Transcript of 12 Common Misconceptions About ADHD

greetings everyone Russ Barkley here and a Happy New Year to you this is my first video in 2025 and for this video I wanted to talk to you about what I consider to be the 12 most common misconceptions about ADHD I bet you've encountered others and if you have please drop them in the reply section maybe I'll do a second video followup on any new ones that you've suggested the idea for this came from a post that appeared this morning in my news speed over its Psychology today it's called 10 toxic ADHD lies to leave behind and I thought it was a good idea to start the new year with this topic because as in the article my intent is to dispel some of the mythology around ADHD that seems to be out there uh you might find this handy in sharing it with family members or Partners or friends who seem to be skeptical about ADHD or about some of the more specific topics I'm going to cover in this video so um let me just get my PowerPoint up I'm not going to go through the psychology today article because I've modified some of these ideas and I've added a couple of others of my own so let's get started with the PowerPoint and by the way cheers to you for the new year as you can see in my picture on this opening slide okay let's start out with what what I think is one of the most common misconceptions out there and that's that ADHD isn't real it's not a real disorder it's just an aspect of your behavior or a kind of personality or just a lifestyle choice that you woke up one day and decided to entertain but it's not a real disorder well as I described in one of my videos a few months ago in which I talk about why ad HD is a disorder this complaint or this comment implies that the person has some concept of what a mental disorder is and ADHD somehow doesn't measure up usually what it conveys to me is a great deal of ignorance on the part of the individual both about mental disorders and how they're diagnosed and therefore the individual seems to live and kind of an information Silo in which they're really not seeking out or even interested in other information that contradicts their ideas in this case that ADHD isn't real but we know that it's real because we have a very good definition of what constitutes a mental disorder it came to us from Jerome Wakefield more than 25 years ago and I think it's among the best criteria there are some other criteria that other people use like that by Lee Robbins or by the American Psychiatric association I happen to think that wake Fields is the best but no matter we have a definition and that is that ADHD is a harmful dysfunction and that means two things that ADHD is a dysfunction in some mental mechanism that is common to all people it would develop in any typical individual so something's going arai to create this dysfunction in what Wakefield referred to as a mental uh adaptation a mental ability that everyone possesses so it's kind of a common trait among humans in this case the common trait is executive functioning self-regulation not just attention or hyperactivity but the capacity to self-regulate over time toward our future and ADHD clearly has ample evidence for this dysfunction second the second part of the criteria is that the disorder must produce harm harm can mean early death increase morbidity or injury or significant ineffective functioning in a major life activity that humans have to accomplish such as family functioning social functioning occupational functioning and so on does ADHD interfere with any of those it turns out ADH meets all the criteria not only is there significant evidence that ADH is a dysfunction in executive functioning there is hundreds of studies that I should have said there are hundreds of studies that ADHD meets all three criteria for harm it increases the likelihood of early death if it is not treated it increases the likelihood of injury particularly accidental injury if not treated and it interferes with many major life activities so there you have it we can address that misconception number two ADHD is due to bad parenting or if you want let's add in the absence of fathers from the family bad schools or any other purely social mechanism that you wish to inject here this is kind of the belief of Gore mate and others who believe that somehow parenting is involved in causing this disorder I heard this earlier from Gordon michat back in the 70s from Alan stro in the 1980s that this has to do with something about the parenting that's dysfunctional that's leading to ADHD in M's case he argues that that's interacting with a genetic predisposition to be hyp sensitive to stress and conflict in the family no matter it's not true we have lots of evidence to disprove this even though back in the 1960s and70s this was commonly believed by professionals it was sarily discounted over the next decade by lots of research including by your fuy who went out and actually videotaped families and studied how they interacted and what did we find we found that yes parents of ADHD children act differently than other parents they give more commands they give more directives they provide more structure they are more irritable they're less responsive to their children and less rewarding of them and all of that could have been used as evidence that are see you're right bad parents but we went further and showed that by putting the children on and off medication and a placebo we were able to make the parents normal so you see the parents Behavior was more of a reaction to a disregulated child and other PE people would act the same way if put in a room with this child indeed my friend Charles Cunningham did a study in which he found that if an ADHD child enters a peer group their peers start to act like little parents in the way they try to manage this disregulated or unregulated individual in addition to that there were lots of studies involving twins in which we can compute the extent to which the behavior or the trait is due to heritability and genetics to within family influence called shared environment or to Unique events usually outside the family or that only happen to one child and that's called unique environment well the twin studies of which there are more than 80 involving tens of thousands of identical and fraternal twins have all found that ADHD is largely the result of genetic variation in people that there is no contribution of within family effects that rules out parenting there is a small contribution perhaps about 20% of variation is due to Unique events that happen to the individual but this could be pregnancy complications lead poisoning head trauma after birth all those non- gentic biological hazards that we know can contribute to risk for ADHD would fall under that category so we have many many studies that refute this and by the way if you're looking for the evidence that I'm citing I'm going to put a reference to the most recent review article of all of the major research and conclusions about ADHD in the description for this video so you can go look it up this is a great review by the world's leading scientists