- They say our attention spans are getting shorter.

(lively music) Oh wait, they say our attention spans are getting shorter.

And sometimes I have to wonder, is it everything going on around us or is it just me?

You hear a lot about ADHD, that's attention deficit hyperactivity disorder.

It's almost a cliche that ADHD is over-diagnosed but what if it's the other way around and how can you tell the difference between ADHD and normal, you know, getting distracted?

That's what this episode is all about.

(lively music) (screen whooshing) Now, officially, there are three types of ADHD.

There's the hyperactive-impulsive type where that is the biggest issue.

For example, you can't stop fidgeting, you feel restless or like you're driven by a motor.

Sometimes it's hard to stop talking and you interrupt often.

Then there's ADHD inattentive type.

Maybe you're really distracted, you have trouble remembering details, you're forgetful or lose things.

You might struggle to organize activities or a schedule.

And there's also a combined type, which is just what it sounds like.

We've put the full criteria in the show description.

If you're age 17 or older, an evaluator will look at a list and if you check off five boxes in one category and you've had these symptoms for at least six months, well, then boom, you have ADHD.

So with ADHD, how do we know that we have ADHD versus just being like normal level of distracted?

- I think that's such a great question.

It's also such a hard question because to really understand ADHD, especially in adults, we have to get at the subjective experience.

And it is very subjective this question of like do you lose focus?

Everybody loses focus at times.

Is this causing impairment in your life in multiple contexts has been the classic criteria.

And for ADHD, 'cause it is a developmental condition, you have to be able to trace it back to childhood.

So there has to be some evidence of it in childhood as well.

- Many people still think of ADHD as just an issue for kids.

That is not the case at all.

In fact, most people diagnosed as children and as many as 86% of them will have ADHD forever.

They don't outgrow it.

But adults are much less likely to be diagnosed.

About 5% of adults have ADHD but only one in five of them know it.

One reason is that in adults, ADHD is less likely to fit in what you might call the stereotype.

- So basically, I was diagnosed in 2020 when I was 29 years old.

It was basically like life burnout, you know?

Everything was just getting too complicated and too frustrating.

I was thinking no, of course, I don't have ADHD.

It's not possible because you know, I don't fit the stereotype I have in mind.

And then I had my assessment and yeah, the psychiatrist at the end told me, "Yeah, it's quite obvious actually you have ADHD."

- So what are some things or some symptoms that people may experience that aren't on the official diagnosis criteria?

- So there are things like, for example, hyperfocus.

We are really interested in something and you know, we are super focused on it for a short period of time generally.

And you know, we even like forget to drink, eat or take a bathroom break and we can just like, we are hooked.

- And I just like know that other people's brains are working kind of different than mine.

It's also just a really interesting experience to have like very fast thoughts because I can see how that contributes to creativity.

I can see how you have all of these ideas that kind of you lose them, which is the negative thing.

Like, you forget them very quickly but you also have the ability to like think of new things very fast because your mind is always like going, going, going.

- [Host] These are common unofficial symptoms, either hyperfocus or it's hard to focus, your mind is racing or you might lose track of time a lot.

- Things like what we call time blindness and sometimes we tend to think that we still have time to take a shower even though we have, for example, an interview on Zoom in five minutes.

There is something else that is not in the official diagnosis, just our difficulty to manage emotion and it can be like enthusiasm or joy but also negative emotions.

So it's not easy to manage.

- So adults may have a hard time recognizing ADHD.

So what are some things that confuse the picture?

Number one and number two, anxiety and depression.

- I think there's a lot of undiagnosed adults who are seeking treatment for depression and anxiety without realizing that the undiagnosed ADHD is driving a lot of those mental health conditions.

- About half of all people with ADHD also have a mental health diagnosis.

Aside from anxiety and depression, there is a lot of overlap with borderline personality disorder or BPD.

Physical conditions can blur the picture too, like hearing or vision problems or thyroid issues.

An overactive thyroid can rev you up and look like hyperactive ADHD.

Number seven on our list is lack of sleep.

Poor sleep quality can absolutely on its own make it harder to focus your attention.

Okay, as a very tired night shift nurse, I understand sleep deprivation and unfortunately, for people like me who work night shift jobs or just people who suffer from sleep deprivation in general, it's a constant state.

It doesn't really necessarily always get better.

- Yeah, that gets really tricky 'cause as you're saying, sleep deprivation, we know that impacts memory and so that could look a lot like ADHD.

And then on the flip side, having ADHD actually predisposes us to insomnia and all sorts of sleep issues.

So it can really be the chicken or the egg dilemma.

So that's where again, I'm gonna rely on a really thorough clinical interview or where I wanna look back and see a person's whole life trajectory.

Also hyperactivity.

Now, not all people with ADHD have hyperactivity but that would not be explained by insomnia or sleep issues.

- Okay, so I think what you're saying is as a tired night shift nurse, the next day, if I'm like barely functioning, that's normal.

- Yeah, exactly.

