ADHD Research Recap: Is ADHD related to trauma in childhood?

When you let go of the masking, you start to see who you really are again. That's a really good point. This study is awesome because they invited a bunch of people into the room and were like, now talk about ADHD. I'd definitely be interested to see more articles like that. They had some really awesome conversations, which indicates that ADHD is not related to trauma. That makes so much sense. Dun dun dun. There is a way that we can figure this out.

Welcome to this week's research recap. This week we have some very interesting articles. We have an article that looks at ADHD and adverse childhood circumstances, which I know has been quite a big thing at the moment in the news or in the ADHD space anyway, with some controversy around that concept. There's also looking at childhood care treatment. And then the concept of how we describe ourselves with ADHD. We have an article here where they've asked people, you know, what they want to call themselves and how they want to communicate their ADHD. Before we get started, I just want to say, I am feeling a little bit ill. Sarah's done a great job holding it down. So if I sound a bit weird, that is why, but we're still going to go through it. We're still going to bring you that content and let's get started. It's going to be awesome. Don't even worry about it. So happy to have you. Thank you.

History of childhood/adolescence referral to speciality care or treatment in adult patients with Attention-Deficit/Hyperactivity Disorder: Mutual relations with clinical presentation, psychiatric comorbidity and emotional dysregulation.

So the first article is called history of childhood slash adolescence referral to specialty care or treatment in adult patients with ADHD. And then it has even more sections, but it's quite a long title and it is by brain sciences. And of course it is from this year. All of our articles are from this year. And what they wanted to know was what are the impacts of having early referral and early methylphenidate treatment on the outcomes and ADHD specifically? And this is interesting. We haven't looked at a lot of articles that have discussions about methylphenidate treatment. This is a first for us. Yes. Exciting. Yeah. So what, how did they do it, Sarah? Take us through it. Sure. So this was sort of a clinical outpatient sample. So everybody had ADHD. They were all diagnosed clinically using the DIVA, which we've talked about before. It's like a adult ADHD self-report scale, but it looks at symptom presentation in both childhood and adulthood. So that's how they tried to do that longitudinal thing. Their sample size was 100. They're all adults. Which is reasonable. Yeah. And they excluded anyone who didn't meet the current threshold or had a history of psychosis or mania. Yeah, they really wanted to look at people who are just ADHD. And so they had a bunch of different measures. All of them were self report. You know, they were looking at a bunch of demographic information, you know, education, marital status, history of other sorts of disorders, primarily substance use disorder. They had a hypothesis that people with higher rates of substance use disorder would have higher sort of adult presentation of ADHD, but they did not find that to be the case. I'm getting a little bit ahead of myself. Interesting. But I thought that was really interesting. Yeah. And then they were also looking at sort of disruptive behavior, current symptoms, executive functioning levels, and emotional dysregulation levels, all self-report. Interesting. So what did they find that people said it happened? They separated their sample into three subgroups. People who were not referred and not treated for ADHD before the age of 18. People who were referred and continuously treated with methylphenidate before 18. And people who were referred before 18 but never treated with the medicine. Interesting. Yeah, definitely. So... What did they find? They found a bunch of things. They did find that symptoms of ADHD were higher in the participants who were referred in early childhood and adolescence. That makes sense. Yeah. They also found that the disruptive behaviors factor was the biggest motivator in receiving an early referral. Right. And again, that makes sense. Yeah. Although the treatment... of methylphenidate did not significantly reduce these behaviors. Really? That's interesting. Yeah. And that's again, that's according to the feedback from the adults who had it. Right. I suppose that yeah, it is all sort of self-report biases worth mentioning again. They did however find that those who were treated with methylphenidate earlier on in their diagnosis experienced lower rates for mood disorders. and a decreased severity for emotional dysregulation at the time of assessment. Yeah, so there is so much going on here in terms of alternative reasons. Everything has a potential other reason, you know. The idea of who got diagnosed, it makes sense that people who had more outward disruptive behaviors were more likely to get diagnosed. We know that already from the research around masking and things like that. It's really interesting that people with ADHD didn't feel like it was helping. I wonder if that might have something. I don't know, but we do have research into self-criticism. I think it's really important to look at what the disruptive behaviors were. Yeah, that's a really good point. Disruptive behavior was measured as having an ODD or any other type of conduct disorder. So ODD is oppositional defiance disorder. And so it kind of makes sense that doesn't go away. It's almost like what this is saying is that methylphenidate is not a good treatment for ODD or any other conduct disorder. Interesting. Did they sort of say that at any point during the discussion? I think that's just an inference that came to me. Mm-mm. Yeah, yeah, it is interesting. I also wonder if it's possible, we don't know, obviously we need to get more data on this, but it is possible that they... The people who remember this and self-report this historical information may still remember all of the criticism that they received growing up as being unchanged between when they started taking methylphenidate and afterwards. Yeah, that's a good point. And that might contribute to their perspective that it didn't improve anything. Well, it does still say that the... people who are treated with methylphenidate experience decrease severity for emotional dysregulation. So maybe like the sort of defiant stuff doesn't impact their quality of life. Yeah. At least in an emotional perspective. Yeah. It's possible as well. They got some ADHD support. We know not knowing you had it can affect you, you know, in terms of your mental health and or sometimes misdiagnosing you as having a mental health condition when you actually have ADHD. It is interesting. I wonder if they got more support earlier on having that experience. Absolutely. When I was reading this earlier, I was wondering if sort of being diagnosed with ADHD as a child protected you from some of those mood disorder diagnoses, because those tend to be like what women with ADHD are misdiagnosed with, you know, it's bipolar, it's anxiety, depression. And I was wondering if having that ADHD diagnosis was like a shield for some of them. Yeah. Before we move on though, I want to talk about the people who didn't receive that support. The people who weren't referred until adulthood were more likely to have a family history of neurodiversity as well. That makes so much sense. What do you mean it's ADHD? It's just a family. You're totally normal. We're all crazy. Sorry, that just cracks me up. can definitely relate to the whole like we all do this. It has to be normal. There's no way. And then the uncovering of the family history of neurodiversity. I think a lot of people have experienced that in the last couple of years. So, yeah, definitely, definitely. That's interesting. Can I ask, by the way, you mentioned it was 100 people. Did you get the gender differences between those people? Cause I'm just curious. I know that women tend to be diagnosed later and men tend to be diagnosed earlier. We also know women tend to be diagnosed more with mood disorders. So it's a lot of complicating factors, but I'm just curious. So 71 males and 29 females. The median age was 22. Right. Okay. That is interesting, right? That is interesting data and interesting that they didn't mention it. Cause that is a huge difference. in the general, I mean, to be fair, a lot of times these researches are often done on women. In fact, one of the papers that we're going to talk about today is entirely done on women. But I do think it's important to make a note of it when you're having these kinds of discussions. Yeah, absolutely. Let's talk about some of the limitations because this is an interesting conversation. So this study was done in Italy. And those of you who are unaware, there's only methylphenidate. There's also just overall less support for people with ADHD, and some would argue less understanding of how that presents. And basically, they talk about how only having one medication option to analyze is a limitation. Would have been nice to see if that had an effect. But really, the only other limitation of this study is that it relied on retrospective accounts, the memory bias and all that. And I do think that is a big limitation. Our retrospective awareness of how our childhood went, it's hard to remember things. And the things that stand out are often the things you were told, and that was why I was wondering if maybe the things that you were told about yourself, people were saying you had ADHD and ODD might not have changed when you got the medication, and that might have meant that you felt like the medication didn't do anything. I don't know, but that's just something to consider. A lot of our childhood memories are actually the memories that people told us, which is a weird thing. An interesting paper, but definitely a lot of room for improvement for sure. They also just pointed out that they really did this study because they wanted to look at the supports that people with ADHD have in the country. Yeah. Yeah, it was really great.

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Childhood Experiences on ADHD Symptom Reporting, Psychological Symptoms, and Cognitive Performance Among Adult Neuropsychological Referrals.

The second paper that we have is going to look at the childhood experiences on ADHD symptom reporting, psychological symptoms, and cognitive performance among adult neuropsychological referrals. This is the same old, our same old friend, the Journal of Attention Disorders. We've talked about the Journal of Attention Disorders many times. But what they really wanted to know is how are adverse childhood experiences, which they called ACEs, associated with ADHD symptoms in adulthood? And this is a very interesting question to be asking right now because for those of you who are sort of in the ADHD space, you'll know that there's a lot of controversy around the idea of ADHD's relationship with trauma in general. So I thought this was a timely article to come out. probably an example of some of the articles that people are reading and referencing when they're having that conversation. So that's what we're going to dive into. So how did they do this research, Sarah? So this is another clinical outpatient sample. The size is sort of 115 adults. The majority of the sample were university students, 73%. Basically, all of this was measured by questionnaire. There is a particular ace questionnaire. It's the original ones from 1998. It's like a yes, no of awful things. You know, it's looking for emotional, physical abuse, neglect, witnessing violence, et cetera. Yeah. So they definitely went through a lot of things. Yeah. They were looking at hardcore stuff. much more so than the study that we talked about a couple of weeks ago. Yeah. Those were much more fluffy questions in comparison. Yeah, I wanted to mention that because this one felt more psychological, whereas the other one felt more sociological. The other one was sort of about your wider society space in some ways. Absolutely. Family and poverty, whether you had a lot of kids in your family, that kind of thing. This was like what has happened to you now. or in the very recent past. And so that was a very big difference. And it was, it was interesting to see both of those. So again, like you said, it was a self-report survey. People also completed measures of depression, strengths, anxiety, executive functioning, and intelligence. ADHD was also self-report. Yes. Yeah. It's interesting they did a test of intelligence. I'm guessing that was to remove certain individuals or something along those lines. I didn't read why they included that. It's interesting when we talk about the results before we get there, I wanted to mention that you have a high ACE score if you have four or more yes answers and low is obviously three or less. Okay, interesting. So what were the results, Sarah? What did they find? Some of what you would expect, I think. So the group... with high ACE scores also had higher levels of perceived stress. The high ACE group had significantly higher levels of childhood and current ADHD symptoms. However, the association was stronger with the childhood symptoms than when they looked at it with the adult symptoms. So basically what that means is that the effect of the trauma on your life had more of an impact on your childhood than on your... adulthood ADHD symptoms. Right. Yeah. And what they were saying there was that there was a potential that childhood trauma may not affect you as strongly when you're an adult, essentially. Sort of like time heals all wounds. I think that's a sort of naive statement, but it's one explanation. Yeah. They also found that there was no difference between the high and the low. risk groups in the depression and anxiety scores. And there also was no difference in executive functioning and intelligence scores either. Which is very, I don't know, I was really surprised by that. That the only difference they found was in the ADHD symptoms. And the stress. Okay, and stress. Fair enough. Yeah, I think it's important to note that all of those factors were measured only at the time of the assessment. While you know, you might have been more depressed or less able to executive function when the trauma was happening. I see what you mean. That part of it sort of got better. Yeah. But the ADHD didn't. The ADHD stayed the same. Interesting how it'd be like. Which indicates that ADHD is not related to trauma. And in fact, they mentioned that quite explicitly. Sarah, do you have a sentence? Yeah. So I'm going to summarize the quotation, but basically they talk about how the higher ACE scores did not predict higher dysfunction in adulthood. So basically experiencing something as a child in their study anyway, didn't predict more dysfunction in adulthood. Yeah, which would be directly against what is currently being said by Gabor Matei at the moment with relation to ADHD and trauma. Yeah. In fact, a lot of people are actually saying the opposite. where they started to heal their traumatic responses and in turn found more ADHD and autism symptoms, which I think is so funny. Like when you let go of the masking, you start to see who you really are again. Yeah. Can definitely be a journey. That's for sure. So interesting and interestingly topical article in terms of the conversation. It is really interesting to see an article. I mean, obviously we always say meta-analysis is what you need to do. This is just one article. This is a self-report article. All of those things still apply. But that is what they found. And that is an indication that ADHD is ADHD. And it might definitely be interesting to see more articles like that. It'd be interesting to see what more articles or even a minute analysis of articles like that find so that we can have a better sense of it. Because there is a way that we can figure this out. Yeah, and honestly, I think the key is probably in brain scans. You know, they can find a functional change as it happens. Yeah, it's probably so far away, but like that's how they're going to do it conclusively. Yeah, no, definitely. We're just out here talking about brain scans again. Neuroscience will save us all.

“Dysregulated not deficit”: A qualitative study on symptomatology of ADHD in young adults.

