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ADHD Science episode 3 with Aja Murray
201 Plays1 year ago
We are joined by the brilliant Aja Murray of the University of Edinburgh to talk about anxiety and ADHD! This is such an important topic and Aja brings real passion and analysis to it.
She is @AjaLMurray on twitter, and her departmental profile is here.
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Transcript
00:00:09
Speaker
Hello. Hello.
Welcome and Check-in
00:00:11
Speaker
Welcome to episode three of the ADHD Science Podcast. Hell yeah. Yes. Now, how are you, Tess? All right. I'm very tired. I'm very stressed. I'm writing my UVG production log right now. I have literally left it to the last minute. It's due on Tuesday. Very much rolling like a dinghy. But it's all right. We'll get there. Oh, sure we will.
00:00:35
Speaker
We are, yeah, so we're going to be quite quick because you've got to get on with your work and I've got to get on with worrying about your work. Nice!
Introduction of Guest: Asia Murray
00:00:45
Speaker
So we're going to talk today to Asia Murray who is from the University of Edinburgh
00:00:52
Speaker
and is going to talk about ADHD and anxiety which is quite appropriate and topical. Hell yeah! Asia is very passionate about the subject and there's lots of thoughts about how we push forward kind of real-time
00:01:10
Speaker
research in ADHD are sort of really interesting about what both about the subject but also about how we go about researching people in their real lives rather than in some sort of laboratory situation so good stuff so without further ado have you got any other ado on the agenda
00:01:28
Speaker
No further ado at all. Oh one thing please do let us know what you think and Yes, we need more feedback. Let us know what we're doing. Well, and let us know what we're doing wrong Yes, so you can find me on Twitter max daily You can find ADHD UK any of those places and just let us know as in any of those places in Facebook or Twitter Do not find me. Don't find Tess and
00:01:56
Speaker
It's probably not hard. Or go to the ADHD UK website where there is a feedback form and poor Anna has taken the trouble of making it so we ought to use it. Shout out to Anna. Right, let's go. Yeah. Bye.
00:02:22
Speaker
Okay, so welcome to our episode for today of the ADHD UK Science Podcast. Hooray, I'm Max, this is Tess. Hi. And we're talking today to Asia Murray, Reader in Psychology at the University of Edinburgh.
00:02:39
Speaker
Welcome. Thank you. Great to be here. There you are.
Research Questions on ADHD, Anxiety, and Depression
00:02:43
Speaker
And we're going to talk about, well, we're going to use as a springboard paper that you did about ADHD and anxiety and the relationship between the two things. So Tess, do you want to start? Yeah. I'll kind of wrap this to questions. When you were doing this research, what was your initial question that you wanted to answer?
00:03:05
Speaker
So I think the kind of starting point for our research with ADHD and anxiety is we know that it's quite common for people with ADHD to experience anxiety and also depression. So I think that's quite well known. But then the question is like, why basically, what are the mechanisms that link ADHD to anxiety and depression? And are there certain symptoms that are more important than others? And something else I'm really interested in as well is like, are there actually kind of like feedback loops as well? Like does it work both ways?
00:03:32
Speaker
And in terms of like, if people develop like anxiety symptoms, does that then exacerbate their ADHD? So these are the kind of questions I was really interested in because I think all of them have got quite important implications for like how you intervene and how you support people to sort of prevent the development of anxiety in the first place. And if it does happen, then how do you actually kind of, what's the best way to intervene to help with those symptoms? And I was just wondering,
00:04:01
Speaker
It might be worth just teasing out some of the ways in which ADHD and anxiety could be could be linked. I mean I suppose the first thing is that having ADHD is in itself particularly in a typical world. Anxiety provoking, I suppose that's the first one. Yeah definitely. Yeah definitely. I mean a lot of the stuff that we've covered in previous episodes is pointed directly to that
00:04:29
Speaker
I mean, it is stressful because the world's not built for ADHD people. But then I suppose equally there's potentially genetic, you know, ADHD is often talked about, quite extensively talked about as a genetic condition, but we don't really talk about the genetics of anxiety quite so much and whether you're not necessarily a geneticist by trade, but some kind of common origin of both is another thing that I think about sometimes as well. Yeah, yeah.
00:04:58
Speaker
And I think there can be quite a lot of overlap even if you look at the way that anxiety and ADHD are defined, you see symptoms like concentration issues and stuff like that that appears in both diagnoses. So you also have to be a bit careful about making sure that if you're finding an association, it's not just due to the fact that basically the same thing is mentioned in both domains.
00:05:18
Speaker
Yeah, you're double counting in a way. Yeah, exactly. But I think there's no one way in which ADHD is related to anxiety. I think there's lots of different mechanisms. And I think Tess is exactly right. It is very stressful to be someone with ADHD in the world. And that can cause all sorts of issues with self-esteem and lead to anxiety. And one of the other things that we're quite interested in, because we think it's probably quite a good point for intervention, is emotion regulation as well.
