Is There a Unique Type of ADHD with Adult Onset

Is There a Unique Type of ADHD with an Adult Onset?
00:00 Introduction and Discussion of Acquired ADHD Secondary to Brain Injuries
02:25 The Controversy starting in 2015 about a unique onset group of adults with ADHD
04:40 Why the DSM criterion for age of onset of age 12 has no scientific basis and should be discarded
07:54 Other evidence that reports of adult onset of ADHD are not reliable nor accurate
10:00 A critical review of the evidence and alternative explanations for people reporting an adult onset to their ADHD
12:12. Summation of the evidence
This commentary focuses on the claim that ADHD can have an adult onset, rather than one during development, and that it may be a unique form of ADHD. The evidence reviewed suggests that this is not likely to be true for various reasons I discuss here
References used in the video:
T. Moffitt et al. (2015). Is Adult ADHD a Childhood-Onset Neurodevelopmental Disorder? Evidence From a Four-Decade Longitudinal Cohort Study. American Journal of Psychiatry. doi.org/10.1176/appi.ajp.2015...
Solmi, M. et al. (2021). Age of onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 6/2/2021. www.nature.com/articles/s4138...
M. Sibley et al. (2017). Late-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25. American Journal of Psychiatry. doi.org/10.1176/appi.ajp.2017...
L. Taylor et al. (2021). Adult-Onset ADHD: A Critical Analysis and Alternative Explanations. Child Psychiatry and Human Development. link.springer.com/article/10....
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[@EdwardThomasLee]

ADHD also gets worse once you hit mid-life. You may have been able to cope through life but once you hit 40 your mental and physical start to decline and you don't understand why you can't cope.

[@kv_5238]

Literally happening to me and you’re the first comment to confirm this for me 😭

[@jakeku2662]

@@kv_5238 Started at 35 for me. Always knew I had something going on upstairs, but everything started to get steadily worse after being a job that had shitty fly in/out schedule. Chronic extreme exhaustion seems to be what really accelerated my crumbling. Diagnosed at 39, and in the light of that I was able to see all the symptoms I had been masking since my teenage years. Just tunred 41 a few weeks ago. Medication was a game changer but not a total solution. I'm slowly making progress. But it's very much a before/after split in terms of what I can do and who I am. Best of luck to you.

[@stevenphillips2653]

I disagree. Life gets a lot more complicated. If you have children, that adds immeasurable complexity to your life. Add to that career and relationship challenges, it's a lot more on your plate than you have in your twenties and early thirties. You do have less energy, but I don't believe there is a mental decline at forty.

[@rebeccat9389]

Estrogen dropping in women can also increase adhd symptoms.

[@andrewdavies2640]

This is a good post and I agree. I think in your teens and 20s you both have less stress and things going on + there is much more novelty which makes the ups more exciting. As you get older you have more responsibility + less novelty so without medication it feels more of a struggle but medication does mitigate this I feel.,@@stevenphillips2653

[@johnbehan1526]

I've used to explain ADHD as "dementia backwards", because you get better as you get older and develop more coping systems. ... Then I hit my mid-forties like a speeding car. I'm more messy and forgetful than ever, and working twice as hard to stay organised and motivated. As an ADHDer, I didn't feel like I needed yet another humbling experience to teach me about shooting my big mouth off, but hey.

[@flawlix]

I think I fall into the category of “had symptoms in childhood but wasn’t impaired.” My mom was a super involved parent and taught me what I now realize were pretty common coping skills. They carried me through high school, but I had a harder time in college and law school (my first year in both was rough until I found my footing). And I had a really hard time once I entered the working world, which is what lead to my eventual ADHD diagnosis.

[@kv_5238]

We may lack awareness of our adhd - our family members are undiagnosed so we grow up thinking we’re normal and just need to “try harder” like our parents and grandparents did. My family is still in denial and now my youngest sister is suffering from it, presenting very serious impairments but doesn’t believe she has it. I was also in denial until a few years ago despite being on adhd medication for over 10 years. (Diagnosed at 24)

[@mrwormtester]

Along those lines, I grew up in a family that does not "believe in" mental disorders; that if you are not very visibly debilitated, you must have character flaws to overcome by sheer will. If you struggle, you are seen as lazy, bad, careless, etc.

