Modern Concepts of ADHD - Peter Hill

Check out Peter discussing this lecture and your unanswered questions on our brand new podcast "Any Further Questions?' available on Apple and Spotify
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Attention-deficit hyperactivity disorder (ADHD) is a combination of hyperactivity, impulsiveness and inattention which significantly impacts those living with the condition. The medical approach to the ADHD pattern of behaviour has been very successful in childhood but the results have been somewhat less impressive in adulthood. This has led to a reappraisal of both causes and treatment in both age groups.
Should the conventional, neurotypical world accommodate people with ADHD as different, rather than disabled?
This lecture was recorded by Peter Hill on 11th March 2024 at Barnard's Inn Hall, London
Peter is a Professor and Consultant in Child and Adolescent Psychiatry who now works in private medical practice, having previously held senior academic and clinical posts at St George’s, University of London, and at Great Ormond Street Hospital for Children.
The transcript and downloadable versions of the lecture are available from the Gresham College website:
www.gresham.ac.uk/watch-now/adhd
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[@iam1smiley1]

You know you have ADHD if you constantly cruise the comments while trying too listen 😂

[@tempestive1]

Not necessarily, but I think we may indeed tend to do it, and end up rewinding the video over and over 😂 like I am about to do

[@josephinejeffery]

Went straight to comments 😂

[@autumn5852]

@@josephinejefferyalways ;)

[@davidjames5517]

Busted😂

[@sorchajones1788]

Ha! Ha! Ha!

[@susanphoenix74]

Thank you! At age 71, I am just learning to understand my thinking and behavior for which I've been punished throughout my life.

[@chrispasson1940]

Same here.

[@joycebrewer4150]

​@@chrispasson1940only 64, soon 65, but 💯% agree!!

[@sgordon8123]

For a very kind view of human behavioural science listen to Prof Robert Sapolsky. He basically demolishes any idea of free will. Makes it hard to judge anybody!

[@pascalbercker7487]

@@sgordon8123 This could cut both ways I'm afraid. It could make it easier! I feel much freer to judge because it's in my determined nature to judge everyone all around me. I need no longer to agonize about getting my judgment right. Can you blame me?

[@nancyhope2205]

It has been a rough life. I did have some luck.

[@fullnewsky]

As someone with ADHD, I appreciate the awareness building ❤🎉

[@isabt4]

Thank you for this great presentation. I will share it. I worked so hard at helping my diagnosed son, who is a wonderful man now. The misinformation and wrong attitude in schools was incredibly frustrating. My son just turned 30, and I hope this has improved in schools, at least a little. I will also try to be kinder to myself as I think I have undiagnosed ADD. I can be so understanding with others and too harsh on myself. Sending love and support to all those “managing “ ADHD for themselves and for loved ones. Thank you to all the professionals dedicated to this! ❤

[@Didgeridoovibes]

So in (very simplified) summary: ADHD is (like most neurodivergencies are, it seems to me) a spectrum. Was diagnosed last year at the age of 38 and was very much assuming this - But it's very nice to hear it from someone who chose to professionally look at the mind of people and figure stuff like this out. Thank you

[@CrackaPackify]

Thanks for uploading! Watched this live and hoped to send it to others. Him roasting Matthew Parris in the most polite way possible is hilarious

[@Star_Rattler]

I also think it's very important to mention that as people get older, they do not get less adhd, as you say, it's more likely that it's just that.People are developing coping strategies and coping life habits in order to get by and it gets easier to deal with and manage.

[@chrispasson1940]

yes, we get to know ourselves but we still have to manage the ADHD thing.

[@Star_Rattler]

@@chrispasson1940 not only that, too, but often the parts of ourselves that are obnoxious to others get stomped down over time. so we still have these adhd urges to interrupt, to info dump, to get excited outwardly, to put energy into things we love that aren't important, and people tell us that's wrong and bad, so we stay quiet and rarely speak up anymore because so many times we've been punished for it, and we dont show our excitement because weve been called childish and we dont do what we like because it's not "productive." so what you can end up with is this violently suppressed person who becomes depressed. i'm thankful i wasn't affected that bad by things, but i know people who are. women. who are so quiet, never speak up, never light up, are holding themselves so still so they aren't annoying... it's so sad. then you tell them you want to hear them out and all of a sudden all of the color comes back into their once grey self.

