Portland, OR: trials.ohsu.edu and https://cancertrials.ohsu.edu/
All over the U.S.: clinicaltrials.gov
For an ADHD group: Big Picture on ADHD and Resources
What is ADHD?
- The name ‘ADHD’ is misleading and considered by many scholars to be a misnomer. Why? 1) Many emphasize that it’s a regulation disorder rather than a deficit disorder; and 2) It’s no longer seen as being so much about attention and instead includes action, motivation, energy, intention, emotion, etc. It encompasses so much of self that Russell Barkley, PH.D., says let’s call it a self-regulation disorder. (Really the same as calling it an Executive Function Disorder, as Thomas Brown, Ph.D., might call it, but who knows all the affected Executive Functions by heart? See the ones affected by ADHD here: https://www.brownadhdclinic.com/the-brown-model-of-add-adhd)
- What the heck then are we talking about when we say self-regulation? Think of regulation related to ADHD as 4 S’s.
- Starting and Sustaining (attention, action, motivation, etc.)
- Stopping and Shifting (attention, action, motivation, etc.)
- Regulation differences between those with and without ADHD show up as two biases for those with ADHD:
- A bias toward what’s most interesting, exciting or, all things considered, the least mind-numbingly dull, boring, tedious, effortful; and
- A bias toward immediate gratification (what is most rewarding, least punishing right now).
- What are the costs of these biases?
- Neglect and procrastination of the boring, tedious things that save us money and time and keep others around us happy with us (less inclined to nag, throw things away, direct us regarding what to do) so that we keep our jobs, get the diplomas we want and otherwise achieve what we want to achieve
- The rewards that come with delayed gratification (e.g., graduating from college, job promotion, building your own business, buying a house, saving for retirement, going on vacation, and healthy body and mind — via exercise, enough sleep and healthy eating)
What are the causes of ADHD?
Research indicates the causes are a combination of genes and environment. The genes are necessary but insufficient. You have to inherit the genes, and ADHD is highly heritable (if you have the genes, your chance of having it may be over 70%). But this still leaves environmental factors. They turn our genes on, off, up and down. And, with ADHD, research indicates there are actually different kinds of ADHD that may have different combinations of genes and environmental “causes.” It’s complex, and some scholars suggest it is most useful to think of a spectrum (vs. categories).
What Brain Differences are there?
Research shows various differences between the brains of individuals with ADHD and without ADHD, including those related to the task-positive network(s) and default mode network (see MIT McGovern Institute research on adult ADHD), brain waves, and chemicals, with dopamine as a big chemical player. For more on dopamine, see the disrupted dopamine pathway hypothesis (or this video) or research on dopamine and ADHD (e.g., Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathway). There are many other brain differences, but this is a sample.
What to do? Practice working with your brain instead of against it.
Resources
On ADHD:
OHSU’s Center for Mental Health Innovation
Jessica McCabe’s How to ADHD (Russell Barkley gave her the thumbs up a few years ago; I have found her mostly accurately reflecting the science)
adhddd.com/comics (Dani Donovan’s images on having ADHD; she is diagnosed with ADHD)
On the Brain(s):
Brainrules.net Videos
On Well-Being:
Greater Good Science Center at U.C. Berkeley
For Research Studies:
Research Review: Past, Present, and Future of ADHD
Below are highlights of an Oct. 2022 review: https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13696.
ADHD Over Time
For most individuals diagnosed with ADHD, symptoms first appear during childhood even if the diagnosis comes later.
For most, disappearance of symptoms for good is rare. It seems to persist though it may at various times appear to fade (i.e., you may no longer meet criteria for the diagnosis at various times over the course of your life).
What factors determine persistence are still unclear.
Current debate includes whether ADHD includes a late-onset variant. Estimates vary widely regarding how many people first present with ADHD as adults: from 30% to 87% (see how widely they vary?).
Still, it’s become clear that fluctuating symptoms and impairment are common. Moreover, there’s a lot of heterogeneity when it comes to ADHD (think of variants having overlap but also differences when it comes to how they present, their particular combination of causal factors, their courses/trajectories, and their outcomes).
Finally, we still know relatively little about later-life ADHD.
Co-travelers
Emotion Regulation Difficulties (ERD), as the researchers call them, are estimated to affect 40-50% of children with ADHD, presenting as being susceptible to anger/irritability/low frustration tolerance. One question then is whether it’s part of a particular ADHD variant/profile of ADHD.
Sleep Difficulties commonly travel with ADHD at ALL AGES. Kids, teens, and adults with ADHD have higher odds of getting too little or poorer quality of sleep compared to their peers. Some researchers are exploring the causal role that inadequate/poor sleep may play.
This may be surprising, but the authors note that for females there are no increased odds of anxiety or depression, as females already have higher rates of anxiety and depression than males even without ADHD being added to the mix.
Living with ADHD
What is noted to be true across cultures? A negative impact on relationships with peers and siblings, higher rates of teen pregnancy, gambling, accidents, and premature death, with impairment persisting into adulthood for over 50% of individuals. The researchers admit, however, that research and practice have neglected “the performance and capacity of” individuals with ADHD. It focuses on shortcomings versus strengths, on disadvantages versus advantages.
