Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Episode 11 with Dennis Golm
148 Plays10 months ago
We join the very lovely Dennis Golm to discuss the weighty subject of childhood maltreatment, and the connection to ADHD. We also get distracted by ducks.
Dennis is @golmdennis on X/Twitter
The paper that we discuss is here: https://pubmed.ncbi.nlm.nih.gov/37138529/
Recommended
Transcript
Introduction to Hosts and Purpose
00:00:08
Speaker
Hello. Hello. I'm Max Davey. And I'm Tess Davey. And this is the ADHD Science Podcast. Sure is. Why do we do an ADHD Science Podcast, Tess? Because we're spreading the word and it's fun and it's interesting. Okay. And also we're ADHD people. Oh, yeah. I'm a pediatrician and you are kind of a psychology student.
Podcast Series Reflection and Feedback
00:00:34
Speaker
Oh God, that's pressure. Well, I will be soon. Right.
00:00:38
Speaker
Just just in case people are wondering who these random people are we have Well, we're coming towards the end of the season series So reason which I really like yeah, and we've got one more episode after today We have had some feedback people wanting content on sleep and by coincidence that
Dennis Goulm's Research Introduction
00:01:04
Speaker
Well, today's not about sleep, but next week, today is Dennis Goulm from Southampton, and he's going to talk about early emotional negativity and ADHD. So that sounds a little dry, but it's really about whether there's a link between that very early temperament of babies and children, and then later having ADHD. And it got
Understanding Early Adversity and Maltreatment
00:01:32
Speaker
us onto talking about emotions and ADHD, which
00:01:35
Speaker
regular listeners will know is a topic we talk about a lot um and is a bit neglected by well most people really yes so anything else to say not particularly okay let's get on with the episode
00:01:54
Speaker
Well, welcome. Welcome, Dennis. Dennis Gohm from the University of Southampton. Could you introduce yourself and then we'll get on with talking about your research. Yeah, sure. So I'm Dennis. I'm a lecturer in psychology at the University of Southampton. We have research centres. I work in the Centre for Innovation and Mental Health and I
00:02:15
Speaker
conduct research and teach on the topic of early adversity, childhood male treatment, and kind of my research tries to understand the mechanisms via which early adverse experiences lead to mental health problems.
00:02:30
Speaker
and also interactions with new developmental diagnoses. Just before we get started, I know I love definitions, you don't love definitions Tess, I love... I'm neutral on definitions, they're a part of life and I accept that. I think they're very important and so I think it's... I mean obviously we don't necessarily need to define ADHD for our audience because
00:02:53
Speaker
We've done a lot of that and people should know. But it's worth just thinking what we mean when we say maltreatment and when we say early childhood adversity. Could you just sort
ADHD and Childhood Maltreatment: Genetic vs Environmental Factors
00:03:03
Speaker
of expand on those a little bit? Yeah, sure. I mean, so early adversity is more of an umbrella term that what maltreatment would be part of early adversity, but all the adversities, all kinds of negative stress experiences early in life and childhood maltreatment.
00:03:23
Speaker
as I can official definition, but generally it includes all forms of neglect and all forms of abuse and under abuse, we would kind of sum up physical abuse, so hitting a child, emotional abuse, so calling, calling children dumb, lazy, or yelling at them to the, to the extent that they feel fear and then sexual abuse. Yeah.
00:03:53
Speaker
So those are the terms. And so should we do our first question so we can sort of start off where you started with this bit of research? So what question were you answering with your research? So we were interested, so I do also research on kind of people who have been adopted or are in foster care.
00:04:18
Speaker
And we have this overlap of people with new developmental diagnosis, like ADHD and autism in children in care, but also amongst kind of male-treated population. Those two overlap, unfortunately, quite a lot. And I was interested in the question why that is. And some colleagues of mine have written this beautiful paper of a large twin study, Southern 8000 twins in Sweden, where
00:04:48
Speaker
they looked at the association between different new development of diagnosis, ADHD amongst them, and male treatment in mono and biotic twins. And what they found was that there is a much, much higher prevalence of ADHD in twins who have been male treated, but that is largely explained by genetic factors. So, and there's a small effect on
00:05:18
Speaker
kind of symptoms of ADHD. And that got us curious. And we thought, okay, and also the paper hypothesized that there might be kind of earlier, maybe temperamental traits that explain why children with ADHD are more prone to male treatment, like before they develop ADHD. So we thought, or maybe it's like, because there's this paper showing that
00:05:44
Speaker
different temperament dimensions kind of predict ADHD onset during childhood. And one of them is negative emotionality. And we thought maybe kind of these early temperament dimensions are a risk factor for not only for ADHD, but also for kind of male treatment.
00:06:04
Speaker
So I'm going to stop you there because there's a lot to unpack in that little summary.
Temperament Traits and ADHD Prediction
00:06:10
Speaker
Sorry. So the first thing is the twin studies because you talked about monozygotic and dizygotic twins and you probably have come across this a bit. I think you expect me to know more about that. No, that's fine because you're not here to know things but can we just talk about what twin studies are and why those two words are important in trying to? Yeah, sure.
