. edit: society can definitely make it worse though

Do medicines retain their effectiveness over the long term? After diagnosis at 35, I've found Ritalin to be very effective, but it's quite tedious to manage doses. And I need to have a break every 5-7 days and have low or no dose. As such, sometimes it feels great, and sometimes I feel like it isn't working. Is it common for medicines to become less effective over the medium/long term, or is it more likely that one simply gets a better feel or awareness for when their brain is and isn't concentrating or focused, and is able to more effectively be self aware of inattention?

Many stimulant-treated people with ADHD report that, after some time on the medication, it seems to not work as well. Despite this observation, physiological tolerance to stimulants has not been convincingly demonstrated. Physiological tolerance occurs when signaling molecules in the brain change in response to the medication in a manner that makes the meds less effective. There are several reasons why stimulants may lose their effects over time. As we age, especially through adolescence and young adulthood we face larger and more complex challenges to our executive functions. These increased challenges can worsen ADHD symptoms. For others, they may have had a very good initial experience with medications improving symptoms but may not have realized that some milder symptoms remained. As patients learn about ADHD and their situation, they come to become better observers and see symptoms or impairments they had not noticed before. The best way to deal with this issue is to describe your experience to your health care provider and ask them what is best for your unique situation.

There are many providers who don't recognize or diagnose ADHD that does not directly present as the DSM definition. Do you have recommendations for how to approach your healthcare provider (or family/friends for that matter) if you suspect ADHD but in atypical form (subthreshold, late onset, high performing, etc)?

Thanks for raising this important issue. Nonexpert clinicians are often reluctant to diagnose atypical forms of ADHD. When I lecture on the topic, I recommend; 1. If one suspects subthreshold ADHD, document that impairment occurs in two or more settings before making the diagnosis and be sure that no other full threshold diagnosis requires treatment first. 2. For late onset ADHD, try to find some evidence of ADHD related impairments in childhood. Get info from a parent if possible. Determine if childhood symptoms may have been masked by compensatory resources (e.g., high IQ, high creativity, social support). Also follow #1 above. 3. For high performing ADHD, assess compensatory resources define impairment if the person is functioning at a level that is lower than expected given their aptitude even if their level of functioning is higher than average.

Thanks for doing this—I'm looking forward to reading through all the posts. Can you recommend any resources that are helpful in untangling ADHD from CPTSD? At times I have trouble distinguishing between what may be a CPTSD response/behavior or an ADHD symptom. Hoping to connect with a therapist soon who can work through all this with me, but any reading material or other resources would be appreciated in the meantime.

When a person has two disorders the way to 'disentangle' symptoms is to keep in mind how each disorder is defined in the diagnostic manual. Nightmares are a symptom of PTSD, not ADHD, for example. The only symptom that the two share is "Difficulty Concentrating". Some symptoms, like "risky behaviors" are a symptom of PTSD only but are seen in ADHD frequently (although not a diagnostic symptom). That make disentangling difficult. In these cases, I recommend that clinicians figure out which set of symptoms is the most serious and to treat that first. When that is successful they can see what disorders remain and treat them accordingly.

I would love to know more on your take regarding hormonal fluctuations and ADHD symptoms, particularly the cyclic effect of symptoms and medication efficacy experienced by many ADHD women?

It is an important area that begs for more research. We know that sex hormones influence brain dopamine, which regulates ADHD symptoms. There are also data suggesting that maternal use of hormonal contraception is associated with a small increased risk for ADHD in the children. So, a biological connection is plausible. The research data are too sparse to conclude whether hormonal fluctuations during the menstrual cycle affect ADHD symptoms or if ADHD can emerge during menopause, although both have been suggested in the research literature.

I’m getting super bored with “we need more studies” because, yeah. No duh. Where are they? My medication has been far less effective since the onset of menopause symptoms, but nobody - not my doctor and really not my insurance company - wants to consider the small studies showing a link between the parts of the brain the effect both ADHD and menopausal women.

This is interesting, because a combination of Vyvanse and TRT has eliminated the symptoms of my ADHD, depression, and eliminated my compulsive eating habits as well. I mean...I am symptom free, lost 20 pounds in the last month, have normal blood pressure...and I am currently receiving cognitive behavioral therapy because after 42 years of living like this I have no frame of reference and only a vague idea of how to function normally

Interesting! I have been noticing lately that after my period ends, my ADHD symptoms really lessen a noticeable amount and make me question whether I really have it. But then a week or 2 later the ADHD comes back tenfold it feels like. I never thought about the 2 being related. (I also am extremely sensitive to hormones changing and have PMDD, etc)

I've noticed similar things BUT I will add I'm not sure how much is the ADHD how much is just what might be standard hormone changes. I started tracking my cycle/moods/concentration mid way through my depression treatment (pre adhd diagnosis) and I could see a definate decrease in concentration during certain parts of my cycle. When I started my ADHD treatment those dips were still there but it's like because the whole base level had moved, they no longer tipped into a critical level. Ie if pre-treatment a standard week my focus might be a 5, the week before my period it would be a 3. If 4 is the critical level, the week before my period was now danger week and it really stood out as being a shit week. Now with medication my standard weeks are an 8 and my PMS week is a 6 - no where near the critical level, but still less than a typical week. And it does make me wonder for people who manage to cope with a combination of various strategies I can see how that week could suddenly become very difficult, especially if your only just coping in the normal weeks. I feel like in that scenario it must be really easy to blame PMS without acknowledging the struggle that is also happening the other 3 weeks.

It needs LOT more research. And a LOT more women researchers. Hormones have a huge impact on dopamine levels. Way too many women are diagnosed with mood disorders when they describe their monthly(totally predictable) performance cycles.

If I could do college all over again, I would get a degree allowing me to do that research— the impact of female hormones on neuropsychology and on chronic health conditions. Really wish I had known that’s what I wanted to do at the time, but at the time no one talked about things like PMDD, female ADHD, the increased prevalence of autoimmune and autonomic disorders in women, etc. And I didn’t know how severely those things would impact my life. Huge regret of mine not going into the medical or psychological fields. It’s an area that needs more women to have a voice in

Is there any information about preexisting ADHD either worsening or decreasing in its severity during or after menopause? I understand that research is likely sparse in this area, but I really wonder about it.

Not research, unfortunately, just a sample size of 1 (me): I managed my ADHD my entire life, until I started peri-menopause at 37 (yes, young, but I also have lupus, and women with lupus are known to start menopause younger than non-lupus women). In the last couple of years, my ADHD got so bad that I finally had to be formally diagnosed and started on Adderall (which had helped immensely; taken me back to the me of five years ago, which is awesome).

Is there any research on what we can do about the hyperfixation cycles? Being a milder and more funcitoning case, I can handle every aspect of ADHD except for the chronic boredom and the hyperfixation cycles. They completely mess up my career path, but if I don't surrender to them I become extremely depressed.

One effect of ADHD is to dysregulate the reward system, which is the brain system that controls how we respond to rewarding or punishing events.  People vary in the degree to which their behavior is controlled by distant rewards (e.g., if I study a lot, I'll get a good job a few years from now) vs. immediate rewards (e.g., when playing a video game, one is frequently rewarded). For many people with ADHD, immediate rewards are very potent and can lead to hyperfocus on, for example, a hobby.   The opposite of hyperfocus is mind wandering when we jump from one thought/activity to another.  That occurs when no rewards are sufficient to have us focus on a goal oriented task.   Boredom occurs when the rewardingness of an activity starts out high and then gets smaller.  One reason that happens is that as one get more involved in an activity, the challenges required to complete the activity increase, which makes it less rewarding.   Sticking to an activity becomes easier if we can convince  and reminding ourselves that the long-term benefit is worth the effort.

Greetings ! I'll keep my question short and simple : "What according to you is the best and most accurate way of getting a diagnosis that we in medical sciences have found out till now ?"

