This is a really interesting paper. It really got into the mind of what it was to have ADHD. They would ask, are you putting something off right now? Ouch. Shh. Do you trust your feelings? And that's almost like a therapy conversation as well. If we can't sort of catch that emotion before it becomes this big giant thing, then our coping stuff isn't going to work. And this is the part where I really felt called out. It's a really great thing to see a paper that is looking at this.

Hello and welcome to a very special episode of the ADHD Research Recap. This is going to be the first one that we do which is live or at least live for us. The members of the ADHD Academy are going to be in here and chatting with us and hopefully they will be answering some of the questions that you always want us to answer when we're going through this research.

Avoidant Automatic Thoughts are Associated with Task Avoidance and Inattention in the Moment.

So we're going to go through two really interesting papers, particularly the first one about avoidant automatic thoughts. I felt personally called out by this paper, but in a good way. And then we're going to be talking about familial associations between ADHD and autism when it comes to genetics and family factors. And we'll be talking about the need for more studies in that case. So I'm excited to get into it today. Yeah, let's get started. Okay, so the first paper that we have is from the Journal of Cognitive Therapy and Research, looking at avoidant automatic thoughts and their association with task avoidance and inattention in the moment. And this is a really, really interesting paper. It really got into the mind of what it was to have ADHD. What they wanted to do was they wanted to look at the relationship between ADHD symptoms, avoidant automatic thoughts, emotions, and inattention. They wanted to see whether overly positive thoughts might be associated with avoiding something as well as overly negative thoughts, which is kind of what we tend to think about when we think about avoiding things. And particularly whether that was a factor for ADHD. Sarah, do you want to describe what avoidant automatic thoughts were based on their definition? This was a really interesting study, basically endeavored to create this construct of the avoidant automatic thoughts. They define it here as spontaneously arising thoughts about delaying the starting or ending of an activity that tends to be believed by the person thinking them. So basically like you have a random thought, you're like, oh, I could just take a little bit more time on here. That's it keeps you away from the next thing that you could be doing. Yeah, what's really interesting here is that they didn't qualify the emotional affect of the thought. So it could be a negative or a positive thought under this definition. Yeah, exactly. They did see the thought as being something that reduces a feeling. They had a great example of this, which is a researcher looking at her task list, seeing an item like working on a manuscript draft, which by the way, we would totally recommend you sub task for this exact reason, feeling a negative effect such as anxiety, or they said a mild form of disgust, which I thought was quite an interesting feeling, but yeah, not untrue. And then thinking, I have time to work on this tomorrow, which disengages that negative effect and results in a failure to engage in the task itself. And this is the part where I really felt called out. They say, in the short term, the thought behavior is reinforced, but in the longer term, the aversive task, in this case, working on the manuscript draft, remains, it becomes potentially more overwhelming. Ouch. And I think we all can think of a few times when that has been the case. Absolutely. Yeah, I mean, it sort of is a call out to the wall of awful. Yes, exactly. Right. It's definitely a wall of awful. And so all of the strategies, you know, the getting focused routine, breaking things down, these are all ways to get through that thought. But in this piece of research, they're really focusing on that wall of awful. I mean, that's. You're exactly right. So how did they measure that wall in terms of the avoidant tasks, Sarah? They had a number of different scales and measures that they used for each of these variables. They did sort of a baseline survey for everyone, the Berkeley scale, self-report, ADHD scale. They had an affect scale, which basically just is meant to measure how you're feeling. And they took the positive. emotions and the negative emotions and combined the two groups. So there were only two instead of four Really just trying to group it all together the avoidant and automatic thoughts There was actually a scale already developed for this Maybe the authors of this study just didn't like their definition of avoidant automatic thoughts But I was able to find that scale and it was really cool It's basically a list of statements and you're meant to say how relatable this is for you personally and so one of them is like Do you ever think, I'll just do this one thing first? Do you ever think, I have plenty of time, I'll just do one more thing before I go? These are all sort of things that we talk about all the time with transitions. Yeah, so it was really interesting to see them in a avoidant thoughts context. Yeah, so that was also a scale that they used. They measured task avoidance by a question at each interval, they would ask, are you putting something off right now? Yeah, which was good. Yeah, I mean, it's really cool because they were asking these like in the moment surveys. Yeah, they had to do the survey three times a day for six days. So that was in the morning, the