00:06:30
Speaker
trying to tease that out because I think it's the twin studies debut in the podcast. So that twin study was conducted by children by colleagues at the University of Edinburgh led by Lisa Dinkler and
00:06:49
Speaker
So monozygotic twins are twins that share 100% of their genetic material and dizygotic twins are basically siblings born at the same time that share 50% of their genetic material. The lay kind of language that would be identical and non-identical, although I appreciate that that's technically, you have to be a bit technical about that. Yeah. And kind of looking at twins who did and did not experience male treatment,
00:07:17
Speaker
allows you to look at the effects of male treatment, but also controlling for shared genetic effects. So because it might be that the effect of, it's not the effect of male treatment, but it's more like because they both have a genetic risk for developing ADHD. So kind of twin research designs allow people to understand what is driven by genetics and what is driven by environment.
00:07:43
Speaker
So you look at pairs of twins and the really interesting ones is where one's been maltreated and one hasn't. Do you see what I mean? Because then you've got almost like a grid.
00:08:00
Speaker
maltreated and monozygotic, not maltreated and monozygotic, so you look at the difference between those two populations and then you've got the non-identical or dizygotic twins and the two differences between the maltreated and non-maltreated there and you look at how different they all are. I mean essentially it's removing the variable of biology so that you can just look at the effect that the environment has on it. Yeah I mean that's the theory, it's not
00:08:28
Speaker
I understand in practices. Yeah, it's a bit more complicated. But yeah, I think that's, that's a pretty good way of putting it. So that, that kind of, so that study gave us the idea and they hypothesized, and maybe there's some kind of shared or trades, temperamental trades, maybe that share a risk with ADHD. And that's why I thought, okay, that's interesting. And then another colleague in London,
00:08:57
Speaker
And they performed this meta-analysis. A meta-analysis is where you look at studies that have already been published and kind of summarize across, run some analysis across and see what is there an effect across all of these studies. And they looked at different temperamental traits and wanted to know whether they predict different new developmental diagnosis. And one of them was
00:09:26
Speaker
negative emotionality, and they found that that predicted ADHD onset, so that's what got us interested in negative emotionality. So that's when kind of a baby cries a lot, faucets a lot, kind of overreacts to things, so it gets upset easily, so that kind of behavior.
00:09:50
Speaker
So I'm interested in what you mean by temperament. And again, it's definitions boy flying in today. We need him. I mean, this is supposed to be my job, but I'm not very good at it. But what do you mean temperament? Our children born with temperament, is that a fixed part of their biology? What is temperament and what is it?
00:10:12
Speaker
What does it mean? I mean, I don't know what the textbook definition is, but I would define it as something almost like a personality trait that is present early on in development so that you can already observe and kind of infants or babies that are a couple of months old to a year. Certain personality dimensions, like how curious are they, right? How active are they? How easy
00:10:41
Speaker
Do they cry? How easy are they upset? Are they quite happy with lots of change? Or have they problem adapting to lots of change, for instance? So it's kind of dimensions of how they act, but also of how they control their emotions. Big word, because no babies can't really do that. But it's more like how emotional are they, how active are they, these kind of things.
00:11:09
Speaker
And how, and when they get a bit older, how, how easy are they to make laugh and smile and those kinds of things? And, and those are, those, I mean, obviously they show themselves in different ways, but the significance is that temperamental traits in a really small babies are important for how the person ends up, the personality ends up later in life with obviously lots of twists and turns in between lots of water under the bridge, but it's important how you are as a baby and how you are as a,
00:11:39
Speaker
an adult connect in some way. Yeah. So it's kind of, so in that case where it predicts ADHD, I think it was more, it was two or three temperament dimensions that predicted ADHD, but it's small effects. So it's small pieces of the puzzle, but it's interesting because it might be, that is because they share
00:12:03
Speaker
similar genes, so it might be the same, so that they maybe represent kind of early risk factors or early signs of ADHD maybe, or it might just, you know, or they share some of the genes that lead to ADHD for instance.
00:12:23
Speaker
but also it could also be not genetic, but it's also how, so the interaction between parents and how a child behaves, right? So a baby might behave in a certain way, and then the parent reacts to that behavior in either a positive or negative way. And because of how the parents react to that behavior, the baby would react in a certain way. So it's very hard to just entangle these things. But disentangling,
00:12:52
Speaker
disentangling. It's quite hard to disentangle that word. To disentangle these things was what you were aiming to do with your study, I believe. Well, I mean, you know, to an extent. So exactly what did you do? And I'm going to jump in with a question too. And what did you find when you did the thing? I'm doing all your jobs. You need to begin doing your jobs. I'm sorry, I'm tired. It is quite late.
00:13:22
Speaker
So, yeah, so we took an pre-existing data set from the University of Princeton, which is called the Fragile Families and Wellbeing Study. It's a large data set where for some reason they oversampled unmarried women. I think they wanted to look at the some socio-economic effects. I think that was the idea, but they have lots of data available from kind of infancy up until
00:13:53
Speaker
I think age 11 or even 15. And they had measures on ADHD symptoms, they had measures on negative emotionality in infants, and they had measures on kind of childhood male treatment.