00:05:47
Speaker
some of the difficulties associated with ADHD could sort of make it more difficult to you know like moderate emotional reactions and to kind of essentially manage emotions in a way that
00:06:01
Speaker
makes it more of a risk for anxiety symptoms developing basically. So you say that there's lots and lots of different possible explanations for what causes these overlaps. Was there a specific one that you were more drawn to than the others as an explanation or a more common one? I think I'm personally quite interested in emotion regulation because I think emotion regulation is something that you can teach as a skill whereas I think unfortunately like some of the other things that are quite anxiety provoking for someone living with ADHD in the world
00:06:31
Speaker
It's a bit more contingent on other people and like the way that society is structured. So I think one of the reasons I'm quite interested in emotion regulation is that it's the kind of thing where you can sort of teach strategies for regulating
Emotion Regulation as a Teachable Skill
00:06:45
Speaker
emotions. Like there's certain strategies that are more adaptive than others. Like if you have like a stressful situation, a bad way of dealing with that is to kind of like ruminate on it, keep thinking about it and kind of end up in a sort of vicious cycle where you just feel worse and worse.
00:07:00
Speaker
Whereas strategies like what you might call cognitive reappraisal, thinking about the situation a bit differently, reframing it, thinking about it more in positive terms can be a good way to regulate emotions. It's not straightforward though because I think ultimately people need to be quite flexible in the way that they use different strategies to regulate their emotions depending on the particular situation that they're in.
00:07:26
Speaker
So it's not like, oh, there's always one strategy that is the right strategy. It's more like you need to have a good repertoire of strategies and be able to use them in a way that is suited to the particular situation that you're in. Yeah. And I would like to return to strategies. I think it's pretty really good way to return to
00:07:46
Speaker
of later on but I suppose I want to hear about your research what you did how you measured and studied the kind of people with ADHD and how you found out what the relationship between their ADHD symptoms and their anxiety was. So we've done a few different studies in this domain and we've kind of measured it in different ways and it's quite interesting that we find something similar like basically irrespective of how we do it so
00:08:14
Speaker
We sometimes will look at people with a diagnosis of ADHD but also we kind of take the view that ADHD symptoms are sort of dimensional. Not to say that like necessarily everybody's a little bit ADHD but just because somebody hasn't got a diagnosis doesn't mean that they might not be experiencing some level of ADHD symptoms. So one way that we approach it is to just use samples from the population measure levels of ADHD symptoms and look at how that relates to things like
00:08:44
Speaker
emotion regulation and anxiety and other factors that might be involved in that association. One thing that we do is we try to capture people's symptoms like in the course of their daily life. So a lot of these sort of questionnaire based measures of symptoms, it's sort of like a snapshot. It's not really giving you how people are really functioning in the course of their daily life. So one of the things we do is we do smartphone based data collection where people do surveys
00:09:13
Speaker
just on their smartphones so they get a little notification. And then that takes them to a little survey with a series of questions. It's just about like, you know, how are you feeling now? What are you doing now? Over the course of like, you know, several days, a few times a day.
Real-time ADHD Symptom Tracking
00:09:26
Speaker
And then we use that to get a better picture of how people are actually functioning in the course of their daily life. Because we think that's much more reflective of how people actually experience symptoms, how they regulate their emotions and how that links to their mental health symptoms, like anxiety.
00:09:43
Speaker
Yeah, that's really interesting. So what did you find with the? So one of the things, yeah, we definitely find that ADHD symptoms are related to anxiety. That's something that comes through in all our studies. We find interestingly also that anxiety can lead to a worsening of ADHD symptoms as well. So it's sort of going in both directions, which is quite interesting. So that's what I was going to ask. How do you tell
00:10:13
Speaker
what the relation, what the direction of relationship, how can you, how, how do you know that it's bi-directional or that, do you see what I mean? Yeah. Measuring the same thing in slightly different ways. Yeah. I mean, it's not infallible, um, cause we're typically using like what you would call observational data. So it's not from an experiment or a trial, but essentially by collecting information multiple times over the course of someone's life, over their development,
00:10:42
Speaker
Then we can use the fact that we've, I guess, like the temporality of it, like we can see, um, if you look at ADHD symptoms, then what happens to the anxiety symptoms at a later time point and vice versa. So essentially by having the multiple time points, we can use different statistical methods that help us to tease apart that directionality.