afternoon, the evening, they were sent text reminders at these intervals. And they had to respond within two hours or the link would expire, which was very cool. And that was called ecological momentary assessment. Just what did you feel? What were you avoiding right now? Yeah, I had never heard of that kind of a study before. And basically what I saw is that it's meant to reduce the report bias that can come from survey-based studies. It was really cool that they added that extra like urgency to complete the thing, you know, like, oh, now we're never. Yeah, I thought that was super cool. Yeah, you got the feeling, although they don't specifically say it, that the people who wrote this paper understood ADHD the ADHD community reasonably well. They had a potential sense of it, basically. I do want to mention this study was done on college-age students, so 18 to 22. It was 101 of them, so relatively small sample size, but not terrible. Seven of them reported having previously been diagnosed with ADHD, but again, they sort of gave everybody the self-rating scale for ADHD and measured. symptoms in that way. But because there were such a low number of ADHD participants in the sample, that meant that they weren't able to really look at how specific ADHD symptoms moderated or affected the relationships between the other variables. So they couldn't reliably say, if you had an avoidant automatic thought at one interval, then you would definitely have it at another interval. All of those sort of analyses were really just too weak to even mention. Yeah. Although they did. Sounds rude. Well, it was an interesting point, you know, and I think they did a really great job here, but I did wonder, and this is just a question for you, cause maybe this is true. If somebody sent you a message three times a day and they said, right now, are you thinking, oh, I could do this later. Or I don't need to do this right now. How often would you accurately know that information? And this is more of a question about the idea of automatic thoughts. I think they did a really great job. I don't actually think that they could have done better in terms of what I know from research, but given working memory struggles with ADHD and, you know, automatic thoughts being automatic and hard to sort of capture, I do wonder sometimes if it's hard to even uncover that you're doing that. Yeah, I definitely see what you're saying. The ways that they measured it were those questions. the ones that I mentioned before, and then asking about the emotions that they were feeling at the time. The reason why they measured this at three times a day is because I think they were really trying to capture as much of it as possible. Yeah. And they probably did, but possibly maybe a little bit of underreporting potentially going on as well. I mean, that's the downfall of every survey ever. Exactly. Exactly. I'm not in any way saying it's... Yeah, because there's always also that personal bias, like how you feel about yourself is going to impact how you answer surveys. Yeah, it's a tricky one because on the one hand, yeah, maybe there's underreporting, but on the other hand, maybe with ADHD, we just we feel like we're always putting something off. So the answer is always going to be yes. So it could be. Yeah. Yeah. Could be either. Well, actually, that's a really great segue. Like let's get into what they found because they found those automatic avoidant thoughts captured at 53% of all intervals. A.M. E.M. afternoon for six days. Yup. And then 97% of the participants at least once captured an AAT, which is really high. Yeah. Alternate like on the flip side, 8% of the sample reported automatic and avoidant thoughts at every interval. And like my heart goes out to those people. They're working with students. I can imagine that I can see how that would occur. So what did they find specifically? So specifically they found that the avoidant automatic thoughts were associated with greater task avoidance and inattention. And again, they looked at task avoidance by asking if you are currently putting something off. And the inattention was measured using the Berkeley scale. And sort of they looked at this in terms of like the overall data. And then they also looked at it like each individual moment and each interval. And both ways came out to have significant relationships. Yeah, that makes sense. That makes very much sense. I mean, one. based on the raw data and then to yeah, it makes sense that it was significant. In terms of how they stay identified people with ADHD, was that based on diagnosis? Was that based on personal? You know, do you think you have ADHD? How did they measure ADHD? Yeah. So seven people reported that they had an ADHD diagnosis, and then they also just used the Berkeley self-report scale to also measure symptoms. Yeah. So it was a self-report scale. It was a pretty good one, but it was, it was a self-report scale as well. Yeah. It was all self-report scales. Yeah. So in terms of what this means, well, let's talk about some of the limitations that we can move on to the practical implications. And we have a question from one of our audience as well, that we'll answer. So the biggest limitation that they found was that they were talking to people very, very much a student sample. And they felt that that limited the generalizability for the rest of the population. As someone who's not 19, I feel that they were completely accurate based on my life. But... And you know what it's like to have ADHD. I think they nailed it. But what do you think, Sarah? I think it would be super cool to see this duplicated in a larger population. People with more variety in their life situations, I