Factually! with Adam Conover - Is My ADHD Real? with Stephen Hinshaw

Episode Date: August 4, 2021

Ever since he was diagnosed as a kid, Adam has wondered if ADHD is a serious psychological condition, or a false diagnosis pushed by an overzealous industry. This week Dr. Stephen Hinshaw, Professor of Psychology at the University of California, Berkeley is on the show to help answer these questions. You can check out his book The ADHD Explosion: Myths, Medication, Money, and Today's Push for Performance at factuallypod.com/books. Learn more about your ad choices. Visit megaphone.fm/adchoices See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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So if all of that sounds good, if you want a big box of delicious snacks like this for yourself, use the code factually for $15 off your first order at Bokksu.com. That's code factually for $15 off your first order on Bokksu.com. I don't know the way. I don't know what to think. I don't know what to say. Yeah, but that's alright. Yeah, that's okay. I don't know anything. Hello everyone, welcome to Factually. I'm Adam Conover. Thanks again for joining me and listening to the show. I'd like to talk about something a little bit personal today. Maybe I've discussed this on the show before, but never in great length. It's something that's really a part of myself, something I've struggled with for a long time, and let's just jump into it. As a kid, I was diagnosed with ADD, or Attention Deficit Disorder. It was later called ADHD, but I was really early

and they hadn't put in the H yet. I was really an ADD hipster, I guess, whatever you want to call me. It's one of the most complicated things about me. And we're going to spend the whole episode today talking about it. So it's kind of a special one. It's a very special episode in the sort of sitcom blossom mold, I suppose, if you will. You know, my main memory as a child was people telling me that I wasn't able to focus. My dad telling me, focus on your objective, which is, you know, an odd thing to tell a five-year-old. You know, people say, Adam, you're jumping out of your chair so much, that kind of thing. I don't remember not being able to focus. I remember adults telling me that I couldn't until eventually

they said I was so disruptive that they took me to see a psychiatrist and that psychiatrist diagnosed me with ADD and they prescribed me with Ritalin. And I took Ritalin for many, many years that I was in school. I actually don't remember that much about it quite oddly. I think I stopped taking it at one point. But then a couple of years later, when I was in college, I found for the first time, I was actually starting to struggle to focus on things that I wanted to focus on. I was not able to do the reading that I wanted to do, even as much as I wanted to do it. And so I went to see another psychiatrist and they confirmed my diagnosis and they gave me Adderall. And I took Adderall for many years throughout college and the years afterwards. And let me tell you something,

it did help me study in some ways. It helped me really focus on learning German, a little bit less so on reading philosophy. It also helped me a lot at focusing, at playing video games and sweeping my dorm room floor at 2 a.m. Adderall is a complicated drug. It's amphetamines. For those of you who don't know, it's simply amphetamines. It has the effects that amphetamines do. It makes you, gives you trouble sleeping. It can make you a little bit obsessive. And, you know, it's often prescribed to kids with ADD and it often seems to work, but there are real drawbacks. And about halfway through my 20s, I realized, hold on a second, I'm taking all this Adderall, I'm taking all this amphetamines, I'm drinking, I'm smoking. These things are all creating a house of cards of substances.

This is not going great for me. And so I quit taking Adderall. And soon after that, I quit smoking. It took me another 10 years to quit drinking. That's a whole other story you can hear about on the episode we did on addiction. That episode is with Judith Grizzell. We did that a few years ago. Check out that episode if you'd like to hear about that part of my story.

So suffice to say, in my mid-20s, I quit Adderall. And I stopped thinking about ADD quite so much. And the weird thing is that it's in the time since then, in the time since I quit, that everything good that I value in my life has happened. That's the time during which I built a career in comedy, during which I started doing standup, during which I started running my own television show. We've made 60 plus episodes of TV and I'm working on a new show for Netflix now. I run a writer's room. I get through all my emails. I do all this shit, right? And that makes me think, well, hold on a

second. Like, what was this diagnosis? Did I really have something called ADD or was this something that my parents, that a psychiatric industry, that a pharmaceutical industry pushed on me that I didn't really need, that didn't really reflect who I was. So I started looking into this recently, and what I found is that I was on the upswing of a massive ADD wave in America. It was a trend, just like I've talked about in my work so many times, an idea that swept the country and that changed the way that we treated many, many children in our society. ADD diagnoses increased massively in the 90s and stimulant use in kids with ADHD increased by four times from 1987 to 1996. It was in that early period that I myself was first diagnosed and prescribed a stimulant. And it's indisputable that that rise in diagnoses and

prescriptions was to some degree driven by the pharmaceutical industry and its relentless marketing of its drugs. So again, put all that together and maybe I never really had ADD. Maybe it's not true about me. Maybe I should rethink this very deep part of my self-conception. And then on the other hand, I try to sit down and write a script for a couple hours. Or I try to sit down and read a book I'm interested in. Or I try to sit down and watch a whole baseball game and I can't fucking do it. I can't do it. I am like a bird constantly alighting off of a wire over and over again. I just got to wait for myself to settle back down,

off of a wire over and over again. I just got to wait for myself to settle back down, peck a couple words into that script until I fly off again and need to go make myself a sandwich or text a friend or something like that. In reality, I still do struggle with attentional issues every single day. So what is it? Is ADD real or is it fake? Is it a serious medical psychological condition or is it imposed upon us by the pharmaceutical industry and by frightened parents run amok? I've never known the answer to this question. It's something that I have been puzzling through for years and I continue to puzzle through. And on the show today, we have a wonderful expert who is going to help me confront some of these issues and help lay out the science of what we do

and do not know about attention deficit disorder. So to that end, please welcome Stephen Hinshaw. He's a professor of psychology at Berkeley and the author of the ADHD Explosion, Myths, Medications, Money, and Today's Push for Performance. Please welcome Stephen Hinshaw. Steve, thank you so much for being here. Glad to be here. This is going to be an important interview for me personally, because I was diagnosed with what was then called ADD at a young age. I think I was on the upswing of the big wave of it.

And it was a diagnosis that I struggled with for many years. I've had many different relationships with it throughout my lifetime. And this is my first time speaking with an actual expert on the topic, other than, you know, the various psychiatrists and people I've spoken to who are very eminent, you know, or they have training and everything. But someone is my first time speaking with someone who has actually studied the issue on a wider scale. So thank you so much for being here. Delighted. Well, let's start with the basics. What is ADHD? It's a very misunderstood diagnosis. And a lot of people would even say it doesn't even exist. So that's what a lot of people think.