And then the final study is a lovely qualitative study on symptomatology of ADHD in young adults called dysregulated not deficit. And this study looked at whether. ADHD diagnostic criteria were applicable for adult symptom presentation, but they did it in a qualitative way. So how did they how did they do the study, Sarah? So this is probably the first one that I have read where it's focus groups. Their total sample was 43 and they had sort of nine focus groups, which means that they had conversations. They were asked both open and closed questions on stuff like How do you feel about the diagnostic criteria? Do you feel it's representative of your current life? What do you feel about misdiagnosis or the timing of your diagnosis? You know, things like symptomology, hyper-focus, emotional ability, gosh, ADHD symptoms over time. Yeah, they talk about RSD, it's great. I haven't seen that, yeah. Yeah, and then they also talked about how the sort of symptoms change over the lifetime. So they had some really awesome conversations. And if you're able to get your hands on this study, you'll be able to see some direct quotes as well. No, very cool. So they use an interpretive phenomenological analysis framework and shout out to whoever had to transcribe, edit and review all of those focus groups. I know how long that will take you because they were looking for everyday life, investigating everyday life for these participants. And so what did they find, Sarah? They had conversations about how basically overall the diagnostic criteria was not favored with the participant pool. They didn't feel that it really captured their personal experiences. They also talked about how symptom presentation changes over the lifespan and the participants quite aptly suggested that changing environments and other behavioral adaptations were more often the case of the change. COVID, for example, was a huge change that a lot of people, you know, I was asked about it on a podcast just the other day, was why did COVID seem to result in an increase in ADHD diagnosis? And I think you can kind of see a hint of that here. Yeah, absolutely. That's so true. Yeah, they also talk about hyperfocus and RSD, which is amazing because they even say later on in the article that those topics aren't discussed in the current research literature. So they consider this to be a novel study. And the participants favored attention dysregulation instead of attention deficit terminology. I support that. Nice. I like that. I like that too. And they also talked about hyperfocus as a double-edged sword, which is something that we see discussed a lot. colloquially. So what was it about that they felt was a double-edged sword? Sort of how sometimes hyper focus can keep you from doing something that you should be doing or need to be doing. Whereas also hyper focus can sometimes be used as like the best way to get your work done. You can get so many things accomplished. You know, it's sort of how we can have that wide range of topics that we tend to, you know, a million hobbies. I posted a meme to our academy chat today. I was like, I've stopped more things than you've started. That's probably true. Yeah, definitely. So yeah, definitely a double edge thought it was interesting to see that discussed. It's very cool to have another qualitative study. I feel like we always get so much of the voice of ADHD people more so than others, although others are very helpful in terms of finding out. answers to questions. It's nice to see something where you can just relax and hear people. And I also wonder what it would have been like in those focus groups because a lot of people with ADHD don't get a lot of opportunity to hang out with each other. So that in itself would have been very interesting. Yeah. I mean, I'm mad because this study was done at Yale, which is in my state. I could have been there. They texted me and asked if I wanted to participate in a study. And I was like, no, I'm too busy. Um, but maybe it was this. Yeah. Well, you're, you're like, guys, I run group coaching. Like I think I can like help you out here. Yeah, definitely. So the limitations are it was predominantly white women from the US being a participant pool. Obviously that gives you a very different view of ADHD. Was there any other limitations in terms of demographics, Sarah? Yeah, they said that 88% of the sample had some college. So obviously that indicated that the more marginalized people were not represented by this study, people who maybe didn't have access to technology as well. So yeah, they said for sure that this isn't widely generalizable, but that it's really interesting conversation pieces. And they also talk about interpretation bias, which basically is just like, two different people understanding something different from the same sentence. Yeah. Which is just a whole thing. Yeah, for sure. And, and very much I think, especially if you're talking to people who have a college degree, they probably have a lot more experience having a conversation about language use and how that works and what we should call things and all that kind of thing. So that may have contributed to their perspectives on what to call ADHD. In terms of their practical findings, what would we say are the practical takeaways from this paper? I mean, I think the bottom line here is that there's not a lot of research literature that really delves into the lived experience of ADHD. And we talk about this sometimes where like, they're trying to measure something, but they don't do it right. Like I saw another meme, oh gosh, I've been on the internet too much. No, I saw another meme that said, when you're getting your screening test and they ask you if you have a problem with socks, you're tempted to say no, because you're like, I have a system for that. But really, that's what they're asking about. Like, do you have a system for socks? Like, how do you deal with these issues? Like a sensory issue? Oh, like separate issues with socks. Right, right. Okay. That is very true. This study is awesome because they invited a bunch of people into the room and were like, OK, now talk about ADHD. Like, what do you think from your experience? And I love that. Yeah, no, it's really, really great. So three very interesting articles today. And I think they're all sort of bringing a lot to the table in different ways. helping to move the research forward in different ways. And some of them are directly relevant to, you know, feel free to post it on the internet if you want to. I know a lot of people are having conversations about ADHD and trauma right now. So if we can help you with a little bit of research to back up what you're trying to say, then feel free. The links are in the show notes. And yeah, really interesting conversation and always good to see the research moving forward.

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