Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Episode 28: Cognitive disengagement with Stephen Becker
0 Plays2 seconds ago
Max is joined by Stephen Becker, Professor of Pediatrics at Cincinnati, about the fascinating Cognitive Disengagement Syndrome, a condition that is both in some ways the opposite of ADHD, but also commonly co-exists.
If you want to know more, Stephen has made a lot of the work on this open access- here for example: https://pubmed.ncbi.nlm.nih.gov/36007816/
Also, we discover what NFL team Tess supports....
Recommended
Transcript
Introduction and Guest
00:00:08
Speaker
Welcome to the ADHD Science Podcast. i am Welcome, welcome. I'm Max Davey. I'm Tess Davey. um And today we are going to talk to Professor Stephen Becker from the University of Cincinnati. Go Bengals! That was almost the first thing I said.
00:00:24
Speaker
Because I'm a Bengals fan. Yes, I am not, but I will not tell you which fan I am because it's not going very well for me at the moment. No, that's true. Not as badly as some, but not not well. Yeah, but it's getting worse. It's not looking great. No. ah there There will be no more NFL chat on this episode um so far.
Understanding Cognitive Disengagement Syndrome (CDS)
00:00:45
Speaker
um So Stephen is a really in i mean it's very prolific um researcher, psychologist by training.
00:00:54
Speaker
What he's really interested in is this thing called cognitive disengagement syndrome, which used to be called sluggish cognitive te tempo. And then they thought, that sounds a bit pejorative. Yeah, it's a bit outdated, isn't ah So they've changed it to CDS.
00:01:10
Speaker
And what's really interesting about CDS is it's kind of the opposite of ADHD in that your brain is slower to process things, slower to react. You find it hard to get your attention on things, not because your attention will fix on it and then wander off somewhere else, but because it just, the the effort of getting onto thing.
00:01:32
Speaker
the thing is so much. And the fascinating thing about CDS, i mean firstly, of course, ah it's it's an attention difficulty, but it's not ADHD. And so it can be mistaken for ADHD if you're not quite careful. And the other thing is it can coexist with ADHD.
00:01:50
Speaker
How? Well, that's the interesting thing. Big question, sorry. We don't really know. I think Stephen's quite open about the fact that they're still kind of... Because they seem, I mean, entirely opposite. Entirely opposite, yeah.
00:02:01
Speaker
And actually, oddly, immediately after talking to Stephen, I saw somebody in clinic, and I think he's got both. He's just some one-time... It's like having autism and ADHD, in a way. But how do you differentiate between the two when you're just looking at a patient? it's very difficult. Because you don't know what's going on in their mind. No, it's really hard.
00:02:19
Speaker
Well, I think...
CDS and ADHD: Risks and Connections
00:02:21
Speaker
It's another one of those things that means we need to spend more time as clinicians asking people about their experience, how they experience tasks, how they experience social interactions, rather than relying on observation or scores or questionnaires or whatever.
00:02:39
Speaker
for that's how i That's what I take from it. But and the moment, it's just a fascinating area. And and sort of the kind of darker side of this, and there does need to be a bit of a trigger warning, because the paper that he was talking about was showing essentially that if you have both CDS and ADHD, you are much more likely to self-harm than if you had one ah either one individually.
00:03:03
Speaker
So then there's this question of to what extent is the cognitive disengagement part of a kind of depression but also something similar to depression but not because CDS is more of a kind of longer term trait so it may be depression mimics it when you see what mean so there's a lot there's a lot to unpack in the in the episodes and we've already talked for ah just over three minutes about it without introducing Stephen so maybe I should bring that in welcome Stephen
00:03:34
Speaker
Okay, so welcome, Professor Stephen Becker. I didn't even ask before we had, before before we hit the button. ah Professor Stephen Becker from Cincinnati. I'm very excited as a Bengals fan to have a Cincinnati person coming on the podcast for the first time. so um my One of my sons, not also Bengals fan, is not here because he's in America, which is a very strange experience for me.
00:03:58
Speaker
um So welcome. um ah could you just but in in um but Could you just introduce yourself to our listeners, please? Sure, absolutely. Thanks for having me.
