Question,Answer,content "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.","Q: 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? Ans: 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." "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.","Q: 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. Ans: >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." "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.","Q: 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! :) Ans: 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 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.","Q: 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? Ans: 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." "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.","Q: 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? Ans: 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." "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/)","Q: 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? Ans: 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/)" 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.","Q: 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! Ans: >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." "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 [svfaraone@upstate.edu](mailto:svfaraone@upstate.edu) for a copy.","Q: 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)? Ans: 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 [svfaraone@upstate.edu](mailto:svfaraone@upstate.edu) for a copy." "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.","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)","Q: 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. Ans: 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)" "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","Q: 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? Ans: 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" "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.","Q: 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? Ans: 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." "Hello! Thanks for doing this with us today! It is my understanding that there may be a genetic component to ADHD that it can be passed down from parents to their children. Is there enough research to ascertain that these types of ADHD are inherited? Or is it just random? Speaking of lack of research, I have a bonus question if you don’t mind. Is there enough research yet to consider medical cannabis a treatment for ADHD?","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)","Q: Hello! Thanks for doing this with us today! It is my understanding that there may be a genetic component to ADHD that it can be passed down from parents to their children. Is there enough research to ascertain that these types of ADHD are inherited? Or is it just random? Speaking of lack of research, I have a bonus question if you don’t mind. Is there enough research yet to consider medical cannabis a treatment for ADHD? Ans: 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)" "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.","Q: 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. Ans: >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." "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.","Q: 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 ?"" Ans: 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." "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.","Q: 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. Ans: 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." "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.","Q: 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.) Ans: 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 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.","Q: 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! Ans: >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." "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.","Q: 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? Ans: 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." "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.","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.","Q: 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. Ans: 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." "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.","Q: 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? Ans: 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." "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.","Q: 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)? Ans: 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." 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.,"Q: 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? Ans: 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." "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.,"Q: 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? Ans: 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." "Thanks for doing this! Do atypical forms of ADHD require atypical treatment so to speak?",The treatments are the same.,"Q: Thanks for doing this! Do atypical forms of ADHD require atypical treatment so to speak? Ans: The treatments are the same." "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.",You are correct. Diagnosticians who only diagnose naughty children as ADHD are making a huge error.,"Q: 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. Ans: You are correct. Diagnosticians who only diagnose naughty children as ADHD are making a huge error." What are your favorite ADHD books or podcasts?,"I don't listen to and ADHD podcasts. I also don't read books about ADHD, only scientific papers. My current favorite is the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7).","Q: What are your favorite ADHD books or podcasts? Ans: I don't listen to and ADHD podcasts. I also don't read books about ADHD, only scientific papers. My current favorite is the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7)." "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.","Q: 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? Ans: 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." 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.","Q: 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? Ans: >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." "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.","Q: 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. Ans: 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." "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","Sorry, that set of symptoms is new to me. I've not heard about them being associated with ADHD. They could be signs of distractibility. If salient stimuli occupy your attention, they will make it difficult to cope on whatever you ought to be doing. If that's correct, standard ADHD treatments should help. Always tell your healthcare provider about new symptoms.","Q: 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 Ans: Sorry, that set of symptoms is new to me. I've not heard about them being associated with ADHD. They could be signs of distractibility. If salient stimuli occupy your attention, they will make it difficult to cope on whatever you ought to be doing. If that's correct, standard ADHD treatments should help. Always tell your healthcare provider about new symptoms." "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.","Q: 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 Ans: 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 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.","Q: 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! Ans: >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." "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.",>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).,"Q: 