00:11:02
Speaker
So it's staggered check-ins on ADHD and anxiety symptoms, which kind of helps you get a better look at how they interact. Exactly. Yeah. And you put it much better than I did. Yeah, that was exactly right. Yeah. Awesome. Well, I wouldn't have been able to put it like that at the other time. So in a sense, what you're saying is that a certain amount of ADHD symptom at time X
00:11:25
Speaker
you know in January we might and this is probably massive oversimplification might be able to influence how much anxiety you're feeling in time you know in June which in turn will then influence this is just I'm doing far too much for our audio listeners I'm doing far too much
00:11:47
Speaker
hand movements and tests is blocking me because I'm interfering with your personal space which I should not do and then in December that might then rebound and predict your the ADHD symptoms again. So in a way and I see this clinically a vicious cycle of ADHD and anxiety symptoms.
00:12:08
Speaker
You're thinking more long term. I was thinking more on a short term. Well, that's a good question. Maybe if you're feeling like anxious in the morning, your ADHD symptoms would be worse later in the day. Which one was it more focused on? So most of the work that we've done has been more longer term, but actually what you say I think is really important because I think there's a lack of studies that look at that shorter term relation. I think that's really important to understand better because I'm sure it's happening on a short term as well.
00:12:36
Speaker
like over the course of a day, not just over the course of like months or years. Yeah. It's probably a lot harder to look at though, because that's a lot more surveys you need to do every day. Yeah, definitely. Yeah. So that's where the smartphone based data collection is quite useful because we can do that in a short term. Yeah. It's just tricky sometimes, because it's obviously quite a big burden to, you know, answer surveys like multiple times a day. So sort of convincing people to do that is quite tricky, which I totally understand.
00:13:02
Speaker
I'm busy. That's how I'm feeling about it. Exactly. It's like... You're feeling any better yet? No, I'm not! Yeah.
00:13:14
Speaker
Yeah, and that's another important point as well. People might selectively not respond if they're feeling bad. So you might get a biased picture of what's actually going on because they're like, oh, I really don't feel like answering right now. And they don't. So you only get the times when they're feeling better or something. But is that not a problem with this way of surveying people anyway? I mean, I'm not saying it kind of makes it invalid, but is that a problem that you have to kind of deal with?
00:13:36
Speaker
when you're looking at your data. Yeah I would say so. I think it's probably just magnified on the shorter scale because I think with these like longer term surveys there's a certain time point that's quite fixed that people will do the survey like they'll either come in or they'll get sent a link and it's quite kind of they're sort of like giving reminders and stuff like that and that's one time point in like a year. Whereas with like this smartphone based thing because it's happening over like you know days and hours
00:14:06
Speaker
There's a bit more opportunity for people to selectively respond. Yes, because it's a lot bigger burden over a shorter period of time. I build it in quite as easily. OK. Sorry, can you cut this out of the edit? Did you already say what the results are? Because I think I mind blanked over it, but you might have not said.
00:14:31
Speaker
I think you said that there was a relationship between the two. So maybe if we cut this out, message the editors. No, we don't edit it anymore. It's very odd. Oh, I'm sorry, editors. Why didn't you make your next question? So what was the relationship? Yeah, that's what I was thinking. Okay. I just didn't want to ask if you'd already. No, no, no, because that's why you're here, Tess. Yeah. Okay.
00:14:56
Speaker
So what was the relationship that you found between the two variables?
Bidirectional Relationship Between ADHD and Anxiety
00:14:59
Speaker
So we find with ADHD and anxiety that it worked both ways. So ADHD symptoms led to more anxiety symptoms later. And then especially in later adolescence, anxiety also led to an exacerbation of ADHD symptoms after that. So yeah, this kind of working two ways thing confirms what Mac said he saw clinically.
00:15:25
Speaker
we definitely see that in the data. And how do you I mean, it sort of makes sense that worsening ADHD. So just some common sense practical perspective, it sort of makes sense that worsening ADHD would make you more stressed because actually, it would just make you function less well, and more things would go wrong for you. So you would feel more out of control. So you would be stressed and that would that would work both for short and long term. But how does
00:15:51
Speaker
greater anxiety than make you have more ADHD symptoms, other than just make you a little bit more agitated, which isn't quite the, well, is it the same thing? I don't, you know what I mean? That's what I'm kind of struggling with. Yeah, I think that's a really good question. It was something that we weren't able to look at in the data that we had because we didn't really have that information. So I think it would be really good to actually do like some more work and find out what the mechanisms are. But I sort of suspect it might be
00:16:19
Speaker
Like say if you're worrying a lot, that's using up your attentional resources, your mind is on your worries. So that's going to manifest like in your behavior is seeming more sort of distracted, not being able to concentrate as well. I guess being like physiologically quite aroused could be manifesting as more hyperactivity as well, more sort of restlessness. That's what I imagine it might be. But as I say, like it's kind of speculating because we didn't actually have that information.