00:04:10
Speaker
And hopefully the Bengals have a stronger season. Well, and they need a defense, but that when this isn't a football podcast. We need Joey. be to stay healthy.
00:04:21
Speaker
um But my name is Stephen Becker. It's a pleasure to be here. I am a professor of pediatrics at Cincinnati Children's Hospital Medical Center and affiliated with the University of Cincinnati College of Medicine. um And I also co-direct the Center for ADHD that we have at our children's hospitals.
00:04:37
Speaker
Amazing. so And you've published a huge amount, I know, on ADHD, and I probably will bother you again about one of the other papers that I'm kind of trying to move work my way through. But what we're going to talk about today is the relationship between ADHD and cognitive disengagement syndrome and how they interface to, in this particular case, talk about um and lead to more self-injurious thoughts and behaviors. So eight i know I think we probably need to say to the listeners, if you are someone who doesn't want to hear about these things and finds it upsetting, then maybe this is one to skip.
00:05:11
Speaker
um We will be talking about this stuff. I don't think we'll necessarily be talking particularly graphically about it, but that that that is the subject of the paper we're talking about today. So it's worth putting that up top.
00:05:24
Speaker
Right. So that said, um what was your question? What was the thing you were you were looking into in this paper?
Symptoms and History of CDS
00:05:32
Speaker
Yeah, so maybe as a starting point, because often I find that people are less familiar with cognitive engagement syndrome. I think maybe can start by giving just a brief overview on what cognitive engagement syndrome or CDS is for those who might be less familiar.
00:05:48
Speaker
um So cognitive engagement syndrome or CDS um has been studied in various ways and to varying degrees since really the mid nineteen eighty s and it used to be called sluggish cognitive native tempo which might be a term that some of you have heard of.
00:06:03
Speaker
And these are symptoms that there's been a lot of interest in whether or not these behaviors are the same as ADHD, or maybe should be part of the diagnostic criteria for ADHD, or if there's something really else separate.
00:06:14
Speaker
Um, and the behaviors that I'm talking about are things like excessive daydreaming, mental confusion or fogginess, kind of a slowed kind of behavior or slowed thinking. Um, so in contrast to, um,
00:06:26
Speaker
David Holtzman, M.D.: A child or an adolescent or adult with ADHD that might have a lot of over activity or hyper activity or impulsive it. Holtzman, We really think about those with CBS that's really on the other end of the continuum feeling kind of more slowed down um and kind Dr. David Holtzman, disengaged, and so it was a work group that I organized and had the pleasure to lead.
00:06:45
Speaker
ah that led to the shift in changing the name from sluggish cognitive tempo to cognitive disengagement syndrome. um And that's in a fully open access ah publication paper, if anyone's interested in reading more, ah where really we outline kind of these two um core pieces of the syndrome.
00:07:04
Speaker
um One of them being this cognitive disengagement aspect, and then one of them being the hypoactivity in terms of the motor movement. and really thinking about these as really impactful in terms of in people's day-to-day lives.
00:07:17
Speaker
So we now have dozens of studies who have shown that these symptoms are in fact distinct from ADHD. They're also distinct from anxiety, distinct from depression or sleep difficulties, even though like we know a lot of things with mental health, they're also interrelated and closely ah related as well, but they are separate.
00:07:37
Speaker
So to your question, we were really interested in um As the research on CDS has moved forward, a lot of the focus has started to become more, not only do these behaviors kind of fit differently from ADHD, but then do they also predict or relate to things that we care about in people's
CDS, Depression, and Diagnosis Challenges
00:07:55
Speaker
lives?
00:07:55
Speaker
And so that was a great study. Yeah, so so and and we definitely need to get back to that. But I think just on the CDS, just to clarify, because you you kind of you you said it, and people might not have heard you quite right, it's hypoactivity. So that's less activity. The person is less active than the um the the typical population, I suppose you would say.
00:08:17
Speaker
um And there's this I think the the the the metaphor of the fog, I think, really drew me in. i think that was a really important one because it is quite distinct from... ADHD, I just want to just to dwell a little bit on CDS because I think people will go, wow, what's this thing? And I think it's worth just pausing a little bit before we go into the specifics of your paper.