think would be helpful. But, Sky, I went looking for the scale that they used because it was like, wow, what were the questions that they were asking though? And it turns out that they were pretty aggressive. I mean, I'm just going to throw another one out there. How much do you relate to this statement? Though this usually sucks me in, I'll just do it for a minute. You know, that was one of the questions that they asked. Exactly. But it was really great. I really appreciated that they were trying to... come up with a new construct for ADHD and a new way of talking about how the brain works here because they pointed out that the research tends to focus only on the negative thoughts, the negative automatic thoughts. We usually just call that negative self-talk, but there's also those overly positive ones as well. We usually call that unrealistic expectations. Or timeliness. Exactly. Sure. I think the practical implications are very, very high for this because it really does outline exactly how your brain works if you have ADHD or how it can work. In terms of the implications, it's really about how to manage that. They talked about CBT strategies being targeted towards negative thought patterns and one of the questions that we got asked was, okay, but then what do we do as adults about these negative strategies? In terms of the overly negative thinking, that's more of a mental health support. But in terms of the positive thinking, although I'm sure mental health support can be very helpful, that's an area where ADHD coaching really can be a beneficial factor because one of the main things we do with ADHD coaching is we sort of do look at those positive emotions because we're talking about externalizing time, supporting transition times, all of these things. showcasing an ADHD friendly planner. And all of that is set up to show how time is moving, to show you how you're going from one task to another, to kind of avoid, first of all, that feeling of resistance entirely, that wall of awful, you know, reducing it. And second of all, having it be like, well, I can't do it tomorrow because I actually do know that it's going to take this many hours and I don't have that time tomorrow to kind of help avoid some of that overwhelm. it teaches us that, you know, while we think, oh, yeah, let me just do this, I'm about to finish it. If you have transition time set up, if you have all of those bits and pieces, you'll, you'll know that's not the case. So I think that's probably my answer to that question. Yeah, that's really true. Also, you know, we talk a lot about emotional self regulation. And, you know, a lot of that really just comes from sort of mindfulness talk. So in this case, because of this overly positive thought you're having, you sort of delay that self-regulation strategy, you know, or like, oh, I don't need this right now, or like, I could just power through this. But really what we could be doing instead is just sort of building in a pause there so that the emotional stimulus can sort of go away, that thought can sort of dissipate, and then we can top down regulation, we can like choose. from our logical brain instead of from our emotional sort of reactive brain. And that is just something that we're not good at. We are not programmed with that pause button, but we can sort of build it. Um, it's like any muscle. It's not a real muscle. That's a metaphor. Yeah. Um, but yeah, like being able to sort of look at something from a not emotional state would probably help be able to trust yourself. Yeah. And if you're struggling with the sort of wall of awful, that idea of not wanting to get started and having those avoidant thoughts as a result of that. I would highly recommend trying our get in focus routine. I don't usually talk about specific things you can try on this podcast, but I think that is so specifically helpful and designed to help exactly what we are talking about right now that it's worth mentioning because it's literally about. taking it step by step to go through and go, okay, well, I could put this off right now, or I could add some dopamine to this task, and then I could write out the subtasks of this task, and so on and so on until you're basically starting the task anyway. So yeah, I would definitely recommend that. But overall, really great paper. I'd love to see more papers like this. It's hard to explain, but anyone who kind of wants to delve into what it's like to have ADHD, more broader examination of the populations and how we exhibit behaviors to outside people, if that makes sense. Those papers are so great because a lot of papers are looking at the outcomes. So the idea of not doing as well at school or at work, that kind of thing. But this paper really delved into how our brain works before we even get to not passing a class or not completing something at work. And I really appreciated that because that is how to solve those things often is to start at the beginning rather than look at the end. Yeah, it's very much about like the subjective experience of having ADHD. Like I hear all the time, it's so hard for me to explain what it's like to other people. It's like, yes, because we could say one of those statements from the questionnaire to somebody else and they may be like, what? Like people think like this. That's like, yes. Exactly. All they could be like, well, everybody thinks like this a little bit of it. Sure. A little bit of time. And you'd be like, but what about the time of six days? What about a hundred percent of the time? Gosh. Like I'm still thinking about those eight people. Yeah, that's so true. Shout out to those eight people who are clearly studying for an exam or something.