00:16:45
Speaker
with that day-to-day. So on. No tests, you go. Okay. Um, do you think that the, cause we know that sleep affects ADHD symptoms. Cause we looked at that. We have. And we're going to go back to sleep in the future episode. We're going to go back to sleep. Okay. We're not going to go to sleep. We're going to remain away. So we know that, um, sleep has an effect on ADHD symptoms. Do you think that anxiety could be
00:17:12
Speaker
causing like issues with sleep that could be leading to worsening of the symptoms. That is a really good point actually. I'm sure that must be one of the mechanisms as well because like you say we know that sleep is related to ADHD symptoms.
00:17:24
Speaker
anxiety is related to our sleep, so it makes sense. Maybe we should do that as our next study. Yeah. That's going straight in the scene. Maybe. I do have work experience coming up. It's a little far. Sorry. What was I going to say? Oh yes, I suppose I was just going to say,
00:17:51
Speaker
Taking Tess's point absolutely, but the thing that you said about using up your mental reserves, and we do talk in clinics sometimes about mental batteries that people have, and that ADHD is something that makes tasks that for other people will hardly deplete your batteries at all, deplete yourself. Processing power. A lot more, processing power. So actually, anxiety is taking up a lot of your processing power.
00:18:16
Speaker
So that doesn't make sense. Sorry, I've been fine all day and suddenly now. Suddenly when you've got to record, that's when it'll catch it. There we go. Well, I have a bit of a cough. Why don't we go to the next question? What does this mean for people looking after ADHD people? So do you mean like clinicians or like say parents of people with ADHD?
00:18:42
Speaker
I think the question's more directed towards parents and carers, but I think a couple other times we've been talking about both.
Recognizing Anxiety in Children with ADHD
00:18:51
Speaker
Okay. So I think from a sort of parents or carers point of view, I think it's good to understand that like having ADHD is associated with more difficulties with regulating emotions. So I think like if, you know, somebody is struggling to kind of like be calm and
00:19:09
Speaker
deal with the stressful situations, I think it's important to understand where that's coming from and not to attribute blame or have expectations that are not realistic in terms of emotion regulation. I think it's also just because it is so common that anxiety is associated with ADHD, I think it's also just something to be aware of and watch out for. Look out for those symptoms.
00:19:37
Speaker
Because yeah, I think like as a parent, like you're in a good position to sort of be noticing that that's happening. And, you know, maybe it's a case of like having conversations with your child and stuff like that and making them aware about these symptoms as well. So that, you know, I think sometimes it can get missed in ADHD as well, because there's sort of, I guess you could call it diagnostic overshadowing, because there's a lot of symptoms that are like going on anyway, it might
00:20:04
Speaker
not get detected so easily as compared to someone who doesn't have ADHD. So yeah I think having that awareness that it might be a thing is quite important. Yeah I feel really strong about that actually. I think particularly maybe more in boys but I don't, I'm not sure, but anxiety gets missed and anxiety in ADHD is a really toxic, I find a really toxic combination. Often those are the boys who are
00:20:30
Speaker
who are lashing out and acting out most in school because their negative emotions are just overwhelming them and they're inculsive and they're getting excluded a lot. And we don't actively seek out their emotional state nearly enough. No. There's that whole kind of thing where a lot of boys, because of the stigma surrounding male emotions, will portray any
00:21:01
Speaker
they will channel any negative emotion as anger. And so if that is coming from a place of anxiety, that's not going to be detected nearly as much as it would in like women or people who are raised as women because they're taught that that's okay to feel rather than like boys who quite often told that that's not. Yeah.
00:21:24
Speaker
we're still not good even though we were kind of we had took decades of mental health awareness we're not that good at that very simple message that the the person who's misbehaving in class or the person who's you know angry also needs to be treated to somebody with emotions and as someone who might need help with their mental health as well. Yeah and it might it might be difficult to tune into that and to understand that
00:21:51
Speaker
it's anxiety as well from the person who's experienced it from their point of view, like ADHD can sometimes be associated with difficulties and sort of like labelling emotions and identifying them. So they might not even really be very aware of themselves of what's going on internally. But the point about boys and girls, I think is a really important one, actually, because I think it is quite different for boys and girls, because with girls, it's often the case that ADHD will get missed and like anxiety or depression will get picked up and it's only later.
00:22:18
Speaker
where it's like oh actually the underlying root cause of all of this was really ADHD it wasn't really anxiety, depression being the root cause and then with boys like you say it's like a bit more potentially the other way around.