What is it? Does it exist? Yeah, it really does exist. It's a reality. But like depression and PTSD and bipolar disorder, we don't have an exact brain scan or blood test that says you've got it or you don't like cancer or coronary artery disease. So we rely on people's opinions about themselves and what other people say, especially about kids with ADHD. And we have some tests that are helpful. So let's get to the point. What is it? So we human beings have a bunch of traits and a bunch of cognitive functions and a bunch of emotions. And some key traits are first, how organized and attentive and focused are you on average, especially when the material is really boring

or rote or it's really challenging or hard. And some people thrive on that. Most people are in the middle of bell curve. And some people just find it really hard to focus and regulate all the attentional mechanisms in their brains to keep on track. And the other big domain is how impulsive are you doing things on the spur of the moment, not thinking it through before, which is also associated with how fidgety and squirmy and kind of physically or mentally restless you are. So we've got this dimension, you know, it's like a scale of inattention and disorganization. And we've got another scale of hyperactivity and impulsivity. And some people, mainly because of the genes that are inside their DNA that they're born with, but also because of other influences, are really on the

high end of lack of focus and or on hyperactivity impulsivity. And if such people have real problems at school, real problems at jobs, real problems in the workplace, real problems with relationships, we tend to diagnose them with this thing called attention deficit hyperactivity disorder. But let's make an analogy in medicine, blood pressure. I might walk in and the doc puts the sphygmomanometer around my left arm and squeezes it, and it comes out as 140 over 90. Well, that's borderline high. And actually actually with the newer standards, I might be considered to have mild hypertension, probably diet and exercise. Let's monitor it. Now, if I walk into the doctor's office and I'm 300 over 200, if the doctor doesn't put me in the emergency room

or get me on medications right away, we'd probably sue the doctor for malpractice. So it's a matter of degree. A lot of people are sometimes focused and sometimes unfocused, especially if things are really boring or really challenging. But what if you're that way just about all the time and your symptoms are at the top of the chart? Or what if it's good for everybody to take risks every once in a while, but what if you're a kid and you take risks all the time? Like the teacher won't catch me if I shoot that spit water against her when she's turned her back to the chalkboard? Or what if I, when I'm a teen, don't resist the urge to try the next substance that's passed in front of me outside of middle school or high school? Or what if I just can't sit still and keep regulated? If you're at

the high, high end of those continua, ADHD, the thing we call being at the high end of those spectra, can be a real problem. It's hard to focus in class. It's hard to learn the stuff that other kids are doing, even though you might be smart. It's hard to keep out of trouble. And as we'll talk about, really high scores on these dimensions, especially if other risk factors are involved, can predict some really bad outcomes like self-harm and suicidal thinking and like huge rates of accidents and real difficulties getting your life together as an adult. So we're not just sort of making up a new diagnosis because we have to diagnose everybody

who's not conforming to societal norms. High ends of these problems are really serious stuff. Yeah, that was going to be one of my questions. And you answered it like a lot of what it sounded like you were describing at the beginning are, you know, what we might call personality traits or they sound perhaps natural. Hey, being impulsive, being, you know, not focusing on dense material, that sort of thing. And my question was going to be what makes it so that we need to call this a disorder or a psychiatric condition that might require medication or treatment or all these other things? And it sounds like that's your answer is that these are approaching levels that we would

call disability, I suppose. Exactly. Impairment or disability. So a big controversy is, can you diagnose ADHD in a three or four-year-old in preschool? Well, half the boys in the world at three and four, because boys' brains are slower to develop than girls, and boys are kind of little monsters more than girls are, you could diagnose half the boys in the world with ADHD. But what if compared to other three-year-old boys or four-year-old boys, you're still at the 99th percentile? It's very likely you can't be in a preschool classroom.

It's very likely you're going to aggress against other kids. You can't follow directions. You're not sleeping much. Your family is bending over backwards with everybody exhausted. And there's potential for child abuse. There's potential for that kid to develop into a kid who's going to show a lot of signs of delinquency later on. So it's how severe are the problems and how much of a problem or disability do they incur even under the best of circumstances? Okay. Well, there's so many places we could start this. And for me, more than any topic, this is really hard for me to divorce from my own experience, but I just want to set the stage a little bit more before I get into that piece of it. Because ADHD is a very controversial diagnosis.

It's been a cultural flashpoint. And flashpoint. And, you know, it seems to be different than a lot of other diagnoses than we have. For instance, it's one where the amount of diagnosis that we've had in America specifically, like it's not as common a diagnosis in the rest of the world. The amount of diagnosis that we've had in America specifically has gone up and up and up over recent years. It's very, very recent. It's, which is true of, you know, hey, clinical depression is, you know, we've had a psychiatric revolution in our understanding of mental health, but you know, it feels like it's a more recent thing. We can look back at folks in the 19th century and say that author was depressed. We have a little bit harder time seeing ADHD. you know, it seems newer. The levels of medication are,

we're medicating kids with a disease at a very high rate or kids with a condition at a very high rate. And the medication itself is very directly a stimulant for most kids who take it. A stimulant that is like, you know, it's basically a recreational drug given for pharmaceutical purposes. And so for all those reasons, people have a lot of questions about it. And how do you view those? Like, are some of those questions legitimate? Are there real concerns

there? They're absolutely legitimate. There's a term in sociology called medicalization. Problems that we had back in earlier times, now all of a sudden become a disease in a medical handbook or a psychiatric condition in a diagnostic and statistical manual because we don't have free will or volition anymore. Everything's a medical condition if you're off the norm. And that's a legitimate criticism. On the other hand, if you're off the norm. And that's a legitimate criticism. On the other hand, let's take in adolescents and adults bipolar disorder, Jekyll and Hyde, manias and high mood swings or real crashing lows. Well, we could sort of get to be kind of armchair sociologists and say, why would we diagnose anybody? Because everybody fluctuates in mood. Well, in fact, if you really have bipolar disorder,

where compared to your normal mood for a period of time, you're way above, you're giddy, etc., etc., but that turns into often hallucinations and delusions and reckless sexual behavior, reckless driving, reckless spending, people breaking their credit lines. And about 40% of people with bipolar disorder make a serious attempt on their lives. And about half of those 40% end up killing themselves. So I've known folks with bipolar disorder and it's very frightening. It can be frightening for them and for their loved ones. That's exactly right. And so, but you think ADHD, it's school kids, it's the Tom Sawyer syndrome, right? It's not really serious. Yeah, it's Calvin from Calvin and Hans.

Exactly. And so, but it's all a matter of degree and extreme and how you fit with the circumstances you're in. We know that 70 to 80% of kids with ADHD are going to have serious academic problems. Again, even though they may not have a learning disability or even though they're in the high IQ range. We know that kids with ADHD are extremely disliked by their peer group. They're the kids who blow out the birthday candles at the birthday party, but it's their friend's birthday, not theirs, because they just couldn't resist the flaming candles on the cake. I've seen this happen. I do relate to this. Things you're saying are pinging for me, but keep going, please.

Yeah. And even though we used to think, well, you stop fidgeting when you're 12. ADHD is a time-limited thing. The underlying lack of self-regulation, the underlying disorganization, that persists much longer than the actual fidgeting and squirming and running around a room so we know now especially from europe where they've got data on every person among the millions of people in scandinavian and western european countries unlike the kind of chaos in the united states people with adhd have high risk for dying about 10 years earlier than they should people with adhd have high risk for dying about 10 years earlier than they should. People with ADHD have high risk for suicide attempts, especially in women, girls and women as they grow up. People with ADHD have

accidents in cars and on the job and have many failed relationships. It may not be as dramatic as the swings of bipolar disorder, but despite the stereotype, ADHD can really wreck a lot of good things in your life. Now, if it were all doom and gloom, why would ADHD still exist? If genes are responsible for extremes, wouldn't a natural selection have bred this out of existence? Well, there's pretty good evidence

that some of the genes that predict to having ADHD back in earlier times in human history might have predicted you're being an explorer. Maybe you were the one who moved in the wake of the earlier rounds of climate change, et cetera, et cetera. Maybe even back in hunter gatherer societies, it's good to be cautious, but unless you're out there in the vanguard looking out for the next hunt, you're to miss it so sure so there's probably some well in any species that we know of it's good to have diversity in genes if everybody's the same and conditions change yeah the species is doomed so adhd is not all doom and gloom but especially

in the 20th and 21st century where we put pressure on kids to achieve ever earlier and where you've got to be perfect and where jobs are scarce, et cetera, et cetera. The rates of diagnosis, the sort of second part of your question, have gone up in part, and we can talk about this in more detail, directly related to academic pressures in different states and different communities. So, ADHD has a biological aspect to it, but culture and expectations and social pressures have a lot to do with rising rates of diagnosis. In fact, the United States and Israel have the highest rates in the world at this point. Yeah, and there's only a social explanation for why that would be the case, right? It's that we treat this phenomena or this set of behaviors differently in the United States than other nations. And we could say, well, they're behind the curve and they haven't gotten up to date with the science and all the great benefits that our medication can bring. Or we could say something in the United