[@mrmaxime]

I was one of those that did pretty well with some struggles later in high school, college became very difficult but I was studying engineering so it's already difficult. My mom was a teacher and very strict so I didn't have any behavioral issues. I just spent hours in class daydreaming then doodling in college. Wasn't til my friend joked I was adhd cause I kept bouncing around on my personal projects. When I read all the symptom I realized, "oh fuck... That's me.. And my dad". seems like if weren't Bart Simpson no one suspected you. I couldn't be bothered to get diagnosed until 3 years after that. Finally diagnosed at 33. I told my dad he might have it too, but being a boomer he said no. He put off fixing a toilet in his basement for 20 years, people used it and flooded the basement because they didn't know. When he finally got around to it, it took 3 mins to do. Whenever friends make plans with him, they tell him it starts 30 mins earlier than they plan on starting because they know hell be late.... Boomers just got a weird coping mechanism that shields them from accepting they have a mental issue.

[@kv_5238]

@@mrmaxime I agree with the coping mechanism some of them seem to have as well as the “you can’t teach an old dog new tricks” mentality. This is why I appreciate Dr. Russell so much in the way he is leading the charge to change the perceptions of doctors and even ourselves who are us afflicted (since we where misinformed most of our lives)

[@KF75411]

This might be an unpopular opinion in this comment section, but whatever the cause or the diagnosis, if a person has executive function, focus, emotional regulation and motivational problems, they should be able to get treatment. I'm not sure if I had ADHD symptoms as a child. Not saying I did or didn't but pretty much everything in my life currently looks like the effects of untreated ADHD and my doctor agreed just based off of that and we tried medication. The lowest doses of ADHD stimulant meds made a whole world of difference! I spent a lot of time seeing many doctors and therapists, trying antidepressants and anti-anxiety meds. Those kinds of medications did nothing but sedate me. Now I actually found something that works and whatever you want to call my condition/diagnosis, I could care less. The meds work, period. The medical field always wants to categorize you into a box as if the science is done and the boxes that we have are all-encompassing . Psychological disorder diagnosis and treatments are more subjective and less concrete than physical issues ,and even physical diagnoses have a long way to go.

[@thaixle7]

Not at all. I’m a psych nurse practitioner and one of the main purposes of these diagnoses are to help guide treatment. Sometimes it unclear whether it is ADHD or a consequence of anxiety or depressive disorder, for example. In some cases, treating with stimulants may be the best course. There is a reason stimulants are used off-label for depression. Yours is Not an unpopular opinion at all. :)

[@deliobaoduzzi6450]

My opinion is far more unpopular than yours . I often wondered if a disruption of executive functions is a form of low iq in certain domains.

[@pas.]

@@deliobaoduzzi6450it seems extremely straightforward that it's a significant factor of IQ (as IQ is usually measured anyway) ... simply taking a test requires a few hours of maintained high-level focus/attention. self-control (inhibition and self-motivation) are crucial for solving problems. (just to read and remember what the task is you need verbal working memory; self-control is necessary to be able to carefully consider possible solutions and answers to questions - instead of just picking the first that comes to one's mind, or the first that just feels okay-ish.) and if we look at planning and operationalizing (breaking down a big task into smaller subtasks) which is usually considered the last (and thus culmination of, or in other words an aggregation of the other) executive functions, then it's simply a major component of applied intelligence.

[@valerieconrad1005]

I know I've had adhd symptoms throughout childhood. I was never particularly impaired because I am quick to learn and get things done. Yes, I procrastinated like crazy, but it never was considered abnormal at my house. In fact, I think it was largely missed because I was the baseline normal child for my parents, and I'm pretty sure my mom also has adhd. In my 20s and now into my 30s, I go through ranges of impairment with some periods being worse than others. I finally decided to get some answers, and as of 2 days ago, I have an official diagnosis at age 35.