Impact of ADHD on Self-esteem and Depression
00:22:31
Speaker
So we've talked about how ADHD and anxiety overlap how do you think
00:22:38
Speaker
ADHD and depression kind of react together? It's quite a tricky question because anxiety and depression very often co-occur with one another as well. Like it's very common for someone to experience both at the same time. So I think there's some commonalities. I think that with depression, I think that we find that there's a link with emotion regulation as well. So that's one thing. But I think also similarly, just this like day to day and broader life challenges of having ADHD and like, for example, having
00:23:07
Speaker
difficulty with like say school or work or like friendships or relationships like that can really undermine a person's self-esteem and then lead to depression basically. So I think it's quite similar in terms of the mechanisms but it's just like a slightly different reaction in the end. I'm just thinking back to the flat batteries thing as well that
00:23:32
Speaker
I mean, I know it's probably a little bit on the nose because one of the ways that people who are depressed talk about themselves is as flat. But I really think that there is something there about just. They often thought of two sides of the same coin, anxiety and depression. But I think in a sense, anxiety is the using the diversion of your mental resources elsewhere into loops of ultimately not very purposeful thoughts.
00:23:58
Speaker
And the depression is just the cognitive and emotional exhaustion. Yeah. It's like that burnout that you get basically. Yeah. Yeah. Because they are, you know, they are kind of qualitatively different things. And I know that they pause. What, what does that mean for the audience? Qualitatively. Okay. Cool. Cognitively. They are qualitatively. Okay. So in the, no, no, you're right. Thank you. That's why you're here. Uh, another reason why you're here. Uh,
00:24:26
Speaker
So in terms of the brain and how it feels, so what I should really have said is subjectively. So how it feels to be anxious and how it feels to be depressed are different in the quality of how it feels. They co-occurs so often that they're usually talked of in one breath. And I think the mechanisms underlying them
00:24:54
Speaker
are probably ultimately very similar, but they are two parts of the same process. They're two consequences of the same process in some ways. And I think what you were saying also gets to the point about how anxiety can sort of lead to depression because it sort of leads to that exhaustion, that like just complete feeling of like hopelessness and lethargy and stuff like that after, you know,
00:25:22
Speaker
feeling anxious for a while. Yeah, because anxiety generally, well, not always, but very often comes first, is the thing that people experience first. It's not a kind of unifying theory of mental health, but I find it useful as a way of thinking about these things, just practically. So, what does this mean for ADHD people themselves? ADHD people themselves.
00:25:52
Speaker
Good question. So I think, again, it's a similar point probably about sort of being aware about what symptoms might be experienced and what difficulties with emotion regulation might be possible. Being aware of that, kind of trying to learn strategies for regulating emotions. So learning about what are the more adaptive strategies for dealing with negative emotions and what are the less adaptive strategies. Like so, for example,
00:26:22
Speaker
say like it's not very adaptive to ruminate on something to just think over something negative and just get into like a negative spiral of thinking. So it's about kind of like catching yourself doing that and having like you know a plan for if that happens then I'll you know divert myself to like a more adaptive way of managing emotions. I think also like there's just there needs to be a bit of self-compassion as well because it is harder if you've got ADHD to do these things and so I think it's like kind of just
00:26:51
Speaker
not being too hard on yourself really because I think that's part of the risk of leading to anxiety and depression is that you know potentially feeling like you're failing at something or whatever because your symptoms are creating these like you know multiplying how difficult things are so I think that's part of it as well it's just like being accepting of ADHD symptoms and the impact that that has and
00:27:16
Speaker
not being too harsh on yourself, I think. I suppose I was wondering about that as well. You've mentioned a couple of times effective and not effective strategies. Are you saying that there's sort of evidence that certain or there's a set of strategies that people can access that have been, you know, shown to work and there's others that aren't?
Strategies for Emotion Regulation
00:27:35
Speaker
Or are you just saying, what are you saying when you say that and where people get those strategies? Yeah, so there's a certain set of strategies that are shown to be more helpful.
00:27:44
Speaker
than others and by more helpful I mean that they're linked to better mental health and less helpful I mean they're linked to worse mental health. So for example suppression, trying to suppress a feeling, not kind of acknowledge it, just trying to make it disappear is not helpful. It's kind of counterintuitive because you think that, you start thinking like oh if I ignore it and if I don't attend to it then
00:28:08
Speaker
you know, maybe that that's a way of dealing with it, but actually it's got this paradoxical effect. It's bad for your mental health to use that strategy too much. No, I mean, we fell on a journey with that as a family, so I agree. And then on the other hand, something like kind of reframing a situation. So again, as something stressful happens, rather than kind of focusing on the negative and, you know, thinking, oh, this is an absolute catastrophe. Think about, well, what is a different way of thinking about that situation that's more positive and, and
00:28:38
Speaker
doesn't focus too much on like things that are going to make you feel bad but more think about like a more kind of either like if it's a way that you can solve a problem or just a way that you can think about it differently that's more positively framed I guess. I think in a lot of conditions especially where spiraling can easily occur like in ADHD, depression,
00:29:02
Speaker
and anxiety taking yourself out of that situation and out of that spiral and just looking in trying to well not necessarily to objectify because that can kind of oversimplify it and like if you over rationalize the way that you're feeling you might beat yourself up for it even more because you're like why do I feel like this this is so
00:29:22
Speaker
that's my worry honestly it's just it's different for everyone for some people like I know for me taking myself out of the situation just taking a second just to myself to breathe look at this let's think about it let's figure out what's actually going on here and let's figure out how it works but I know for some people that just doesn't work at all yeah and I think that I mean
00:29:47
Speaker
completely couldn't agree more with more that for people for whom they work, those strategies are really effective. My worry about the recommendation of strategies is the guilt you get when they don't work. They don't work for you and the self blame that you get. So I mean, we're not disagreeing at all. But just just if you can't find strategies for yourself that are working, it's not your fault. I think it's really important message for people.