00:08:37
Speaker
um First of all, is it something that you can get a diagnosis of? and I know you kind of can't in the UK, but can you get, ah is it something that is diagnosed in practice or is it a research diagnosis?
00:08:50
Speaker
That's a great question. That's a really important point. I'm glad you raised that. um So it is not an official diagnosis in the any, it's not in the diagnostic and statistical annual mental disorders. It's not in the ICD.
00:09:03
Speaker
So it's not an official diagnosis. And I think that is really important to know. um Really, we do think about it as a kind of at this point, a research construct. That being said, clinically, we do see this, including at our hospital where we have a service for these youth.
00:09:20
Speaker
um So often what that might look like is ADHD, for example, with features of cognitive disengagement syndrome might be something. And the way that we talk about that with families, to your point, is that it is related to ADHD, but also different. And so we think about distractibility, for example.
00:09:36
Speaker
we might think about, right, I might be distracted by, you know, a car driving outside my my office window right now or one of my kids trying to come to my office or things like that. These are things in my external world that are distracting.
00:09:47
Speaker
But we can also be really distracted by things going on internally. So being distracted by our own thoughts or our mind wandering or daydreaming. and And so that's kind of one of the ways that we talk about it with families as well. So CDS would be an in more of an internal distractibility by our own train of thought.
00:10:06
Speaker
How does it, because I'm very old, I remember when we used to talk about ADHD and ADD. How, do you think a lot of the kids who used to be, and they used to be this sort of two different categories, there you know the attention deficit disorder and the ADHD,
00:10:23
Speaker
How many of the kids who maybe at that point, when before it was all merged into ADHD, how many of those kids that were called ADD would now be within your kind of CDS construct?
00:10:35
Speaker
Probably a sizable percentage, probably a fair number. um And we do know that across the ADHD presentations or subtypes, anywhere from 25 to 50% of individuals with ADHD will also have elevations in these CDS behaviors as well Yeah.
00:10:54
Speaker
And I think that's one of the difficulties. And and is it is it a neurodevelopmental condition? is you know Has it got that kind of, so do we know yet if it has that kind of similar pattern of being quite biological, quite genetically driven, running in families, all that sort of stuff? Or is it something distinct and different? Does it come from a different kind of place?
00:11:15
Speaker
The short answer, I'd say we don't know. would say the signs that we have are we do know it can emerge early in life. There are a few genetic studies that have been done and there is a strong genetic component, but it's not as strong. this studies that have been done so far, it's not as strong as the genetic component for ADHD.
00:11:34
Speaker
And so we have started to think about what are other environmental contributors potentially these behaviors. For example, trauma exposure, particularly interpersonal trauma, um and things along those lines are things that we are starting to think about, but we really don't have a lot of data yet.
00:11:49
Speaker
And that anecdotally makes a lot of sense with people who have suffered trauma talk about brain fog and they talk about difficulty getting stuff, getting their stuff together and and getting things done in a way that does make, does make you think of the CDS descriptor. Okay.
00:12:03
Speaker
Thank you so much for that. That was, that's gold dust for me. Cause I've so met met so many of these kids and I'm like, you're kind of ADHD, but you're kind of not. And I don't know where to fit you. And I might just fit you in this category, but I'm not very happy about it because,
00:12:16
Speaker
I mean, okay, before we move on to your paper, just quickly, because this is this is this is the thing that's happening for me. Do you treat it? I mean, do we know what do we know about treatment of CDS yet?
Treatment and Self-Harm in CDS
00:12:27
Speaker
Again, we know, unfortunately, very little. We have signposts.
00:12:32
Speaker
um So we've done some small, non-randomized trials, um looking at a mindfulness process.
00:12:41
Speaker
We've done individual behavioral sleep based intervention, and those both showed some nice promise. um And then there's also kind of some school based kind of um what we generally recommend is to find those interventions that you know are evidence based for ADHD, especially in a tentative presentation um and start there in terms of organization, time management skills are always going to be kind of beneficial.