[@eliseholton9284]

Early onset late diagnosis

[@Trammiliin]

I had to go to 3 different doctors to get ADHD diagnosis. In my childhood ADHD symptoms were my smallest issue. I grew up in extremely abusive and neglectful family with PTSD, and having signs of ADHD really didn't stand out from that mess. From my adolescence years to 40's I suffered from cycles of depression and burnouts every 3 to 5 years. When I finally after some years of trauma therapy figured out, it's ADHD, it was bloody hard to convince the doctors. Although my brother has it diagnosed (in late 30's) and my mother has very clear signs but refuses to get diagnosed. First doctor said if I had ADHD it must have been diagnosed in my childhood and I probably have some other mental disorder. I grew up in a post-soviet country and was kid in 90's. No one even had heard of ADHD back then, how on Earth my messed up parents should have noticed my ADHD and took me to doctor? Second doctor wasn't sure whether it's PTSD or ADHD. The psychologist who interviewed me at the second place asked questions like how hard it was for my parents to handle my temper, supervise my school work etc before age of 12. I just could not answer those questions because they didn't even try to parent me, I was parented by myself. There was an option to have this interview together with a parent who could describe how I was as a child but I didn't see it as an option because my only living parent has no idea how I was as a child. So, the psychologist concluded that I did not have ADHD symptoms before age of 12. Third doctor was initially convinced all the ADHD symptoms I have could be explained with a list of other mental health disorders from depression to personality disorders. But finally I took some tests and it showed I do have ADHD. The whole process took 8 months. So this childhood onset topic is bloody frustrating for me. Especially kids who grew up in chaos, abuse and neglect due to their parents' mental health and substance abuse issues can't really tell did they have ADHD symptoms already in childhood. And at the same time ADHD parents are more prone to be dysfunctional.

[@user-xr7zb1ze6x]

My life has been a huge fuck up, I can finally understand what it is but came too late, I'm in 40s now.

[@Trammiliin]

@@user-xr7zb1ze6x it’s never too late! I got diagnosed at 39 and my life has improved a lot since then. Validation helps, educating myself about ADHD helps and medications help. Of course I feel angry and sad when I think about those first 39 years, but next 30-40 years will be better.

[@fendiagram3082]

oof that sounds rough, such a clear case of how the medical models and systems just aren't fit for purpose in so many ways for not just adhd but diversity generally. Trauma informed services and some basic decency/common sense could make the world so much better for everyone. Sounds like you deserve a medal for standing your ground, landing on your feet and being able to share yr experiences despite the many obstacles and frustrations. Thanks!

[@Trammiliin]

@@fendiagram3082 thank you for your kind words. I was so desperate and upset by the situation. My reality was during those 8 months that although all doctors admitted I have signs of ADHD (impulsivity, lack of motivation, hardships with concentration and directing my attention, almost non-existent working memory etc.) I can't be diagnosed with ADHD because I have no evidence I had it already in my childhood. I'm really happy that this "evidence from childhood" topic is now discussed and maybe diagnostics criteria will improve on that sense. So other people with chaotic family backgrounds do not have to go through the same BS.

[@KF75411]

The first psychiatrist I saw sent me right back out the door just because he saw that I used marijuana. What followed was about 13 years of heavy drug use and distrust of mental help. Nearly 30 years later and if I could meet him today I would give him a serious piece of my mind!

[@ginnyjanisse1220]

I agree that onset of the condition and then the onset of symptoms may not always correlate. Especially if you have inattentive or combined-type, where the outward behavior associated with childhood onset are mostly obscured. I know I have struggled with this neurodivergence my whole life, but I never knew what it was due to the hyperactivity part almost never being there. If I just tried hard enough I was able to overcome most of my learning struggles, until I reached higher learning where compensating didn’t cut it. Thank you for going over this as a subject that is easy to misunderstand and oversimplify.

[@TylinaVespart]

Could it also be that as time goes on we (hopefully!) get better at recognising adhd? Thinking here about how many of us didn’t get diagnosed as children, even where it was present and visible with hindsight. Edit; Oh you say this about 30 seconds after I commented 😂 once again foiled by my impulse to comment while still watching.

[@ElinoraMilanesi]

lol that impulse is the story of my life

[@BryanAllenSmith]

I'm curious on why certain people were disqualified from the claim that they had ADHD because they drank or used drugs? I thought that it was a higher chance to abuse alcohol or drugs if you had ADHD

[@SomethingStrange910]

Perhaps the researchers evaluated whether those people's ADHD symptoms started before or after drug abuse. Just a guess.