00:30:16
Speaker
I think the other important thing to say is like it takes a lot of practice. These are not easy strategies to use. I mean, you do need to have a lot of patience and really, really be very like compassionate with yourself because
00:30:29
Speaker
It's not easy at all. And I think that's something that really gets missed in a lot of the self-help mental health industry. I call it an industry because that's what it is. It doesn't capture, and the same is true of parenting advice. It doesn't capture that this is tough and hard and needs patience and the ability to cope with failure and keep going. Which is also difficult for some of the people who are struggling.
00:30:57
Speaker
And things may get worse before they get better. And none of that makes it into the online videos or the, you know, 10 great tricks to improve your mental health. It's really, really hard to start with when you start that process of trying to get yourself out. Sorry to take this on again, but I feel like if you did say that, it's going to get worse before it gets better.
00:31:21
Speaker
or like this is really difficult you need a lot of motivation that could bring on that kind of sense of like okay well that's not going to happen. Well quite right exactly so that's the difficulty. We're in a massive dilemma here because you don't really know which way to go because it could end badly for everyone in every situation.
00:31:40
Speaker
Please. But I suppose that's right. But I suppose that the message I get from that is that one message doesn't work for everyone. And you have to have conversations with people on an individual level, which is really difficult when you have overwhelming need and relatively few people who are specialists or who are able to offer some kind of service. But even also,
00:32:07
Speaker
kind of narrowing of mental health support to only be able to be given by someone who's super specialist rather than just be a conversation. I don't know. I don't know what I'm saying here really. I think there's real dilemmas and difficulties here with how we talk about it. I think they should teach more. This is a one single statement. I'm not going to say anything more about it. I think they should teach more about this in PSHG. Oh yeah. A lot more. Completely. Yeah, I agree. Definitely. And from like, you know, earlier as well, because these are
00:32:37
Speaker
and skills that take a long time to master. So, you know, I think the other thing that you made me think of as well is about the kind of you needing a lot of motivation to do these things. And I think sometimes these sorts of interventions can be a bit dry, a bit boring, a bit kind of like a bit of a drag. So I really think that like for people who are providing these interventions, they really need to make them more exciting and more interesting and like
00:33:03
Speaker
You know, there's a lot of buzz around kind of gamification. So like, for example, mental health, digital health tools that have got some gamification in it where you can get like points for complete exercises and stuff like that. I think that sort of stuff can help to make it a bit less of a drag. But I think if you just assume that if you just give people like, here's a list of exercises to do, go away and practice emotion regulation.
00:33:27
Speaker
It's quite a lot to ask of people to kind of like self motivate to do that. Yeah. And it sets them up for guilt and failure. Yeah, exactly. That's always my worry. Just small plug that we are planning in the next few weeks to have something up on the ADHD UK website of strategies, but not one strategy that can work for everyone.
00:33:47
Speaker
strategies which are kind of chosen by our members, members, you know, people who we work with and upvoted or downvoted according to people who visit the website and potentially and we hope different strategies for different age groups, genders, different, you know, groups who might need a different set of strategies. So that's something that we've been talking about for a long time in the charity and we're finally at the point of being able to make the IT work.
00:34:15
Speaker
So hopefully that will not be one of the next few weeks. I'll try to link in the chat. The other thing I wanted to mention as well as one reason why these interventions are quite difficult is there's a lack of co-production with people who have ADHD. So they're being designed by people who don't necessarily understand like what it's like to be using them. So I think are these going to be sort of like crowdsourced from people with ADHD?
00:34:40
Speaker
Yeah, yeah, that's all needed, I think. Yeah, well, we'll see how it goes. We may get some odd results and odd things. You're going to need someone to go through this and make sure that people aren't putting random stuff. Well, I just wonder if people might put some cheeky stuff in there. You're opening up a forum to the entire internet. It's not going to go well. Maybe some curation need to be. Yeah, OK, fine.
00:35:09
Speaker
Yeah, so we're going to get a boat in a boat face kind of situation, is that what you're saying? Or maybe, we'll see, but yeah that's the idea and it's sort of democratising though in a way, although as you rightly say Tess, there may be pitfalls in that.