00:14:08
Speaker
So everything we needed for our study and we wanted to see, so the question was, so we kind of know that negative emotionality predicts ADHD and we wanted to see, and we know that childhood male treatment predicts ADHD symptoms, so not ADHD onset as a disorder, but symptoms. And we wanted to know, so does negative emotionality not only predict ADHD symptoms, but also
00:14:36
Speaker
childhood maltreatment, that was one question. And the other question was, it does, we know that childhood maltreatment predicts ADHD symptoms, but do ADHD symptoms also predict later maltreatment? So is ADHD itself a risk factor for being maltreated by a caregiver?
00:14:57
Speaker
And importantly, we're talking symptoms here, not disorder. So we're not talking about... Yeah. So you said something that was really
Implications for Teaching and Clinical Approaches
00:15:04
Speaker
interesting because you said, now let me get this right, that maltreatment was associated with ADHD symptoms, but not with ADHD onset. Can you explain that? Because I think that might end up being important later on. Yes. So that's what they found in the twin study is that they found that
00:15:22
Speaker
whether or not people have a diagnosis of ADHD, that is largely explained by genetics. But there's a small effect on the symptom loads or how many ADHD symptoms or how severe ADHD symptoms someone has. And that has also been replicated in adults that there is this effect of male treatment on ADHD symptoms. Not necessarily onset.
00:15:50
Speaker
So it sort of doesn't change your chances of getting ADHD. And I think this is really important. It doesn't necessarily change the chance of getting ADHD, but it may make the ADHD you have more difficult to manage. Yeah, possibly. Yeah. Yeah. Yeah, I would say so. Because it's, I mean, there's a question mark whether maybe in very, very severe cases of made treatment where they could override genetic risk. But then I'm
00:16:20
Speaker
So I'm talking about some of our studies of kind of adoptees who experienced very severe early institutional deprivation. And in that case, we might argue it could potentially override genetic risk. But there's an obvious question mark, but to that, but generally, I would say the fact seems to be more pronounced on symptoms.
00:16:44
Speaker
And when you, I mean, this is not necessarily a cheerful episode in lots of ways, maybe we should put some warnings at the top. But when you say institutional abuse, it's sort of not necessarily the remaining orphan cohort specifically, but people who have been abandoned very early on and received very poor care within institutions, often not in the UK, because whatever else we get wrong, we don't necessarily do that. No.
00:17:13
Speaker
hardly any institutions left in the UK, if any, that's residential care. But in that case, I was referring to Romanian orphans, because I've been involved in the English Romanian adoptee study. But generally, institutional care is bad. It's not bad. It's not good generally. So there's a drive towards deinstitutionalisation based on lots of data that it's definitely
00:17:43
Speaker
worse kind of family based care is better, much better than kind of institutionalized care. Even if institutions are quite good, there's still negative effects. So even if, you know, they're clean and there's food, there's still quite often a low kind of child to staff ratio. So that's not enough staff or high turnover.
00:18:08
Speaker
So it's just the lack of stability or one significant care figure that you can rely on and form a significant attachment to. This is all as far as I'm aware from learning. We're not necessarily going to be going deep deep into attachment. Attachment is the key mechanism here, isn't it? Probably. Definitely one of them.
00:18:33
Speaker
But to go back to your, it's fine. Going off on tangents is what we do. But to go back to your study, so you're looking at this cohort of single parents, single mothers. They're just oversampled for single moms.
00:18:50
Speaker
But most of the data comes from mums and not so much from dads. So you just explained the word oversample that you used. It's the study. So the people who collected the longitudinal data, they recruited more single mums than married mums, because the idea for the study, I think, originally was to look at the effects of single motherhood on child development, I believe.
00:19:19
Speaker
or child well-being, and that's how the study came into play. So it's more like a sample that is skewed towards a lower socioeconomic status. Yeah. Longitudinal research is research that takes place over a long time. Thank you, Tess. I'm trying to contribute something. You are contributing a lot. Questions? Observations? Yeah.
00:19:48
Speaker
Hair. Your hair looks really nice. Oh, thanks. There you go. I think it's the lighting. It is the lighting. The lighting on your hair is excellent. I was just trying to think of what your country uses. I mean, the beard hair on the other side of the screen is also incredible. There's some strong beard hair, yeah. So if you're not watching, if you're not, if you're not on YouTube, if you're on audio, just at least check out the YouTube.
00:20:12
Speaker
yeah because this we've gone video and audio at ADHD UK you can see our lovely faces sorry enough about enough about us um okay so we keep trying to get back to your studies and what we actually did we were not getting very well thought so we got this cohort and you you examined essentially examined data that was already out there in the world and looked for correlations and looked for how
00:20:39
Speaker
Reading the paper, you sort of almost built a model of how you thought the world might work and see how well that model matches the data. And that's important. I think it's important to get their heads around. Yeah, that's exactly what we did. We tested a kind of statistical longitudinal statistical model, which is usually something where you have something like a predictor or some symptoms that predict a behaviour later and a couple of years later down the line.
