Wellness Wednesday: ADHD Awareness Month


Black and white image of fidget spinner, motion blurred.
Fidget spinners can help some people with ADHD concentrate. (Arbyreed / CC BY-NC-SA 2.0)
ADHD Awareness Month
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It's October, and it's ADHD Awareness Month. I have a special guest with me this morning: Dr. Lidia Zylowska is an associate professor of psychiatry at the University of Minnesota Medical School, and a psychiatrist with M Health Fairview. She specializes in the treatment of adult attention deficit hyperactivity disorder, and believes that best care happens when patients are empowered with knowledge and skills for optimal brain and mind-body balance. During her career, she has pioneered the application of mindfulness in treating ADHD.

Every Wednesday morning at 8:30 CST, Jill Riley connects with experts and local personalities for some real talk about keeping our minds and bodies healthy — from staying safe in the music scene, to exercising during a pandemic, to voting and civic engagement. Looking for more resources and support? Visit our friends at Call to Mind, MPR's initiative to foster new conversations about mental health. Subscribe to Wellness Wednesday as a podcast on Spotify, Apple, RSS, Radio Public, Stitcher, or Amazon Music.

Jill Riley: Like I mentioned, it's ADHD Awareness Month. Now, when I was growing up, there wasn't a name for the disorder. I started to hear about ADD after I graduated high school, and then I started to hear about ADHD. Are they the same thing?

Lidia Zylowska: They're not quite the same thing, but the terms are often used interchangeably. ADD became the term that people often talked about when thinking about ADHD, focusing on the attentional deficit aspect of it. Nowadays, especially in the scientific field and in the clinical world, we use the more comprehensive term ADHD — which focuses on attention deficits, but also hyperactivity [and] impulsivity as part of the condition.

When I think of ADHD, I often think of it as being kind of like a childhood disorder — but as I just read a few moments ago, you specialize in the treatment of adult attention deficit hyperactivity disorder. How many adults in America have ADHD? