Hi, we are the ADHD Skills Lab podcast. My name is Skye. And my name is Sarah. And we will be your hosts, chatting to you about practical ADHD strategies you can use, the research behind some of these strategies, as well as interviewing other professionals with ADHD about how they've developed skills and working through struggles in their lives. You might know us from Unconventional Organization, where we talk about this kind of stuff all day long. So we're super excited to have you along and we're going to chat through it together.

Awesome. So this week we are going to be talking about three interesting studies. The first one's looking at the brain and differences in brain function, which is always something that we really enjoy. The second one that we have is looking at the pathway from ADHD to depression in adolescence, but there's some limitations to that study that we'll get into. That means it's not necessarily saying what it might be. from the title. And then the third one is looking at predictors of quality of life in adults with and without ADHD. And we'll be talking a little bit about what that is, what that means and what we might be able to do with ADHD to improve our quality of life because it's always a bit depressing when you get a study that basically says your quality of life tends to decrease and there's definitely strategies and helpful things we can do to help with that. So we'll be talking about that and our own experiences as well.

Genetic overlap between midfrontal theta signals and ADHD and ASD in a longitudinal twin cohort

Okay. So Sarah, do you want to start us off with the first paper? So the first paper is looking at brain signals and some of the genetic overlaps in twins, which was very cool with ADHD and ASD. Yeah. So this was a really great study. It sort of required a little bit of legwork before I could really get into it. You know, there were the mid frontal theta abbreviation and I went, Oh gosh, what is that? Um, yeah, I had to rewatch the videos. Right. So full disclaimer, like we are not neuroscientists. This is just sort of fascinating to me, which is how I'm able to motivate myself to do some of this legwork. But yeah, it was really a fascinating study. So this one is sort of a longitudinal study. They look at their groups sort of 11 years apart and they, they did the study on twins. So identical and fraternal, they didn't really discriminate. The sample size was 566, pretty even male to female split, which I really appreciated. And of those, sort of 111 met the criteria for ADHD. So how did they measure that criteria? Cause we always want to check that. Sure. Yeah, no, that's a great question. So at age 11, so that was sort of the first time that they met up with this group. It was- the ADHD parental questionnaire, which is pretty standard for a childhood diagnosis. And then when they came back at age 22, they interviewed all of the participants. And so it was basically someone who's qualified to diagnose. Yeah, yeah, definitely. So what were they looking for specifically with these brain scans? So what they were doing is they're hooking you up to this fancy machine, you know, the EEG, and they were having you do these computer tests. So they were essentially just looking for your ability to control, like the cognitive control structures. Um, and so this specific test was something like, you know, it would show you an arrow and you'd have to press the corresponding button on the keyboard. That looked hard. Actually, they had like those outer arrows that were going in opposite directions from the mid arrow and you had to focus on the arrow in the middle and not get distracted. I did look at the pictures of that and be like, Oh, that would not have. That would not have been easy. You know what? I had mixed feelings. So like if I was in the zone and I was really just able to only focus on the middle and block everything else out, it could have been all right. But yeah, that really just sort of depends on the mood you're in, you know, can't manufacture hyper-focuses. Definitely, definitely. But yeah, so they were just looking at sort of what portions of the brain were lighting up when you were doing that. And so with those twins, some of them would have had ADHD, some of them would have had. ASD, they also had both, which was pretty cool, you know, because we talked before about that diagnosis. Did they say anything about whether twins were more likely to both have neurodiversities? Did that come up? Oh, I actually didn't notice that at all. Um, yeah, I was just curious because sometimes that's something that comes up, people are looking at like the genetic connection and we know ADHD is connected, um, genetically. Yeah, I mean, that's really a good point. I didn't notice that anywhere in the study. But actually, we probably should mention that while this study has not been peer reviewed, it has been accepted by a reputable journal, which is the Journal of Biological Psychiatry. Yeah, so it's already sort of been received, they revised it, they accepted it again, it will now be peer reviewed at this point. So we've got research that hasn't even hasn't even necessarily hit the peer review yet, but yeah, no, that's good. Yeah, and you know what? The format of the study is also a little bit lacking. It's sort of not what I'm used to looking at when we're reading an academic paper. Like it doesn't even have sections. It was definitely a tougher read. It was, if any of you get through this paper, just tell us. I will send you a personal message being like, congratulations. So what they