That's situational.

That's normal.

- [Host] Last on our list but definitely not least, autism spectrum disorder or ASD.

It is very common for autism and ADHD to go together.

- So I was originally diagnosed with like a ton of things that mostly I'm not currently diagnosed with.

That was until I was around 18 when I started having the...

I continued to have these like panic attacks is what I was diagnosed with, but they were autistic meltdowns, and that is when the person diagnosing me was like, "Maybe it's just the ADHD."

And I was like, "What ADHD?"

And she was like, "Oh you need to be tested for ADHD by the way."

- We've posted some graphics in the show description about how these conditions overlap and how they're different from each other and definitely check out our recent episode on being diagnosed with ASD as an adult.

With ADHD with children, boys are more than twice as likely as girls to be diagnosed and there's still a gender gap when it comes to adults.

But does that really mean that ADHD is less common for women?

So some people say that the criteria is too broad, that we are over-diagnosing and then some people say that we are underdiagnosing.

What is your take on it?

Which do you think is true?

- I think in some situations, we're overdiagnosing.

I would say we are underdiagnosing in women and girls and gender queer and BIPOC populations and adults.

So that's a lot of groups that I would say we're underdiagnosing, particularly in adults.

Yeah, I mean I have a pretty classic kind of female journey of autism and ADHD in that ever since young childhood, I had mental health issues.

I had OCD in childhood, I had depression.

I then turned into a teenager who had a lot of issues with depression and self-harm, and all of the classic undiagnosed ADHD girl kind of clustering of experiences.

And I wasn't identified until my children were identified, which is again a pretty classic experience for a lot of autistic, ADHD adults.

- It's not just an academic question because if you have a diagnosis, you can start treatment and ADHD is generally considered a very treatable condition.

As many as four in five patients get better when they take medication.

- For me, I remember like researching ADHD medication and people were like trying to lower everyone's expectations and they were like, "It's not gonna be life changing.

It's not that big of a deal."

It was, it was that big of a deal.

It was absolutely life changing to me.

I remember just like sitting on my couch and like hearing birds outside and I was just listening to 'em and I was like, "Oh my God, I'm alive for the first time in my entire life."

So for me, it was a very noticeable difference with that medication specifically.

- There are two main classes of medication for ADHD: stimulants and non-stimulants.

Most people respond better to one or the other.

Unlike antidepressants, these medications don't have to build up in your system.

With stimulant medications, it's almost immediate and with either kind, you don't have to take it every day or all the time, just days or times when focus is more important.

So some doctors want to use medication as like the last resort.

You say that there's advantages of treating ADHD with medication early.

Why is that?

- Yeah, I think there's unfortunately a lot of unnecessary fear around medication.

And while I think we should always be cautious with medication, what the data suggests, what the research suggests is that treatment, stimulant treatment of children actually reduces the risk of developing depression, anxiety, bipolar, substance abuse orders later on in life.

One study found that when you use stimulant medication in childhood, it reduced the risk of substance abuse and abuse in adolescence and adulthood by 85%.

- Of course, there are many non-medication strategies to deal with ADHD.

Some people rely on a detailed written schedule and visual reminders, like posting brightly colored notes around the house.

- It's really about trying to find ways to work with your brain and you know, to adapt your life to your brain and not the other way around.

- [Host] Some people use electronic timers to prompt them all through the day.

- What's really important is that we test things and see what's worked for us and what don't because every people with ADHD are different.

And it's really important to not try to force something if it's not working.

Use it if it's working and if it's not working, just lose it, it's okay.

- And basic self-care is really important.

Stress and exhaustion will definitely make your symptoms worse.

Sleep, exercise and avoiding junk food can help a lot.

That's good advice whether you have ADHD or not.

One thing we hear over and over is that getting the right diagnosis can be life changing.

- All of a sudden, it felt like 100 mysteries were solved and I finally understood myself.

And so it was a deeply empowering experience of self-understanding that frankly, I didn't think I'd ever be able to experience.

- It's really something that you need to take time to process.

It's okay to have really big emotions right after your diagnosis.

I was basically grieving, you know, because you start wondering why I haven't got this diagnosis earlier and maybe my life would've been different, and how am I supposed to do things now?

- 'Cause you kind of look at your entire life, but you have a different understanding of it now.

That was a huge thing with thinking about how it was in school and how everything was with like teachers, like how I was just getting in trouble all the time for things that were not my fault.

And you think about like how other people treat you and everything and it's... Like, I remember I just started crying in school and someone was like, "What's wrong?"

And I was like, "My entire life is different than I thought it was."

- I mean, it's not magical because it doesn't, you know, just fix the issues you can face in your life.

But you can just, I think develop some kindness towards yourself, self-acceptance and accept that you are different and yes, just stop to try to conform so much.

And I think, yeah, it's really beneficial in the long run.

(screen whooshing) - That does it for us on this week's episode of PBS Vitals.

Hit us up on our socials, @PBSVitals.