States is a little bit whacked. We've gotten something twisted and we're doing something strange to our own children, or it could be both. But it is, you know, it is a little specific to the United States. In some of the national data, so the Centers for Disease Control and Prevention, they've been doing surveys of diseases around the country for years and years and years. But only in the last 20 years have they started to ask in these phone surveys of families across the country about ADHD and autism and learning problems, et cetera, et cetera. and autism and learning problems, et cetera, et cetera. In the most recent versions of these surveys, and this isn't just people in clinics, these are 100,000 randomly chosen families talking about their kids. In certain states, if you're a boy over 10, so you've had a little bit of history in grade school. In, let's think, Alabama is one, North Carolina, Arkansas, Indiana, 30% of boys have received a diagnosis of ADHD. Wow.

Now, I don't like stigmatizing terms, but that's crazy. Yeah. Something's wrong. Yeah. The world average is about 5% to 6% of kids have this condition, largely pastor genes, where even under the best of circumstances, they're really having trouble self-regulating. Thirty percent? That's insane. It's because, and we've actually, in the book I wrote with Richard Scheffler, The ADHD Explosion, Richard's a health economist here at Berkeley and I'm a psychologist, we found that those states and regions within states that do test

scores or bust, unless your district, your public school district is getting those test scores higher and higher and higher, those are the places where the rates of diagnosis have gone to these insane levels. And especially, and this is a new trend, ADHD used to be a white middle-class boy thing. Now we know that girls get it at half the rate of boys, but they still get it. And for the first time now, black kids and kids of color are getting diagnosed more than white kids, which is partly because the science is catching up, but it's partly because in federally funded Title I public schools with these achievement pressures, the school administrators are desperate to get these kids help.

Or until it became illegal a few years ago, if you diagnosed a kid in that public school district with ADHD, guess what? Next spring, that kid was pulled out of your district's test score pool. Yeah. Wow. You could improve your test scores of your district by diagnosing a kid with ADHD and their scores are pulled. So it's really political as well as biological. Yeah. Well, let me raise the ante for you because I've, look, so I've done a lot of thinking on this myself. I recently, like I said, I was diagnosed at a young age. I was medicated,

you know, first my parents gave me medication. Then I took medication myself in college because I was actually encountering, I want to do the work and I'm not able to do it, you know? And then I started taking Adderall. It actually did help me with some part of my schoolwork. Then through my mid twenties, I realized I was still taking Adderall and I realized, you know what, this is leading to a whole lot of unhealthy behaviors. I'm drinking too much. I'm smoking too many cigarettes. And I don't feel that it's helping me with comedy, which is what I was working on with writing and things like that. I stopped taking it. I started exercising. I quit smoking and my, my life got better. Um, and then I went

for, you know, 15 years having great success in my chosen field, uh, without any medication of any kind. And I feel that I live very functionally, you know, my affairs are in order. During the pandemic, I began to feel for the first time in many years, I'm really having trouble struggling with getting what I want to get done done. I can't focus on a script. I can't focus on the writing I want to do. So I got myself, I got myself reevaluated by, you know, I was like, let's see what medical science will give me today versus what I had when I was, you know, 11 years old. And through that process, I had a whole battery test done. And I ended up thinking, you know what, I, I do have this condition. I've been wondering, is it, is it even real? You know, because I had been doing quite fine, but I, you know, got enough testing done. I talked with a wonderful, you know, psychologist who, who walked me through all of it and said, you're, you're, you score very well in these areas. You have a deficiency in this area.

And based on your history, I can tell you, you know, you're very high functioning, but you have ADD. So I believe that it's real, right? However, on the other hand, I look at, It's real. Right. However, on the other hand, I look at I also started reading about the social history of ADD and reading about how, OK, it was it was a real thing that was diagnosed in kids. But what do we have? We have a testing, a diagnostic criteria that is in many ways subjective, where you ask kids, you know, a dozen questions or so. Do you have trouble sitting still? Do you have trouble focusing? Very easy to say yes to that when the answer is a maybe or a no. Then you have a brand new pharmaceutical intervention that is being really pushed in massive amounts of advertising, advertising which appealed directly to parents' own insecurity about their kids. You know, your child will sit still and do well in school. And as you want them to, if you give them this drug and you've got, you know, schools that started encouraging parents to, to take it for the reasons that you, that you said. And then

you've got as in adulthood, the same companies, the pharmaceutical companies now marketing to adults and try and, you know, I adults around me in, you know, my age now are saying every day a new friend says, you know, maybe I have ADD. I don't know. I was thinking about it. I'm having trouble with my writing. And I went to a psychiatrist and I got a diagnosis and I think I have it right. And it's, you know, the Buzzfeed quizification of the diagnosis. So, so I'm, I'm looking at all these qualities. We've got, as you said, no brain scan can tell you that you had it. It's subjective criteria.

The drugs make anybody feel good. You give anyone Adderall and they're going to say, wow, I feel better than I did before I took this until they crash, right? Everyone, it'll work equally on everyone in that way.

And you've got this thing where it fits, like diagnosing yourself fits our notions about ourselves, about our society. It like gives people comfort. And so to me, I look at it and say, this is a recipe for rampant over-diagnosis. So even though it's real to me,

I'm like, it almost looks like the vast majority of people who are taking these drugs maybe don't need to be taking them. So it's very hard for me to know how to think about it. That's me laying out everything that I've learned so far. I'd love you to tell me what it looks like from your view based on what I said. Well, you raise a lot of really important points and let me see if I can address a few one at a time. I know that was a lot, but it's all important stuff. So in the book that Sheffield and I wrote a few years ago, the ADHD explosion, myths, medication, money, and today's push for performance. There's a lot of myths out there.

It isn't real. It is about money and productivity in a capitalist or postmodern society, right? And so school pressures are there. And you mentioned the big pharma, the pharmaceutical industry. I love them and I hate them. The government doesn't fund enough to get cancer drugs or mental illness meds into the market. So the companies invest billions of dollars and they want to make it back and they want

to keep their copyright and trade patent protection. And they're getting a good return on their buck if they can market the medication well. And what really aided that, you hit on this a minute ago, in the olden days until about 1999, you'd see if you open a medical journal, you'd see the big advertisements for doctors. Here's the newest pill for schizophrenia or for cancer or for diabetes or for bipolar disorder, ADHD. As of 1999, there are what's called now DTCs, direct-to-consumer advertisements. You see on late-night TV or you see in a lady's home journal or TV guide, big ads for all kinds of medications, often for mental illnesses. How many countries, Adam, on earth,

allow direct-to-consumer ads? Two, the United States and New Zealand. The rest of the world says it's unethical. And some of these ads are, look, so I read recently this book called ADHD Nation, which is by a journalist about the history of, you know, maybe you think this book's a crock of shit. I thought it was pretty good.