Heritability
It’s high: estimated to be 74% for general population twin samples. So, if your identical twin has ADHD, there’s about a 75% chance you do, too. What gives? It’s believed that ADHD arises from an interplay between genetic and environmental factors.
“New Leads” Regarding Genes
- Different genes may account for childhood, persistent adult, and late-onset ADHD.
- Genetically-based sex differences may exist.
Environments
The paper references an “umbrella review of meta-analyses” that “identified nine associations as having high credibility (random effects p < .000001, or p < .000001, n > 1,000; Kim et al., 2020).”
Most were “maternal pre- and perinatal factors including prepregnancy and pregnancy overweight and pregnancy hypertension, gestational hypertension, preeclampsia, acetaminophen use, and smoking.”
“Two were child factors – childhood eczema and low serum vitamin D.”
All were of “modest” effect size “(Odds Ratio(OR) < 2.0).”
“Several other smaller associations were also deemed reliable (p < .001) including child blood lead level, child blood magnesium level, maternal stress during pregnancy, and maternal selective serotonin reuptake inhibitor (SSRI) exposure during pregnancy.”
Concluding Remarks
After going through “new leads” across various areas of research, including on the brain, the scholars acknowledge a shift of perspective that has mostly come from outside academia and research labs as the “most radical challenge to the ADHD paradigm.”
“Perhaps the most radical challenge to the ADHD paradigm comes […] from a new socio-cultural rights-based concept that has emerged outside the clinical and scientific sphere – neurodiversity (Pellicano & den Houting, 2022). This both casts ADHD as part of a wider spectrum of naturally occurring variation and challenges the DSM assumption that ADHD is a disorder caused by dysfunction within the individual – replacing it with the assumption of ADHD as neuro-divergence (Sonuga-Barke & Thapar, 2021).
May you find this reading of use.
For an ADHD Group, from self-regulation to procrastination
The Nature of Willpower (aka Self-Regulation aka being the Captain of your Ship)
If you want a condensed version:
Episodic Future Thinking (to remember intentions and follow through with them):
Research Study on Mechs & Fxns: https://pubmed.ncbi.nlm.nih.gov/29130061/
Scholarly Explanation: http://www.its.caltech.edu/~squartz/files/atance.pdf
Understanding, and Responding to, Procrastination
Additional Resources (for all three posts on an ADHD groups)
https://askjan.org/index.cfm (for accommodations, free consults)
https://selfcontrolapp.com/ (for sinking your ships/designing a “no-temptation button”)
https://freedom.to/ (ditto)
https://www.uclahealth.org/marc/audio
https://greatergood.berkeley.edu/article/item/a_five_minute_breathing_exercise_for_anxiety_and_mood
For an ADHD Group, from environment to self
Changing Self by Changing the Environment (for Fuel & Friction)
Extreme Friction/Designing an (Effective) No-Temptation Button (second part)
Self-Compassion
Research Study on ADHD and Self-Compassion
Ted Talk on Mindfulness, Shame, Self-Compassion:
Video: https://greatergood.berkeley.edu/video/item/how_to_be_kinder_to_yourself
Urge Surfing (useful for procrastination and impulsiveness)
Article: https://www.dartmouth-hitchcock.org/sites/default/files/2021-03/urge-surfing.pdf
Video: Kelly McGonigal’s Google Talk (see last intervention, where people hold their breath)
For an ADHD group, from overview to optimization
Understanding ADHD
Video: What is ADHD? https://www.understood.org/en/articles/what-is-adhd
Videos: https://howtoadhd.com/
Cutting-Edge Research on ADHD:
https://mcgovern.mit.edu/research-areas/adhd/
Cool Comics: https://www.adhddd.com/comics/
Multitasking
To sum up the Stanford research: “In about half of the studies, the heavy media multitaskers are significantly underperforming on tasks of working memory and sustained attention. The other half are null results; there’s no significant difference. It strikes me as pretty clear that there is a negative relationship between media multitasking and memory performance – that high media multitasking is associated with poor performance on cognitive memory tasks. There’s not a single published paper that shows a significant positive relationship between working memory capacity and multitasking.”
But, see more for factors that influence multitasking:
Media-multitasking and cognitive control across the lifespan
“Collectively, the findings suggest that higher levels of media-multitasking are associated with better multitasking performance (as assessed in cognitive tests), but only for individuals aged ~ 7 to 29 years.”
“Interestingly, in our data the sign of the relationship between multitasking costs and multi-media use also changes with age from positive in young participants to negative in older participants, suggesting that the demographic composition of participant groups may have significantly influenced the pattern of results observed in previous studies.”
The study authors concluded, “These findings suggest that age is an important moderator of the relationship between technology use and cognition.”