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. Ans: >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)." "Hello Doctor, Has there been any research on if regular exercise can help improve ADHD symptoms?",There are many good reasons to exercise but research shows it doesn't improve the symptoms of ADHD.,"Q: Hello Doctor, Has there been any research on if regular exercise can help improve ADHD symptoms? Ans: There are many good reasons to exercise but research shows it doesn't improve the symptoms of 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.","Q: 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! Ans: >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." "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.",I agree the name is not ideal but think it would be too confusing to change the name now.,"Q: 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. Ans: I agree the name is not ideal but think it would be too confusing to change the name now." "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. &#x200B; **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.","Q: 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. &#x200B; **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. Ans: 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 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)","Q: 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? Ans: 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)" "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'","Yes, the prevalence of ADHD is higher in prisons than in the population.","Q: 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' Ans: Yes, the prevalence of ADHD is higher in prisons than in the population." "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",I don't know anything about it but did find this: [https://pubmed.ncbi.nlm.nih.gov/30034331/](https://pubmed.ncbi.nlm.nih.gov/30034331/) We know that ADHD is associated with temporal processing deficits so it makes sense that it would affect sense of rhythm.,"Q: 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 Ans: I don't know anything about it but did find this: [https://pubmed.ncbi.nlm.nih.gov/30034331/](https://pubmed.ncbi.nlm.nih.gov/30034331/) We know that ADHD is associated with temporal processing deficits so it makes sense that it would affect sense of rhythm." "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?",Medications for ADHD have great effects but cannot teach people skill they never learned. CBT may help but is most effective if the patient is taking medications.,"Q: 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? Ans: Medications for ADHD have great effects but cannot teach people skill they never learned. CBT may help but is most effective if the patient is taking medications." "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 :)","When you speak with your healthcare provider ask about non-stimulant options such as atomoxetine and extended release versions of guanfacine, clonidine, viloxazine.","Q: 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 :) Ans: When you speak with your healthcare provider ask about non-stimulant options such as atomoxetine and extended release versions of guanfacine, clonidine, viloxazine." What's the true perfect job for someone with severe ADHD?,A job that capitalizes on the patients strengths and is not too affected by their weaknesses. Guidance from a neuropsychologist about strengths and weaknesses can be useful here.,"Q: What's the true perfect job for someone with severe ADHD? Ans: A job that capitalizes on the patients strengths and is not too affected by their weaknesses. Guidance from a neuropsychologist about strengths and weaknesses can be useful here." "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?",I no longer see patients as I devote my time to research but what you describe is not unusual based on the small literature on that topic.,"Q: 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? Ans: I no longer see patients as I devote my time to research but what you describe is not unusual based on the small literature on that topic." "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.",Those theories have no basis in data. We do know that the two disorders co-occur and share some genetic and environmental risk factors but one is not a manifestation of the other.,"Q: 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. Ans: Those theories have no basis in data. We do know that the two disorders co-occur and share some genetic and environmental risk factors but one is not a manifestation of the other." "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.",">Can a person clearly fit BPD criteria and then ADHD/ASD It is very common for a person to validly meet criteria for several disorders. Current research suggests that this is partly due to disorder sharing common genetic and environmental risk factors.","Q: 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. Ans: >Can a person clearly fit BPD criteria and then ADHD/ASD It is very common for a person to validly meet criteria for several disorders. Current research suggests that this is partly due to disorder sharing common genetic and environmental risk factors." "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.","Q: 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? Ans: 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." "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",ADHD is associated with sleep disorders which can lead to chronic fatigue.,"Q: 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 Ans: ADHD is associated with sleep disorders which can lead to chronic fatigue." "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.,"Q: 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. Ans: 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." "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.","Q: 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? Ans: 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." "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.","Q: 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? Ans: 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." "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?","Genes are clearly involved in causing ADHD but environmental causes also exist. As of now, genetic testing is not useful for diagnosing ADHD. That may be possible in the future. It is something my lab is working on.","Q: 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? Ans: Genes are clearly involved in causing ADHD but environmental causes also exist. As of now, genetic testing is not useful for diagnosing ADHD. That may be possible in the future. It is something my lab is working on." "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?",I could write a book about what the future might hold so I cannot respond here. We do address that somewhat at the end of the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7). The genetic data don't suggest that many more people could be suffering than anticipated? We have a pretty good handle on prevalence from population studies which estimate ADHD affects about 6% of kids and 2.5% of adults.,"Q: 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? Ans: I could write a book about what the future might hold so I cannot respond here. We do address that somewhat at the end of the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7). The genetic data don't suggest that many more people could be suffering than anticipated? We have a pretty good handle on prevalence from population studies which estimate ADHD affects about 6% of kids and 2.5% of adults." "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?","That is a tough question. Stimulants can aggravate anxiety but when anxiety is caused by the symptoms of ADHD, then treating the ADHD can lessen anxiety. I think the latter is a behavioral effect, i.e., when symptoms lessen patients perform better and have fewer