[@TeeganLee]

I’m also curious how they determined that the ADHD was secondary to a substance use disorder, and not that the substance use was secondary to the ADHD, considering that substance use is highly correlated with ADHD. I thought it was pretty well accepted that someone can have the disorder, but manage to push through and cope without treatment, possibly at a sub-clinical level, until something changes, whether life circumstances or hormones etc. and that one extra thing pushes them into needing to seek help. It doesn’t cause the ADHD, it merely causes them to lose control of their ADHD and that leads them to seek care. Why couldn’t substance use be a factor just like going to college or starting menopause?

[@ButterflyonStone]

@@TeeganLee Possibly because there is evidence that heavy long-term substance abuse affects the brain - including cognition, attention and behaviour. So it would be hard to determine if the presentation is ADHD or drug use or both. You wouldn't want that confounding your study. I think people forget that ADHD isn't the only possible cause for attentional difficulties, there'll be other differentials including physical health factors that do need to be given serious consideration.

[@TheKaurK]

I don’t know if I ever had symptoms as a child, or if my parents compensated.. but all my ADHD symptoms appeared big time after being in a car accident and going through the emotional trauma of losing my father in that accident (a drunk person took a sharp turn and crashed into us). I was 13 then and I know I have never been the same since. To me it feels like there was a clear distinction between what my brain could do before and after that incident. All my focus, my motivation, my processing speed, ability to retain stupid simple stuff- everything took a major hit and I have struggled with it all ever since and I feel that the symptoms only worsened as I reached adulthood. I have coped and survived and went to college and held a job and have felt consistently overwhelmed for years. I used to call it brain fog but I only just found out that maybe I have ADHD at 30 years old. I don’t know if it’s because it’s the inattentive type, or the symptoms are mild enough, or that I am a brown woman and grew up where anything to do with mental issue was heavily stigmatized, or what... I know there’s anxiety etc that can cause similar symptoms but ultimately I don’t have a clear cut label to help me because of the DSM requirement of showing clear symptoms before 12. I am fortunately getting the help I need because my doctor gets that I am struggling regardless of not neatly fitting into a box.

[@user-jc3rk5ur4u]

I am in my early 40s and decided to get a PhD two years ago. Although, I had established several coping mechanism to get two master's degrees (heavy procrastination ), it seems they are no longer useful in PhD and I am thinking about quitting after a year and half without any progress. I was stubborn, nasty and disorganized as far as I can remember. But that was not a major issue. Now, i need organization and the ability to concentrate on long term tasks like paper writing. I also need to spend twice time on reading because i lose my consciousness (attention) several times while reading and need to go back and reread. I really can't. It is no longer solvable by last hour studying or using the deadline pressure as a motivator. No more energy for fighting. I can barely remember my childhood. I was straight A till end of primary school. And C or D afterward. And i had discipline problems till mid high school. Those are all i can recall. And maybe some specific events. Can it be ADHD? Can the medicine change me? Or simply the PhD is not my job and i have to quite? If I have had ADHD but can't remember the age of unset, then what? 🤔

[@markkielty]

Feel the same way brother

[@dande_lion]

Exactly this happend to me during the last two years. Plus a new job at university that overwhelmed me completly and I tried to "function properly" so bad that I ended up in burnout. And with newly diagnosed ADHD at the age of 41. But that's a really good thing. It finally explains all my struggels and life finally feels managable again. (Slowly, since I still feel like an empty dopamin balloon. 😅) I haven't tried out meds so far but will, simply to know what they can do for me. Regarding my job at university and PhD: I decided to quit. Neither the job, nor the thesis are right for me (at least for now). I was just the same learning type as you and it worked great for me as well, but as you mentioned: not so well for writing a thesis without any deadlines and orientation. So, yes, it can easily be ADHD in your case and I would recommend seeing a specialist ( I am not btw ;-)). Just knowing that already changed a lot for me! Edit: Just because I decided to quit, of couse doesn't mean that it is the right thing to do for you as well.

[@user-jc3rk5ur4u]

@dande_lion I have talked to three psychiatrists during the past five months. However, each of them diagnosed a different disorder, and none was ADHD. The last one said general depression and for the past 40 days, I have been on med without any progress. I asked them to check me for ADHD and all of them told me almost the same thing: "You have a lot of ADHD symptoms, but we can't officially diagnose that because you haven't provided us enough symptoms from your childhood. The symptoms you mentioned mostly had an unset time during your adulthood. So, we need to consider other treatments." I couldn't find any psychiatrist who did not stick into DSM-5.