00:21:08
Speaker
Um, and we also tested some, what we would call mediators. So, um, you know, mediators kind of a mechanism that might explain an association between two things. So it might be that, um, you know, so it could be that negative emotionality, um, predicts ADHD symptoms, but that is because it increases med treatment and med treatment then in turn.
00:21:37
Speaker
Yeah, exactly. It increases ADHD symptoms, for instance. So that's what a mediator is, and we looked at a couple of those as well. That's a lovely little cycle going on there, isn't there?
00:21:49
Speaker
Lovely as one word for it. I was being sarcastic. Just for the benefit of our listeners who've become confused by us constantly getting distracted, what was the modal that you found? What is your best guess at how these things interrelate according to your model? We found that negative emotionality of an infant at 12 months of age predicts ADHD symptoms
00:22:19
Speaker
directly or indirectly four and eight years further down the line. And also, and that was the thing we were interested in, negative emotionality, also predicted male treatment through the caregiver at ages five and nine years. So if parents report, my child cries more, it kind of overreacts to things, it's very fussy.
00:22:49
Speaker
Then they had a higher likelihood of reporting to maltreat their child to a higher degree at age five and age nine years. That was one of the main findings. I think it's probably worth moving on to our third question because the implications of that are very interesting. What does this mean for people looking after ADHD people? That can be teachers, parents, doctors.
00:23:17
Speaker
I think, first of all, it's important to say that the effects we found while they were there and significant, they were small in nature. And also they are
00:23:32
Speaker
not what we would call deterministic in the sense that they increase the likelihood of being maltreated. So it's a risk factor for baby to be maltreated later. But it doesn't mean that only because it's present in the baby, so the baby cries a lot that they will be maltreated, if that makes sense, right? It's just something that increases the probability. And it's a small effect. So it's one piece of the puzzle, but one piece that might kind of
00:24:01
Speaker
help us explain why we have this overlap between ADHD symptoms and maltreatment. So why we have, you know, higher,
Complexities of Diagnosing ADHD in Maltreated Children
00:24:10
Speaker
much higher proportions of children with ADHD in samples that have been maltreated, like children who live in care, for instance, by the way, about two thirds have lived in care because they have been maltreated. And we have much higher numbers of ADHD than in the general population. So it's kind of,
00:24:28
Speaker
trying to explain where that overlap might come from and maybe it's because you know there are early indicators that put them at risk like for example negative emotionality but also the other thing is that having ADHD symptoms themselves put them is a risk factor that increases med treatment later on so it's not one directional but it goes in kind of both directions. Yes so exactly because a child who's exhibiting
00:24:56
Speaker
A child is negatively emotional early in life and then starts developing, gets sort of neglected, starts developing ADHD symptoms but also presumably other symptoms such as oppositional defiance and aggression. Define opposition. I will in a minute. They are more likely therefore to the placement with their birth parents to break down.
00:25:18
Speaker
And of course, there's obviously parental things, often parents with ADHD themselves who, you know, with their own issues. So I think that's the story here. Oppositional defiance is basically the way I kind of explain it and please come in. But basically, it's like, it's like, it's like the child can't meet the needs of the adult world and basically just goes, no, I'm not doing it. Just stop. Okay.
00:25:45
Speaker
And often it kind of manifests itself in refusal to follow instructions, tantrums, but not it's distinct from something that comes up later in older childhood, which is deliberate. It's not necessarily deliberately going out of your way to hurt or disrupt the adult world. It's just resisting the adult world and doing whatever it takes to not do as you're told. That makes sense.
00:26:10
Speaker
Whereas conduct problems in conduct disorder is much more sticking two fingers up at the modern, at the adult world and trying to kind of undermine it, being a bit more delinquent. Peace. What do you mean peace? Two fingers. Oh, fine, yeah, yeah. Two fingers the other way. Oh, even one finger. What? Oh, even one finger, Tess. No, no. Yeah. OK, that does make sense. Sorry. Is that OK? Yes. That's sort of reasonable. Good job, definition boy. Thanks, definition boy.
00:26:42
Speaker
Is that that's a reasonable kind of summary? Yeah, I mean, what I think one important kind of limitation of this study is that we don't know the whether or not parents or caregivers in that case had ADHD. You don't know because we didn't have data on that. Yeah. And then we mentioned that that's, you know, a limitation that we couldn't control for, you know, parents levels of because because there's a high genetic link
00:27:08
Speaker
you know, it might very well be that caregivers also have higher levels of ADHD symptoms. We do know that there's a genetic link. Oh, yeah, yeah. So there are certain assumptions you can make, although obviously you can't make a general sweeping statement about it, but you can go that you can say probably a lot of these children's parents did have ADHD. But then again, if you're looking at environmental factors, that might not be the case. And if you're talking about how it may override genetic risks,
00:27:36
Speaker
Yeah, but I think that's only with quite extreme. Yeah. I mean, they're all certain assumptions you can make in that case.