00:13:05
Speaker
I'm really thinking, at obviously, at the individual level, kind of what are the difficulties and impairments that they're experiencing and trying to match any treatment approaches directly to that. yeah I'm a psychologist by training, so I'm not a physician who prescribes medication.
00:13:18
Speaker
um But there are some studies that suggest ademoxetine, for example, might be beneficial. the The data on stimulants are um somewhat mixed. Okay. that's but Are you being polite?
00:13:30
Speaker
and Perhaps a little bit. Okay. um So let's talk now. Okay. You've given us a brilliant 10 minutes on CDS. that You know, fantastic. Let's talk about your paper. What was the, so you you were looking at the impact of CDS on real world impacts, real world behaviours, which obviously is crucially important for looking at whether this is something we need to start adding to our options diagnostically in terms of treatment.
00:13:57
Speaker
So what what was what was the specific thing you looked at? So we've done um a number of different papers looking at various domains of functioning. The paper that we were really interested in is building from the probably the strongest association that's been found in the CDS literature so far has been linking CDS to depression and high depression symptoms, including the longitudinal studies that we do have show that it's CDS predicted.
00:14:23
Speaker
increases in depression and not the other way around. So that's really important, isn't it? Because you'd say, well, of course you're going to be brain fogged if you're depressed, but it goes that way. That's really interesting. Yeah. and so you don't know this yet, but like some of the things that I'd start to then think about is, are these symptoms, if we identify them early and if we see these symptoms, if we can, maybe are they a precursor to those who might be at risk for developing later more observable depressive symptoms, then obviously that would be really important to know from a assessment and a prevention standpoint. Absolutely. Yeah.
00:14:55
Speaker
And okay, so so there's this link with depression and and therefore we we go on to what you looked at, which I think was self-enjurious thoughts and behaviors. That's the kind of phrasing you used. Exactly.
00:15:08
Speaker
Yeah, so there have been only, i think, three or four studies that have previously looked at CDS in relation to ah self-harm behaviors. um All of them limited in various ways in terms of either small samples or non-representative samples, such as college students, yeah or not great measures of either self-injurious thoughts and behaviors or not great measures of CDS, because we really didn't have strong validated scales for assessing CDS until really in the last five to 10 years.
00:15:37
Speaker
yeah um So we wanted to recruit a new sample of 10 to 12 year olds. It's a pretty large sample of about 340 youth that were recruited in the Cincinnati region around the hospital where I work.
00:15:50
Speaker
um And they came in and they did a variety of different tasks. But one of the things that we really focused on was um looking at um self-harm and self-injurious behaviors in a couple of different ways, including teens completing a rating scale themselves, um as well as we had a clinician-administered structured interview to look at um ah various domains of self-injurious thoughts and behaviors as well, which hadn't really been done previously.
00:16:14
Speaker
Could you just explain what the Raven scale is in this context? for the suicidal ideation rating scale. Right. Oh, the rating scale. Sorry, I thought you said Raven scale. Oh, no, rating scale. Rating scale.
00:16:27
Speaker
It's not, it but for the listeners, it's not a scale of how much you like Ravens because, you know, i quite like Ravens, but that's not what we're talking about. I'm a big fan. um So, and so, okay. So you're basically looking at these different ah variables, the the amount of ADHD, the amount of CDS, the amount of,
00:16:48
Speaker
self-injurious behaviors um and then i know from your paper you then kind of looked at potential confounders to potential variables like uh i'm just reading it off actually you know family income sex race all those sorts of things that could just confuse and muddy the waters yeah to get closer to to your to to to the true relationship i suppose Yeah, that's exactly right. And I think to know a little bit more about the sample, this was a community-based sample. So they were not all diagnosed with ADHD, in nor did they all have elevation. yes We intentionally recruited for the whole distribution, the whole continuum of severity.
00:17:24
Speaker
And so in that community sample, we did have 23% who reported some history of suicidal ideation. Yeah. and fine About 8% reported a history of a suicide plan.
00:17:35
Speaker
actually um And then about 6% reported a history of non-suicidal self-injury. So this could be things like cutting behaviors or burning oneself or things like that.