00:35:28
Speaker
God, I thought you said pitbulls. Pitbull? Well, my pitbull is a strategy for my ADHD. Interesting strategy. Well, pet therapy, no? That's the thing. Dogs are great for ADHD. I'm talking like... I'm talking like Mr. Worldwide, Mr. 305, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back in again, back
00:35:57
Speaker
I know you've got his picture on your wall, ironically. I don't have it, I don't have it. You used to. Oh, I do. You do? It was a lovely outfit. Properly hated there. And a swoony kind of thing. No. Oh, please. You have got, literally, you have got his picture on your wall. I'm like, who the hell is this guy? No, because... Very nice. Tessie's not best at the situation. Tessie Tessie. One of my mates got me a card that said, um, you're my Mr. Worldwide. And I was like, well, that's so sweet. So I hung up on my wall.
00:36:27
Speaker
Even though Tess was a Pitbull fan, there you are. Completely off track, sorry about that. Breaking news. Breaking news. Breaking news, exactly. Go on then Tess, you wrap us up. Okay. Because we're getting distracted. So what's your next question? Oh, next question. I think that our next question is going to focus on how do we translate this into
00:36:56
Speaker
interventions that are actually effective for people and actually usable and not completely dry and boring. So at the moment we're collecting data from adolescents with ADHD using this smartphone based methodology. And we think that that will give us a better sense of like how people are functioning in the course of their daily life. So it's a bit more kind of like valid. And we think that will give us more of an idea about, you know, targets
00:37:25
Speaker
in people's actual daily lives, how they're actually functioning, as compared to like the more traditional questionnaire design where people just, you know, fill in something, paper and pencil online or something. It's just like a list of symptoms and risk factors and things like that. So that's the kind of direction that we're going in now, because I think there's a bit of a, a bit of a difficulty with like the interventions that there are
Challenges in Applying Learned Skills
00:37:47
Speaker
at the moment. They don't necessarily generalise very well to people's daily life. So people might learn some skills,
00:37:53
Speaker
but then it's more difficult to actually take those skills and actually apply them in the course of your daily life. It's quite a different matter to do like a sort of exercise and let's say again, emotion regulation is an example versus actually take that into your daily life and apply it. So I think our focus next is like, well, how do we make that transition effectively so that people can actually apply this in their daily lives? I think that's really exciting because it's like the, it's the,
00:38:22
Speaker
It's the translation. It kind of bridges the gap between what we know we ought to be doing as ADHD people. We know we ought to be using the strategies and using them actually. Big jump. Big jump. Yeah, exactly. It is. Yeah. It's a big gap to bridge, I think. Yeah. Because we're so good as doctors or psychologists or whatever, just sort of telling people, oh, well, have you tried this? Have you tried that, et cetera, et cetera.
00:38:51
Speaker
And it just makes us feel better that we've given some advice, but actually if it's not actually applicable in people's everyday lives, you know, when they're feeling at their most stress, when they're in the supermarket, when they're thinking about whether to have a drink or whatever, those don't take drugs or whatever. That's, it's useless if you're just kind of giving it out and then it's sort of sitting there on the shelf. Life is so much more complicated, isn't it? Than, you know, what we imagine when we give out this sort of advice. Yeah. Yeah.
00:39:20
Speaker
I mean, I feel quite surrounded about it that we very often just generally give advice to kind of make ourselves feel better. People like, this is such like a, whoa, that's so deep, but like... Go on. Anyway. I'm going to go get it. I feel like... I'm going to go get it, George. Okay.
00:39:44
Speaker
I feel like people massively, like, massively underestimate how different, like, people are. And I know that's such, like, a broad statement, but... I think we're very, like, what we do is we sort of assume that other people are like us, so we sort of, like, project how we are onto other people, and just, I think you're exactly right, we completely underestimate how different other people are, not just from each other, but from us as well, so...
00:40:13
Speaker
when we're thinking about what's going on in terms of like other people's brains, like we're just using ourselves as a model, but that's not accurate because everybody is so different in terms of how they're wired. A lot of the advice that you'll get will be, this is what worked for me, rather than what kind of you're doing, which is, this is what worked for like, run the what with like the, oh my God, I'm ruining this podcast. I'm so sorry.
00:40:44
Speaker
It's, it's less of a, this is what worked for me and more of a, this is what worked for this group of people. Yeah. But that can, which is, it's, it still might not be helpful because you might not be like fit in with the same things that have happened to that group of people, but it's a lot more helpful than just, this is what helped me. But what you have is the potential to not necessarily, because people talk about sub grouping ADHD and splitting it into sub, sub groups and subdivisions with ADHD.