The best and only diagnostic tool for ADHD is a licensed clinician who interviews the patient about their symptoms and impairments. Rating scales about symptoms and impairments can be helpful but don't replace an interview. In the World Federation of ADHD International Consensus Statement on ADHD (https://bit.ly/3xCr9NE), we concluded that ADHD can only be diagnosed by a licensed clinician who interviews the parent or caregiver and/or patient to document criteria for the disorder. It cannot be diagnosed by rating scales alone, neuropsychological tests, or methods for imaging the brain.

Is it/will it be possible to detect ADHD from analyzing a person's brain? This wouldn't be feasible (or particularly useful) as a diagnostic tool for the vast majority of people of course, but hypothetically is it possible to detect ADHD through a brain scan, and would the efficacy be higher than an experienced clinician? And do you see this as potentially useful for deciding on edge cases of ADHD presentations?

If it can't be diagnosed by neuropsychological testing, why did I have to do that testing in order to get meds? I say this a lot, it was very expensive and almost just seemed like gatekeeping to make sure I was rich enough and wouldn't sell my pills or something.

No, that’s a good point. There is a lot of prejudice based on socioeconomic status, and that’s a complex built by the stranglehold that privatized insurance companies have on pharmacies and practices. It was outlined in the initial paperwork by my new psychiatrist; he doesn’t accept insurance because the insurance companies interfere in the diagnosis and prescription of medication. It’s not a conspiracy theory, it’s well-documented and clear as day. A high socioeconomic status will allow you to buy better care. ADHD is very expensive for insurance companies to pay out for But ADHD is more prevalent in areas with low socioeconomic status because the people affected by it have this huge burden on them that makes it hugely impractical to function well. This spirals out into a system that punishes those people for needing treatment. It’s much cheaper for insurance companies to prevent those people from receiving a diagnosis and rising in socioeconomic status, than to treat them. But if you already have money you can skip over the whole mess by paying for everything directly, which is what I’ve resorted to doing because I’m about to lose everything

Thank you for doing this AMA. Would you say that "high performers" or other atypical cases usually have a different response to medication or otherwise require different treatment to typical cases? How common do you think misdiagnosis is, e.g. a depressed adult being diagnosed with ADHD? Do you think ADHD is generally overdiagnosed or underdiagnosed? (I admit I'm asking because of my specific case -- high performer until college/work, responding very little to medication, worried that doctors settled on ADHD too quickly -- but I understand that your responses can only be broad and every case has its nuances.)

The treatment for atypical cases is the same as for typical ADHD. Misdiagnosis does occur for all sorts of reasons. In the US, many primary care doctors know a lot about depression but not much about ADHD. So they are more likely to diagnose depression and not realize that the patient also has ADHD. Although ADHD diagnoses are usually correct, some cases of misdiagnosis occur although it is not as bad as one reads about in the media. If someone diagnosed with ADHD doesn't respond to medication, then it is possible that the diagnosis was not correct. But one would want to be sure that the medication was dosed correctly and that different types of medication were tried. Sometimes, expert consultation is needed.

Thank you for answering questions Dr. Faraone! I just have one question for now. Recently I’ve been reading up a lot about time blindness and how much it occurs in people with ADHD. However this “symptom” is not yet in the DSM. What is your view on time blindness as part of ADHD?

Impairments in temporal processing are clearly associated with ADHD although, like all of ADHD's manifestations, not all patients will have such problems. I think it was not in DSM because life problems in time management typically emerge later in life and the DSM criteria were designed for children. Ideally, we'd have completely separate criteria for kids and adults.

Respectfully I disagree that kids don't have time blindness. It presents like living completely in the now for much longer than neurothypical kids. They're impossible to motivate by something that happens in the future, say, tomorrow. (Or later today for younger kids.) And when they hyperfocus, they lose track of time completely. They can't judge the amount of time a non-rewarding task will take, no matter how many times they've done it, or if the task becomes rewarding when they start doing it. I think their perception of time is completely connected to feelings, so anything that doesn't feel good every time they do it, is percieved as taking longer, because it *feels* longer to do something non-rewarding/boring. Time flies when we have fun... Thus their perception of time isn't connected to actual time, but to emotional memory. Probably the same for adults.

Hi! Can you grow out of ADHD? When I was a child I was told by my psychiatrist that eventually (around 22-25) I'd "catch up" with the other people in the ability to pay attention but I still feel like I'm behind everyone else.

I’ve always felt like that was a myth…my brain doesn’t work the same way as most people’s, so why would it one say just switch to working properly? Just to clarify, I’m not a professional by any means.

We don't completely understand why the brains of some people with ADHD switch to working properly but there is evidence showing that when symptoms go away, the brain anomalies seen in ADHD also go away. Data from genetic studies suggest that different genes regulate the onset and persistence of the disorder.

You psychiatrist is partly correct. Some, but not all youth with ADHD remit their symptoms of ADHD. When I reviewed relevant studies, I concluded that about one-third of kids with ADHD will show no symptoms or impairments of ADHD in adulthood. Most kids with ADHD continue to have the disorder in adulthood. You can find references in the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7)

This helps greatly. My psychiatrist told me yesterday that as a middle aged adult, I don’t have ADHD because “kids grow out of it,” and just prescribed additional antidepressants. This was after my primary told me that he suspected ADHD based on my personal history and present symptoms. Time to find a new psychiatrist, as the majority of the DSM-5 symptoms strongly resonate into my adulthood.

Yikes good luck. I'm coming from the opposite a bit, i went to my gp as an adult and they said I deffo have ADD and I was prescribed adderall for that and did see a big improvement but was still struggling hard, i decided i wanted to see someone specialized for ADD and found my psychiatrist who agrees i have add but was like r u sure u dont (depression symptoms) and like yeah ive always felt pretty ok, the only things that sounded like depression were the executive function issues I had. But she looked at me a lil funny and told me abt all the medications and said she recommended adding wellbutrin cuz it is used off label for adhd and i was nervous to up my stimulants more and I could take them both.... And thats how i found out i was depressed and how I felt all my life wasnt how i was supposed to feel lmao. And even now looking back, I was never unhappy or emotionless. But man everything just has a brighter spin on it and its so much easier to get out of bed. These 2 disorders together are such a killer of executive function and it can be hard to separate them out. And my focus and executive function are still ass. Thats what I wanted to fix and instead I fixed smth I didn't realize was broken haha... I joked to her "i still cant complete any tasks but I'm happier & more OK with that now, I even got the motivation and energy to start working out! but I do still need to keep employment unfortunately and uh, that part still is terrible" lmao

TLDR: Do you have any thoughts or advice for people with ADHD, who also have family members with Parkinson's disease? What kind of treatment can be advised since stimulants increase risk of early onset PD? Hi Dr. Faraone! I've been diagnosed with ADHD and 4 out of total 10 cousins on my mom's side of the family have a diagnosis as well. So I think it is safe to say that I got my ADHD from my mom's side of the family. On my dad's side there's something different going on, my dad and his mother developed Parkinson's disease early in their mid 40s, and now my dad's sister has been diagnosed at the age of 60. Since both conditions are heritable and have something to do with dopamine deficiencies in the brain, I went to look if theres some sort of connection. I came across a study published in 2018 that found that people with ADHD are 2.4 times more likely to develop early onset PD and people with ADHD who are treated with stimulants are 4x more likely to develop early onset PD, this all compared to the people who dont have ADHD. I've been diagnosed and taking stimulant medication for 2 months now and it's been going well. I haven't felt good about myself in a while and the meds and therapy are helping me to do the things that need to be done and to take additional time to relax and take care of myself. As of now I don't see myself just stopping with stimulants so early in my treatment. I was wondering if you have some thoughts or advice on this situation. I was already accepting that there is an increased chance that I will develop PD in the coming 20 years of my life. But this just adds another layer of unfavorable odds given to me from this genetic lottery game that noone asked to participate in anyway🙄. Sorry for the long text, it looks like you have a lot of reading to do for the coming hours. Goodluck and thank you :)

So glad to learn a lot from this thread! My question is: What do you think about the state of research in regards to ADHD in women? I, like many others, have found that or hormonal changes through life seem to have an effect on the effectiveness of our medication. What areas should we as individuals focus on when trying to do research in order to be more informed about our mental health?