00:27:44
Speaker
I mean, I almost, sometimes I slightly wish that we hadn't kind of studied the remaining orphans quite as intensively as we did because they sort of give the impression that things can happen. There's a very extreme case and people extrapolate that to, and I'm not saying, I'm not trying to minimize somebody who grows up poor is, you know, has a parents who are, have their own issues with mental health and drugs and, you know, gets neglected, ends up in care. That's really difficult, but it's really different
00:28:13
Speaker
to the kind of scenes that we had in the early 90s of these children who had no care virtually at all. Yeah, I mean, we always say it's a very severe form of neglect. So that's what it's kind of comparable with somewhat, but there are also other things because it was obviously very hygiene was very bad and then also
00:28:40
Speaker
see very cool conditions. Their physical condition was also very poor. Is this the Romanian orphanage? I don't want to go into detail, but it was just they were all really packed in and there was no solid figures and they weren't fed much. For people who don't know what it is, it's just a pretty horrible treatment of a lot of orphans in Romania. And a lot of them are not orphans.
00:29:09
Speaker
They are called orphanages because I think there was something to do with the overpopulation and no one could take care of their kids so they were giving them into the government because the government were like we'll take care of your kids and then the government did not take care of the kids yeah but I mean it's a whole ordeal not to dwell on them because
00:29:33
Speaker
The kids that we're usually dealing with day-to-day have not starved, have not, just as me, have materially done. The majority of children who end up in care end up in care because of neglect. But neglect can mean anything, right? Neglect cannot be supervision. Neglect, so kind of mum and dad might be too drunk or too high to take care of their children, or they might not supervise them and they play
00:30:01
Speaker
where it's dangerous for them, or the way they could get hurt very seriously. Or it might be that they don't wear proper clothes for the
00:30:11
Speaker
whether or are emotionally neglected. So it's, you know, lots of different types of neglect. It's really, it's really variable, actually, isn't it? Sorry, it's not, it's not a delightful topic, is it? No, but, but I think in a way, but I think in a way, sort of neglect is really important to talk about, because what it is, I think, is a failure to meet the child's needs in whatever way. Yes. And I use the word failure. I don't know if it's even the right word, because sometimes
00:30:39
Speaker
It kind of almost gives the idea of it being deliberate. No, I mean, I teach a 30 year undergrad module, which is called Childhood Male Treatment and Mental Health. So we only talk about the topic and links to mental health. And as part of the module, we invite some guests and for instance, we invite social workers.
00:30:59
Speaker
from a regional adoption agency. And we were talking about that, whether they think that, you know, their treatment is deliberate. And they were like, probably in my, you know, in my career, the vast majority of cases is not deliberate. It's not like they
00:31:16
Speaker
caregivers are intentionally hurting the children, but it's more like, it's not black and white. It's a very complex situation. Often they experience trauma or may treat them themselves. But just to go back to the implications of your data for clinicians or for teachers, I suppose the first thing is,
00:31:42
Speaker
One of the things that happens is that we get presented with these kids and they have been maltreated or they have, they are looked after by the local authority or whatever, and they're exhibiting ADHD symptoms. And there's often a bit of a kind of debate about, well, is this properly ADHD or is it a consequence of their maltreatment? And to me, the implication of what you said is that yes, the ADHD
00:32:10
Speaker
symptoms might have been made a bit worse by the maltreatment, but we can't put the whole thing down to the maltreatment. Yeah. Yeah, exactly. I would say so they definitely can make ADHD worse. And I think it's, I mean, but that is true, I think for lots of
00:32:34
Speaker
let's call them challenging behaviors, maybe of children who experienced male treatment. Because I would say it's important to not take these kind of behaviors personally or interpret something into them, right? So it's more like understanding where they come from, rather than kind of, you know, punishing the child for behavior that they cannot do much about maybe.
00:33:00
Speaker
So it's more like helping them to maybe develop strategies to control their behavior so that they can maybe pay better attention or that they don't accidentally hurt someone or so. But it's more like understanding where it's coming from and then meeting them in an empathetic way.
00:33:22
Speaker
happen because no, there's a good example would be done. That's one from the UK trauma counselors, like there's a swim team. And, you know,
Need for Comprehensive ADHD Assessments
00:33:33
Speaker
that someone gives the other person like a friendly shove, and they kind of completely overreact because I think that was intentional to hurt them and dunk them on the water. And then the swim coach could react in a kind of punitive way and kind of say, Oh, you excluded from the swim team now.
00:33:52
Speaker
Or they could understand where that overreaction comes from and work with a child on understanding why they react that way and help them to not react that way in the future and give them a chance to change it, right? Which would be more like a trauma informed.