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Yeah, this member of the Academy, you're pretty much nailing it here. You know, you say I have a nagging sense of doom, but it will take me ages to even pin down what that is about. So maybe we are putting something off. I mean, I think this is, again, they mentioned the student population was It's not so generalizable because you know often what you're putting off when you're in school because it's the assignment that you're not doing. But if you're in adults, there's lots of things you could be putting off. You could be putting off a bill that you've sort of forgotten about it. You could be putting off getting some just maintenance thing that you know is going to cost you thousands of dollars down the line if you don't do it, but you put it off and that can contribute to that nagging sense of doom without actually. being in your conscious brain. Yeah, I mean, I definitely understand the working memory aspect that's going on here. But I also feel like this might be important to discuss, especially with ADHD, we sort of have to train ourselves at some point not to trust how we feel, because it's not what we're supposed to be doing. That's not what other people are expecting or like, Oh, I better calm myself down so that they don't think I'm weird or like, whatever. So we just sort of train ourselves to ignore those sensations. that are associated with the feeling. And the sensations are actually like the warning signs of a really intense emotion building. And if we can't sort of catch that emotion before it becomes this big giant thing, then our coping stuff isn't gonna work and we're just gonna have a really bad time. And yeah, it just takes a while. And it takes longer, you gotta self-regulate. I mean, I think you're totally right. It really comes down to, you know, do you trust your, your feelings, you know, how much and why, and that's almost like a therapy conversation as well. But to that end, I think I agree with your point, Sarah, which is mindfulness practicing mindfulness, even for a few seconds a day. And I say seconds because that's, that's how I'm starting. Honestly is a great way to start to bring. more things into your awareness. And that might help you get to a space where you can actually acknowledge or identify if you're experiencing those automatic task avoidant thoughts. Yeah, I mean, even a sort of modified mindfulness practice has research backing it up to show that it does help improve over the long term. There are studies where they sort of follow up with people who've done like a short little program six months later and they still have sort of improvements in their life. So 10 seconds, three seconds, whatever it takes. Yeah. But I definitely agree. I think it's an interesting conversation to have about ADHD, working memory, a lot of other factors leading to the fact that our thoughts aren't necessarily just there to be identified very easily if asked, if we're even aware that we're having thoughts. Yeah, that's interesting too, because it reminds me of that thing like, can you close your eyes and picture an apple, but with voices in your head. Yeah. Like we're not crazy. I would recommend anybody doing this to like actually try and listen to your thoughts and see if you can identify any avoidant thoughts over the next couple of days. Let us know. Can you do this? Is this a struggle? Because it's a huge, you know, it's a really great thing to see a paper that. is looking at this. And so I want to be incredibly supportive. But at the same time, you know, we do have to go, okay, well, is this actually capturing the ADHD population? Or is there a sort of adjustment that needs to be made in the next paper that can do that specifically? Do they all have to practice mindfulness for like a month before they even do the study as part of the study? To make sure that your data is correct? Yeah, yeah, definitely.

Association between cumulative psychosocial adversity in the family and ADHD and autism: a family-based cohort study.

Looking at the association between cumulative psychosocial adversity in the family and ADHD and autism. This was a family-based cohort study. And we're going to focus particularly on the ADHD side, cause that's what we look at, but also because that's kind of what they ended up looking at as well. What their research question was, was they wanted to know whether early psychosocial adversity, which we'll define in a minute, led to ADHD or ASD. And they wanted to see whether there was a causal effect or whether there was some kind of, what they called familial confounding, which means is it genetically related? And that might be what's going on. So can you take a minute, Sarah, and just sort of explain what psychosocial adversity is? Yeah, so in this study, they sort of looked at psychosocial adversity through divorce. parental financial problems, low education, psychiatric history, criminal conviction, parental bereavement, so like if a parent loses someone, a first degree relative, they say, or if you have a large family size, which means four or more children in the immediate family. Which was a little funny. My husband has five kids in the family, so I thought it was quite funny. So yeah, those were the different adversity aspects. Right. So they were looking at all of those two. So basically what they did was they developed an index. So if you experienced zero of those things in the first year of your life, then no risk. You're great. But then that went all the way up to sort of experiencing four or five of these psychosocial events. Yeah. And they called that something specific. They called it like dose specific. So they were sort of looking at The cumulative effects. Right. That's more when we get into the analysis of it. They were looking at each individual gap. So they were looking at how people did who had zero of those factors. Then they were looking at how people did who had one of those factors. And then two, and three, and four, and five, nobody was exposed to six or more. So that's nice. But