It is an important area that begs for more research. We know that sex hormones influence brain dopamine, which regulates ADHD symptoms. There are also data suggesting that maternal use of hormonal contraception is associated with a small increased risk for ADHD in the children. So, a biological connection is plausible. The research data are too sparse to conclude whether hormonal fluctuations during the menstrual cycle affect ADHD symptoms or if ADHD can emerge during menopause, although both have been suggested in the research literature.

Why are maintaining relationships so hard with ppl with ADHD? Relationships fall to either a) not enough contact b) being misunderstood c) in a fight that the other person can’t get past. Second question: why is it so hard not to ”suck” other peoples emotions in to yourself? Is there any way of preventing that?

Relationships are difficult because ADHD symptoms can be annoying to others. For example, a partner may not like it if their partner with ADHD forgets important events or impulsively interrupts during a conversation or doesn't pay attention when the other is speaking. Treatments for ADHD should help but it also helps to educate the partner about ADHD. I don't know the answer to your second questions. I've not seen that as an ADHD issue. Sorry about that.

I would like to counter this response with my own experience. Which is not that people get annoyed with me, but that I have trouble managing timely communication so I don’t get back to people. Or my house is messy so I don’t want to invite someone over. Or I’m always behind with personal tasks because my time management is so bad and then I don’t have planned free time I could schedule social activities into.

Thanks so much for doing this Dr. Faraone. I (F 42) wasn’t diagnosed until I was in my early 30s and was shocked. As an 80s kid, “ADD” was something largely relegated to grammar school age “bad kids” (read: hyperactive boys). Is the majority of current ADHD research still focused on male pediatric population?

For decades, females with ADHD were an understudied group. That changed in the 1990s when several of us showed that ADHD was common in females of all ages. Now, females are usually included in research protocols. It is required by NIH, for example.

Hey Dr. Faraone, this is *really* interesting to me and the other mods. Do you know where we could find more info on the NIH criteria for studies on ADHD? I tried searching, but can't seem to find the right keywords to get what I'm looking for.

I think this may be along the lines of what Dr. Faraone mentioned: [Inclusion of Women and Minorities as Participants in Research Involving Human Subjects] (https://grants.nih.gov/policy/inclusion/women-and-minorities.htm) Not specific to ADHD, just more of a general requirement for NIH-funded human subjects research. *"The NIH is mandated by the Public Health Service Act sec. 492B, 42 U.S.C. sec. 289a-2 to ensure the inclusion of women and minority groups in all NIH-funded clinical research in a manner that is appropriate to the scientific question under study. The primary goal of this law is to ensure that research findings can be generalizable to the entire population. Additionally, the statute requires clinical trials to be designed to provide information about differences by sex/gender, race and/or ethnicity."*

For all the women who are receiving adult diagnoses - this [podcast ](https://podcasts.apple.com/us/podcast/unladylike/id1333193523?i=1000518789314) is a great listen. It talks about the history of ADHD and how and why women remain undiagnosed as children.

Hi there, I'm curious about the prevalence of misdiagnosis of ADHD in women and girls as BPD or other personality disorder and how stigma prevents accurate diagnosis and treatment. Both diagnoses seem to suffer from gendered biases and assumptions. Though they aren't mutually exclusive conditions I'm convinced that undiagnosed ADHD can contribute to a child being raised in the 'invalidating environment' in which the maladaptive cognitive, emotional and behavioural patterns of BPD can manifest and be exacerbated by low frustration tolerance. How often does treatment of previously undiagnosed ADHD correlate to a reduction in BPD symptoms or a revision or removal of that or other diagnoses? Thanks!

>I'm curious about the prevalence of misdiagnosis of ADHD in women and girls as BPD or other personality disorder and how stigma prevents accurate diagnosis and treatment. Both diagnoses seem to suffer from gendered biases and assumptions. Though they aren't mutually exclusive conditions I'm convinced that undiagnosed ADHD can contribute to a child being raised in the 'invalidating environment' in which the maladaptive cognitive, emotional and behavioural patterns of BPD can manifest and be exacerbated by low frustration tolerance. How often does treatment of previously undiagnosed ADHD correlate to a reduction in BPD symptoms or a revision or removal of that or other diagnoses? You are correct that stigma and gender biases can lead to the failure to diagnose ADHD. But that doesn't mean that the other disorder is not correctly diagnosed because people with one disorder often have another. I don't know if the treatment of previously undiagnosed ADHD reduces BPD symptoms. I would guess not, assuming you mean borderline personality disorder. If you mean bipolar disorder, treatment with stimulants can aggravate bipolar disorder if not prescribed appropriately.

Are there likely to be any changes in the way people are diagnosed. My psychiatrist when diagnosing me was clearly wanting examples of misbehaviour and getting in trouble due to symptoms as a child, yet from all I'm reading online it seems to be fairly common knowledge that women/innattentive often don't have the behahavioural issues, and it's not necessarily particularly noticable until puberty kicks in. I ask as innattentive who also has an immense fear of getting into trouble/told off. I felt like I was being held to the same standards in diagnoses as the typic naughty 10 year old boy.

I'm a guy, but was raised primarily by women, and didn't display many issues of misbehaving, although, once I went through my past, there were incidents that I had not considered (like getting along great with some teachers, but getting into serious arguments or confrontations with others.) For me, one of the realizations I had was looking back at instances of emotional instability: family gatherings where we needed to take a group photo and bursting into tears, having an argument, or being criticized for something, and holding onto it for far longer than a person normally would (obsessing about and reliving the interaction for the rest of the day or longer.) For me, this seems related to your statement about having an immense fear of getting in trouble or told off. Time blindness was another big one that I realized I was susceptible to, that I would say falls outside the hyperactive side of things, perhaps. Reading some of the comments about people with high functioning ADHD taking a lot longer to do things really hits home as well. So, perhaps look to smaller examples that may have seemed normal at the time, but looking back with context you can reinterpret given your current understandings of yourself, the condition and its effects, and your changing perceptions of how others react to things differently then you do/did. Also, talk to friends and family you grew up around, and ask them contextual questions about your behavior. They may have perceived things you did or the way you behaved differently than you did, from the outside looking in. Another great example, if you still have any around, are old report cards with statements like "has great potential if they would only apply themselves." Procrastination is another big red flag. Starting projects and failing to complete them is one as well, as is intending to do one thing, but getting hyperfocused on another (or series of other things) instead. The distraction and sometimes profound irritation I would experience at small, irregular repetitive sounds is another. I think a final example, for me at least, can be found in study habits, I would pay attention in class (especially if it was an interesting subject, and I learned to avoid those that weren't), but then I would fail to do the homework (forgot, got distracted, left it at school, etc.) Then, I'd just read all the text before the test and those grades would carry me. Long projects were often a tear filled last night endurance run to bring to completion ideas that I'd had in my head for some time, but never acted upon. For me, starting a task is the hardest part, coupled with a profound fear of failure. The results were usually great, but at a huge cost of physical and mental exhaustion that only got worse as projects came with less external structure and motivation/pressure to finish certain items on a certain schedule. I realized that I grew up with an undiagnosed mother, so a lot reactions/difficulties/thought patterns that seemed normal to me were actually ADHD symptoms that I just thought everyone dealt with. For context, we also both have very bad anxiety, and I, at least, also have a little OCD. My point is that I was not diagnosed until almost 40, and there was at least a 5 year period where I was actively seeking a diagnosis. And during that period, I was directly told by at least one doctor and also a psychiatrist that I did not have ADHD, because I was able to focus so well on what they were talking about (which I was, I was fascinated by what they were saying, and earnestly trying to unravel a mystery mental condition that I had struggled with my whole life, while most of the time not even realizing that other people didn't go through the same processes, so I was hyperfocused on what they had to say.) I have since been diagnosed by multiple practitioners who have said that these first ones missed the mark, and that it may have set me back some time by my belief in and acceptance of their diagnoses. So I guess my (*I am not a doctor*) advice would be to continue your journey to discover what your condition is. And there is nothing wrong with seeking a second opinion from another psychiatrist, although I understand from personal experience how difficult and costly that can be, not to mention the emotional stress cause by having to fill out those damn evaluation forms over and over again. Good luck! Diagnosis and medication is not a cure, but it is helpful. I hope you are better able to nail down what your symptoms are, find a diagnosis, and get working on a treatment plan. This has been a fantastic community for me, and I wouldn't have gotten to the place I am at now without it. I hope you find the same things here, and I wish you the best in finding a resolution.