found was really interesting was basically that the way that the responses were shown with those theta waves in the brain was really similar when you had ADHD and ASD. They did look at both. We're focusing on ADHD, whether you were at age 11 or at age 22. So there was a consistency there that I think... speaks to this concept of what they said, these relationships were stable across time. There's a core dysregulation of the control processes in ADHD, and that didn't seem to dissipate when people were older. And I think that that's really interesting because we get a lot of questions often about ADHD, does it go away with age? And again, it's really hard to tell because we're looking at two very different people. I mean, if I remember what it was like at 11 and honestly at 22, cause they're both in the past now, there was a very different people. So it was interesting. Yeah. This was really intense. They found a lot of really technical things, you know, cause they also were looking at sort of error processing and sort of your ability to detect when you've made an error and things like that. But yeah, basically the core of these results is really, they were just trying to see whether or not the two age groups would be similar. In fact, when you look at the graphs that they provide for this, there's not a lot of variation. Everything is around the same types of curves, which is really interesting. Yeah. What that's basically showing is how people with ADHD respond to doing that kind of test where you're looking at those arrows and you're trying to click on it and you're trying to switch. how well we do that or how well we don't do that stays pretty consistent across time. And that's a good indicator of our attention in general. Although Sarah, you did mention there was something interesting about how adults reacted to doing that test versus people who were younger, which I thought was interesting about the idea that adults were more likely to be like, oops, I made a mistake. Yeah, it was, it was when they were looking at like when you made a mistake, the adults sort of were able to recognize that. Whereas the children were not, and that was the same across all of the groups. So the ASD and the control group as well, which led them to think that it's probably just a childhood development thing. Yeah, which is cool. I mean, I think that it's also funny because if we think about all the papers that we've talked about how we respond to making a mistake as adults with ADHD. That can be quite an emotionally triggering thing for us sometimes, depending on our experiences. And we're actually going to talk about that pretty soon in one of the next papers. So in terms of, you know, that idea, maybe it's sort of to say like, Hey, like, hopefully something that we've learned as an adult is that we've learned how to be like, oops, didn't see that. Oh, well, that's fine. You know, that's my ADHD and I have coping strategies for that now. conscious coping strategies. Cause a lot of these are looking at more like our unconscious automatic responses, which seem to be similar, but we do have more skills. Hopefully now as adults and better ways of managing our environment and also feeling how about all the mistakes, all those really fun mistakes that we make that we can see on ThetaWave is with EEGs apparently. In terms of the sort of overall impact, what do you think that impact of this kind of study is? really what they say is just that we need to have a deeper investigation into like symptoms that you have when you're a childhood to see if they still exist in adulthood as well. So they made the call for future research to investigate the impacts that this has to people's quality of life, which is really interesting considering what some of the next studies are about, as well as sort of a functional impairment. So that's like life skills, you know, work and school performance and things like that. So sort of, they basically just want future research to investigate more, not just people doing a silly computer task, basically. So go in more depth in terms of like, okay, that's one way to measure this, but let's look at it in more depth because you're right. Like I have never done that task as an adult or as a child. I don't expect to do it anytime soon. It may hint at something I do in real life, but it's definitely not measuring it accurately, but yeah, no, definitely. And there was no conflict of interest or financial funding that we found. There was an interesting overlap here between ASD and ADHD, which was a little bit tricky to, to determine. And I think the important thing is just that whether it was ASD or whether it was ADHD or whether it was both, it seemed to be consistent across time. Yeah, that's, that's a really good point because of the way that they used the twin groups, it became really difficult for them to like control for that in any way. but they did have a control group, which was good. So the other thing that they mentioned is that they basically just wished that they had a larger sample size because that always leads to like improved validity. But honestly, for a longitudinal study of this type, they got a lot of people to come back. So. 566 people and how many came back? They had 119 identical twins, 164 fraternal twins. And 111 met criteria for ADHD with 47 meeting the criteria for ASD and 16 for both. I will say shout out to all the people who came back and did two EEG tests, one in childhood and one in adulthood, because that's consistency, that on its own, it's consistency regardless of what you did in the actual test.