five is still a lot. And so the dose-dependent thing means basically between intervals, like what was the impact. Okay, that makes sense. And in terms of what we were looking at, I mean, there was a lot of participants for this study. This study was from Sweden. Shout out to the Sweden study coming in hot again with their giant population. They had over a million participants born between the 1st of January 1990 and the 31st of December 2009. That was a lot of people that were in the study. So how did they do this study, Sarah? I'm assuming it was a survey of some kind. So actually all of the data here is pulled from various population based registers. So there's more than one, there's one on like medical data and like other things that they were looking at, but basically these are mandatory for all of the citizens of Sweden, they have to sort of update their information. Yeah. So then they pull the data and use it for research, which is cool. Yeah. They followed the data until 2013. So basically that's sort of when they stopped collecting, started analyzing, but that means that the average amount of time or the median average amount of time in between initial and follow-up was 13.8 years. It looked to me like they were only looking at two points in time, which is fine. I think with almost 2 million people, it would have been crazy to look at more than that. There were some populations that they excluded from this study. So anyone who obviously was stillborn, congenital malformation, if they were twins, which I think is interesting, but I guess they used them for a different study. Yeah, we talked about that last week. Yeah, yeah, exactly. And then sort of anyone who died or left the country in the first year of their life, because then they weren't going to be able to catch that information about the outcome after their first year of life. Exactly. And speaking of the outcome, so what did they find when they were looking at this population? It's a little bit hard to answer just because they ran the analysis in a few different ways. So when they looked at the general population, so they like crunched all of the numbers, everybody's in one large group, they found that for each additional bad thing, there was a 41% increase in risk of developing ADHD, big air quotes, though these associations were weaker when they ran this information again in the family subgroups. And so what I mean by family subgroups is they had the general population, that's everybody. And then they also had only full siblings and analyzed their information. They looked at only half siblings and that was a subgroup. And then they looked at full cousins and that was a subgroup. And the reason why they did that is because they were trying to determine the genetic influence. They don't talk about genetics really in this paper. They call it familial confounding, which I've been calling a third option. Yeah. Yeah, which was interesting. They sort of talked about genetics a lot without talking about genetics in some ways. Yeah, but because they ran those groups, they found that actually, I'm going to air quotes again, the risk of developing ADHD or autism was similar among families. Okay. Yeah, it had less to do with the experiences that people had. Yeah. bit of a turn in some ways. It felt a little bit like twist at the end kind of story writing because they came in going, right, we want to look at psychosocial factors. And then they were like, Oh, actually, this familial confounding is a bigger factor anyway. So really what this paper is about is the fact that we should be doing more research into genetics in ADHD because really that's. what this is about potentially. So it did feel a little bit like, oh, okay. Yeah, great. But like, yeah, it was like you had me in the first half. We were chatting about this before we came on because Sky was like, what did you think? You know, it always gets that way when we're talking about the cause of ADHD or autism. But I just pointed her directly to the last sentence of this paper, which I'm going to share with everyone because I don't think this one was open access. we advocate for using family-based designs or other genetically informative designs to account for unmeasured familial confounding when conducting studies on the etiology of ADHD and autism. Yeah, it felt like sort of they had to prove that the thing didn't exist in order to get more buy-in for these arguably more intensive genetic studies. I think that's very true. And when you have a population of a million and you can do a survey, and kind of get a sense of what is going on here. It makes sense to do it, to then indicate that more research needs to be done. In particular, they said there was an interesting quote that for adults with ADHD, due to their genetic predisposition, they tend to experience more adverse life events. And that's kind of what we were talking about was the chicken or the egg. Is it that you have adverse life events because your parents have ADHD or is it that ADHD is? causing, and again air quotes there, the ADHD itself, or is it a mix of the two? So definitely more genetic research needed there. The other thing that this study didn't do at all was look at what are the different types of familial confounding? What is that then? Yep. So that's just a whole other area that needs to be explored that's just not. Yeah, and partially it's like you said, it's quite hard to do genetically, but definitely. Definitely keen to read those papers for sure. Cool. Well, really, really great session today, going through these different papers. Very exciting. And thank you so much to everybody who joined us in the ADHD Academy, came along as a listener or participated in the chat. I see your messages here. I'm sure we'll continue this conversation over in the ADHD Academy. And if you want to join the ADHD Academy and be part of the conversation, you can always find the link down below. Well, thank you so much everybody. And we'll see you later. Bye. Thank you. Bye.

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