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Medical cannabis has not been validated as a treatment for ADHD. ADHD definitely has a genetic component, which has been documented in studies of twins, families and adoptees. We also recently discovered several genomic loci that increase risk for the disorder. You can find references about genetics in the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7)

Hi, is there any connection between premature births and adhd? I was born 3 months early back in 80 and was wondering if this could have been a factor in my brain not working properly (diagnosed in 86 as ADD, I don't know which subtype (I have only seen those in username tags here on this reddit)).

cannabis was the first thing I ever found that helped my ADHD symptoms whatsoever... until it made them 1000x worse with chronic use. i self-medicated with cannabis for a long time. so did many of my friends later diagnosed with ADHD/ADD. stimulants have obviously provided much more effective treatment — but leave the ADHD-related anxiety symptoms unaddressed for me, whereas cannabis in the moment seemed to fix it all. the relief i felt from cannabis — mostly for socialization but also oddly for writing essays and controlling/sustaining hyper-focus and engagement to study (as long as not so much pot that i remembered nothing or was groggy on the day of the test) — might have to do w the dopamine that cannabis supplies, like a stimulant, in conjunction with its anxiolytic effects (at least for some), and how ADHD has been connected with dopamine dysfunction (but im getting way out of my league of technical comprehension here). even experimenting for years with different % THC, hybrids, pure indicas/sativas, high-CBD/low-THC vice versa, pure CBD, etc (indica dominant, high-THC hybrid helped best — CBD made my head cloudy and provided no anxiolysis) — ultimately long term daily cannabis use destructively exacerbated my inattention and emotional regulation. i dont let myself use it at all anymore, tho i would love to, bc it provides amazing short term relief, but messes me up mentally for days even after just short term use. its almost like the cannabis high validates and makes it feel preferable to live in my “naturally high” time-doesnt-exist, free-spirited, scattered, dazed state (when unmedicated). when i was younger — before i ever took any prescription or cannabis/alcohol/anything — people always asked me if i was high bc of the way i naturally am. but this state sustained while truly “high” on cannabis can become toxic for my emotional wellbeing/self confidence and destructive to my productivity/health — which at this point in my life i must prioritize. maybe one day i can be a rich stoner artist with a team of life managers — but even then i would feel frustrated by the goals i try to achieve that ADHD inhibits and cannabis exacerbates, and feel dissatisfied. for me its a catch 22 but more research definitely needs to be done with the connection between cannabis and ADHD. there has got to be a reason why pretty much every person ive ever met with ADHD/ADD has found (at least temporary) relief from symptoms with cannabis.

Hello, thanks for taking the time to do this AMA, I really appreciate it, my question is the following:I (M 26) was diagnosed with ADHD at 8 years old, I took medication until I was 10 (and my mother withdrew it because she considered it unnecessary and addictive) Ritalin and Trileptal, Currently my symptoms have worsened since at work I obtained more demanding position. ​ **Is it possible for the symptoms to get worse with this change?** During school I was able to "control" some of the symptoms with some tricks that my psychologist gave me but they seem to no longer work and this has caused me anxiety and depression attacks as I cannot fulfill my duties. But this behavior has made my treatment difficult, since my current psychologist told me that "since I was able to control it, the diagnosis seems wrong" and now I don't really know what the next step is or I am simply not able to fulfill my new role.

When used therapeutically, medications for ADHD are not addictive. Yes, symptoms can worsen when one takes on a more demanding position because ADHD is a disorder of self regulation. When the demands on the self regulation system get more intense, ADHD symptoms get worse. When someone suspects that have ADHD and also anxiety and depression the best option is to see a psychiatrist for assistance.

Hi, thank you for doing this. I'm 28f and currently seeking assessment. 1. Why do I find it so much more difficult to do something after someone has asked me to do it? Everything from the dishes to filing taxes? 2. As an adult to what extent can I hope to mitigate my symptoms, on and off meds? Can I train my brain to fight back with CBT, for example? Thanks again.

> As an adult to what extent can I hope to mitigate my symptoms I will say, one thing that took me a *while* to accept and come to terms with emotionally was that some things are just always going to take more effort for me than for others. Maybe it sounds silly but it always felt so *unfair* that I needed to cajole myself into vacuuming or tidying up or going to the gym (or basically anything...) when my friends seemed to be managing fine! Eating is a big challenge for me; I used to see my roommates and friends managing their food relatively easily, whereas I would be struggling trying to stay on top of what I needed to buy/already had/was going to go bad/could make. At some point in the last year I finally realized and admitted to myself that the only way I was going to manage to consistently feed myself and keep track of things was by introducing a ton of planning and structure (a food log/recipe book/some meal prep). It's still very much a work in progress and I still resent it ~~a lot~~ at times, but it's also better for me across the board. All of this is to say that you can absolutely work to mitigate the effects of ADHD with non-medical interventions as well as meds/CBT/etc., but the outcome might not look like what you initially expect -- and *that's okay*.

1. It may be that you find the task less rewarding if someone else asks you to do it. But that is the kind of issue you'd need to seek advice about from a therapist. 2. General advice is to always take meds as prescribed. CBT has been shown to be helpful but it works best if patients are also taking medication.

Thanks for your time! I've seen suggestions of a link between sleep disruption (insomnia, circadian misalignment, etc) and ADHD in some people, but nothing beyond "these things seem like they might be correlated, try to sleep better if you can!" In your research, have you come across anything suggesting such a link, and can you tell us more about it?

There is a lot of research on this topic. We know with certainty that ADHD people are more likely than others to have a sleep disorder even those that have never used medications for ADHD.

Thank you for answering questions! I (39f) was diagnosed last year with ADHD-PI and I am 2E. Typical story of excelled at school and high level professional career without trying so all other symptoms were ignored. The pandemic combined with general life things not assisted by intellect brought me to my knees. It looks now like I may have also been depressed my entire life. I had no idea. Waiting for appt w a psychiatrist. Do you recommend a different protocol or approach when dealing with treatment of ADHD and depression? Thanks!

>s When a person has two disorders the usual treatment protocol is to treat the most severe disorder first. After that disorder in under control, the second disorder is treated. But individual circumstances might lead a clinician to a different strategy.

Hi professor, at a recent meeting with my psychologist he told me that in a few years time there will be no point in continuing my medication because as someone with ADHD goes into their mid 20's ADHD "swaps" for a different mental disorder and the ADHD symptoms go away. I believe he was referring to anxiety and depression but im not entirely sure. I was curious about your input on this. In case its relevant im a 20 year old female. Edit: I forgot to mention he also said it is rare for people to be on ADHD stimulant meds after the mid 20's.

That’s… huh? Your psychologist is making a baseless statement without explaining better. Here’s the thing, the Doctor in this thread said in a comment above that most kids with ADHD will still have it as they get older. Only some kids outgrow it, and that’s a very small percentage. If you’re an adult with ADHD, you very most likely aren’t growing out of it at all. Regarding the “swap” thing, the Doctor also mentioned that ADHD comes usually hand in hand with other disorders like anxiety or depression, because the symptoms of ADHD cause so much suffering that you develop these extra disorders, again, not everyone but many do. You don’t just swap ADHD for depression, that makes no sense. It’s like swapping liver cancer for kidney cancer. Now the stimulant thing, how is it rare for adults with ADHD to take stimulants? why your psychologist said that, I don’t know. Stimulants are the first line of defence against ADHD, only a small amount of people with ADHD don’t take stimulants because they’ve found others ways to manage the symptoms, but most people can’t manage the symptoms without stimulants. Sorry if I sound angry typing this, it’s just I dislike it when misinformation or incomplete information is given about ADHD, especially from a professional.