Impairment’s Role in the Pathway From Externalizing Psychopathology to Depressive Symptoms in Adolescents With ADHD

So the second paper, you know, we just talked a little bit about the control group in the first paper and the second paper. I will flag right from the beginning, doesn't have a control group. And we're going to talk a little bit about that. But they basically focused on this concept of, is there a pathway between what they called externalizing psychopathology, which basically means ADHD. They had a bit of ODD thrown in there, which is oppositional defiance disorder. And the idea that it could be linked to depressive symptoms. in adolescence with ADHD. So they did a big correlational study essentially on that. And yeah, Sarah, do you want to take us a little bit more into what they were trying to find essentially here? Sure. So the whole point of this paper, as it seems, is that they were trying to look at the role of academic, social and family impairment. as it relates to externalizing psychopathology, which is just sort of symptoms of externalizing your emotions, it seems like, and that relationship to the development of depression or sort of like existing depression scores among young adolescents with ADHD. So the reason why there's no control group is that they took a clinical sample of 326 middle school students enrolled in an ADHD intervention. For people who are not in the United States, I don't know if you guys have middle school, but it's sort of like the, it's like 11 year olds to 13. It's sort of before you get to high school. Oh, that would be intermediate school in New Zealand. So it's like kids all in puberty and stuff as well. Gosh, that was a wild time to be alive. Yeah, that was a wild time to be alive thinking back to my intermediate middle school experience. I'm glad I wasn't involved in this study. Um, yeah, so basically this study is, it's all sort of surveys. There's one self-report, there's parent report surveys as well. So I think before we get into what they found in terms of this connection between what they're sort of classing as ADHD, but also oppositional defiance disorder, and for those of you who don't know what oppositional defiance disorder is, should we just have a quick definition of that? It's a childhood behavioral problems characterized by constant disobedience and hostility. So acting out essentially is kind of what they're looking at. And if you look for the three symptoms, it would be anger, irritability, arguing and defiance. And it's something that especially in kids gets diagnosed pretty highly correlated with ADHD when we're doing childhood diagnosis. And there's always some controversy around it, I will say. We don't really talk about it much because we don't work with kids and we don't... We work with ADHD, but I do know enough to know that there's some controversy around ODD diagnosis and ADHD diagnosis, honestly. So both. So they were looking for symptoms, right? So it's like things related to what could be considered to be oppositional defiance disorder, not an actual diagnosis of it. That's absolutely right. Yeah. There were no actual diagnoses taken into account here except for probably the ADHD diagnosis. Was there actually evidence of that in the paper? I'm always curious to know, did they bring in, I guess they were in there for an ADHD intervention. So it doesn't explicitly say whether or not they independently checked for an ADHD diagnosis, but it does say in the paper that all of their entire sample came from a school-based intervention for ADHD, which basically means that they would have needed a medical diagnosis in order to access. that intervention, we can be quite strict with stuff like that. Yeah. So it's somewhat, it's basically implied at that point. Yeah. So there were a number of surveys done, but I think it's really important to recognize which of these surveys were done by the students, which of these surveys we've done by the teachers, which of these surveys were done by the parents, similar to how we would with all of our studies. So the depression, whether you felt depressed, essentially that was done by the students, but whether there was conflict with the parents that paper was done by the parents, not by the students. So they didn't check it with the students. And they also didn't seem to check it with the teachers. Did they check it with the teachers as well? No. Yeah, which was interesting. Yeah. Yeah, the only time they checked in with the teachers is about the ADHD diagnosis. That's just part of how we diagnose kits with ADHD here. Yeah, that makes sense. So basically it's interesting because they have this, they draw this kind of map, if you will, where they. have this link between ODD symptoms and this link between ADHD symptoms and this link between conflict and this link between depression, but all of the different measures are all correlational measures and they're all being done by different people and there's no control group. So I think that's really just a really good basis to have for this study. Yeah, so they found that among the adolescents with ADHD, conflict with parents seemed to be responsible. at least partially responsible for the relationship between the aggressive