Um, there's good, there's good and bad parts to it. I've read the book and I know the author, so. Okay, great. I figured you would since you're in the field, but it's really, uh, you know, a social telling of, of, of this story. And, and it, the, some of the ads that are reproduced in the book is, you know, there's a, there's a mother saying, thanks to Adderall XR. I'm proud of you. We can play a game. Good job on your homework. Like it's a mother saying, thanks to Adderall XR, I'm proud of you. We can play a game. Good job on your homework. Like it's specifically, the ad is targeted to a mom

and it is specifically making the promise that this ad will make your child a joy to be around and will make them better at their studies and turn them into the perfect kid you've always wanted. And it's impossible to look at this without saying this is grotesquely unethical and it's going to work like gangbusters. Well, there's another ad. So I don't work for pharma. I don't consult with them. So I'm allowed to talk about it under what's called the fair use doctrine. So I can talk about kind of you're being a critic of these ads. There's another ad for an ADHD med with a smiling white mother and a smiling white seven or eight year old boy. And the mother says, and a smiling white seven or eight-year-old boy. And the mother says,

when I see Jason, when he's on his medicine, I see the real boy, not his ADHD. Conveying, not very subtly, that the medicine will take away the stigma and shame. You'll see the real person emerging underneath if you get rid of those annoying symptoms. Now, that's a huge assumption right there. And who wouldn't buy it, right?

And it's also, I don't know, like, you know, the way I look at disability has changed so much over the past decade. And I, you know, to the extent to which I think of myself as having a disability because of ADHD, I still wrestle with that. But looking, using our contemporary sort of like understanding of this, what a horrible thing to say about your child who has a medical condition to say, oh, I don't see the real, oh, this medical condition means it's not my real son. It's some sort of horrible Jekyll figure who I need to like, that's a, that's an awful,

that's an awful thing to say. And you talked about obviously too, for yourself and for many others, ADHD doesn't stop when you hit puberty as we used to think 30 years ago. So the newest, uh, the strain of ads are for adults with ADHD because by far the fastest growing market share is for adults with ADHD meds. Yeah. Kids with ADHD, more kids are diagnosed these days, so more get medicated. But for the last 20 years, about 60, 70% of kids with a diagnosis get medication. But if you're an adult who gets medicated or gets diagnosed,

the rate of being medicated has gone up from about 5% to much, much higher levels. So that's where the market is. Adult women are the fastest growing market for sure. And there's a major ad for an ADHD med that says, showing pictures of adult women, if you have ADHD, you're twice as likely to get divorced as the average woman. And you're twice as likely or three times as likely to get divorced as the average woman, and you're twice as likely or three times as likely to get depressed. So take the medication and you'll stay married and you won't get depression, which is totally simplistic. And again, these direct-to-consumer ads may be creating false markets. Now, the other side would say, we've denied that girls and women get ADHD for so long, and we've denied that adults have it. Let's give them a fair shake of treatment. And maybe it reduces the stigma to see an ad out there in the real world. And it will certainly reduce prices because it's competition.

It's a complete BS argument. It doesn't reduce prices at all. It raises prices because for 12 years after you get your drug approved, you can charge anything you want before they come to generics. Whether it is a good thing for somebody to say, you know, these mood swings of mine, maybe I do have this thing called bipolar disorder. You know, maybe that'll get somebody help. They need it. But it's way too tempting to say, because everybody in the world has periods of not focusing, with a quick and dirty kind of ad saying, if you don't focus, well, you've got ADHD. And people will doctor shop until they'll find a doctor who says, yeah, you have it, and here's the prescription. And you don't have to shop far. You don't have to shop far. talk about is for people with legitimate ADHD who are clearly in the high percentile ranks,

who really do have problems because of this condition. Medicine can be very helpful, although there are ill effects, which we'll talk about. But by far, the best results come from combining medicine with, for a kid, behavioral programs, more structured home life, more frequent rewards in school, reducing homework into shorter bursts, et cetera, et cetera. And for adults with things like cognitive behavioral therapy and organizational skills therapy, where you're learning to control yourself, not just have your brain dopamine levels controlled by medication. But you'd think from the ads, it's medication or bust.

Yeah. Well, and that gets a lot into, I want to ask you about the social model of disability and how much of this is, is it not fitting us not having a societal model that fits what's really a natural difference in kids and neurodiversity and all that. But I just want to ask while we're on the topic of the pharmaceutical industry, a whole lot of my career as a comedian, I don't know if you're familiar with my work, but I tend to tell a story that goes, hey, capitalism created a false impression that we all need to do X, Y, Z. They bombarded us with an ad campaign until we all believed it. Listerine convinced us we all got to use mouthwash, even though there is real no medical reason to use mouthwash. Right. And I look at my own history with this diagnosis, right? I think I was told there was

something wrong with me as a kid. I don't remember there being something wrong with me. I was told that there was something wrong with me as a kid. I went to a psychiatrist. I was given this medication. I don't really remember much about it. I've been wrestling with it on and off it. When I finally quit it, that's when every good thing in my life happened, right? And I've tried it again since. And it hasn't helped me. I tried some medication. Hasn't actually helped me. Right. And in fact, all of that tracks with the beginning of a massive ad campaign on the part of the pharmaceutical industry and a mania for ADD. And so I look at it and I say I could it sounds like I could tell that same story about ADHD and the medications, that the whole thing is a con on the American public, except for the fact that I also believe

the condition really exists, right? Based on talking to you, based on knowing other folks with serious cases of ADD and based on my own testing and me knowing where my limitations are, I believe there is a real difference in me and in other people that, you know, psychology and psychiatry can say something about. So how do I reconcile those two stories? That is what I've never been able to understand. Yeah, I think it's the story of our age in many ways. Over-medicalization, overselling people as commodities or people as biological vessels that the only way to get normal is to take a pill that changes your brain chemistry. And there are realities to mental disorders like ADHD, bipolar disorder, PTSD. Sometimes

medications are lifesavers. But let's consider the name ADHD, attention deficit hyperactivity disorder, used to be called ADD, attention deficit disorder. Yeah. It's assuming that people have a deficit in their ability to pay attention. Well, if that's true, why do so many people with ADHD, when they find their groove or something you really love, they can't get away from it for eight hours in a row? There's hyperfocus, right? Yeah. That's not an attention deficit.

I think if I could do a couple of things, and I'm so glad you've appointed me czar, at least for the day, so I'll work on this. Yeah. Change the world for us. Tell us how to think about this. I would change the way we talk about ADHD medicines and the name ADHD itself. ADHD is not a deficit in attention. It's a deficit in the ability to regulate your attention and regulate your working memory and regulate your inhibition. No, should I do this or not? When situations change, right? So it's a bigger issue in general self-control. Maybe, let's say I'm a middle schooler.

Maybe math is my sweet spot. And algebra, if you could titrate the meds hour by hour, I don't need the meds at all. But in English lit, reading long passages or long poems, you know, I'm going wild. I can't sit still. The different structures we have, going from a rote to a more challenging task, going from something you're naturally good at to something you're not, ADHD is a problem in regulating and shifting your effort as situations change. It's also a problem in being as intrinsically motivated as many people are.