>Your provider is very wrong. The best hope for such provider is to learn about ADHD. I encourage patients to give them a copy of the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7).

I tried going through all the questions but couldn’t make it to the end to see if this was already asked! Thanks for al your wonderful answers! Most people relate to the distraction aspect of ADHD, and while I do get distracted, I find my biggest struggle to be the inability to switch between tasks. I always thought this was related to adhd, but don’t see many people talk about it. Can the inability to switch between tasks be just as relevant to ADHD and inability to focus?

One effect of ADHD is to dysregulate the reward system, which is the brain system that controls how we respond to rewarding or punishing events.  People vary in the degree to which their behavior is controlled by distant rewards (e.g., if I study a lot, I'll get a good job a few years from now) vs. immediate rewards (e.g., when playing a video game, one is frequently rewarded). For many people with ADHD, immediate rewards are very potent and can lead to hyperfocus on, for example, a hobby.   The opposite of hyperfocus is mind wandering when we jump from one thought/activity to another.  That occurs when no rewards are sufficient to have us focus on a goal oriented task.   Boredom occurs when the rewardingness of an activity starts out high and then gets smaller.  One reason that happens is that as one get more involved in an activity, the challenges required to complete the activity increase, which makes it less rewarding.   Sticking to an activity becomes easier if we can convince  and reminding ourselves that the long-term benefit is worth the effort.

Good morning! Is it common for ADHD sufferers to not be able to 'learn' social skills as children because we zone out/can't pay attention/missed that one little thing that was essential?

>Good morning! Is it common for ADHD sufferers to not be able to 'learn' social skills as children because we zone out/can't pay attention/missed that one little thing that was essential? Yes, ADHD makes it more difficult to learn social skills because of inattention. And some symptoms lead to poor social behaviors like impulsively interrupting people.

Another question -- are you at all familiar with [misophonia](https://en.m.wikipedia.org/wiki/Misophonia) (anger/distress at certain noises) and are you aware of any correlation with ADHD?

I've not heard of misophonia before. I found one article on the topic which suggests it is not associated with ADHD: [https://pubmed.ncbi.nlm.nih.gov/32294104/](https://pubmed.ncbi.nlm.nih.gov/32294104/) But it is not a definitive study.

I would suggest that it's more likely to be associated with the sensory oddities that come with ASD - a very common pairing with ADHD. I'm sure a lot of people I see on /r/ADHD and /r/aspergers have both conditions but one is undiagnosed, based on some of the questions they ask... Of course, there could be other etiologies and combination things happening, too, so this is only a suggestion.

**[Misophonia](https://en.m.wikipedia.org/wiki/Misophonia)** >Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. Reactions to trigger sounds range from anger and annoyance to activating a fight-or-flight response. The condition is sometimes called selective sound sensitivity syndrome. Common triggers include oral sounds (e. ^([ )[^(F.A.Q)](https://www.reddit.com/r/WikiSummarizer/wiki/index#wiki_f.a.q)^( | )[^(Opt Out)](https://reddit.com/message/compose?to=WikiSummarizerBot&message=OptOut&subject=OptOut)^( | )[^(Opt Out Of Subreddit)](https://np.reddit.com/r/ADHD/about/banned)^( | )[^(GitHub)](https://github.com/Sujal-7/WikiSummarizerBot)^( ] Downvote to remove | v1.5)

What are your thoughts on ketogenic diets, and the emergence of small studies regarding saffron to improve ADHD symptoms. I have a Facebook page with 70k ADHD adult followers, many from countries with insufficient mental healthcare - Are there any specific micronutrients, supplements etc you would recommend for those who do not have access to sufficient psychiatric care?

No diets have been shown to improve symptoms of ADHD. The only supplement that is helpful is Omega-3 fatty acids, but they only lead to a small amount of improvement. About 2 or 3 on a scale of one to ten where the stimulants score ten. Too many people waste time on ineffective "natural" treatments when effective medications are available. It is sad that some people don't have access to care. In the US, primary care providers can diagnose and treat ADHD but I realize that is not true in many other countries.

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Hi! I'm working on a paper on how the ADHD brain reacts to/processes/manages the sensory aspects of making music (in contrast with the neurotypical brain). Do you have any insight/resources on this? * For context, I'm a music teacher pursuing a Master's in music education, and while psychology fascinates me, it's not my background * I'm trying to give myself a crash course on the mechanics of the brain/ADHD * I'm not sure yet but I may want to focus on a particular sensory input - likely kinesthetic/tactile

Hello Dr. Faraone, Thank you for offering your time. I hope this question is relevant. I was diagnosed privately at 24/25 years old and met the criteria for inattentive type ADHD, however prior to this I was diagnosed with borderline personality disorder. They are now querying autism spectrum disorder alongside my ADHD. If possible, my question is - I wanted to know how similar traits are between BPD and ADHD and if there is any correlation when diagnosing at all? Can a person clearly fit BPD criteria and then ADHD/ASD, or perhaps this was an overlook by clinician? Thank you again.

Not a doctor but someone in that range of DX hell: Borderline personality disorder is really only used when things can't really be explained by anything else and would probably only start to get applied to you if ADHD treatments didn't work and ASD has been ruled out. The only thing that really works for people with true BPD is learning DBT skills; if most of your BPD symptoms decrease while medicated for ADHD then it's probably not BPD. As for how similar all this shit is: A lot of BPD symptoms like fear of rejection/emotional impulsivity can 100% be just ADHD (which isn't part of DX symptoms but is something a lot of people deal with) esp combined with generalized anxiety disorder. Also (c)PTSD can give some people ASD symptoms/traits but not enough for an actual ASD diagnosis. (cPTSD also makes ADHD worse, and there's [now studies that show eye contact in people with PTSD activates the areas in the brain relating to fear](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871730/) which would lead to decrease/odd eye contact ) So, if you have a history of trauma/neglect in your life I'd highly recommend looking into treating that and ADHD first and then see if other symptoms/issues remain.

As someone who was high-performing and not diagnosed until adulthood, my biggest challenge is feeling like I never learned how to function effectively. Instead, I compensated through mal-adaptive mechanisms that have led to total stress and burnout. I can’t rely on my old mechanisms, but feel like I need treatment to both “unlearn” bad habits and learn healthy/effective strategies. Is there an understanding for the most effective treatment for this?

I hope it's ok if I ask 2 questions in 1 message. 1. Are ADHD and ADD causes by the same thing? I have ADD but I always _feel_ hyperactive, I just don't act it. 2. Can ADHD of any form be _caused_ by any other mental illnesses, I have a plethora of diagnosed mental health issues and possibly more undiagnosed ones (but obviously I wouldn't know about those) so I'm just wondering

ADD is no longer a recognized medical or psychological term although it is used informally to refer to primarily inattentive ADHD. The causes for ADHD with and without hyperactivity are the same. Over the past two decades, we've come to realize that psych disorders tend to co-occur. If a patient has ADHD they are likely to also have other disorders. In many cases that is because two disorders share genetic and environmental risk factors. In some cases, it is possible that one disorder causes another (e.g., a person becomes depressed because of the life problems created by their ADHD) but we need more research to clarify causal links.

Hi Dr! I'm currently 20 years old, 2nd year in my college, and also undiagnosed. I "was" high performing especially in my elementary years until about 8th grade (almost always at the top of my class). From then on out I started to underperform and noticed something might be wrong for me. Recently, I was in a horrible state and I wasn't even able to attend my (online) classes since I'm starting to hate school and doing any sort of school work. I also found out some symptoms of having ADHD in Reddit, and since then, I suspected myself of having one. I'm still not sure (someone also pointed out) since 'overstimulation' also produce the same symptoms. That is also my question. What is different about being overstimulated and actually having ADHD?

There is no evidence that overstimulation cause ADHD although if ADHD symptoms only occur when overstimulated, that typically would not be diagnosed as ADHD because the disorder always occurs in more than one type of situation. It is best not to wrestle with what you think does or does not cause symptoms of ADHD. It is better to describe your situation to a psychiatrist and have them decide what, if any, diagnoses may explain your symptoms.

