Part 1: Attention-Deficit Neuropsychology (ADHD) with Russell Barkley
64% of the talking has a confirmed speaker.
“I'm so glad your life was spared because you have changed other people's so much.”
She feels grateful that Barkley's survival will continue to benefit many people.
“Is ADHD just cute and scatterbrained like an adorable manic pixie dream character in an early aughts rom‑com?”
She questions the trivialization of ADHD as a quirky personality trait.
“the persistence of ADHD to adulthood was linked to an almost 13-year reduction in estimated life expectancy.”
ADHD is associated with roughly a 13‑year shorter expected lifespan.
“That to me is the modern age of research, and then by 1990 we had all the Neuroimaging stuff was beginning to start by the year 2000. Molecular genetics was kicking off and everything just exploded after that. So we go from a couple hundred papers in 1960 to 400,000.”
Research output exploded from a few hundred papers in the 1960s to about 400,000 by the 2000s.
“As of a few years ago. I mean, it's just startling to go to Google Scholar, enter ADHD and its precursor terms and do the math. I mean, it's just enormous. I know I, I read all research every week. On Fridays, published in The World, and it's 35 to 40 articles a week. So do the math on that. It's 1,500 to 2,000 papers a year are now coming out on this disorder.”
About 1,500–2,000 ADHD papers are published each year, roughly 35‑40 per week.
“If I did a blood sample, I would not see these mutations. But if I sample your sperm or if I look at your child, I will find the mutations in that baby and you and your spouse don't have them unless I look at eggs and sperm.”
Some ADHD‑related mutations are de novo, detectable only in the child’s germ cells, not in parents’ blood.
“If you wait a decade to have children from age 20 to age 30, then you now have 8 times more mutations in your eggs and sperm, but particularly in your sperm.”
Delaying parenthood to the 30s can increase germ‑line mutations up to eight‑fold, especially in men.
“The longer men and women wait to have children, those disorders begin to rise in frequency.”
Later parental age will likely cause rising rates of ADHD and autism.
“They take about 30 years to mature and they're delayed in people with ADHD by several years, or what I estimate to be probably around 25-30%.”
Executive functions mature over 30 years but are delayed by roughly a quarter in people with ADHD.
“In a neurotypical brain, there's a good balance of top-down and bottom-up signals, but in the ADHD brain, the top-down signals are relatively weak and possibly overpowered by the screaming bottom-up signals that are reacting to stimuli.”
ADHD brains have weaker top‑down control compared to bottom‑up sensory signals.
“I came up with the word, as you saw in my book, time blind.”
Barkley coined the term "time blind" to describe ADHD‑related time‑management difficulties.
“my experience is that disability trumps disorder in terms of academic accommodations”
A listener notes that identifying as disabled yields better academic accommodations than labeling as a disorder.
“Eli Lilly coming out with Strattera, which is a norepinephrine drug that increases norepinephrine in the brain.”
Strattera, produced by Eli Lilly, is a norepinephrine‑boosting medication for ADHD.
“there's actually a recent paper from last week that shows that it's probably closer to 500.”
Recent research suggests up to 500 genetic sites may be involved in ADHD.
“And eventually about 93% of the time we find a drug that works for you, but not always.”
Clinicians succeed in finding an effective ADHD medication about 93% of the time.
“55% are completely normalized on the medication.”
Roughly half of patients become fully normalized with medication.
“if you have not Googled Dani Donovan, Google her. She's an illustrator who's created some hysterical cartoons and illustrations about what it's like to have adult ADHD.”
Listeners are urged to look up Dani Donovan’s ADHD cartoons for relatable humor.
“It took my twin brother 37 years to wake up and realize that his, his life was the result of his decision‑making and not all the other people he wanted to blame for that.”
Barkley shares how his twin brother finally accepted personal responsibility after decades of blaming others.
“Just a note on the word normalization. That's a clinical term that means the use of medication to bring mental functioning or performance in line with a prevailing cultural norm, as opposed to trying to achieve performance enhancement.”
Normalization refers to using medication to align performance with cultural norms rather than to enhance it.
“So medication, and you know, I look at ADHD as the diabetes of psychiatry. You would never turn away insulin if I told you you were a diabetic, and yet you have as much a biological problem as the diabetic has.”
Barkley compares ADHD medication to insulin for diabetes, emphasizing its biological necessity.
“Also, once a pharmacist told me that I didn't need the antidepressant I was prescribed to deal with mood swings from my ovarian failure. I just needed G6PD.”
A pharmacist advised that a hormonal issue, not depression, required treatment, highlighting the importance of proper medical evaluation.
“Studies show that people get about a third of the work done and have higher rates of anxiety, illness, and turnover in a bullpen type of office environment.”
Open‑plan bullpen offices reduce productivity and increase anxiety, illness, and turnover.
“I don't think the diagnosis can be accurately or reliably made in less than 2 to 3 hours.”
A thorough ADHD evaluation typically takes at least two to three hours.
“And I've even heard you say like, uh, you know, leave Post-it notes for yourself, have them be different colors, something that engages you and is novel will, will help.”
Using colored Post‑it notes can help keep an ADHD mind engaged.
“by the time you're in your 30s, 35 to 50% of adults with ADHD have developed an anxiety disorder?”
Around a third to half of adults with ADHD develop an anxiety disorder by their thirties.
“There was a photographer in Atlanta who put it beautifully. He said, I'm out on a photo shoot and I can't remember whether I agreed to pick up our 5-year‑old at daycare today or my wife, and it's 4 o'clock. So the kid's been out of school an hour. Is he sitting at a curb with his teacher because I'm not there? And he freaks out. Okay?”
A photographer forgets a daycare pickup, illustrating the everyday memory lapses common in ADHD.
“Back in the day when I came in, it was 6 to 7 boys referred for every girl. That's now fallen down to about 3 to 1, which is about the legitimate sex ratio.”
Referral ratios for ADHD have shifted from roughly 6‑7:1 (boys:girls) to about 3:1.
“So until the Equal Credit Opportunity Act, a bank could refuse a credit card to an unmarried woman.”
Before the 1974 Equal Credit Opportunity Act, unmarried women could be denied credit cards.
“eliminate a whole set of foods— dairy, wheat, corn, soy, eggs are common culprits. for 3 weeks, and if improvement is detected, start adding the foods back one by one for a couple of days.”
He suggests an elimination diet to test food sensitivities in ADHD.
“There is no evidence underlying that particular mythology. It's the other way around. People with ADHD gravitate toward engaging technology and are more engaged by it because of its highly reinforcing properties.”
No evidence that screen time causes ADHD; ADHD leads to more screen use.
“it can reduce your symptoms for 45 minutes to an hour and a half by engaging in vigorous activity.”
Vigorous activity temporarily lessens ADHD symptoms for up to 90 minutes.
“40% of kids and adults with ADHD have serious sleep disruption.”
A large proportion of ADHD individuals suffer sleep problems.
“Adults with ADHD tend to have a peak time of arousal 3 to 4 hours later than typical people.”
ADHD shifts daily alertness later in the day.
“Dr. Ferrari's advice was post your goal on Facebook or Twitter or tell a friend, because just a whiff of potential future public shame can really get the job done.”
Posting goals publicly creates accountability and motivates task completion.
“If nobody knows I'm cheating, then I'm going to cheat, right?”
People are more likely to cheat when they think no one is watching.
“Road rage is characteristic of 40 to 55% of adults with ADHD.”
A large proportion of adults with ADHD experience road‑rage incidents.
“next week we'll give the bright sides and the tips and the perspective on ADHD.”
The next episode will focus on positive aspects, tips, and perspectives about ADHD.