[@lascreen3198]

In my 50s and my ADHD is much worse because in addition I now have the common forgetfulness that comes with age. Recently I locked my keys in the trunk of my car for the first time EVER. I was always so hyper vigilant about those things because the stress/anxiety of it possibly happening forced me to over focus on checking and double checking. Now I can’t maintain that vigilance.

[@Albinojackrussel]

05:54 You cant just put text up there and tell me not to read it! I have ADHD and now I have to read it, and its a terrible distraction from the work im actually trying to do while listening to the talk.

[@HappyMomma412]

🤣

[@Didgeridoovibes]

lol spot on xD

[@user-jj6im6bp6k]

This is the most comprehensive understanding of my recent diagnosis of ADHD

[@loloknight]

the meta data of this video on how many times one of us went back cuz one word sent us flying....

[@mydogsareneat]

Thank you for uploading ❤ 😊

[@spocksdaughter9641]

Exceptionally well done, not only for enthralling presentation. But solid current data that is rare. Female now age 74 dx @ age 56 by accident. Would anyone want a pic of my brain!!

[@joycebrewer4150]

Oh, wow ! I was late diagnosed with autism 6 years ago, but the possibility of inattention also being part of my mix was never investigated. Yet when you went down the list I easily ticked off 7 out of 9! Not so much the HD list. Being inconspicuous was a major goal of mine from preschool years on.

[@chrispasson1940]

as far back as i remember, about 5, i tried to blend into the background

[@iam1smiley1]

My report cards ALWAYS said "Crystal daydreams constantly and doesn't pay attention" 😂 51 year's old, they knew I was dyslexic like my Dad but I was more ADD...be quiet and don't draw attention.

[@feed8647]

This was really interesting and I thank you for spreading awareness! Too many people still have prejudices about ADHD. I had them myself. Diagnosed at 27, I brainwahsed and bullied myself into believing that it was my fault that I was different, that I just needed "to try more" to be like others or that other people had the same problems I had and they were just better at dealing with them. Having my diagnosis is really helpful for me, but it also makes me angry. I can not get around wondering how different my life could have been, how much easier if the people that were responsible for me had seen the clear signs of my neurodivergence and had acted accordingly. How my life would have been if not only I had gotten medication earlier, but if people would have been understanding and empathetic towards my "quirks" and problems. There is a reason many undiagnosed people have not only a high risk of substance abuse, but also of other psychiatric disorders. It is highly stressing to try and be "normal" and to mask.

[@mnlalx6512]

THANK YOU❤

[@OriginalSuperfreak]

Thank you Sir 😊

[@Horribilus]

Eureka! (The best feeling I have ever had in my life !)

[@australiancomposer]

1:07:00 - The irony of asking 3 back to back questions in a talk about ADHD 😂 I wish people wouldn't do that. One and a time!

[@Albinojackrussel]

51:30 nuerotypicals can do that?

[@isabt4]

That is what I thought too! I can’t possibly do that!

[@australiancomposer]

I assume if they can it's not especially easy? I was trying to do it along with the video and to do it ended up repeating 98643 / 9864/986/98/9 in my head and only verbalizing the last number 😅

[@jimmygravitt1048]

Mind wandering is watching this while also downloading sources for something I am researching on total solar eclipses, while also having to find out who the tallest group of people are in the world, then having to find out where the Dinaric Alps are, then having to find out the origin of the name Montenegro, because that guy you were in the Army with had the same name, then realizing one of your sources has the date 2000-12-1 instead of 2000-12-01, then remembering you never got a satisfactory answer as to the relationship between sickle cell anemia and sickle form macular whitening from viewing the eclipse, then you hear this guy break through talking about mind wandering.... I wonder what that's like.

[@philuin9594]

I find elvanse better than concerta but although its sorting the impuslive aspect its having a seesaw effect and seems to making the inattentive aspects worse. I take 60 mg a morning i dont know whether to get them increased or changed.