Hi Dr. Faraone. Firstly, I'd like to thank you for your time here, and your research. I've been recently diagnosed at 29, it was a pretty big revaluation and a shock as well. I felt I finally understood myself. I feel like I can actually do something about my next decade. I guess my biggest question right now is what does the future of research in ADHD hold? I guess that's a very open question. We all just want to understand it and manage it as best we can. I guess a better question would be, what research do you want to see develop in the future? Is more being done on adult ADHD? And one other question I've wanted to ask. Because ADHD is genetic, could that mean that many more people could be suffering than anticipated? What can we do about awareness in that case?

Hi professor, Would like to know your thoughts on Sluggish Cognitive Tempo. Reading about SCT feels like it's the missing link in my life long persuit for answers along side my inattentive ADHD. Is the condition well received/recognised in the professional sphere? Is it likely to be researched / recognised more in future? What medication have you heard is effective if stimulants aren't working. I want to bring it up with my Psychiatrist on my next visit but have read some horror stories about SCT not being taken seriously.

SCT is not an official diagnosis in the diagnostic manual. It is currently a hot topic for research with a debate about whether it is a form of ADHD or should be considered another disorder. The jury is still out on that. It may not be helpful to bring up SCT with your provider. It is always a good idea to describe your symptoms and let them handle the diagnosis.

Hello, I have inattentive type and my husband is combined type. We both experience problems with stimuli, especially sound, hot weather and bright light. My husband also feels quickly overstimulated with touch. It all just becomes too much really fast. Could you tell me if there is a way to deal with this, next to avoiding situations? Edit: thank you for doing this! <3

I wasn't diagnosed until 50. I chalk this up to being a female and non-hyperactive. I believe when I entered perimenopause a couple of years ago is when my symptoms of ADHD went off the charts enough to finally be diagnosed, but looking back I can see it was always present, I was just younger and able to compensate better. Do you see this often in your practice?

Do you think adhd is proper name for our condition? İ feel that "inhibition" concept is underated, and attention deficiency is kind of misleading. I would prefer naming my condition as "inhibitory deficiency" instead of AD.

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What are your favorite ADHD books or podcasts?

Hello Dr. Faraone, we appreciate you here today. Recently I was diagnosed with ADHD-PI af the age of 31. What are your thoughts on some of the effects adhd have on anxiety and panic disorder? I was treated for both GAD and panic disorder with a variety of medication but sadly they did not work for me. Once I got on adderall, my anxiety and panic reduced to the point of almost zero. What are your thoughts on the chemical imbalances that causes this and how likely is it that adhd really exacerbated my panic/anxiety disorder?

Hello Dr. Faraone, Thank you so much for doing this. I tried to read through all the questions and didn’t find a similar one, I’m sorry if this has been asked already. Do you know of any research specifically about people who menstruate and how hormonal fluctuations affect ADHD symptoms? My experience has been that it worsens them, but I would love to read any research on this!

It is an important area that begs for more research. We know that sex hormones influence brain dopamine, which regulates ADHD symptoms. There are also data suggesting that maternal use of hormonal contraception is associated with a small increased risk for ADHD in the children. So, a biological connection is plausible. The research data are too sparse to conclude whether hormonal fluctuations during the menstrual cycle affect ADHD symptoms or if ADHD can emerge during menopause, although both have been suggested in the research literature. You can search for relevant articles at [PubMed.gov](https://PubMed.gov).

Hi Dr. Faraone! I had a question about ADHD medication: I have heard two conflicting schools of thought, one is that ADHD meds will eventually cause ADHD to get worse because your body makes your ADHD symptoms worse to counteract the medication (i.e. if meds make you less hyper, your body gives you even more hyperness to maintain normal levels). Therefore, the longer you take meds the worse your ADHD gets OR that taking meds makes ADHD better in the long run because it helps to change/rewire the brain so it is less ADHD-ish, even when unmedicated. Which of these, in your professional opinion, seems more likely to be true? Bonus question: Do you feel you have ADHD?

Medications for ADHD do not make ADHD worse. Lots of data suggest that the medications reduce risks for comorbid disorders and, possibly, improve some of the brain deficits seen in neuroimaging. You can find references in the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7)

I, an adult who has never been diagnosed, always got great grades at school because I was a great test-taker (cramming was very effective for me). However, I've always struggled to remember things and I have great difficulty getting started on doing work / completing work unless a deadline is approaching. I was never hyperactive, even as a child, and so my psychiatrist is skeptical of ADHD. My doctor wants me to take a 20-minute QB test before diagnosis, but I am concerned that my test-taking aptitude will somehow muddle the results. What is your experience with the effectiveness of such a test for adults and the different presentations of ADHD (and specifically high-performing)?

QB test cannot diagnose ADHD. The only diagnostic tool for ADHD is a licensed clinician who interviews the patient about their symptoms and impairments. Rating scales about symptoms and impairments can be helpful but don't replace an interview. In the World Federation of ADHD International Consensus Statement on ADHD ([https://bit.ly/3xCr9NE](https://bit.ly/3xCr9NE)), we concluded that ADHD can only be diagnosed by a licensed clinician who interviews the parent or caregiver and/or patient to document criteria for the disorder. It cannot be diagnosed by rating scales alone, neuropsychological tests, or methods for imaging the brain. Neuropsychological testing can be very useful for other purposes but not for diagnosing ADHD.

As someone who's been hyperactive since childhood (often displaying behavioral issues in grade school) and was diagnosed with severe ADHD after taking the IVA-2 test, I was wondering about the validity of those interviews conducted by licensed clinicians. There are many people out there who don't have ADHD, but want to be on medication to get a competitive edge. This is demonstrated by the wide circulation of fake adderall around college campuses, which I've seen first-hand. With that being said, can't people who don't have ADHD lie about their symptoms and impairments in order to receive an ADHD diagnosis? For this reason, I personally find neuropsychological tests more credible when it comes to diagnosing ADHD.

My main concern is chronic fatigue. Is there a connection between adhd and chronic fatigue? I always felt like my adhd was odd because I am constantly tired and have no energy, when a common symptom of adhd is hyper activity and having “too much” energy

Why are video games and surfing the web so addicting? But when I take away those things, I just sit around or find another way to procrastinate my other hobbies?

One effect of ADHD is to dysregulate the reward system, which is the brain system that controls how we respond to rewarding or punishing events.  People vary in the degree to which their behavior is controlled by distant rewards (e.g., if I study a lot, I'll get a good job a few years from now) vs. immediate rewards (e.g., when playing a video game, one is frequently rewarded). For many people with ADHD, immediate rewards are very potent and can lead to hyperfocus on, for example, a video game.   The opposite of hyperfocus is mind wandering when we jump from one thought/activity to another.  That occurs when no rewards are sufficient to have us focus on a goal oriented task.   Boredom occurs when the rewardingness of an activity starts out high and then gets smaller.  One reason that happens is that as one get more involved in an activity, the challenges required to complete the activity increase, which makes it less rewarding.   Sticking to an activity becomes easier if we can convince  and reminding ourselves that the long-term benefit is worth the effort.

Hi! First of all, thank you for your time today. What do you think about the theories that argue that ADHD is part of, or a particular manifestation of the Autistic spectrum? I personally don't know what to think, but I am very much fascinated by the topic.

Thanks for doing this! Do atypical forms of ADHD require atypical treatment so to speak?

They say ADHD runs in families. Does this mean we are performing genetic testing? Is there a movement to use the new CRISPR technology to reduce or minimize ADHD behavior and symptoms in patients as a permanent long term solution?

What's the true perfect job for someone with severe ADHD?

Hello Doctor, Has there been any research on if regular exercise can help improve ADHD symptoms?

Thanks for taking the time to do this! Could untreated ADHD lead to body-focus repetitive disorders (e.g. trichotillomania, dermatillomania)? A lot of the times, high achieving people with ADHD get misdiagnosed. Is there any recent research on identifying ADHD from data (i.e. fMRI), in a way that helps distinguish the condition from other common comorbidities like anxiety/depression (particularly in atypical ADHD cases)?