00:17:46
Speaker
How does that compare as as a number for a community sample, not a clinic sample of just adolescents off the street? That seems very high. So I think the suicidal ideation variable is high, but it's important to know that that's a, have you ever had thoughts about killing yourself, not do you currently?
00:18:05
Speaker
No, no, sure. And so it is, unfortunately, those are consistent with rates that we do see in other other studies as well. Yeah, yeah. No, I just think the the listeners might feel that's kind of shocking, but it is just ever. Have you ever, you know, sort of felt like this? Okay, thank you.
00:18:22
Speaker
And so then what did you find? That's the next question. Yeah. So to your point, we did control for account for a lot of other different factors, including we accounted for ADHD symptoms. um We also ran some pretty, um I would say, astringent analysis, but we also controlled for depression, where we know depression is obviously very strongly associated um with suicidal ideation and related behaviours.
00:18:43
Speaker
um And we found a really um interesting ah pattern where we did find that even once we accounted for those other things, CDS symptom severity was associated with suicidal ideation and planning, even once we accounted for those other factors. Even if you account for depression, you account for all of these things, CDS is still an important predictor of these kind of behaviors, self-harm and suicidal thoughts.
00:19:08
Speaker
That's right. Depression was certainly the strongest. so um as we would expect um But even once we accounted for that, we also found um that association between CDS and suicidal ideation and planning. And what do you think?
00:19:19
Speaker
Go on. I was going one thing that i think is an ah also interesting is we also saw a separation where CDS was not associated with non-suicidal self-injury behaviors, whereas ADHD symptoms were.
00:19:33
Speaker
So we did kind of see kind of this pattern of CDS being associated more with suicidal ideation and possible planning whereas adhd symptoms were more clearly associated with non-suicidal self-injury.
00:19:44
Speaker
So non-suicidal self-injury is self-harm when, and I'm being very basic here, but non-suicidal self-injury is basically when you feel, when you hurt yourself, but you're not feeling like you want to end your life. So it's conventionally in the kind of, kind of shorthand, it would be when you're feeling very frustrated and you're, it's a kind of maybe a more of an impulsive thing, but you haven't laid down a sort of ah thought of a plan or something around around ending your life. So it's a different, psychologically, it's a different phenomenon, although obviously there's overlap between all of these things.
00:20:18
Speaker
Yeah, that's right. it involves a, there is a purposefulness aspect to it, but without any intent to die. So often this might be, you know, used as kind of a, not a particularly helpful, but as a way to cope with emotions or an emotion regulation approach in terms of either cutting behaviors or burning or banging one's head against the wall or things like those, but without any intent to die. But there is a purposefulness to it.
00:20:44
Speaker
Yeah, yeah, absolutely. A purpose to to to to hurt. And that's interesting because we don't we do know that those are related to ADHD, but my feeling has always been that there is an element of impulsivity to them, which presumably would be less likely to be present in CDS in the absence of ADHD symptoms, that that impulsive element of things.
00:21:05
Speaker
um What do you think? Why do you think CGS predisposes to suicidal but um thoughts and planning? That's a great question.
00:21:16
Speaker
I think I do want to flag. um we don't yet know if it actually predisposes. So i do want to say i don't want to overstate the findings in terms of these are cross-sectional one snapshot in time data.
00:21:27
Speaker
We are following the sample ah currently over time to see if we actually then see if CDS predicts future. no Very, very good point. Just to clarify. But really, um i think I'm really drawn to one of the leading models or theories around suicidal and self-injurious thoughts of behaviors broadly um is the interpersonal theory or the interpersonal model of suicide.
00:21:51
Speaker
where that theory really suggests that there's those that are highest risk for things like suicidal addiction are those who experience a couple of different things. One of them being, um, what's called thwarted belongingness.
00:22:04
Speaker
So this is kind of feeling kind of that social disconnection piece. And then the other is ah what's called perceived burdensomeness. So this is feeling like you are ah liability to others that, um,
00:22:16
Speaker
that you are a burden to others. And really the model would say that those who experienced both this thwarted belongingness piece with their interpersonal relationships, and also feel like they're a burden to others, that those are individuals who are going to be at higher risk for suicidal ideation and possible behaviors.