[@dande_lion]

Sorry to hear that. I don't know where you are located but here in Germany they consider the testimonials from 1st to 4th grade and a questionnaire of the parents regarding the behaviour in childhood.@@user-jc3rk5ur4u

[@deel2435]

menopause, menopause, menopause, being female. I've met so many women now who've been diagnosed while going through menopause. not one of them fit this mould (no private education, no help to cope etc) they all say they struggled when they were growing up or they excelled. all of them say that life became unbearable through menopause and they were diagnosed. so the question remains are these women developing ADHD through menopause or were they simply missed out. what's interesting to me is that I know 2 women who were told that their ADHD had developed due to menopause and therefore they had Adult Onset ADHD.

[@SaSPonchICo]

Traditionally they'd be counted among "late diagnosis" group. ADHD is easier to manage with hormonal cycle is up and running.

[@deel2435]

@@SaSPonchICo This is not strictly true but appreciate your comment.

[@anniekate76]

I love the helpful talks you put up! Thank you so much for making all this education freely available.

[@shaneward_adhdreimagined]

Dr Barkley, with all due respect, this is where some of us spend our time on the battlefields of social media. The psychiatric fraternity does itself no favours and makes some of our jobs more difficult defending them. How do we (globally, since I'm not in the US) tell clinicians to ignore the DSM when it's defined as the gold standard of psychiatric diagnostics? Here in SA a clinician will toe the DSM line because that is how they are taught, and medical aids (insurance) will not recognize a late diagnosis. On the other point - surely it is time consider a clear distinction between neurodevelopment ADHD and acquired ADHD? The lack of clear distinction muddies the waters for late diagnosed (neurodevelopmental) ADHD because it then overlooks how a lack of earlier diagnosis impacted on a person's life course. Throw into the mix the added confusion that allows long Covid to be lumped into the ADHD field due to overlapping symptoms makes the challenges all the more difficult for the average person to accept that those born with ADHD have had lifelong challenges even when they were not diagnosed. Acquired ADHD is an injury, neurodevelopmental ADHD is a lifelong chronic experience.

[@deliobaoduzzi6450]

What causes acquired adhd?

[@shaneward_adhdreimagined]

I want to be careful and caveat my response that *my* answer is an opinion. An opinion rooted in my belief that the "ADHD is not real" segment of society feeds off the nebulousness of the term ADHD and the confusion created by the medical community. *If* we regard ADHD as a neurodevelopmental disorder with polygenic inheritability, then acquired ADHD is not ADHD, with a (again) caveat . If the acquired suggests an epigenetic response in early development then it could be ADHD. However, I'm (again, imo) of the mind that acquired by Brain Injury should not fall under "classical" ADHD because it is not related to a genetic model, nor would it be inheritable to the next generation. It's part of the problem atm that the experts in the field don't appreciate, and something they don't seem willing to tackle.

[@deliobaoduzzi6450]

​​​Maybe they don't tackle it because it's very unfrequent . Many women in menopause feel symptoms that mimic adhd , same for borderline intellectual functioning . These cluster of " symptoms" we call adhd are also present in other disorders / syndromes like klinefelter , down syndrome , asd and others . It's very perplexing indeed . Like you , i don't believe adult onset is the same thing unless for example , the adult patient encountered the same " cause " that the young patient encountered . A toxin ? Maybe there's more than lead poisoning that can cause these symptoms. A major unresolved stress and depression coupled with a not so high iq could also mimic the symptoms . Sorry for my english ,i'm italian . ​@@shaneward_adhdreimagined

[@thebeatles9]

I learn more from you than I do my graduate studies. What are your thoughts on the supposition that psychiatry is largely still in "belief" of the medical model? Isn't it widely established now that biopsychosocial has superseded it? For example, some of these new cases of ADHD could be onset from the past few years of worldwide heavy drug, alcohol, and social media use, etc, resulting from pandemic coping? Until we have medical tests such as with somatic diseases, where we stick someone in a machine and it spits out if their brain is "ADHD" or not, it's seems the most logical conclusion. I feel like if the symptoms match, you have a dx and can start treatment--restoration of function should be the only goal, and as you pointed out etiology seems to be largely irrelevant if the patient/client is getting better. Thank you so much for your work and it inspires much thought, and I'd love to hear your thoughts on this and any guidance you may have.