00:34:09
Speaker
way of dealing with. So in a way, if you're thinking about, so from a doctor's point of view, it's sort of deciding about diagnosis from a teacher's point of view, often they are trying to balance discipline against understanding. And I suppose one of the implications is that yes, maltreatment may be important in as well, but the ADHD needs to be treated as ADHD and the maltreatment and the whole thing needs just to be understood as
00:34:39
Speaker
behaviours that come from somewhere are not necessarily deliberate, but arise from this kind of complex web of different kind of causative factors. I mean, no pressure to the teacher. Well, exactly. That's what I'm saying. I'm like, you've got 30 kids. How are you going to do that? I think it's kind of, as I said, that a child with ADHD is not
00:35:02
Speaker
I don't know, sometimes they are annoying in the classroom because they are loud or can't sit still. I mean, we have both been that tough. You still quell, you less so now. But it's not like they are, I guess it's just understanding that they're not intentionally being annoying. It's more like they can't help themselves and I don't know.
00:35:28
Speaker
how to deal with all the stimulation or there's not enough stimulation, right? So, you know. Yes, exactly. Either over or under stimulation and... Well, they might be much better listening if they kind of are moving around on the chair or have a fidget spinner in their hand. Yeah. Because that might help, you know, concentrate. I think it's just thinking about that they're not doing that to wind you up.
00:36:01
Speaker
I think it's so much more difficult than the job of a doctor to decide whether someone's going to PhD or not is the job of a teacher to engage these often really, you know, people with lots of complex behaviours in learning and they do it with much less resources and much less pay.
00:36:22
Speaker
Yeah, we work a lot with, we do a lot of kind of science outreach with schools. So we spend a lot of, so I've been lucky enough to see, you know, a few classrooms and we did an after school club with, we run an outreach project called NeuroKids where we talk to little people about the brain.
00:36:41
Speaker
Brilliant. Basically, and bring brain models and little explainer videos and talk about different topics from kind of reception up until year nine. So we were lucky enough to see a couple of classrooms and yeah, I mean, you know, teachers doing quite a good job, but it's like a very hard job sometimes. You often get several kids with complex histories in a single class.
00:37:08
Speaker
And sometimes they have support, like there's a teaching assistant who can help someone in the classroom and they have one-to-one support, which is great. But I suppose, again, the maltreatment that they might know about, again, there's some simple messages, the maltreatment that they might know about is important.
00:37:29
Speaker
in influencing the symptoms, but it's not the reason the child has ADHD. And so if they think a child has ADHD, they should refer for an assessment. Yes, please. Exactly. And also, it's important to say not doing the other way around. So not because someone has symptoms of ADHD to think, oh, they have been med treated, right? Don't assume that, please. So
00:37:57
Speaker
But, you know, because there are lots of different reason why children have ADHD symptoms. Yeah, no, that's very true. And that's why you need assessments. And that's why we need more resources for assessments. But that's another. And we need them early, I think. I think for kind of children in risk groups, like particular children in foster care,
00:38:21
Speaker
I think if we had a standard
Supporting High-Risk Families
00:38:23
Speaker
early diagnosis of mental health and new developmental symptoms, that would be fantastic to intervene early. Well, that's tricky, isn't it? And I think it almost kind of gets into the policy implications of your work, because clearly, you could even go back to the infancy.
00:38:45
Speaker
Because you talk about diagnosis, and clearly you are not going to be diagnosing a hyperactive baby with negativity. I mean, you wouldn't diagnose ADHD before age three, probably. I'm personally a bit ropey about doing it before four. Yeah. And even then, okay, so you could in theory
00:39:08
Speaker
come up with a story where you identify children with temperamental traits who are at risk of later maltreatment and therefore pick them up. And not just because there are projects of looking at high risk families, but we're talking about high risk babies. Yeah. So I think that's probably where
00:39:30
Speaker
not health workers, the people, health visitors, health visitors. Yeah. So that's, I guess, where they might come into play. So obviously, I think it's very important to stress small effects, right? So so not, yeah, but but I think just monitoring and seeing because I think one part might just be identifying parents who struggle with a child's temperament, right? And he might benefit from extra parental training or some
00:39:57
Speaker
strategies and how to deal with or just from extra support I think because I mean what we want to do what's important to me is that you know I would very much like to see that children don't experience male treatment because that's you know such a risk factor for all sorts of things and for obvious reasons obviously we don't want children to be male treated.
00:40:19
Speaker
But I think it's kind of identifying maybe this child has a difficult temperament and also can see that Karen has trouble dealing with that because if your child is crying all the time, that is stressful. Of course it's stressful. But if you then don't have the coping strategies or the parenting strategies, then it's much more likely that you kind of are overwhelmed and might overreact and do something that's bad for you and the child. So I think it's about kind of
00:40:48
Speaker
identifying parents who might struggle with the temperament of their babies and then offering early support to kind of prevent negative downstream consequences. And that's
Challenges for Parents with ADHD
00:41:03
Speaker
not early diagnosis, that's early intervention. Yeah, that's early intervention. And I'm sort of a little wary of early, honestly, a little wary of early diagnosis because it can get stuck. And if you've got people who are kind of
00:41:19
Speaker
in the ADHD ballpark but not quite there and you don't make a diagnosis everyone's like oh well they said it wasn't but it might be we just don't know yet you know if you go with the really little ones and so I think we sort of need language which identifies high risk situations without necessarily committing ourselves to the kind of diagnostic
00:41:37
Speaker
categories which can become very hard to shift once you've kind of committed yourself. Anyway. It reminds me of what Alex is doing and stuff, but it can get spare. I just want to mention it, you know, start Alex's stuff. Go on. Tess has been working with some of the guys in Oxford about something similar to this. Go on. Yeah. This reminds me of Alex Hendry's work and the intervention work that she does with high risk toddlers for ADHD and autism.