[@marcaaron1890]

I have all the innatentive traits to the max but not really from the hyper side, what does it mean?

[@QCCatPlanes]

It sounds like the *Primarily Inattentive Type* of ADHD. There are three types of ADHD. I also have the Primarily Inattentive Type.

[@Tim_Small]

If I remember correctly, about 30% to 40% of people with ADHD only exceed the threshold on attention symptoms. This is known as "predominately inattentive type" ADHD and was previously known as ADD. As far as I'm aware, "predominantly hyperactive" type is rare, and most people have "combined type".

[@Namaerica]

This is so very interesting. Thank you.

[@QCCatPlanes]

20:40 that is likely due to the high rate of un-diagnosed adults, especially women, and adults in their senior years. If it is neurological, it is permanent - life long. Maybe, an undiagnosed 80 year old will be more likely to have falls due to the impairment that ADHD causes in the brain.

[@escapeplan4]

Although I'm not happy that I probably share this condition with criminals 😬 but overall thank you for this lecture.

[@rebeccazegstroo6786]

Is there a standard brain to compare to?

[@user-uu8wh9du1d]

Heh, lecture is mesmerizing me.

[@thumper8684]

Is response to medication a strong indicator of ADHD? My experience of seeking treatment in the 2000's was that this was the evidence that convinced skeptical medical professionals.

[@thumper8684]

Answered at 56:00 minutes. I had asked because Professor Hill started by saying there was no (I think he said objective) diagnosis.

[@PhillipHilton]

​@@thumper8684depends on the individual physiology. I have ADHD and I'm on Ritalin - which makes me calm as a coma - however I have another friend who is on slow Concerta because he found Ritalin hit him like a hammer. Both of us were diagnosed in our 40's. As an aside my wife who suffers with hay-fever but not ADHD once grabbed a blister pack of my Ritalin mistakenly assuming it was her antihistamine. She then had to go and lie down for two hours while it wore off as her mind was racing and heart pounding.

[@s.m.4948]

I don't think ADHD falls away as we grow older. The traits used for diagnosing ADHD are based on pediatric cases, so we outgrow certain behaviours (guess what!? At 40 years old you probably will no longer be bouncing in your seat or shouting out answers before asked) but are as profoundly ADHD as ever.

[@PhillipHilton]

Fetal alcohol syndrome has a 90% correlation with the onset of ADHD? That's basically 1:1. This makes me wonder whether the widespread use of aspartame as a food additive has contributed in some small way to the increase in ADHD in the global population. For those of you unfamiliar with aspartame it's a commonly used sweetener that's used extensively in processed foods that your body metabolises into methanol and then formaldehyde. Yes methylated spirits and embalming fluid. Ingesting small amounts of methanol don't do much damage to a healthy, fully developed human being with functional kidneys - unless you have elevated creatine levels - however I'm not sure if the same tolerances would apply to a developing fetus.

[@chrispasson1940]

interesting

[@sookibeulah9331]

Could be. However, I think the biggest increase in diagnosis is simply awareness and understanding. I’ve been diagnosed at age 51. Excepts from my school reports could be lifted from diagnostic criteria. My bother is also diagnosed as are several of my first cousins on my mothers side. I think my mother was severely ADHD as were at least two of her siblings. Her other siblings may have ASD (ASD & ADHD run concurrently in families) ….. all of us were born before Aspartame was in foods.

[@doctork1708]

An EXCUSE.

[@bastiaananthonijsz]

so look at the whole pic

[@skcrw252]

I still believe, as I have since Id first learned about it, that there is this essence, a tendency or need for self- and hyper,stimulation that is very obvious and explainable in its "neurotypical" instances (and obviously related to impulsivity, working memory, attention*, impatience, etc.) across all domains that is pervasive and constant as a character trait - the diagnostic changes, therapy and overall contemporary conceptualization, however, I believe to be misguided and ultimately harmful

[@QCCatPlanes]

What is a person to do then?

[@Ross_Embossed]

🚨🚨 The diagnosis and *"Inattention List"* 🚨COMPLETELY IGNORES🚨 the Structure and Stresses of the person's life & work organization 🚨🚨

[@Tim_Small]

Correct diagnosis takes that into account. Many adults with ADHD try to arrange things to compensate (I.e. chose jobs where the ADHD is less of a problem).