Little kids always need praise and rewards. Once they get skills, we assume that they're going to start to perform those tasks on their own. People with ADHD have this funny relationship with rewards, mainly because of dopamine in their brains, where they're going to take more structuring for longer periods of time to get good at stuff that most, I mean, our human brains didn't evolve to learn to read. Did we have classrooms on the savannas of Africa 60,000 years ago? I don't think so. And now the last 200 years is compulsory education. We're asking kids to do things that human beings never evolved to do. So it's a mismatch between our genetic makeup and these recent cultural adaptations. That doesn't mean that ADHD is totally a myth or totally a social construct. There's a reality in our current century and millennium and current

social situation where if you don't learn good stuff in school and if you don't learn some self-regulation, you're in trouble. And there's some people, about 5% of kids around the world, who have extreme problems in this. But the jump to over-medicalization, the jump to thinking you're wrong, your DNA is flawed, this doesn't decrease stigma. It increases it. It makes people think you're either neurotypical or you're neurodeviant, and there's something wrong with you. It's on a continuum. It's like the blood pressure example I gave 20 minutes ago. At some point, I may need for my hypertension some meds, but then if I get on a really strong exercise program and change my diet

maybe i can tape away the statins from my cholesterol or the blood pressure meds some people as they get older adolescence and adulthood they find a job that's a good groove for them medicine that might have been helpful before may not be as much but then if you change jobs or you go to grad school whole new set of of demands come in. You may need to get back on the medications for a period of time to help you focus because it's a new situation. It's not all or none. Yeah. So that's my first czar thing. ADHD isn't an attention deficit.

It's a larger deficit in self-regulation. Second, stimulants. That's the main meds that work for ADHD. Terrible term. Everybody knows what an SSRI is, a selective serotonin reuptake inhibitor. I kind of know what it is, but it's antidepressant meds. They're for anxiety and depression. Yeah.

The brain, there's a neuron in your brain, and the end of it, the axon squirts out serotonin that sits in this little minute gap called the synapse end of it, the axon squirts out serotonin that sits in this little minute gap called the synapse and it hits the next neuron and makes that electric current go on in the next, you know, the chemical makes the electricity go on and on and on. What's an SSRI do? Serotonin usually sits out there in that gap, does its thing on the next neuron, and then gets reabsorbed back into the neuron that squirted it out. It's called reuptake. It should just be called uptake, but pharmacologists don't know grammar. It gets reuptoken back, right? Yeah, yeah, yeah.

What does Prozac do? What does Zoloft do? It keeps the serotonin out in the synapse longer because it doesn't let that first neuron soak it up back as fast. So, the serotonin out in the synapse longer because it doesn't let that first neuron soak it up back as fast. So, the serotonin has more time to act and regulate the whole chain of neurons down the track. Helps a lot with depression and anxiety for many people. Is it a cure? No, but it can help. What's a stimulant? It's an SDRI. It's a selective dopamine reuptake inhibitor. So dopamine is in about 6% of the neurons in our brains, but it's in four really important pathways that have to do with your ability to move. Parkinson's disease is a loss of 90% of your dopamine-containing neurons

in a very deep brain area that leads to Parkinson's disease. Other areas or pathways that contain dopamine go from your frontal lobes back into your midbrain and your thalamus and your striatum and your caudate, all these brain regions that help you regulate yourself. They help you focus. So ADHD may be in some people through the genes that predispose to it. You don't have the same amounts or the same regulation of dopamine in your brain when you're

young as other people do. So, if you give the stimulant, there's that neuron in the path, squirts out dopamine, gets reabsorbed, reuptaken, but the stimulant stops that reuptake and keeps the dopamine active a few seconds longer. That helps many people with ADHD regulate, but only for the few hours at a time when that medicine's in your bloodstream and brain. Does it teach you how to read? No. Does it teach you how to get along with peers better? No. Does it teach you how to screenwrite or write comedy scripts or write psychology books?

No. It's an adjunct. It may be in many cases of properly diagnosed ADHD, except most ADHD is diagnosed in kids in our country by a 10-minute visit to a pediatrician's office with no history, no rating scales, no nothing. So, of course, we're going to over-diagnose. The professional groups have standards for good diagnosis, but we don't pay for them with insurance and we don't enforce it. And those same doctors with the quick diagnoses, what's in their treatment bag of tricks?

A prescription pad. Yeah. Medical doctors don't know how to do behavior therapy, cognitive behavior therapy, all the kinds of skill building that people with ADHD need. So no wonder, A, we over-diagnose and B, we over-treat with meds.

The meds as SDRIs, they're actually stimulating the parts of the brain and brain pathways that help you regulate yourself better. If you're an adult without ADHD and you're going out to a party and people having a lot to drink, I'm going to fall asleep. But if I take Adderall, not for medical use, I can drink more without passing out. I can stay up all night before my midterm and study because whether you've got ADHD or not, stimulants will keep you alert longer too because dopamine subserves alertness. Yeah. If you're a young adult without ADHD and you start to use in adolescence or adulthood stimulants as party drugs

or smart pills, right? Make everybody smarter and better students. There's a 15 to 20% chance you're going to get addicted to those medications. Sorry, we have to take a really quick break because, and we haven't, because this is fascinating. We're going to come back, stay right on this point. We'll be right back with Steve Hinshaw. Steve, we're back. We were talking about stimulant medications. Right. And the fact that they are.

And S-D-R-I is my new name for them. Not new, but. Okay. So they do this to dopamine in your brain. And I think that's very helpful to hear that and to understand the neurochemistry of it and why it works. But however, I have taken many of these stimulants throughout my life. I took Adderall for probably six or seven years.

And a couple, like a month ago, I took Vyvanse a couple of times because I wanted to see if it would help me write. And it was, I had such a striking experience because I took the Vyvanse and immediately I felt this feeling course through like my blood, like my feet, I could feel it in my fingers. And it was like, oh, hello, old friend.

Like, like I hadn't felt this in 15 years. And I was like, wow, I remember exactly what this felt like. It's like Adele. Hello, it's me, right? Yeah, yeah, exactly. It's very much so. And I felt like you feel like fucking popeye eating the spinach it's just like bazoom like here i go and then as usual as i remembered about five hours

later i started to feel kind of stretched out i started to feel kind of thin my heart was sort of racing kind of oddly i i i was i felt like both tired and wired at the same time then that night i had trouble falling asleep, right? It took me a long time to sort of wind down. I got less of a good night's sleep than I did before. I was a little bit tired the next day. I took the Vyvanse again. Vyvanse, by the way, same as Adderall,

just like an extended release, right? And I felt- Slightly different way of getting the dopamine going, but same thing essentially. So I felt the boost again when I took it the next day had even more trouble sleeping. And then day three, I woke up and I was like, I can't keep doing this because this is like, first of all, it wasn't really helping me. Right. But also it affects it. I was like, wow,

this affected my whole body as much as, Hey, drinking, drinking a couple of shots of whiskey. Right. It makes you feel different. Your brain also makes you feel different in your heart and in your fingers and all over your body. It's like that big of a change almost. And to me, it just underlined, I understand that there are people, I was going and reading people on, on Reddit who have ADHD and they're like, Oh my God, I was suicidal. And I started taking this stuff and it really helped me out. But I was like, you know, for me, this was maybe the whole time I was taking it. It was really just giving me a boost.