[@oceanistoosmall]

Yes! But those features are not permanent. It is like becoming insulin resistant due to sugar abuse vs early or late onset type 1 diabetes. Your environment and lifestyle could impair your PFC / executive function but ADHD people have structurally different PFC and activity at the receptors. Anxiety also causes executive dysfunction

[@russellbarkleyphd2023]

Yes, the medical model has been superseded. Only critics of psychiatry still site it as an issue, in my opinion

[@publius9350]

This is one of your best in my opinion. Thank you for all you do. There is so much that needs to be done to repair the field, but I think an important thing most psychiatrists need to address is the loss of childhood records and the defensive and sometimes hostile nature of parents to diagnosis as they find it to be criticism of their own parenting in some form. Secondly, understanding that old diagnoses for family members may have been misdiagnosis based on understanding of the time. Basically, you need to be able to work with a puzzle with missing pieces. Also, I noticed you mentioned various cause of brain injury, but did not specifically mention car accidents - is there a reason? I think this would be one of the most common reasons for frontal lobe damage in any car dependent culture. Also, metabolic changes in either disease or age. No need for extremes like gun shot trauma.

[@saltiestsiren]

I don't think I had symptoms as a kid, at least not the inattentive or hyperactive issues listed in the DSM. Perhaps they were simply not very disabling. Perhaps what I was able to focus on was appropriate---class lectures and whatnot. I always loved learning and gym class was my personal nightmare. I started getting focus issues around the time I started having panic attacks and severe general anxiety in middle school, but even then they were pretty mild. Depression, OCD, and BPD developed over my teenage years and steadily worsened. By my early or mid-20s, my executive functioning as a whole was a wreck. I'm also just an extremely thought-heavy person. I am constantly thinking about many things at once. One could say I have high anxiety all the time, or that I have internal hyperactivity. I have no idea which of my many diagnoses to attribute symptoms to, so even though I was diagnosed with ADHD last year, I'm not very attached to that diagnosis, especially because my body cannot tolerate stimulants or Strattera.

[@CapnSnackbeard]

I have always had ADHD, but it has gotten more pronounced the older I have gotten. My parents still don't believe it, but I have never been any different. My habits never changed. In fact, I leaned into them, and built them up. I was a bright kid. It was being released from school, and allowed to posess myself and my time, that my so-called "intelligence" has blossomed. I am still terrible at arithmatic, and am number dyslexic. Yet I can intuitively engage with mathematics on a high level so long as the thing I am thinking about is "grown" in my own mind, and NOT placed there in isolation, in no particular order, for no discernable reason. School provides both instant and delayed feedback to performance. I was able to "concentrate" in school because of fear. Fear. That is why I "did not have ADHD until I was an adult." As an adult, I have always avoided that arrangement. I don't like or want bosses. I function like a superhero when surrounded by my other ADHD and autistic friends. I now live and work in an environment with no need of money, paperwork, or other trivialities that consume the lives of the "healthy" and "normal."

[@dianasimplifies]

I agree. I grew up in a family where you made straight As period. And I liked school a lot, my probs came after I grad college. I have never had head trauma of any kind that I know of but I have some ADHD traits for sure.

[@stefanmanfreda6218]

Question regarding age of onset - what should one do if diagnosed negative for adhd predominantly bc symptoms didn’t start developing before adolescence and weren’t visible by age 12? The clinic responsible insists they did everything based on newest evidence by following these dsm-5 guidelines

[@piotr780]

"FAS and ADHD are separate conditions that often occur together"

[@fernandavasconcellos4799]

Can you make a video about ADHD and personality (especially the big five)?

[@thedisasterinquiry9662]

I wonder if the drug-use was filtered out before or after looking at age-of-onset reporting issues. That is to say, we already know that people with ADHD are susceptible to addiction issues. I wouldn't be surprised if some--if not many--of those people had unrecognized genetic ADHD hidden under their current drug use. You speak about this, and I'm grateful for it, but it remains wild to me to what extent the memories of the patient and their parents are relied on when it comes to that early diagnosis. Obviously there's no guarantee that the parents also have it, but they sometimes do, and then you're left with a whole family of unintentionally unreliable narrators. When I was a child, my father used to joke I had "juvenile dementia"...