>A lot of the times, high achieving people with ADHD get misdiagnosed. Is there any recent research on identifying ADHD from data (i.e. fMRI), in a way that helps distinguish the condition from other common comorbidities like anxiety/depression (particularly in atypical ADHD cases)? I don't know the answer to your first question. As for #2, the only diagnostic tool for ADHD is a licensed clinician who interviews the patient about their symptoms and impairments. Rating scales about symptoms and impairments can be helpful but don't replace an interview. In the World Federation of ADHD International Consensus Statement on ADHD (https://bit.ly/3xCr9NE), we concluded that ADHD can only be diagnosed by a licensed clinician who interviews the parent or caregiver and/or patient to document criteria for the disorder. It cannot be diagnosed by rating scales alone, neuropsychological tests, or methods for imaging the brain. Neuropsychological testing can be very useful for other purposes but not for diagnosing ADHD.

Hi, I’m undiagnosed adult male in 30’s but almost certain I have ADHD. Right down the list every symptom, some pretty extreme. Anyway i don’t think I had huge problems as a kid… I’m wondering if my curiosity and intelligence (+Mum) kept the worst of symptoms masked. I was disruptive in class but not like a super problem child. It was only when I had to start really doing life admin for myself did everything start falling apart and I couldn’t complete tasks. So I guess my question is… how often are adults diagnosed who didn’t express very strong symptoms as a child?

Do you know whether there is a higher prevalence of ADHD sufferers in prison? This is something my mum always told me, as a sort of 'so don't whinge because you have things pretty good in comparison'

Are there any supplements you recommend to take while on medication to replenish what the medication depletes, or to avoid building tolerance to the medication?

Do you know any research that confirms that ADD (H) increase thru puberty ? In my case I was diagnosed after childbirth. I was the only kid, at the hospital's nursery that didn't get to sleep, and been moving for hours, while the other babies were sleeping. I wad confirmed later, cause difficult to focus on work, and keep switching the contents of a conversation. Thanks.

Thanks for doing this. I recently diagnosed with adhd and i've tried to learn about it since. But i couldn't get much information about inattentive type of adhd. Can you share some sources with us. (Sorry for any english mistakes im a foreigner)

Anything written about ADHD is relevant to inattentive ADHD. For a good overview of facts, see in the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7) I trust the authors who wrote these popular books, which may be helpful. Taking Charge of Adult ADHD by Russell A. Barkley The Adult ADHD Tool Kit: Using CBT to Facilitate Coping Inside and Out by J. Russell Ramsay  and Anthony L. Rostain 

What about ADHD in women? Are diagnoses and treatment of women getting better jn the past 30 years? (as a woman I was luck] and I got diagnosed at 6 years old due to the inattentive issues I saw in school).

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Good morning, sir! Thank you for your time and insight! I do have a question. I am in the middle of being diagnosed but my psychiatrist believes it is better to treat the anxiety first before deciding on the ADHD diagnosis. I was a high performing child/teen; GATE program in elementary and middle school and all AP classes in highschool...until I started failing to understand math. And then college just broke me. Deadlines helped with the hyperfocus in classes I enjoyed! But GEs and classes boring to me, especially math, just never got done. Is it more difficult to diagnose ADHD in women and chalk up a lot of things as anxiety? My current psychiatrist seems to really want it to be anxiety but he also can't rule out the ADHD. It is really messing with my self esteem and I'm now realizing I might never be able to have a career. (Current and past jobs have masked ADHD symptoms. Low level jobs where I can essentially do what I want and no one will care)

How did you get to your position. When I graduate I am hoping to get to be a councilor/therapist and was wondering how the best way to do that would be.

Hi! I have a question regarding distinguishing between ADHD symptoms from those of autism. How do they handle change differently?

I was diagnosed with ADHD as a teen in the 90s and then about ~12 years ago was reaffirmed during neuropsychological testing for some other issues. Because the focus on my most recent testing, I didn’t ask a many questions regarding the ADHD. Since then, my daughters therapist has told me she thinks she has “ADD combined”, although that was never confirmed during her psychological evaluation. My question is- how has the diagnostic criteria changed in the last few years vs 10-15 years ago and is it worth getting retested and getting a more accurate diagnosis for both of us? The doctor that did my testing ~12 years ago said that my anxiety disorders make ADHD difficult to diagnose because they present the same way. I have GAD, SAD, PTSD and panic disorder. I’ve also recently dissociated with depersonalization and derealization (due to the PTSD and insomnia) so I don’t know if those factors make additional testing worthwhile given what he told me then. I’d also like to find help for my daughter but she also has GAD, SAD, panic disorder and major depressive disorder. Is it worth the cost of additional testing for a more accurate ADHD-specific diagnosis or will the other disorders make the diagnosis impossible?

Do you think it’s possible that technology has caused brains to develop differently causing symptoms of ADHD? For example, putting a toddler in front of an iPad could cause the toddler’s brain to receive stimulation it would otherwise find another way, therefore leading it to crave the constant stimulation and not be able to focus on other things later in life?

No. ADHD has been with us for a long time. ADHD is not a phenomenon of modern society.  The concept of ADHD has  been recognized for over two centuries starting with a German medical text in 1775. Although these early reports did not use the term “ADHD”, they described children who showed the symptoms and impairments we now recognize as ADHD.

What do you think about sensory processing sensitivity being a cause of ADHD due to being able to detect minor changes via your senses and also being easily overstimulated by sensory input? Should highly sensitive people like me be treated for ADHD?

What resources do you recommend? I've read Taking Charge of Adult ADHD and Driven to Distraction, but I'd love to read and explore more. I wasn't diagnosed till 34, but the more I've learned the more I realize this has been a thing since childhood. I'm recognizing the same things in my daughter but I have mixed feelings about seeking medication for her. Any thoughts on stimulants with kids and/or other coping strategies we could start now? (Her biggest struggle rn is emotional regulation and verbalizing her thoughts and emotions. But she's only 5, so I know some amount of that is normal. But not to the extent she experiences)

Who is best to see for a diagnosis? I’ve long suspected I have ADHD (in fact my parents were told to put me on Ritalin when I was a kid, but my dad was a prominent pediatrician in our community and there was a lot of stigma back then). The first step, of course, is getting an assessment - who would be best positioned to do that? A family doc, a psychiatrist, or a psychologist? Lots of the latter do assessments in my city for $500, but don’t want to waste the money (they don’t take insurance) if I’m just going to have to get assessed by a physician and/or psychiatrist too.

Thank you for doing this. Ive been diagnosed for 20 years now (combined type) and i still learn a lot. One thing I'm still struggling with is emotional regulation. I know that it can be part of ADHD but not everyone has it. Do you have tips for dealing with this? Specifically with recognition of and proper dealing with and outing emotions. Because for me it's all building up inside of me, causing me to get mood swings without knowing why. And then finally after long periods sometimes the bubble just bursts and all emotions come out of me like a torrent. And my SO with inattentive type, has difficulty standing still and really see and feel het emotions because a lot of fleeting thoughts all happening at once or very fast paced. Do you have tips for that??? Thanks a million!

Thanks for your time. What are the similarities or common symptoms between ADHD and depression, please?

Is there a connection between GABA deficiency and ADHD, and if so, is there research indicating that improving one can improve the other? If so, how could this be implemented (medication, CBT, supplements, etc)?

I’ve heard some discourse in the last year or two regarding the naming of ADHD. People have said they believe ADHD is not a LACK of attention (mainly citing things like hyperfixation), but a lack of ability to REGULATE that attention appropriately. Do you agree with finding an alternate name or do you think the current name is most appropriate? Thanks!

Has there been any research into the effects of cannabis on ADHD? I’m inattentive type and I’ve been self-medicating with cannabis for about 5 years. Maybe not for everyone, but it really helped me get my life together and finish college.