00:22:33
Speaker
And one of the other most strong correlates of CDS is social withdrawal specifically. So we know that sort with ADHD are very often, um, experience social difficulties, but often that is more because they might be more aggressive or they might be more rejected from their peer group, especially kids.
00:22:51
Speaker
Whereas we know that kids with CDS are much more likely to be isolated and withdrawn. And so then we start to think about what that might mean in the context of risk for something like suicidal ideation.
Clinical Implications and Childhood Manifestations
00:23:03
Speaker
Yes, and and that makes a huge amount of sense. And I think what I'll probably do is put something in the ah link in the notes about the interpersonal theory, because I think a lot of people will be thinking about that and and kind of go, oh, I want to read more about that. So we'll we'll find something and put it and put it in the show notes afterwards.
00:23:18
Speaker
So what is what if I'm sitting in my clinic, um as I did today, earlier on, and i what implications do this finding and the whole kind of thinking about CDS at this time for an ordinary clinician like me, what are the implication implication implications?
00:23:38
Speaker
I think as a starting point, if you have a clinic or if any of your listeners have a clinic that really focuses on ADHD, I think it makes a lot of sense to embed a questionnaire related to CDS. We have very brief 15 item questionnaires that go all the way down to age three, all the way up into adulthood.
00:23:55
Speaker
And they're really well validated. and we have now dozens and dozens and dozens of families who have reached out to myself and other researchers in this area saying, Oh my goodness, I've come across this construct this idea.
00:24:09
Speaker
and to your point earlier, it like describes my kid in a way that other professionals have not been able to capture. yeah And so I think being able to provide families with some sense of, or patients directly with some sense of, Hey,
00:24:22
Speaker
There is this label, there is this there is this construct that people are trying to actively understand and understand also what it means for them terms of clinically. um And so there are very active kind of forums on things like Reddit or Facebook groups and things like that as well, where patients themselves have kind of organized to try to better understand um their experiences in the world.
00:24:42
Speaker
um I think since we know that these symptoms are also linked to higher rates of depression, higher rates of suicidal ideation, I think those things should also be assessed as part of standard routine clinical care. But certainly if someone's scores elevated in CDS, that might just give that clinician um a little bit more context in terms of potentially that social withdrawal piece or some of those more internal distress signals that that that individual might be experiencing or prone to experiencing in the future.
00:25:09
Speaker
Yes, because it wouldn't necessarily change your treatment plan for ADHD, but it might cue you into some other aspects of of the management that that would would be helpful. and And some explanation for people for why they feel some some of the ways that they feel.
00:25:25
Speaker
i suppose i I tend to work a lot with younger children. um although with some adolescents. And does it show any differently? Because obviously one of the lot of the things you've talked about with CDS is kind of subjective feelings, the feelings of of withdrawal. and and And I'm sure that does happen in younger children. Does it show itself differently at at sort of, I'm going to translate to American, elementary school, supposed to what you would call it, and we would call primary?
00:25:52
Speaker
Yeah, it does. um Certainly show up in primary or elementary school. So we also, i think it was a couple of years ago where we published a different study where we actually, for the first time, went out to recess, went to actual schools where these were grades. Yeah, yeah, yeah.
00:26:09
Speaker
One of my favorite things to do as a pediatrician is to go to recess at elementary school. It's just so adorable. Yeah. It's chaos.
00:26:20
Speaker
It's very loud. It's very overwhelming. Yeah. but We had an amazing team of on my research team would go out to all of these different elementary schools and code every fifteen seconds during recess what the wow the child was doing it. We had students with elevations in CDS yeah based on teacher report.
00:26:38
Speaker
And then we also found a comparison child, um same grade, same sex, yeah without elevations in CDS. And we used kind of this coding system. And we actually found that the kids with CDS were significantly less likely to be engaged with others during recess.
00:26:55
Speaker
And we're also significantly, on the other hand, more likely to be um coded as either being alone during recess or in parallel play, which meant they were actually therere near another child, but they weren't directly engaged or interacting with either a child or another teacher or school staff member.