00:42:04
Speaker
And they use a lot of diagnostic tools with the babies to kind of, well, the toddlers to kind of identify problems in executive functioning. But they don't make a diagnosis. They're not there to make a diagnosis of the child, they're just there to identify the child's difficulties and help the parents create strategies and understand how to help and support their child. So looking at these tools more dimensionally,
00:42:32
Speaker
I don't know what that means. In terms of how much of these traits you've got, not whether you, between nought and ten, how many of these traits have you got rather than do you have a diagnosis, do you not have a diagnosis? Yeah, I guess so. See our Alex Hendry episode. Link in the show notes. I should listen to that one. But yeah, I mean, it's, yeah, I think it's
00:42:58
Speaker
Because it's a big difference, right, between diagnosis implications of a diagnosis, right? Because a diagnosis should lead to treatment that helps in some way, right? While here it's more identifying mechanisms of risk to understand, you know, why children with ADHD might be more at risk for being med treated because of maybe early temperament and because of maybe
00:43:26
Speaker
their ADHD symptoms and how people react to them as well. Also things like experiencing bullying than from outside of a caregiver context, because other children can be mean as well. Yes, other children can be very mean, like your brothers. Okay. Just trying to lighten the mood. Oh, God. They can be a bit mean. They're your sons. Okay, fine.
00:43:56
Speaker
It's my job to make fun of them. All right, let's do the last question. Let's move on. Before we start, before we start getting some sort of court case against me by your sons. Realistically, it is only one of them. Okay. So what does this mean for ADHD people themselves? I think from our study results, I would say
00:44:23
Speaker
being, because if the negative, I mean, if you already have ADHD, then obviously your life as a baby might not be important. So in hindsight, it's more, I think, more relevance probably for children with ADHD, that they might be at risk for male treatment because of the ADHD symptoms. So I think it might be relevant for, I mean, even though we didn't look at bullying in this study, but if we
00:44:53
Speaker
kind of assumed or we kind of also know that children with ADHD also have experience with bullying. So it might be things like anti-bullying policies in school or being aware who is at risk of getting bullied, but also maybe, you know, if there was some would be some, when we diagnose a child with ADHD, maybe some mental health or new developmental diagnosis literacy for the parents, like education might be important.
00:45:22
Speaker
to kind of, you know, how some parent training maybe how to how to react to the behaviors the child is displaying and what kind of parenting strategies like punitive strategies not to use. We've got a generation of people who are becoming parents who know that they are ADHD. And so we have a lot of people who are worrying about how they then respond.
00:45:46
Speaker
when a child is difficult or whatever that means. I mean, I've read this study and I don't know what is interesting, but it might also be that there they had some preliminary evidence of that the way they interpret their evidence was maybe parents with ADHD can react better if their children have ADHD because they are familiar with the behaviours.
00:46:10
Speaker
But then again, there can be extra issues there because maybe, hypothetically, your ADHD manifests differently than that of your parent. And maybe your parents find that slightly difficult to understand. Yes, maybe, Tess. That does sometimes happen. Can you think of a pair of people whose ADHD is really quite different who sometimes misunderstand each other? No, actually I can't. I just track everything I just said. I can't think of any examples. I just want to put out that, you know, it can be in both directions.
00:46:40
Speaker
And understanding how it interacts would be quite interesting, but also keeping in mind that maybe the parents with ADHD have experienced more trauma or stressful experiences. And then is it the ADHD or is it the stressful life experiences, right? So it might not be the ADHD, it might be some trauma they have experienced because of the ADHD or, you know, so it's very complex.
00:47:09
Speaker
Yeah. And I think in a way, one of the things that I'm thinking about in terms of your work, and it isn't, it isn't the kind of this, this is true, therefore I should do this kind, it's not that kind of implication. But I think one of the, what I've been struck by working with ADHD UK, the charity and hearing the stories of people who are coming up to ADHD diagnosis or have just had an ADHD diagnosis as adults, is the number of
00:47:37
Speaker
traumatic experiences that they've had and how many have been, I would have said, maltreated, whether or not that was actually picked up. But you hear the stories and the previous
00:47:49
Speaker
kind of manifestation of this podcast was extraordinary brains. And we basically heard lots of stories, you know, then half of them, I would say people were maltreated by the definition that you've given. I mean, there were some really quite common, right? It's not something that is super rare. Like when we, especially when we talk, so when we look at studies where people answer, as adults answer questions about growing up, then they would say that the most common type of metering is emotional.