[@adultADHDindia]

ADHD is still seen as a childhood disorder world over. DSM contributed to it by defining age of onset. Now too late to undo the damage. Might as well embrace adult ADHD so people understand even adults can have ADHD (onset till age 30).

[@bodycoach_bo]

Hi Dr Barkley. Thank you for all the work you do in this field! A question I have, because I see mixed answers on the Internet: Does high-dose vitamin C (1000mg+) really act as a sort of “off-switch” for amphetamine-based ADHD medication? And if this is the case, how quickly does it work?

[@russellbarkleyphd2023]

Not to my knowledge but you can use Google scholar to search the journals for research on this.

[@efib5514]

It might "sound" weird but a bit after I got my Elvanse 30 pill today (I'm new to ADHD treatment) my (vasomotor) rhinitis got a lot better. Could they possibly be related?

[@Waverathon]

Dr. Barkley, when will you be coming back? I hope you are moving well but you haven’t uploaded for over a week! I miss you so much :(

[@gausgrin649]

Hello Mr Barkely. With hopes you read, I have an unrelated question. In 2012 you gave a lecture where you talk about Ego Depletion as an important consideration in managing ADHD in children. Looking today, the literature seems to be quite split on it - how do you stand on the validity of it as a theory in 2024? do you agree that evidence is inconclusive or is the lack of consensus due to some other reason? Would love to know your opinion. Huge admirer of your work, thank you.

[@russellbarkleyphd2023]

Inconclusive. The textbook on Handbook of Self Regulation has a chapter by Baumeister suggesting it can be a problem but other studies suggest not.

[@wowwee0]

Dr. Barkley could you talk about "ADT" or "Attention Deficit Traits"? I have been seeing it more recently and I am not sure if it is legitimate.

[@westingband]

Any chance you know of specialists in the central part of CA? Very hard to find competent assistance in this region (Tulare/Fresno/Kings counties).

[@westingband]

I was a normal case of inattentive as a kid but it got way worse after concussions in football and then some later traumatic experiences. Working my way back.

[@dhalvorsen8739]

I went undiagnosed until 45 when the wheels fell off, been 10+ years and just gets worse…idk

[@ryarya3291]

Hi, during my childhood I was over focused on studying and up till the age of 23, it was my only activity, nothing else interested me. I just wanted to be a straight A student and i brilliantly succeeded, At 23 when my studies started being solely focused on clinical training ( I studied medecine) and in a non structured way I must say, there I developed a total lack of organisation, decision making and I started developing ADHD symtoms severe enough to prevent me from ever working. I continued my MD because of all the informations I had in my head, I managed somehow to finished my MD but could never go into residency or work. Could that be ADHD? never had drugs or any brain injury. Thank you for your opinion.

[@oceanistoosmall]

Yes! You're a classic presentation. It could also be overlapping OCD

[@ryarya3291]

@@oceanistoosmall Hi are you a psychologist?

[@andymellor9056]

Question. What exactly do we mean by "onset"? Thinking of children, behaviour due to ADHD that's acceptable in one family might be unacceptable in another and hence would be differently reported between the two famies.

[@aFuzzyKiwi]

Is there reliable information on ADHD and Fibromyalgia/chronic pain comorbidity? I saw a couple small citations referencing MPH as helping both in some cases, but struggling to find more info. Have you touched on ADHD with chronic pain before? Thank you.

[@russellbarkleyphd2023]

Yes, use Google scholar to search the journals but I know there are several papers on this comorbidity. .

[@guillaumeb6698]

Or could it be that some people have been coping with their unbeknownst ADHD by masking for most of their life, until some major life event (break up, job loss, death of a closed one etc) breaks their adaptation and they suddenly go full ADHD ? It seems to have happened with my dad. I don't know if it's ADHD, and/or ASD, and/or some other condition (some sort of "light" psychosis, he's certainly not self-aware) but serious issues in my parents couple triggered a change in him, resulting in ADHD/ASD/borderline -like behaviours.

[@thebeatles9]

Dr, I read an Adult article referencing pre-frontal development is not done until ~35 for ADHD compared to the 21-25 for others. Is this true at a biological development level, or is it implying more of a psychological/cultural maturity level?