Like I might as well have been, you know, it was just giving me a recreational boost that I was enjoying, but I, was it, was it helping or was I just getting all those other effects out of it? It is a weird thing to give kids amphetamines. Is it not? It's, it's counterintuitive. Why would you speed up a person who's already hyperactive, right? Yeah. Their brains must be different. Well, remember, stimulants is the wrong term. When they're used right for people who really need them, they stimulate the brain pathways that help keep you restrained. For you, it sounds like in your adult years now, you're getting kind of a euphoric effect and kind

of a boost that isn't good for your health, isn't good for your heart, and you've learned to do your writing and your performance without it. People have a bell curve, a range of differences. Some people can't really survive without medication. Other people learn that as kids, it kept them in school and kept their game going. But as adults, they've learned other coping strategies. It's like, does a person with diabetes always need insulin? Well, the brain's more plastic and fluid than the pancreas. So people might need to keep taking for organs other than

the brain medication very regularly. The brain can adapt to learning. The brain changes and sprouts new neurons as we learn. People who've really needed ADHD meds when they were younger may be able to learn the strategy. They don't need them anymore. But as I said a few minutes ago, other people, as they change jobs or go back to grad school or whatever they do in adulthood, may temporarily need those medications to help them cope with a new and strange situation. So every case is different. You can't believe the ads or the articles say 72.8% of people improve. Everybody's different. Well, and a lot of what you said makes sense to me because, you know, especially when I took it in college, it helped me with some things and not others.

It helped me with anything that was sort of like mental mechanics. It helped me. I was studying German at the time. It helped me do language exercises. And later, later in life, my early twenties, I was doing web design and video editing, basically programming and stuff like that. And it really helped me with that. Like something that was very mechanical. It made me great at crossword puzzles. And in fact, it gave me, I had, I would have a problem because I would, I would be unable to do my actual work sometimes because I would become so hyper fixated on solving a puzzle or, or a video game of some sort. And now here's the weird thing as an adult, I'm actually very good at doing all those mental mechanics things.

I'm good at getting my inbox down to zero. I'm good at doing my taxes. I'm good at, you know, that sort of thing. You've learned executive functions is the neuropsychological term. Through the plasticity of the brain. Can you get up in the day and plan and organize and regroup after a failure? And no, I'm going to turn off that dinger so I don't get any more damn inbox messages right now. Yeah, I can mostly do those things now.

Can you use the strategies of a day with or without medication, especially without? That's a large part of what ADHD is. People aren't very good at those executive functions. Seems like you've kind of taken a masterclass at that, which is great. So somehow I think I have, I have built coping mechanisms in the right areas in my life. Like I, I don't use a to-do list excessively, but I, I do keep a list over here. I'm pretty good at keeping a calendar and et cetera. And so I've, I feel that I've built a lot of coping mechanisms, but there's still a place where, you know, I feel a block at times. I want to be able to focus on a script or on a

piece of writing or a piece of reading. And reading has always been one for me that especially in college, I would found myself unable, even when I was on the Adderall, unable to read for a long stretch with the speed that I wanted to without flitting away and coming back. And part of it for me has been getting more patient with myself in those moments. I've started to accept, you know what, for me, working on a script means I got to spend 10 hours trying and I'm going to accept that six of those hours, I'm maybe not going to get a lot done and I'm going to fly away and come back and fly away and come back. And eventually the bird eats the birdseed. You know what I mean? You sound like me with my latest book. It's on the 14th draft of the first paragraph that I finally get what I want to say. And then I go for a good

stretch of a few pages and it takes time. Writing is hell is half of the problem. That's right. But most of life isn't a speeded test. It's not like a typing test. You have to take how many words per minute. It's quality, it's effort, it's redrafting, and it involves all parts of your brain, not just the parts of your brain that are going to sit down and do something rote, which maybe stimulants will facilitate for a long period of time. period of time. Yeah. But so, so before we move off of medication, I understand that for me, maybe I don't need them right now in my life. And I assume there are folks who have more severe difficulties than I do, where these medications can really help transform their lives. Is that not the case? That's absolutely the case. Okay. Well, so here's the thing that still concerns me though, is again, I have friends again, every day who say, you know what? I'm having a little trouble writing too. And I talked to a friend and they told me to go to their psychiatrist. Turns out I have ADD and now I got

these meds and guess what? I take them and I feel great. And in the back of my mind, I go, man, it just, it just feels great to take those meds. You know, like it just feels good. It feels good to snort a line of Coke too. Doesn't need it. And hey, maybe nothing even wrong with you doing that. But it doesn't mean it's medicine that you need. And and so I still see that weird thing about this medication that doesn't happen with SSRIs really or with insulin. Right. Where it's it's there can be this if some folks need them, but it's very easy for folks who don't. It seems like to end up taking them. And as you say, get hooked because they are simply they are addictive drugs. It's it took when I quit taking Adderall, it took me a couple of weeks to get it out of my system and to stop craving it and to stop feeling like I had to have it. Well, right before our break, I were right in the middle of a point. So I said, oh, that's fine.

Well, right before our break, we're right in the middle of a point. Oh, I'm so sorry about that. Oh, that's fine. 15% to 20% of people, adults who want to super party or be a super student, will take stimulant meds, and they're going to get addicted to them. If you're an adult with bona fide ADHD, and that doesn't mean a psychiatrist after a 10-minute interview says you have it. I mean, it takes a lot of work.

You've got to get report cards from grade school. You've got to do a lot of historical interviews. You've got to take a lot of tests. If a person has ADHD and some decade in our older years will have the genomics of this nailed down, if you've got a certain gene pattern that predicts ADHD, there's probably several that do, there's good evidence right now that many people with ADHD, if they take medication, they get not euphoric, but a little bit more straight-laced, don't have any craving for it, and are very unlikely to get addicted. So there may be a protective fact for some cases of ADHD against stimulants being drugs of abuse. But our diagnostic rates are so high and our diagnostic standards are so poor, it's hard to sort it out.

Yeah. And what you're saying is right, that if you don't have ADHD, you did the BuzzFeed quiz version and you went to the slightly sloppy psychiatrist and they just gave it to you and you started taking some and you're like, woohoo, amphetamines feel good to take. Well, then you could end up getting addicted to amphetamines, which is a big problem. That's a harm. It's a huge harm. And again, what we do, every medicine has side effects. Every medicine has beneficial effects or it wouldn't be approved. What's at the level of the population, the benefits for many people with ADHD versus especially with the direct-to-consumer advertising and the disease-mongering, getting people who don't need these meds at all potentially addicted. And it's a gray area. We

need to take a good, hard societal look at this. Look at Oy look at pain relievers which 15 years ago the medical profession said we're under treating people in chronic pain they have terrible quality of life and then we get advertisements for and billions of dollars from some companies into promoting this is a great comparison synthetic and we have huge rates of death and so it's not all yes or all no all black or white because there are still people there are still people who have that severe pain and need those drugs and in fact for some of those folks we the pendulum has now swung back so far the other way that that those folks are now falsely labeled as drug seekers and they're not able to get the medication they need. I think it's a really good in the very, very last chapter of the ADHD explosion right before the huge, it was published in 2014, right before the huge surge of opioid

overdoses and deaths. Scheffler and I talked about this exact analogy between stimulus and pain medication. Yeah. Okay. Well, let's move off of medication. I really want to talk about the social aspect of this because, you know, again, I was diagnosed at a young age. I certainly believe that I was posing a problem in the classroom, right? For, for my, I was a smart kid. They, they bumped me up a year because they thought I was, you know, I was impulsive and I was like causing disruption in the classroom. They're like, maybe he's, you know, we should bump him up a year to see if he'll, you know,

do a little better with a higher level and all that. But, you know, eventually I was medicated and really, you know, after doing some therapy and things like that about these feelings, I was really, you know, what it turned out to be to feel to me is I was really told that there was something wrong with me as a kid, you know, by my- Which is a terrible thing to tell a kid. Yeah, by adults and by other kids. As you said, I was ostracized by, you know,

I had trouble getting along with other kids and et cetera. And now, again, I'm an adult, I'm coping fine. And I'm like, you know, I don't think there was anything wrong with me then either. I think, you know, I was posing a problem for adults sometimes, but I was also a child. And, you know, like how bad could it have been? You know what I mean? I was like a little disruptive in class. Like, you know, what's the big fucking deal? And so how much of this, when we talk about the social model of disability, which we've talked about on the show, is like, in a lot of ways, disabilities are only a problem because society hasn't accommodated them.