published just a few months ago so let's continue myth number three ADHD is outgrown by adolescence we can dismiss this right away because we now have many follow-up studies including my own but others that were done even earlier and started back in the 1960s and70s and all of them find that ADHD persists into adulthood how much well as I talked about in my video a couple of weeks ago on this topic it depends on who you ask and how you measure it but overall we can summarize the research as showing that at least 2/3 or more of people people with ADHD remain fully symptomatic and impaired by adulthood an additional group does not meet diagnostic criteria but has high levels of symptoms and impairment and then there's a small group perhaps about 10 to 15% who do eventually outgrow the disorder but it's a very small number and it's not very common so we have lots of studies to show that ADHD is not outgrown but as my video a couple of weeks ago showed it can fluctuate marketly over time so that every few years we can find that you're still in the category or you've moved out of the criteria and then you move back in later and then you move out that can happen just by a few symptoms fluctuating so that instead of having the necessary SI or 12 you have 10 or five depending on which dimension of symptoms we're talking about so you can kind of move in and out of the diagnosis that doesn't mean you're outgrowing the disorder it just means it's varying in severity to some extent so that was myth number three myth number four is ADHD affects only boys or males this was kind of the belief back in the 50s and 60s but it was quickly refuted by research on Clinic referred individuals in which we would see that girls were being referred although back in the 70s it was mainly about 6 to1 boys to girls it took a while for families to start referring their girls with ADHD and eventually it started to catch up and now it's down to 3 to one boys to girls now why was that has to do with the fact that boys are more aggressive and disruptive and harder to manage and therefore the boys get referred earlier than the girls because they're just a pain in the ass they're harder to deal with and that's a little less true of the girls who tend to be more talkative sociable flighty and so on the girls can be difficult too and they can be defiant and challenging but not as much as the boys might be there's also some sociological research to show that families are quicker to refer a male child than a female child to get help why is that well it's believed in these studies or at least in these writings that it has to do with the fact that we need to get boys independent and self-supporting so they can go on and have families whereas back in the 70s when these articles were written it was less true that that would happen with a female you could always marry off your daughter with ADH and someone else could take care of her but that was a lot less likely to happen with boys now again this is a 50-year-old idea and it's probably a a lot less true today than it was back then but that was one of the reasons given for why boys were getting referred I think it largely has to do with the point I made earlier and that is that boys are just more aggressive more disruptive harder to manage more defiant than the girls tend to be eventually the girls do get referred and as we're now seeing over the last decade there's been an explosion of referrals of girls and women with ADHD to clinics and they're now finally getting the help that they richly deserve that was denied to them or at least not available to them back in earlier decades okay enough on that myth how about this one ADHD is just hyperactivity or being busy well I got to tell you back in the early part of the 1900s that was principally the belief that we were mainly dealing here with excessive motor activity and that idea held sway even up into the 1960s and led to the naming of ADHD as hyperkinetic reaction of childhood in the dsm2 even though the criteria mentioned the inattention and the impulsiveness it mainly focused on the hyperactivity well now we know that ADHD is just a lot more than moving around too much as I've already mentioned ADHD is a massive problem with the seven executive functions that are needed for people to self-regulate to show self-control and you can see my other videos on what those seven very important executive functions are I won't go into them here for the sake of time people with ADHD are just lazy oh God I hear this all the time and I bet you have too from family members from friends from strangers and others this is just an excuse for laziness well we know that people with ADHD do find it harder to activate at toward work and that they are more likely to break away from their work and Skip across other topics or other projects rather than finish the work that they have and so these problems with motivation and attention are viewed by the lay person as a reflection of laziness you just don't care you're just a layabout Naro well as my parents generation used to refer to people well we know that's not true we know that these problems with motivation and persistence have to do with brain-based difficulties in the systems of the brain that give us self motivation it's one of the executive functions and it's a biologically based problem in the genetics and Neurology of ADHD not just something the person is choosing to do so the evidence is clear about the neurobiological and genetic basis of this problem with motivation attention distractability and persistence okay let's move on to myth number seven ADHD is just an excuse for bad behavior frankly I've actually encountered some parents who have tried to use this to get their children excused from any consequences oh your child happened to bring a gun to school this morning well that's just as ADHD and you need to let that slide well no we don't as you know from my other videos ADHD is an explanation for why something bad or disruptive may have happened but it's not an excuse for absolving the individual of the consequences for their behavior and you can see that in an earlier video of mine where I talk about this issue of holding people accountable even though we understand why the Behavior was more likely to happen there are ways to prevent it from happening again so no it's not an excuse but it is an explanation now myth number eight medication is just a stop Gap or Band-Aid approach to management now Dr mate mentioned this in his book scattered Minds that medication is not the way to go that it's a short-term solution that it papers over or covers up the real problem which in his book of course is the bad parenting that leads to stress and Trauma of the child which interacts with their sensitivity in the child and that leads to Boom ADHD comes out in the individual it's rather silly notion I'll address it again in a later video I've already talked about it once about a year ago on this channel this this idea of ADHD arising from bad parenting stress and Trauma in the parent child relationship but back to this one we know that