[@thalieab]

Hi, i have a big question ¿adhd and autism there are relationated?

[@iliyanovslounge]

ADHD and autism co-occur more than expected by chance. They are known to share some genetic and environmental risk factors.

[@little1133]

why is this random old man psychologist so spot on with his adhd videos?? why are you so good at your job

[@LucarioBoricua]

Oh, he's not a random old man psychologist, he's a retired psychiatrist and long-time lead researcher on ADHD. We're talking about someone who's a maximum authority in their discipline.

[@dianasimplifies]

Lol random old man....my dad is a 60 plus year clinical psychologist and still working at 92. This dr on this channel is not old 😅

[@deliobaoduzzi6450]

​@LucarioBoric he's a psychologist not a psychiatrist 😊

[@justinwest4923]

Sorry- I'm struggling with something. At 10:58 you describe a child having ADHD symptoms but not being impaired by them until adulthood, and seem to make the argument (at least by implication) that in this case they would have in fact had ADHD since childhood, despite its later recognition. To me, this seems contradictory to something you have said in the past, which is that a disorder is defined by impairment, rather than physical or neurological deficiencies, or even measurable symptoms. According to this definition, I would think the hypothetical situation you described, in which the person didn't experience noticeable impairment until adulthood, would qualify as "Adult-Onset ADHD". I realize this may be pedantic or I may have misunderstood something, but I'm having trouble reconciling these two ideas.

[@LucarioBoricua]

The DSM-5 criteria requires distress / impairment caused by the symptoms during a recent period prior to the diagnosis (at least 6 months and in more than one setting / area of life functioning), but it does require some of the symptoms to be present before age 12 (regardless of impairment) as proof that there was onset during the development period. Keep in mind that other stuff can cause ADHD-like behaviors without a neurodevelopmental origin, in which case that would not be ADHD.

[@justinwest4923]

@LucarioBoricua I'm still struggling to wrap my head around this.

[@LucarioBoricua]

@@justinwest4923 Mental and neurological disorders are significant differences in the brain which can make life more difficult for the person, but those difficulties are not a one-size-fits-all deal. Depending on the environment, level of support, social response, and even compatibility between the person's interests and abilities, these differences may or may not cause enough problems to justify diagnosis. There's a certain level of subjectiveness in diagnosing psychiatric conditions for which there's no objective diagnostic criteria that doesn't involve the clinician's judgment (ex. blood test, genetic testing, brain scans) or corroboration of symptoms through testimonies or documented proof.

[@DC-oh1um]

If it’s caused by injury later in life is it not called Executive Dysfonction and not adhd? For exemple I have had a brain tumor and I started presenting symptoms close to adhd. In fact that’s how I realised that I was having similar behaviour to my daughter who since then has been diagnosed adhd!

[@russellbarkleyphd2023]

It can be called that but also acquired ADHD

[@larryjohnny]

Although I have a Doctoral degree classical guitar performance and attended prestigious schools UCLA, CSULA, and Claremont Grad. School. I was and still am a cannabis daily. I wish I could have figured out my ADHD earlier. I have slowing gotten away from smoking cannabis with a bong or joint. I have switched to the vaping pens and gummies to avoid destroying my lungs. With my ADHD diagnosis in Oct. 2024 I have been weaning myself off of cannabis for ever. I have given up drinking in 06/22 but I didn’t have any benefit with Alcohol and am angry about all the advertising they do to make it look “cool”.

[@puddin12dt]

❤❤❤❤

[@yarntoast]

Dr. Barkley, please respond to the interview Dr. Palmer had with the influencer, Mel Robbins. I believe many will be harmed and appropriate care for children will be avoided and delayed because of it.

[@russellbarkleyphd2023]

I agree. It’s not that clear cut as he suggests and he ignores huge evidence of other neural network deformities not to mention genetic factors.

[@elizabethhenning778]

Dr Barkley, is there such a thing clinically as "ADHD paralysis"?

[@russellbarkleyphd2023]

Not to my knowledge.

[@therabbithat]

Honestly I think it would be silly to say a lady who, for example, got mercury poisoning at work now has ADHD because since the poisoning she more than meets the criteria.. But if you can't prescribe her ADHD meds or treatment without the dx I guess you have to say she has ADHD