and the rule-breaking symptoms and depression. They found a pretty clear relationship between aggression and rule-breaking symptoms and scores of depression. Basically, it seems like the conflict with parents measure is response. Mediator. Yeah. That's a great way of putting it. Yeah. Where does the ADHD come into that? Because did they just roll the ADHD into? The ODD at that point, was it separated? That's a good point. Because it's not the same thing. Yeah, I mean, I don't even think it really came into play at all because everybody in the study had ADHD. Of course, of course, that makes sense. It is still kind of interesting that it wasn't a connection. Yeah. So they sort of looked at the group of ADHD people and then they just looked at the... Yeah, their relationship with their parents and... Okay. Yeah. So in terms of takeaways for this, this paper, from our perspective, and we're not the be-all and end-all of this, so if you did write this or you know somebody who did, as always, please reach out. We'd love to chat to you. This paper didn't have any control groups, so it's really hard to know if they're looking at something that's specific to ADHD or if they're just looking at how parents and kids react and what that means for depression. They also didn't ask anybody except the parents if there was conflict. So different parental expectations of conflict and what that looks like and rule breaking and what that looks like are likely to have come into play here as well. So while the study postulated a connection, this is not the paper that I would use to make any decisions about ADHD depression and oppositional defined disorder. If anything, it really stands as a reminder of make sure you check where the research is going. It's going to be one of those papers guys, but make sure you check your research paper. Yeah. I mean, they even mentioned that 166 participants had missing data on at least one variable, which is, they said it was common for schools though, which I thought was really interesting. That's fair, but that's just under half their sample. Yeah. Yeah, definitely. Definitely. So, so an interesting paper and one that we wanted to flag because this is something that comes up a lot and I think it's always important. to just remind people that, yeah, if you are talking about these kinds of topics, just make sure that the research is, because this is a peer reviewed paper that was published this year about this topic. So, you know, it's always good to just have a little check or maybe get somebody to have a listen to this podcast and see, see if the paper says what we think it does and what are the limitations of that. And if you have a child with ADHD, I know Sarah, you had some practical takeaways. from your own experience with kids experiences being at home versus at school and what work it can be to be at school with ADHD? Yeah, absolutely. I mean, we just went through the diagnostic process with my nine-year-old this year. And I can just say they sort of let me look at all the rating scales once we were done. And I just thought it was so interesting that my survey and the teacher's survey painted a very different picture of a child. And the doctor even addressed that and said, sort of, we would expect to see this. You know, when kids are at school, they understand that the expectation is blah, blah. And then when they get home, all of those expectations are kind of gone and they can finally take that mask off. And even sort of when I'd asked him about something like that, he said a very similar thing, just like, I'm home now. Yeah, which I think is a really important thing to take into account with this paper as well, is if we're only looking at parents' experiences. And we're also looking at school-aged kids who are in puberty, who are going through intermediate, which is not the best and easiest age to be. Especially with ADHD. That's the first time I really remember those executive functioning struggles coming through the amount of papers that I lost in book bags that I just didn't remember that I had was pretty high. Yeah. I mean, if you're a parent of a child that age, good luck. like more power to you, like you're doing such a great job because it is so hard and things are always changing and there's very little like there's no rule book, there's no guidance really. And you know what, just remember that you're only seeing one version of this child. And that can be really important to remember. Yeah, definitely. It can be tough. We don't work with kids, we work with parents and we're parents ourselves. I haven't gotten to those years yet. So this is still my own historical. experiences, but yeah, it's tough. I mean, we talked to Danielle a couple of weeks ago about emotional regulation, how to emotionally regulate yourself and your neurodiverse kids. And it's definitely, definitely a struggle. So if you see a paper like this, just remember it might have some limitations to it. Don't worry just yet. And there's lots of different strategies and lots of people you can reach out to if you need help with anything. Don't forget to subscribe to our podcast, which you can do on any of your podcast players. to get weekly updates when we launch a new podcast episode.