00:27:12
Speaker
And that immediately makes me think this must be a lot of kids who get referred for autism assessments at this age. And then you kind of would turn up an an autism assessment and actually probably their social communication would be okay, but they're very withdrawn and people wouldn't quite know what to do with them. So that's another group where we as clinicians who do assessments might feel this is a bit mysterious and as you see, it might be a useful construct for us at that age, you're not necessarily an age where you get a lot of suicidal ideation necessarily or more self harm, but, but, but, but you'd still have that cohort who would look to, to, to an untrained eye, quite autistic in a sense.
00:27:50
Speaker
Exactly. That's exactly right. And I think to your point earlier in terms of, does it shift kind of how you might treat care, your intervention plan for ADHD, I would say it might not often do that.
00:28:02
Speaker
But I think there are instances, if you think about like social dynamics, that it might actually be really helpful. We don't generally think, for example, of social skills training as evidence-based for most children with ADHD, because we know that if they bring them into the clinic, they know how to They know the right, so to speak, answer, but yeah in the moment, during recess or during lunch in the cafeteria, it's hard for them to execute on the spot.
00:28:28
Speaker
Whereas we actually see in the developmental literature for children who experience social withdrawal, that that might be something where actually social skills training can be really helpful in terms of teaching things around you know assertiveness or asking follow-up questions or eye contact or things like that so those could be things that if you're seeing that clinically that might be something that you pull out of your your your tool bag even if you don't frequently use it students. Assuming me of course you have the tool bag and you have the money to do all of this stuff and that's all fine because research to an extent operates in a different, has to operate in a different world to to the real world of particularly the NHS and British schools which are newsflash and not flush with money at the moment but that's okay.
00:29:09
Speaker
um So what about for ADHD people themselves? what ah What's the implications of this paper and your work more broadly about CDS for people with ADHD?
00:29:21
Speaker
I think more broadly, I want people... to feel that they can understand as best as possible their experience in this world. yeah And so I really try to be cautious about, I think sometimes having things like additional labels can, I think we need to be cautious about that as well, especially when we're thinking about things like daydreaming, which can be a really beautiful and helpful thing as well. yeah dances creativity And so I really think striking a balance there, but really I think what continues ah for me personally to do this work is really kind of engaging with patients
00:29:55
Speaker
and families and caregivers who identify so strongly with this to understand, then what does that mean for others um that hopefully we can provide the best support possible for as we as we learn more?
Community and Research Directions
00:30:07
Speaker
Yeah, I think that's right. And I, know you know, I have some um caution about, you know, go go out and join a Facebook group or a Reddit or a subreddit.
00:30:20
Speaker
But to this seems like somewhere where a lot of the push probably is coming from the grassroots of ah people ah recognizing this and identifying with this. And I think one of the refreshing things about ADHD is the fact that people power, for for want of a better word, is important in the conversation, that it isn't just us researchers or the absolutely American Psychiatric Association for handing down stuff.
00:30:47
Speaker
I don't know what the American psychological is. What's the psychology version of the APA? version of the apa So it's still the APA, but the okay it's the American Psychological Association would be APA, or the American Psychiatric Association would be also APA. Also both APA. That's not the use of talking. Oh, well, fine. Most people don't know the difference between a psychiatrist and a psychologist, so that's okay. I published recently, just earlier this year, actually in a kind of a review paper, and in that I included a ah table of quotes from
00:31:19
Speaker
that from adults who identify with CDS, from caregivers, I really do think hearing from the community themselves um is incredibly important. Yeah. Yeah. Okay. So I will, we'll point people to, is there a, is there um like more of an official ah support group or or some, somewhere people can go to, to kind of find more out more. I mean, obviously we can post the paper, but it's, you know, it's, ah it's, an ah it's an it's, it's on a website that people might not have access to. So where's a good place for people to find out more if they've kind of thinking about CDS and they're like, they want to know what more what it's about.
00:31:53
Speaker
Yeah, there's not an official support group. I think there are some really helpful videos on YouTube that um some of my colleagues and myself have ah done before. so um Dr. Russ Barkley has video. Dr. Joey Frederick has some YouTube videos that I think are sound.