You know, like being in a wheelchair is really only a disability when there's cupboards that you can't reach and there's curbs you can't get over. And if we can accommodate those, then it goes from a disability to a difference. And, you know, neurodiversity as a movement is part of that as well. So how much is that part of the story here that ADHD for some folks is just, hey, this is just a different way that the brain works. That, as you say, can have negative and positive effects. But, hey, why don't we just accommodate it, especially for children, instead of medicalizing it, labeling it, medicating it to such a big degree? So this is, I think, the question of our decade moving forward, especially about neurodevelopmental disorders like autism and

ADHD. So the neurodiversity movement started some years ago, really from the autism community. Yeah. Did Einstein have Asperger's, now called high-function ADHD? Did Thomas Edison? Lists of very creative people. Elon Musk, even self-professed on Saturday Night Live, et cetera, et cetera. So maybe being extremely male, analytic, and focused focused and maybe not as caring about relationships or as attuned to them isn't an illness. It's just a set of traits. And maybe under certain circumstances, and there's a lot of great work in the disability community now about getting young people, young adults with autism spectrum disorders into tech jobs because they do them better than neurotypical people in many ways, right? I agree with that. What do you tell the parent of the five-year-old

who's never spoken, has seizures, is mutilating, headbanging, and can't sit in a classroom for more than five minutes? Is that just a difference? I think it's a disorder, a disease or something by then. It's something that needs a more serious form of treatment. But it's what I said at the very beginning. It's all on a continuum. We don't have on the bell curve of all the traits we humans have a cutoff where you're this far out on the tail and beyond it, you're diseased or disordered and short of it, you're normal. It's just on a continuum. And ADHD is exactly the same in that way. So could we just accommodate? Well, remember, I mentioned early part of the interview, hunter-gatherer societies. Well, there would be no ADHD in such societies, right? Because there's no school and

everybody's out either foraging or hunting or preparing food for the next week. And do we get a monsoon or do we not? And yeah, but what if you're so impulsive and there's three arrows left and you misfire on all of them and the tribe goes hungry for a week. Maybe even in a non-modern, postmodern, industrial, educational society, there's a limit over which being impulsive is a problem. So back 60,000 years ago in the savannas of South Africa, would we have given Adderall? I don't know for a kid like that. Well, it might have helped you run faster if you needed to get away from a lion. But the argument today is if we just could accommodate, if you didn't have to, if the schools of today weren't like the one-room schoolhouses, rural America, mid-1800s, the British factory model, people can stand, people can choose activities.

I think that's good for everybody, especially people with ADHD. Would it eliminate the individual differences? Would there be some people, even in a more modern, fluid classroom that is activity-based, they're still going to have problems. At what point do you medicate? At what point do you accommodate? These are the questions of our era. It's not that I don't believe in the total social disability model, where if we just

accommodated, there'd be no illness or no disease. I think that's an extreme. But I also don't believe that any time you're a couple of percentage points on the peak of the bell curve, you've got an illness that's equally pernicious, and it robs us of our humanity, and it removes the diversity from our species that makes us thrive. I'd agree with you entirely. And I would never argue that, you know, there's no such thing as a condition that requires truly, you know, medical intervention. And, you know, I believe the folks, the accounts that I read, the folks I know who say these drugs have actually

helped me. It's a little bit difficult for me to say myself, because if you asked me at different points in my life, I would have said the drugs helped me. And then ask me a year later, I'd say, actually, I think I'm hooked on something that's making, making my life worse. And it's hard. It's hard to know. Yeah. And I'm only knowing you today. So maybe you developed enough skills that you really didn't need them anymore. Or maybe they did help you more than you now realize when you were in fifth grade or sixth grade or seventh grade. But after a while, you didn't need them as much anymore. Or maybe some milder accommodations to the classroom back then might have taken care of it.

Could be. Life doesn't have a rewind, unfortunately, but the issues you raise in bringing up your personal accounts and the issues society faces now about painkilling medication and about stimulant medication, SDRI medication are huge because it's going to determine the levels of productivity and happiness and thriving of everybody in society. Yeah. But do you fear that, I agree with you that there's a happy medium there that we need to find. But to me, it feels like we are, the end that we are on is that we are punishing too many kids, medicating too many kids, that we are not, you know, that when we catch a whiff of ADHD, we're assigning medication.

We've constructed a system where people are self-diagnosing as adults and receiving medication that they possibly don't need. Like that we have gone from not knowing this is a disorder to, you know, doing it. Seeing it everywhere. Seeing it everywhere. And that we need to pull it back. That, you know, I feel like I see the direction we need to go. I'm not entirely sure about that because I'm no expert, but I'm curious what you see. I see. So when Scheffler and I were writing the ADHD explosion and going into the Centers for Disease Control data, it's called the National

Survey of Children's Health, and it's been repeated every few years. And we broke it down state by state, region by region. And we, I'm not making up numbers here. There were regions in North Carolina, Arkansas, and Indiana where 35% of the middle schoolers had been, boys had been diagnosed with ADHD. It's crazy. It's not right. It is societal mores about medicalization run amok, and I knew we were in serious trouble. And so a lot of the research I do now, the book writing I do now, the speaking I do now, is to right the ship to demand appropriate diagnostic assessments and evidence-based treatments and don't take the meds any more than you need to. And it's also to remove the stigma.

Don't take the meds any more than you need to. And it's also to remove the stigma. So the other topic, if we had more time, we'd talk about is I grew up in a family with really serious mental illness. I grew up with a dad who had bipolar disorder from the time he was 16 until in his mid-50s, misdiagnosed with schizophrenia. He was absent for months or even a year at a time when I was a kid. I didn't know if he was alive or dead because the doctors told him and my mom back in Ohio, they both taught at Ohio State, if you ever tell your kids about your schizophrenia or whatever mental illness it was in your hospitalizations, the kids would be permanently destroyed. So, I grew up in an era where mental illness was so shameful it could never be talked about. I thought it was my

fault when my dad was gone. I internalized it. We've got to be open about our range of vulnerabilities, some of which are problems in living, some of which may border into or cross over into mental disorders. We need to be open about the best treatments. If we never talk about it and push it under the rug, everybody loses. If we over-medicalize and anybody two percentage points above or below the mean is the victim of an illness, we dehumanize and we cut off our human potential. So I think these are the issues of our 21st century. In fact, when I get on my high horse, I say, and of course, not that we're perfect on racism, given the events of the last couple of years, but with civil rights, with women's rights,

with sexual minority rights, transgender rights, the full rights of people with mental and neurodevelopmental disorders is one of the last frontiers for humanity, right yeah it's in order for people to live full lives and that means both not burying it and equally as much not seeing it everywhere and calling everybody diseased who doesn't fit a norm yeah i mean the way people talk about mental illness is still as though someone's a criminal when they say oh that person is mentally ill like i've heard people you know when people talk about social issues in los angeles for instance where i when they say, oh, that person is mentally ill. Like I've heard people, you know, when people talk about social issues in Los Angeles, for instance, where I live, they say that, oh, there's mental illness on this. Well, that means we should help folks if they have an