00:48:19
Speaker
abuse, so kind of being yelled at, that you're afraid, or being called names, being called stupid, lazy, these kind of things. It's almost experienced if you talk kind of one of incidents, but that's experienced by about a third of people. And I suppose what I was getting at is that people might find it, one of the important things when you get to diagnosis and when you become an adult and you have all these difficulties is sense making.
00:48:49
Speaker
I think it's really powerful to kind of make sense of your experiences and what has happened to you. And I think this kind of narrative that you have these things about you, which are not unchangeable and temperamental and biological and genetic, whatever you want to call it.
00:49:06
Speaker
which have made you vulnerable to these other experiences, can be helpful in people's own narratives about themselves, I guess. Yes, we have actually, I have that exact situation. I was at a conference two weeks ago and I presented this paper as a poster. So basically the poster is just a short scientific summary with lots of pictures, right, where you talk to people for one and a half hour or two hours who kind of are interested in your work.
00:49:34
Speaker
one person come up and look at the post and was like, that's me. I've been diagnosed, I think they were, they had been diagnosed with ADHD kind of recently and were like looking at my post and think, yeah, a lot of what's on there kind of applies to me. Yeah. And that can help and it can be
00:49:59
Speaker
difficult for people to see it all laid out in that kind of unemotional language that you inevitably have to use when you're doing science, but also it can make people feel, oh, OK, what I've been through is something that's recognisable and can be made sense of, I suppose, sometimes. Yeah, I think it helps understanding or making retrospectively making sense of, you know, it wasn't me or, you know, this has happened because of
00:50:29
Speaker
So I think, yeah, I do think that's a helpful thing. But I think what you said is quite important about we have that generation of people with a diagnosis of ADHD who are becoming parents and then providing them with awareness or tools that help would be great. But not saying they need them necessarily, right? But maybe some need them. And if they do...
00:50:56
Speaker
or on the other way, kind of offering, you know, if we have health workers who has visitors and then we have, you know, if you spot families who struggle with difficult temperament and just supporting them early on would be so nice. That would be possible. It would be so nice if we had resources to support vulnerable children early in life before the end. Well, I guess it's more about
00:51:23
Speaker
Let's say it's about priorities of people who make decisions about where money goes. I wonder who these people could be. What should we do, the last one? Good. So what's your next question? What are you going to be working on once this is all wrapped up? Actually, one follow-up project and we just applied for some money and we're hoping we're getting some money.
00:51:51
Speaker
We're going to hear this month, I believe, would be actually to study parents with ADHD and their children's temperament and also their history of
00:52:05
Speaker
may treatment and other types of trauma and to get some ideas of how this interacts. So is a combination of maybe the presence or absence of ADHD symptoms and the presence of absence of certain temperamental traits that are not a good combination, for instance, or could we say, hey, it's actually not
00:52:30
Speaker
you know, or is it a parent history of trauma and the interaction with the child's temperament? That is important to know. So it's kind of because in that study, we couldn't, we didn't know whether parents had ADHD, since we didn't have any information on that, we want to do a study where we look at parents with a diagnosis of ADHD in that case, and who have kind of young children, we want to look at the temperament of the child, we want to get the parent history of trauma. And there
00:52:59
Speaker
Parenting behaviors and see how it all interacts and the hope to disentangle some of the questions we have and then hopefully if if if necessary or get some ideas of Obviously we need to look at parents with and without ADHD and then understand Which parents might benefit from some support and then the next step is to come up with that support Yes, well exactly and that's that's what it's all about
00:53:29
Speaker
Well, brilliant. Thank you for that. We look forward to hearing the results of that when it gets published and I kind of see it and Mike got a fee. Wonderful. Well, thank you very much for joining us. Is there anything that you think we've missed out that we haven't talked about that you wanted to? I think we covered everything. Thank you. And I learned about ducks as well.
00:53:55
Speaker
Long boy. Long boy the duck is dismissing from York University. I think we should name our ducks on campus now. Yeah they should. The Southampton duck should be named. How about this time you find the shortest duck and you name it short boy instead. That would be good. That'll stick it to those Yorkists. I know back in the 15th century again. No no no. I'm thinking about the Wars of the Roses.
00:54:25
Speaker
You're not much of a history person, are you? No. No, never mind. All right, we'll stop there. Thank you very much. Thank you. Thank you. Thank you very much for joining us. And bye. Bye.
00:54:39
Speaker
OK, so that was The Lovely Dennis from Southampton. Lovely Dennis. Dennis is the one contributor who has actually chased up whether the episode has yet to come out. So hello, Dennis. I'm assuming you're going to listen. Dennis' episode was affected by some technical difficulties where I lost the login to the website for about three months. Oh. Yeah, so sorry about that. That was mainly my fault. Sorry, Dennis. But that's ADHD for you. You do dumb stuff. Well, oh.
00:55:08
Speaker
So the login wasn't lost. You lost the login. I lost the login. It's complicated. It's a boring story to do with. You could have easily played that on technical difficulties. I respect you broaning up to it. Well, I think we've got to show kind of, you know, who we are as people. Right. Anyway, that, on that bombshell, is it time to say goodbye? I would like to have a nap so I will say this. Okay. Goodbye.