00:41:13
Speaker
I'm not sure I'm a big fan of that. You don't need to sort out the differences in ADHD by creating more boxes to put people into. That's going to make more problems. That's my feeling. But what you could do is get to the point where you can take the strategies that are useful for all people with ADHD to an extent and pick for you, given your age, gender, particular situation, how anxious you are, what kind of job you have,
00:41:43
Speaker
how much sleep you get, I don't know, you know, various, various personal variables, what strategies are likely to work for you. So you can have that personalization without having to. Yeah. Because people get so attached to the categories as well and they sort of reify them and it causes all sorts of issues. I think, you know, just never heard of this. Well, do you want to,
00:42:10
Speaker
The categories in terms of the categories. And all of the kind of splitting that goes on. Well, I mean, I guess the main distinction that's made is between like inattentive versus hyperactive impulsive. And then so you'll have these two main areas of like difficulties and then you'll have people who have both. That's the main distinction that's made typically. But then there's also sort of interest and sort of
00:42:37
Speaker
sub gripping in other ways as well. That like the sort of diagnostic system would make those main distinctions. Yeah, I think that's right. And then people would be sub typing as, you know, autism, autism ADHD as a combined condition. And then there will be subtypes of ADHD with this and ADHD with that. And
00:43:03
Speaker
I mean, I think at one point somebody asked me, which of the five types of ADHD have I got? And I'm like, well, I don't know. But I had to be nice and say a combined type. I mean, putting things into boxes make it a lot easier for people to understand. Yeah. I mean, these boxes... People do it with personalities. I know you hate the MTBI test, but some people really love them because it helps them really simplify something that's so, so complicated. I'm FSG6.
00:43:33
Speaker
No, that's not one of the, I don't know. I think it can serve, it can have some benefits because it can help with communication and it can help having a label can sometimes help people make sense of their experiences. But I just think you need to not believe in them too much and take it too far because they do have the limitations. They are kind of arbitrary to some extent. And the other thing that you just made me think of as well is like, I think probably more than subtyping
00:44:02
Speaker
the kind of direction of travel at the moment is going to be much more like individual level personalization. And so again, like sort of smartphone based data collection is quite good in terms of that potential because you can get quite detailed profiles on people's symptoms, triggers, you know, what sort of stressors might precede what symptoms and stuff like that. So that helps you learn much more like what might work for an individual person.
00:44:30
Speaker
as opposed to kind of relying on what works on average for people with ADHD. So I think that's quite an exciting direction as well, but it's still kind of in its infancy at the moment. So I have to see where that goes. It's an absolute treasure trove of data, the smartphone and all of that kind of way of gathering data. You can get so much more. We are learning about that. It's called hypertextuality. Should you be learning about that sort of thing in school? I've disapproved.
00:45:01
Speaker
I've actually not heard that term before. So what does hypertextuality mean then? It just refers to the sheer amount of information that is on the internet or just the click of a button to anyone who has access at all. It's a really good word. I like it a lot. Yeah. We're learning about that in sociology now. My teacher will be so proud of me. The reference to sociology at A level. Hooray. Wonderful.
00:45:27
Speaker
Okay I think before Tess and I entirely lose the subject and start talking about something completely different. I had two coffees before we recorded. Did you? Yeah. That explains a lot. We want to thank you very much Asia for coming and best of luck with all of your work and if you want to come back on and have chat or maybe we can
00:45:47
Speaker
Uh, get you to one of our events in the future. I'd be very, very, very delighted to see you. Well, the, the, the charity. Yeah. Okay. Guys, we're doing events going to start talking about merch in a minute. Um, all right. Well, thank you very much. We'll leave it there. And, um, uh, and, oh, I suppose if people want to contact you and ask you about your stuff, are you on kind of social media and so forth?
00:46:13
Speaker
Yes, I'm on Twitter. Should we do links? Will there be, I can do my own handle and stuff like that? Yeah, but you can find me on Twitter or my email address at University of Edinburgh as well, is online as well, so yeah. Yeah, you do it massively hard to find, like some of the people who have dragged out. Wonderful, thank you very much and goodbye! Bye! Thank you so much, bye!
00:46:36
Speaker
Right, so that was Asia. Hell yeah. That's your new thing that you just do. I don't think hell yeah could be a trademark catchphrase. I'm pretty sure it's been used before. Pretty much what you do when I say things at the moment. Just my default response. Very tired.
00:46:52
Speaker
I just wanted before we go to thank a couple of people. Well, actually, let's just talk about Anna this time. We'll talk about John next time. Anna is the business manager for IDH UK and has basically helped us to not do all the bits of having a podcast that we're not good at, like publicising it and organising the
00:47:16
Speaker
kind of all the admin stuff. And she's been amazing. She's been so helpful. So Anna, thank you very much for all your work on this series. I know you won't be around for the next series, but we will miss you then. What? A different response from Tess. Wonderful. All right. Anyway, please let us know what you think as we said before, and we will see you next week. Well, we will discuss John during the outro. Guys, fingers crossed it's going to happen.
00:48:06
Speaker
Alright, bye!