illness. They mean it as, no, this is a dangerous thing that we need to be frightened of. It's awful. Well, let me end here because we do need to come in for a landing. You know, for the folks who are listening to this, of which I'm sure there are many who are wondering, hey, I'm 30 years, however old they may be, they're adults, they're thinking, well, I have trouble focusing. I've wondered if I have ADHD, or I spoke to a psychiatrist, they said, maybe I did, should I take medication? Or I was diagnosed as a kid, how do I feel about that now? Like, folks who find themselves in that same liminal space that I have so much, what do you suggest they do? How do I feel about that now? Like folks who find themselves in that same liminal space that I have so much, what do you suggest they do? How do you suggest they think about, you know, finding

a solution that works for them so that they don't end up a either ignoring a problem that might be real or be taking fucking amphetamines that they might not need? Yeah. I mean, it's a very good and fair question. And I would say, even though I'm, as you can tell, very emotion laden about the whole topic of mental illness and stigma, try to be as scientific and objective about yourself as possible. Don't just rely on your views. Ask your partner, ask your friends, ask your parents if they're still around from x years ago ask your workmates have people been saying on the job for the last 10 years adam you're on the verge of being fired because you just don't listen to what anybody else says and i have to repeat four things after an office memo because you just don't get it

that would be a sign, even though you think the boss hasn't told you how to do it right, that'd be a sign that there may be an underlying ADHD issue there. And find somebody in your medical community or psychologist community who's an expert in diagnosing ADHD, not just that they had six weeks of residency training on it years or decades ago. The more objective you can be with yourself, everybody, I mean, there's a few people who have been perfectly focused their whole lives. I've never met them, but I'm sure there are. Everybody else fluctuates as situations change. ADHD is an extreme of such changes as situational demands, ebb and flow, get an objective diagnosis, do the testing.

It's not going to take 15 minutes. It might take a couple of hours. You might have to fill out checklists, have other people fill out checklists, get an honest opinion. And then, as you have done soul searching in your adult life, given what I've learned and my coping skills, what kinds of treatments do I really benefit from and which might be harmful to me? Yeah. Well, to that point, yeah, the evaluation I had done as an adult was, you know, I spoke with a woman for about, with a psychiatrist for about two hours about my personal history. Then they had me take an ADHD evaluation evaluation a personality test that was like 400

questions a an iq test which i don't even particularly believe in but it was once they explained to me what it was designed to evaluate and how they were using it i did feel it was helpful and then i talked to them more and then they wrote a you know an eight page report that synthesized all that information together and then i was able to speak with her for another hour. And, you know, we concluded looking at all these things and putting them next to each other, you know, here's what we do feel that you, we can say that you have this and what's the next step. And I found that a very responsible and helpful way to do it. It wasn't just half an hour. No, this wasn't fly by night. This was an evidence-based assessment. And, but that doesn't mean that you're not part of the equation. You get to choose what to do with that. Right. Yeah. Yeah. And that's and that's really wonderful. And and what are the things that, you know, you say not everyone needs medication. Right. It's helpful for some, but not for all. If folks have that evaluation, they say, I think I have it, but do I really need medication?

What are the other, we don't talk enough about what are the other things that can be done? So I'll start off with medication. Even if you do have ADHD, there's two main kinds of stimulants. There's the amphetamines, Adderall, Vyvanse, et cetera. And there's the methylphenidate class, Ritalin, Concerta, Focalin. They are somewhat different chemically. They both do the same thing. Nobody has a test to know whether you do best on class A or B or B or A. And nobody knows which dosage. It may take you a few weeks or even months to figure out, gee, I bombed on Adderall, but on Concerta, kind of a long-acting form of Ritalin,

I felt much calmer and better, and I didn't have the side effects. And many people, especially adults, get over-medicated, especially if they've got the form of ADHD that's more inattentive rather than rambunctious and impulsive. So be a scientist there. Make sure you've got the right dose and the right kind of medication. But in terms of other treatments for kids, kids with ADHD don't do very well going into a therapist's office and sitting down and analyzing their dreams or analyzing their play. They need action-oriented reward programs, meaningful consequences, and the teaching of academic skills and organizational skills. This wide class of behavioral parent training, behavioral classroom management. As you get older, to late adolescence and adulthood, CBT, cognitive behavior therapy.

How do you manage time? Many people with ADHD are bright and creative and a whole day's gone by and they think 10 minutes has gone by. There's a time management issue. You can teach those skills. Organiz organizational skills. A lot of people with ADHD get really frustrated when people don't like their ideas. And so there's anger management problems. There's effective psychological cognitive behavioral treatments, both individual and group that are evidence-based. They really work for people with ADHD, whether you're on medications or not.

Got it. So yeah, there's, I feel that somehow, you know, in my own life, I've been able to build that suite of tools. For the most part, I still struggle sometimes. I guess I should expect that we all, we all will. It was so funny, like, you know, taking the medication this last time, I had this hope that I would take it. You know what, I'm in my thirties now. Maybe I'll take it and I'll just have an easy day writing this script. You know what I mean? And it'll solve all my problems. And it didn't. And it's hard to give up that idea, you know, that there's going to be some magic fix, but you can make progress if you do these things. There's big progress if you do these things. Slow and steady wins the race. Kids with ADHD, people say, I'm going to try this new reward chart at home and get the teacher on board. And the kids in reading circle and the kids are sitting there 20 minutes and the kid with

ADHD sitting there for four. And so the first day of the program, they say, well, we expect Billy to sit for 20 minutes. No, the first day you expect him to sit for six minutes. No. The first day, you expect him to sit for six minutes, and then eight, and then 10. Slow and steady with ADHD wins the race. Small steps. You feel better about yourself. Other people around you see that you're working, and this is a long game. ADHD doesn't end when you're 12. That report you got, which sounds very thorough, you're going to have, Adam, some of these underlying tendencies the rest of your life, unless some miracle occurs. But it's how you cope with them, and it's how you deal with them, the kinds of skills you build.

That's what it's all about. Yeah. Well, thank you so much, Steve, for being on the show. The book is called, once again, The ADHD Explosion. The ADHD Explosion, Myths, Medication, Money, and Today's Push for Performance, Oxford Press 2014. If you want to pick it up, you can get a copy at our special bookstore, factuallypod.com slash books. And when you do, you'll be supporting not just this show,

but your local bookstore. Steve, thank you so much for joining us on the show. Really can't thank you enough. This has helped me learn a lot about myself as well. Well, thanks for the great questions and it was a delight. Well, thank you once again to Stephen Hinshaw for coming on the show. I can't thank him enough for helping me think through this. His book, once again, is called The ADHD Explosion, and you can get it at our special bookshop, factuallypod.com books. That's factuallypod.com books. And when you buy a book there, you'll be supporting not just this show, but your local bookstore as well. Thank you so much once again for listening. I want to thank our producers, Sam Roudman and Chelsea Jacobson,

Ryan Connor, our engineer, Andrew WK for our theme song. You can find me online at adamconover.net or at Adam Conover, wherever you get your social media. If you have a comment on the show or a topic you'd like to see us cover, send me an email at factually at AdamConover.net. I do read and reply to emails. And thank you so much for listening. We'll see you next week on Factually. that was a hate gun podcast