[@arkaig1]

Autism is an atypical response to becoming accustomed to hearing "no". ADHD is similarly an atypical response to becoming accustomed to having to decide to "go" or "not go". It is impossible to pin down ON THAT SPECTRUM because it is against a statistically observation of "expectedness", which is externally malleable. To make it approach something objective, consider it beyond the "expected normal variance" of the general observation of it yielding the maximally most effective outcome. Of course, then there's the problem of choosing ones own perspective. But that's why it's hard. For clinicians and sufferers. You might get some additional insights in considering the term "neuro-typical", which is typically expressed opposite "neuro-divergent", but should actually be expressed against "neuro-A-typical". And, GIVEN A CHOICE, one's correct choice is based upon the environment in which they are operating, and in which they feel they can make a positive impact, for themselves or others. Cheers!

[@bastiaananthonijsz]

stil is a trauma respons from your urly childhood and then you gonin fight ore fight stil as baby you can't go way wen in a fight of your parents stres so sone get introvert some extrovert so put in a super and there you have you adhd

[@jasondiasauthorpage615]

Fruit salad? Weak. The kind of argument by analogy true believers make in lots of other contexts. Ad hominem attacks on journalists are also maybe a bad idea.

[@zam1007]

He's not arguing. What do you believe or understand to be the 'argument' with the fruit salad analogy?

[@tionblack]

Get a life

[@futures2247]

So dishonest and biased

[@sakaimae]

I would like to ask why you feel this way, if you feel happy sharing?

[@futures2247]

@@sakaimae sure, he talks about this construct completely uncritically and as if its all settled science when nothing could be further from the truth. This is not just the case for the construct of 'adhd' but for all so called disorders in the DSM. For something specific to 'adhd' try searching for these two short but illuminating recent papers, the first 'ADHD in the DSM-5-TR: What has changed and what has not' and then The (Un)real Existence of ADHD-Criteria, Functions, and Forms of the Diagnostic Entity and if you would like more context look for the book by Psychiatrist Sami Timimi 'insane medicine' or read the free serialised version of it over at Mad In America.

[@ecco256]

Although grammatically correct, the lack of subject in the sentence implies it should be read as “I am so dishonest and biased”.

[@zam1007]

@futures, which part(s) did you have difficulty with? Also, how qualified are you to critique this presentation?

[@thesoundengine]

Yikes! There are a lot of traits that I really struggle with, I may just be lazy though. Lots of brain fog with day to day tasks and an endless tree of spuriously linked thoughts. I’m pretty sure I can train my brain not to have these traits, take advantage of the remaining neural plasticity I have. I trained myself to read when I was a teenager after getting a late dyslexia diagnosis. I’m very skeptical of drugs because they often require monitoring and modifying to precise doses, and I just don’t have faith in the current health care system.

[@Albinojackrussel]

The older I get the more convinced I am that laziness doesn't exist. If you were truly lazy, when you wouldn't be struggling. The fact that you are struggling to do things is evidence that you aren't lazy and you are trying. I strongly recommend you look more into "executive dysfunction" as I suspect that's what you're struggling with. A lot of the symptoms of dyslexia and ADHD overlap, and dyslexia often comorbids with ADHD, so you may have ADHD or you might be struggling with some of the same issues as ADHDer due to your dyslexia. You don't need to take meds if you don't want to, but that doesn't mean that other tools for helping ADHDers won't be useful to you.

[@isabt4]

I agree, there’s a cause for what presents itself as, or feels like, laziness. I don’t think we’re just lazy.

[@joycebrewer4150]

​@@isabt4😊YES!

[@nizzie16]

@@isabt4agree! Laziness has always been used as an accusation against people who are struggling for a variety of reasons, in order to avoid looking for those reasons. It’s very much linked to our views and treatment of poverty: instead of fighting the root causes of the system such as inequality, it’s much easier to just blame people for being inherently bad and thus responsible for their lot of life.

[@lascreen3198]

@@nizzie16People who are never “lazy” are easily amused by the mundane.