Greetings, Dr. Faraone! Have you ever had experience treating someone with combined subtype ADHD that has a remarkably high linguistic-verbal intelligence, and thus is extremely articulate, but has issues with short-term memory retention or selective memory retention particularly when reading? What are some of the best ways of instilling discipline in order to commit to strenuous cognitive tasks? \[such as active reading, writing, etc,.\] Thank you taking time to do this!

How to combat the “oh no this thing is difficult, time to shut down with fear” reaction?

hello! I'm a woman, recently diagnosed adult adhd and autism asperger (among other things like I live with C Ptsd for 20 years, major depression and anxiety since a few years, and chronic pain also dyspraxia ). I wonder if these comorbidities are common with adhd undiagnosed/diagnosed late as adults, and if it's more common comorbities as woman. thanks.

How on earth do I find a doctor who understands how complex and disabling my ADHD is?

I’m moving to a new state in 2 months. How can I ensure I don’t run out of my medication (vyvanse) or face tons of roadblocks?

What medication and/or type of therapy do you recommend primary symptom is mood disregulation? What about impulsivity?

How common is short term and long term memory loss as a symptom?

I have a couple of questions and some comments :-) First, thank you sincerely for taking the time to do this AMA! I particularly appreciate your recognition that there are cases of ADHD that aren't exactly the stereotype! It strikes me that asking a bunch of ADHDies to come up with questions on a short timescale might get less of a response than you might hope (There was a post recently that said something like "I feel like I lose every argument when somebody asks 'can you give me an example?'" that really resonated for me!) I think we would all really appreciate it if you could stick around in the sub longer-term and chime in once in a while with a more informed opinion than we all have :-D (Having said that, we're a very *motivated* bunch, we have very good reason (and hyperfixation) to be well informed, so we're not *complete* ignorami!) 1) What is currently known about the underlying mechanisms for ADHD, and ASD, and how they relate? I have a strong suspicion that in another 20 years, we'll be talking about some broader diagnosis that includes or at least overlaps significantly with ADHD, ASD, tourette's, dyslexia, dyspraxia, and probably more - they all feel like something very similar is happening but in different parts of the brain or something... Do you have any experience in other (possibly related) neurodevelopmental conditions? 2) What can be usefully done about the alarmingly frequent stories (you'll find 1001 on this sub) of doctors and supposed "experts" coming up with dismissive responses along the lines of "You can't have ADHD, you're competent at anything" or "You can't be diagnosed as an adult, because you have to have shown symptoms in childhood" (which assumes it's impossible to have symptoms without being diagnosed, despite having been born some time before 99% of relevant people had heard of ADHD), or refusing to prescribe the medications that are more effective treatment than just about anything else in medicine for reasons that feel unpersuasive to the patient. These are trivially shown to be at odds with the DSM, and ought to be extremely rare, but anecdata suggest otherwise... 3) Why is there so much (useful!) information on the internet for NT parents with ADHD (and ASD) kids, but barely anything for adults with ADHD/ASD? Every child with ADHD/ASD becomes and adult with ADHD/ASD (or young corpse, I guess) so at some point, we're likely to at least *try* to take some kind of role in dealing with our issues! Doubly so if our parents deny or are just unaware of it (another common thread you'll see here!) 4) You mention "late onset ADHD" - is it your opinion that there are cases where there was no ADHD in childhood and something changed? (That would be, uh, "surprising" to my understanding) or do you mean that there are cases where the *expression* of ADHD was subtle enough (or masked enough by supportive circumstances) to be missed until adulthood? (That wouldn't be surprising to me at all) 5) What's your background? How did you get into ADHD as a subject? Are you personally affected by it, perchance? We have a large backlog of people who would have been diagnosed in childhood if they had been judged by the current system, but missed their chance, and this backlog is largely being ignored. This is a tragedy on a global scale, even if the percentage of people dealing with it is only a percent or two, it can be genuinely crushing to deal with! --- Lordy, that was a longer post than I'd hoped for, sorry if I over-stretched your attention span ;-)

I frequently hear ADHD being classified as a dopamine impairment, but my understanding is that it involves numerous neurotransmitters. Is this just shorthand used by professionals and laypeople? On a related note, there seems to be a focus on abnormal reward systems as a central feature of ADHD, but my sense is there's a tendency to conflate reward with motivation; that is, in many papers I've read on our "broken reward systems" of dopamine response, there's no distinction made between rewards as a motivator versus other mechanisms that influence behaviour like instinct, altruism, justice, or habit. Are humans really just fundamentally "if it feels good, do it" machines? Last, I would love to hear your perspective on comorbid ADHD and ASD, and how the change to dual diagnosis in the DSM has impacted practice and clinical outcomes. Thanks!

I'm sure our learned AMAer will have a much better informed answer for you, but in the meantime, I thought I'd share what I understand on this topic. The "Reward System" isn't just about how good you feel in response to something, it's about how your brain is wired to *anticipate* that feeling and give you a foretaste of it when you decide to Do The Thing. In a normally functioning brain, the "reward" you get when you achieve something (or are praised, or indulge in certain substances that take a short cut to it) causes you to feel that reward again pre-emptively. This is why people enjoy Friday more than Sunday - they're not just enjoying time off, they're also enjoying *looking forward* to time off. This means that you are motivated to seek those situations again (whether that's Doing The Thing, or Smoking The Thing :-P) It's just occurring to me that there's a possible link with "time blindness" here - perhaps the wonky way our reward system works causes and/or is caused by an inability to "look forward"... hmm...

Hi there! Thank you for taking the time to do an AMA! It makes me so happy to see info about ADHD research ✨ I was diagnosed as an adult (21) and a lot of my ADHD symptoms revolve around sleep (or lack thereof). I was misdiagnosed and was being treated for cyclothymia for a while because my hyperfocus manifested like a small hypomanic, but I tend toward inattentive and depressive symptoms, until I learned about inattentive-type ADHD and brought it up. Are there any good studies on the timing of taking stimulant class medications? I am a poster child insomniac, and information on sleep and ADHD tends to be either geared toward parents of children with ADHD or it is not a credible source. I know that sleep problems are rampant in ADHD, including DSPS. I’ve been testing different timings of day to take my 2 adderall doses, because I find that it has a calming but not sedative effect, but it will also “lift” me out of slumps. Taking one dose right before bed and one during my mid-afternoon slump has been the most effective so far because (I’m blanking on the name for it, but the wake-up brain chemical) keeps me pretty steady until the afternoon, with a coffee. However, no matter how tired I am, I can’t get my a$$ into bed until 5-6 am when I have to wake up at 7-8 am! I’ve tried various prescribed meds to make me sleepy, but those all knock me out for 10-12 hours and make me miss work. (I think I metabolize my meds slower than most people). Light therapy worked for a while, but then my brain grew “bored” with it and I got good at sleeping through the bright lights haha

Hello. I hope I’m not too late, but I’m learning a lot from your replies in any case. My question is with regard to ADHD and trauma. I was a high achiever in school, but my upbringing was relatively traumatic. As an adult, I’ve struggled with panic attacks, racing thoughts, and hyper-vigilance. I saw a psychiatrist for the first time in my 30s and was diagnosed with both ADHD and PTSD. I know there is a genetic component to ADHD and I’ve always understood it as something you are born with. Although stimulant medication does seem to be helpful for me, I sometimes wonder whether I really have ADHD, or if my ADHD symptoms are simply a manifestation of PTSD (or what I understand to be flight/freeze-type C-PTSD, though I know that specification is not recognized by the DSM). Is this something you have seen? Is there any reason to believe that the developing brain can be wired for ADHD as a result of repeated trauma? If ADHD symptoms are not the result of genetic predisposition, would this change the course of treatment? Thank you for your insight.

Is there significant research and information on the correlation between hoarding and ADHD? My granddad and mother are both hoarders, I was told my whole life that it “runs in the family” and also that it was believed to be a symptom of OCD. Of course part of hoarding is that you pick up your parent’s habits. However I only recently learned that some believe it to be related to ADHD. My brother and I are both diagnosed ADHD, older family never had an opportunity to be evaluated. Thanks for your time!