Dopaminizing
Book: THE WILLPOWER INSTINCT by Kelly McGonigal
Ted Talk (See First Part on Reward Substitution):
Optimal Brain Functioning, Setting Up for Effective Self-Regulation
Talks at Google (see first intervention)
Article: https://greatergood.berkeley.edu/article/item/what_is_the_best_diet_for_mental_health
Video (see the two on exercise): https://brainrules.net/video-tutorials/
ADHD & Romantic Relationships
Two well-circulated research studies came out relatively recently (2020, 2021) on ADHD & Romance.
First, 2020: Researchers looked at attachment styles & ADHD except, here, they looked at the non-ADHD partners of individuals with ADHD (74.2% with an official diagnosis). They wanted to know how the partner’s a) attachment style and b) ratings of their partner’s ADHD symptoms, together, influenced c) relationship quality.
What they found suggested that a partner’s high level of anxious attachment may make “the negative effect of ADHD symptoms on romantic relationship quality” worse. And, “Though insecure attachment styles are generally thought to have a negative impact on romantic relationships, avoidant attachment was generally associated with more positive outcomes….” Avoidant attachment refers to being an “Island” as couple therapist Stan Tatkin, Ph.D., describes it. Think of someone who likes you around sometimes but often at a distance. Dr. Tatkin describes anxious attachment as being a “Wave.” Think anxious about losing you but also doing things that might push you away.
As the researchers put it, “Individuals with an anxious attachment style experience heightened emotion during perceptions of abandonment (Dutton et al., 2014), frequently questioning the commitment of their partner (Bowlby, 1988).” On the other hand, “Individuals with an avoidant attachment style often seek to avoid conflict with their partner by withdrawing and becoming quiet and task-focused (Butzer & Campbell, 2008).” Why would avoidant partners possibly be a better match for individuals with ADHD than anxious ones? Consider that individuals with ADHD more often have such insecure attachment styles themselves. Good question. If you want to read how the researchers interpreted the results, you can get the study for free here https://scholarcommons.sc.edu/etd/4839/ (go to the conclusion section). Also remember this study looked at the ADHD partner’s perception of the relationship vs the perception of the person with ADHD. It’d be interesting to know much they line up.
Second, a 2021 study looked at the state of the literature on ADHD & romantic relationships to show what’s known and what remains unknown. The abstract is available here: https://pubmed.ncbi.nlm.nih.gov/33421168/. At this time, however, unless you have special access (as a student, for example), the article costs. A workaround is to look it up through the public library and see whether you can get a copy through ILL, for example. I will give you an overview of its content.
First, the researchers start with dating. There’s a gender difference that you may find interesting: “…young adult heterosexual men with ADHD appear to have more lifetime romantic partners than men without ADHD (Canu & Carlson, 2007), whereas young adult heterosexual women with ADHD reported having fewer lifetime romantic relationships than women without ADHD (Babinski, Pelham, Molina, Gnagy, et al., 2011).” They then delve into why this may be the case given other research findings.
Several studies suggest that as well as gender, one’s primary symptoms matter (inattentive, hyperactive/impulsive, or both). How they matter, though, depends on what you are looking at. So far, clinically significant inattentive symptoms, generally, stand out as the ones associated with lower levels of relationship satisfaction. So good news for those with other primary symptoms?
Well, it depends. Research coding how people actually behave within relationships overall suggests more conflict showing up for those with a combined presentation of ADHD (clinically significant levels of both inattentiveness and hyperactivity/impulsivity).
Next, the researchers turn to violence and sex. The research on violence is a bit complicated to describe briefly, and the researchers cite very few studies. So I’ll leave it out. Here’s what the researchers say about sexual activity after going through various studies: “Altogether, ADHD is a marker for adults prone to risky sexual behavior and unexpected consequences, but those with persistent symptoms and comorbid disruptive behavior problems are at greatest risk of both.”
What about marriage and divorce? It sounds bleak. I wish more researchers asked about some of the positives that may be present, so let me say this: research looks at groups, averages, frequencies, and the like. Often these frequencies are low but higher than they are for the comparison group (here, those without ADHD). So usually what you are getting with “more likely” and similar research language is a higher chance of something; however, you may still have a higher chance of the other possibility (e.g., it may be that one group has a 30% chance of something and another a 40% chance so overall even the group with a 40% chance has a 60% chance of the desired result). This said, here’s the researchers’ summary on marriage and divorce: “In sum, marriages including adults with ADHD are more likely to be unsatisfying, a burden for partners, and to end in divorce.” You see “more likely” and this can be scary but the next question is HOW much more likely? Five percent? Ten?
Finally, the researchers delve into the complexities of ADHD and how so much is still unknown. They discuss the focus on heterosexual relationships, for example. They, nonetheless, develop recommendations for therapists doing couple therapy where at least one partner has ADHD.
I hope this is of use to you.
Brain Change
This resource is one of my favorites for changing the brain and behavior (if you want the change).
Guided Sensory Awareness Recording
Distress Tolerance practice from Dialectical Behavior Therapy (from Marsha Linehan’s DBT Skills Handouts); video used to capture audio (nothing to watch)
Lawyers’ assistance blog with a lot about ADHD
This blog for lawyers has quite a bit for those with ADHD, including articles on procrastination.
Tonya Lippert 