Predictors of Quality of Life and Functional Impairments in Emerging Adults With and Without ADHD: A 10-Year Longitudinal Study

Okay, so let's get into the last paper. So this was predictors basically looking at the quality of life for adults with and without ADHD. And this was another longitudinal study. So this was done over 10 years. And what they hypothesized was that ADHD predicts lower overall quality of life scores in adulthood. Which is something that we do see a lot of papers like this. They do show that there can be a lower quality of life and it can be, I just want to flag some people, it can be a little bit triggering to read about that. So definitely be aware as we dive into this paper, because, you know, we have a lot of strategies, we have a lot of supports and strengths, but when we're just going into the way that it affects our lives, we can feel a little bit, I guess. Pointing at you. Yeah. Feeling attacked. Yeah. So if you feel like that, just know that we have ADHD as well. We understand. And, you know, maybe fast forward to the takeaways of the study. Yeah. So what did they look at, Sarah? They were looking at the relationships between ADHD symptoms, executive functioning deficits, and internalizing difficulties. And now they define internalizing difficulties as different scores of anxiety. Um, so they looked specifically at three different types of anxiety, just like the general kind worry, and then also social anxiety. And they basically just wanted to learn a little bit more about the relationships between all of those variables and quality of life. What did they measure quality of life as? Because quality of life is a whole. theory discussion in the research. They use so many different measures for this. So many different rating scales and things like that. They looked at the perceived quality of life. So 19 items that was social, physical, and cognitive quality of life specifically. So they were kind of looking at how you benefit socially and physically and cognitively, and they don't have the actual questions. this is a short paper, but I imagine we'd be able to find them. If anybody wants to know, it's the PQOL, the perceived quality of life score. So this study was a longitudinal study, which was really interesting. It was part of the Norwegian study, which was known as the line-up study or the Lilly Hammer neurodevelopmental follow-up study. And it comprised a baseline assessment, a two-year follow-up, and then a 10-year follow-up. And it looks like it finished in 2019. So that's where this data is coming from. So in terms of the clinical sample, there were 85 children and adolescents with ADHD and 15 neurotypical peers. And then at the 10-year follow-up, they managed to retain a sample of 61 adults with ADHD and 40 neurotypical peers, which although it wasn't a huge number, that's pretty good in terms of like how many people came back 10 years later. Yeah, it looks like they only lost like 20 people. Yeah, I was very impressed by that. I wonder what the incentives were. There might have been some really big incentives. If this was a big government study, there might have been, it might've also been connected to the hospital that people were at, so that might've been a lot easier for them to work through. In terms of the measures that they had, they measured executive functioning, quality of life, ADHD symptoms. externalizing difficulties, which you mentioned was those three kinds of anxiety, as well as any functional impairment. So family work, school, life skills, social activities, risk activities. They had a lot of measures basically. Yeah. The functional impairments is basically like, how does that matter on a day to day basis, you know, how does this impact you? Exactly. And so in terms of the results, they had a really cool table. If anyone is reading this paper. You'll find the links in the show notes, but if you go down to page 460, you'll find that, oh, that's not the right page. Apologies. Page 463. They found overall that individuals with ADHD reported significantly lower quality of life across the total scale and all subscales compared with the neurotypical individuals. And this is something that we see in other papers as well. So they reported significantly more total functional impairments and also in those areas of work, social life and family. And there's a table where they go through and you can see that there's a significant lower quality of life based on the subject of measures, looking at your physical quality of life, your cognitive quality of life, your work quality of life, your life skills as well. And you're social. And then there was a few that were not significant, but still interesting as well. So yeah, Sarah, do you want to speak to that a little bit? Yeah. So, you know, this was pretty sad. Obviously we know that ADHD has a lot to do with sort of