medication is more than just a stop Gap our Band-Aid we know that it goes into the brain that it helps to readjust the neurogenetics the neurotransmitters of the brain that it helps the brain to function more typically and that leads to improvements not only in the major symptoms but in self-regulation more generally we also know that the medication can prevent a lot of different harms and impairments in the individual from accidental injuries to early death to teenage pregnancy to dropping out of school to crime and aggression and so on ADHD medications have been found to reduce the probability of these in the individual so medication is not just covering up the real problem the problem in ADHD is neurogenetic and the medications for ADH can be thought of as neurogenetic treatments okay now that we've handled that one let's move on and look at number nine medication is the only solution for ADHD kind of the opposite of the last one well no it's not it is the most effective in comparison to any of the other treatments that are out there the rigorous reliable research that has been done in comparing various treatments to each other makes it very clear that nothing beats the medication in terms of the number of people improved the the degree of improvement and the number of impairments in life that this treatment can address but it's not for everybody 10 to 15% or more of people don't respond to the medications that are on the market other things need to be done for them but it's quite effective on the other hand there are many other things that we want to see added to medication one is education get yourself and your family educated about the disorder it's kind of like diabetes if your child had diabetes or you had diabetes first thing you would read about it learn about it so that you know what it is and that allows you to better understand and manage it the second thing is that we like to rearrange the environment what we call accommodations what I call scaffolding or prosthetic environments to help reduce the symptoms and make the person more effective at achieving their goals in that situation the third thing that we talk about is of course the modification of behavior where possible working with adults with cognitive behavior therapy working with children and their families around behavioral parent training around classroom man management programs and so on all of these behavioral Solutions are designed to help manage Behavior better and therefore reduce the symptoms so there's lots of things we can do out there in addition we've talked about exercise is very helpful for the short-term coping with and managing ing ADHD some research suggests that maybe mindfulness-based practices might be helpful we could use some more research on that it's looking promising it's certainly not a Panacea or an alternative to medication but it might help some adults in some cases we've talked about adult ADHD coaching on this channel as a helpful supplement to your medication to help with maybe transferring from cognitive behavior therapy sessions out into the real world coaches deal with you more often and can help you more often meet your goals and fulfill your treatment plans and so on by contacting you more often and making you accountable so enough there's plenty of other nonmedical interventions for ADHD they're not as effective but they are complimentary in the sense that they help in addition to whatever the medication may be doing okay let's talk about the next one I'm just going to back up here a minute people with ADHD can't be successful we can dismiss this right away just Google ADHD success stories and you will see a Litany of celebrities of athletes of professionals and others entrepreneurs Business Leaders who have ADHD and have been successful so I don't need to go into that I have a post a couple of months ago where I talk about some of these success stories and you can even look at my one a month ago on celebrities with ADHD how about this myth people with ADHD can't complete college or professional education programs that is patently false however we do find that people with ADHD if they're not treated are less likely to go on After High School to complete a two or fouryear college program perhaps 30 to 40% of the US population pursues a college education that figures about half that for people with ADHD about 20% but that's usually with people who are not getting treatment treatment allows them to go on for advanced postgraduate education and to succeed while they're there so it's not impossible for people with ADHD to complete college or even professional programs like Medical School law school psychology or other disciplines they're a lot less likely to do so but not impossible particularly if they are highly intelligent and they have treatments and accommodations available to them here's another one ADHD is a category either you have it or you don't well that's kind of the way the dsm5 presents it doesn't it here's all the criteria if you meet them you get diagnosed if you don't meet them you don't but that I think obscures the point that we know about in research that ADHD like autism is a dimensional disorder that there are degrees of ADHD in the population some people are just symptomatic but not impaired we would call them subclinical forms of ADHD there are others who have more symptoms and then become impaired and they meet the criteria for ADHD and even among those who have the diagnosis of ADHD there is a range of severities of the symptoms and the impairments so think of ADHD as a dimension but we carve it up into a category in part because the more extreme your symptoms are the more harm it causes and at some point we give you this label in order to get you treatment the other thing to keep in mind as I said in my earlier lecture on ADHD as a real disorder is that we have to make categorical decisions in life do I medicate you or not do we give you special services in school or not do you get Social Security Disability or not do you get accommodations in work or not those are all or none categorical treatment decisions and therefore we need to turn ADHD the dimension into ADHD the category in order to help us decide whether this person warrants any of those treatments doesn't mean you can't treat people who don't meet all the criteria and indeed we do if they're impaired but it does mean that a lot of things that clinicians governments insurance companies and others have to do is to make a categorical decision and creating the category of ADHD out of the dimension of adhc helps us to do that okay well that probably took a little longer than I had planned but I hope that you found it useful and that it can serve you well in life not just for yourself but with others who you know who hold on to some of these misconceptions or who are just skeptical about the disorder all right thanks for joining me for this first video of 2025 again my best wishes to you for the new year thanks to subscribing if you're a subscriber if you're not think about doing so as well and as always live well be well and take care bye for now