00:32:11
Speaker
um And then also these two major larger review papers that we've done in the last couple of years, ah very intentionally, I've made those fully open access. Wonderful, right. They are not behind any library paywall. So anyone who wants to read them um They are readily free to download. And I'm also happy to send any anyone in any other information as well. This is one where the show notes are going to be extensive, but that's okay. We'll work on that after we finish recording. You can send me some stuff and um and I can do some Googling around. That's also great.
00:32:42
Speaker
um So that that that sort of brings us to our final question, I think, which is what's next for you? And I know you research lots of different things, but this this line of reasoning about CDS, what what comes next for you and your team?
00:32:58
Speaker
Three things come to mind. One, the sample that i described, we're continuing to follow them. um yeah Funding is tight here in the United States as well for science currently, with a lot of changes also happening. Lots of changes happening, yes. There are a few.
00:33:14
Speaker
um So we are hoping that to secure funding to continue following the sample, which if we're able to do that would be really, really informative in terms of understanding things over time.
00:33:25
Speaker
um But then i'm also really interested in going earlier in the developmental spectrum to some of the earlier things that we talked about in to get a sense of when do these emerge? What is the association between things like CDS symptoms and perhaps early literacy skills or school readiness?
00:33:40
Speaker
um I think those are um important areas to to kind of think about. And I think the third thing that i'm actually really excited about is to partner with kind of the lived community on some type of research study um as well. And so we've started to have some conversations related to that in terms of um just even getting a sense of um demographics and characteristics and other sorts of domains of functioning that are really important to the population um is something that really excited to hopefully do in the next year or two.
00:34:09
Speaker
Yes, because you've you've got you've got that groundswell and we we we can just harness that so so effectively if we if we actually just, well, i I can't speak for myself because I'm not really a researcher, but it's ah it's out there and we can really really tap into it beautifully.
00:34:24
Speaker
So thank you so much for all of that. That's been a real eye-opener for me and I hope for the audience as well. And um hopefully we'll have lots of people going to to the videos and and and start to really a conversation about this.
00:34:34
Speaker
I'm going to go off and try and convince the rest of my team that CDS is worth screening for in ADHD clinic with all of the other stuff we have to do. But that's OK. That's OK. I will fight that fight.
Closing Remarks and Future Guests
00:34:47
Speaker
um And and um obviously, we both just have to hope that Joe Burrow stays healthy this season and um we we get a better but a result from the bank. case was that that's That's another thing to hope for.
00:34:58
Speaker
But Stephen Becker, thank you so much for joining me today. And goodbye. my pleasure. Thanks so much. but Bye bye. um Okay, so that was Stephen. Thoroughly lovely man. Thoroughly. One of the great things about him, I thought, was how eager he is that everybody finds out about this stuff.
00:35:15
Speaker
I love it when someone's passionate about thing that they're talking about. That's always lovely. Yeah, it was really great. um And I think what he's doing is fascinating. And I think it was one of those things that I'm pretty confident will become fairly mainstream within a few years.
00:35:29
Speaker
But he's very much at the kind of forefront of it. Good for him. Congratulations. Congratulations. Go Dolphins. Oh, now Tess. ah You asked me to. Tess has unmasked herself as a Dolphins fan. Oh, God. Many people now.
00:35:47
Speaker
Unsubscribing from the podcast. Slapping their foreheads going, I'm not listening to a Dolphins fan. um yeah anyway i'm thinking It's It's Don't worry about it. It's not like anyone else in my family supports the dolphins. It's not like I really have any reason. No reason at all.
00:36:01
Speaker
But not much more reason than me with the Bengals. Okay. So that was it. ah Please do follow ADHD UK on social media. Please join... Oh, the dog is here. Hello.
00:36:12
Speaker
and Please join our Facebook group. um I know Facebook is evil but that's where it is. Yeah. ah And it's good. And next week, very exciting celebrity guest, genuine celebrity guest, Robin Ince. Robin Ince. Coming next week. I'm in this interview as well. Celebrity appearance, it's me. Yes.
00:36:33
Speaker
All right. And that's it. A little teaser for next week. Bye. Get Bye.