emotional dysregulation. And so I'm sure that played a part into sort of the lower quality of life that they found. It was really interesting to me that the executive functioning piece that they looked at. those deficits like deficits in that area only predicted certain outcomes, struggles with family and things, but it didn't actually make much of an impact on the quality of life overall. Yeah, it was more the emotional side where you were really seeing those differences. Yeah, right. And then when you get to the anxiety piece, that also predicts lower quality of life and functional impairments. Yeah. which the authors were saying that that's why it's so important to sort of target emotional regulation when you're evaluating someone for ADHD and recommending treatment outcomes. Yeah, definitely. I think it is really interesting that the cognitive functioning deficits, which we talk about a lot, they affected your quality of life, which is a subjective measure up to a point. But if you felt positive about yourself and positive about your life and You weren't struggling with anxiety and emotional regulation as much. And it did seem to be the case that your quality of life would increase. And that connects to everything we've said about ADHD and self-criticism, ADHD and struggles with rejection sensitivity. Like all of that comes into this conversation. Yeah. I mean, for somebody who sort of lives this life, it almost seems like really Like, well, of course, having these additional emotional impacts are going to decrease my quality of life, but it's really a totally different experience to see it written in a research paper with like actual measures. Yeah. And I think in terms of practical takeaways from this, it's knowing that maybe the time and energy that you invest into supporting your emotional regulation is according to this one study. It's not the be all and end all by any means. potentially going to have an effect on your overall quality of life. Because sometimes it can be, there can be a sense of, well, why should I bother to spend time working on my mental health and my executive functioning? Is it worthwhile or should I just focus on the productivity side of it? Just focusing on those cognitive skill benefits and not the other side, but in terms of your quality of life and you know. That's a really important factor. It does seem like it's important to do both. Yeah. I mean, I think this paper does a really great job at highlighting how important it is to start that work as early as possible. Yeah. And if you have kids, which we talked about a little bit before, that might mean helping your kids emotionally regulate. And if you want to learn more about that, I recommend starting by listening to our interview with Danielle Sullivan, who talks a little bit about it and had a bit to say, which was great otherwise. Yeah. Definitely focusing on that mental health support and ADHD friendly mental health support as well, understanding the ways that we have those executive functioning struggles. Yeah, especially for this age group as well. Yeah, definitely. And if you're looking to understand it a bit more, we do have some papers on burnout and self-criticism and we also have some online courses on that topic as well. And that might be a good first step to then go and decide what kind of additional supports you want. to access. Okay. So we had three very interesting studies. Two of those were longitudinal studies and one was the study of adolescence in middle school, which feels a long time away. So that's my connection for what those studies are. Yeah. How did you, how did you feel about these papers, Sarah? Yeah. So these papers all really looked at sort of that adolescence, like that puberty age. And so that was a really neat connector. You know, sadly they all sort of highlight that, you know, what we experience in childhood and in adolescence and sort of just further cement when we're becoming adults. But yeah, I mean, I think the important thing to remember here is just that as early as possible that we can start doing some of this educating for the kids, you know, if you have kids specifically. And if you don't. and it's just you sort of rocking out, then you might want to give yourself a little bit of compassion for making it to this stage. So well done, you. Yeah, yeah, well done you and well done us because we were both late diagnosed. So we're all going to collectively go, yeah, we did it, pat on the back. Yeah, exactly. Yeah. And we will, as always, when we do these research, try and focus on the practical takeaways and the strategies. So. Hopefully next week we'll be back with some more positive, practical focused studies, but it's also good to check in and see what our experiences have been like and how they've changed or haven't changed over time. 

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