reasons to be nervous.","Q: 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? Ans: That is a tough question. Stimulants can aggravate anxiety but when anxiety is caused by the symptoms of ADHD, then treating the ADHD can lessen anxiety. I think the latter is a behavioral effect, i.e., when symptoms lessen patients perform better and have fewer reasons to be nervous." "Hello professor, I've been diagnosed with ADHD about 10 years ago. I've learned a lot to mitigate my symptoms using medications and psychotherapy, and I could live my life fairly well because of this. However, my father got very sick with brain cancer when I entered my twenties. He eventually died after about a year of slow deterioration. This led to me having trauma from seeing him go through this process and heavy grief after he passed away. I noticed that it became harder to manage my symptoms like I used to be able to, and that my daily life suffers more from symptoms like forgetfulness and executive dysfunction. This has been going on for multiple years now, and as of yet improvement of this has been slow. I wondered if you know anything about ADHD interacting with trauma/grief/depression, and maybe if there is any research on this matter that I could read so I can learn more about this subject myself.","I don't know of any readings on the topic but do know that when someone with ADHD has another, untreated, disorder that puts them at risk for worse outcomes. So, it is best to seek advice from a mental health professional.","Q: Hello professor, I've been diagnosed with ADHD about 10 years ago. I've learned a lot to mitigate my symptoms using medications and psychotherapy, and I could live my life fairly well because of this. However, my father got very sick with brain cancer when I entered my twenties. He eventually died after about a year of slow deterioration. This led to me having trauma from seeing him go through this process and heavy grief after he passed away. I noticed that it became harder to manage my symptoms like I used to be able to, and that my daily life suffers more from symptoms like forgetfulness and executive dysfunction. This has been going on for multiple years now, and as of yet improvement of this has been slow. I wondered if you know anything about ADHD interacting with trauma/grief/depression, and maybe if there is any research on this matter that I could read so I can learn more about this subject myself. Ans: I don't know of any readings on the topic but do know that when someone with ADHD has another, untreated, disorder that puts them at risk for worse outcomes. So, it is best to seek advice from a mental health professional." "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 ","Q: 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) Ans: 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 " [deleted],FDA has not identified any long term consequences of taking ADHD medications. You can find details about risks and benefits in the International Consensus Statement on ADHD: [https://bit.ly/35ZVUR7](https://bit.ly/35ZVUR7).,"Q: [deleted] Ans: FDA has not identified any long term consequences of taking ADHD medications. You can find details about risks and benefits 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.","Q: 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)? Ans: 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." "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).","Q: 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! Ans: 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)." "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.","Actually, research shows the reverse symptoms of hyperactivity and impulsivity tend to decline with age while inattention tends to stay constant. Of course, that refers to average data. Some individual trajectories may be different.","Q: 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. Ans: Actually, research shows the reverse symptoms of hyperactivity and impulsivity tend to decline with age while inattention tends to stay constant. Of course, that refers to average data. Some individual trajectories may be different." "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?","I don't recommend any supplements. 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.","Q: 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? Ans: I don't recommend any supplements. 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." "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?","It is not common, but it does occur, especially when the child was protected by high IQ and a supportive environment.","Q: 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? Ans: It is not common, but it does occur, especially when the child was protected by high IQ and a supportive environment." "Hi! I have a question regarding distinguishing between ADHD symptoms from those of autism. How do they handle change differently?",The two disorders are easy to distinguish because their diagnostic criteria are very different. I don't know if and how the disorder affect handling change differently.,"Q: Hi! I have a question regarding distinguishing between ADHD symptoms from those of autism. How do they handle change differently? Ans: The two disorders are easy to distinguish because their diagnostic criteria are very different. I don't know if and how the disorder affect handling change differently." 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.,I got a PhD in clinical psychology and then did a post-doctoral program to study psychiatric epidemiology and genetics.,"Q: 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. Ans: I got a PhD in clinical psychology and then did a post-doctoral program to study psychiatric epidemiology and genetics." 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).,"Yes, female were understudied and undertreated until about the 1990s. Today, there is a good deal of research about ADHD in females.","Q: 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). Ans: Yes, female were understudied and undertreated until about the 1990s. Today, there is a good deal of research about ADHD in females." "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.","Q: 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? Ans: 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." "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.","Q: 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)? Ans: >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." 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?,I don't know of any data indicating that sensory processing sensitivity causes ADHD. But anyone who who thinks they have symptoms of ADHD that are causing problems in living should see a healthcare provider.,"Q: 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? Ans: I don't know of any data indicating that sensory processing sensitivity causes ADHD. But anyone who who thinks they have symptoms of ADHD that are causing problems in living should see a healthcare provider." "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.",Medical cannabis has not been shown to be useful for ADHD.,"Q: 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. Ans: Medical cannabis has not been shown to be useful for ADHD." "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)","When a person has two disorders, the usual approach is to treat the most severe disorder first because, sometimes, symptoms of the other disorder also go away. Usually they do not. So your psychiatrists' approach seems reasonable but should not continue indefinitely if ADHD symptoms do not remit.","Q: 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) Ans: When a person has two disorders, the usual approach is to treat the most severe disorder first because, sometimes, symptoms of the other disorder also go away. Usually they do not. So your psychiatrists' approach seems reasonable but should not continue indefinitely if ADHD symptoms do not remit."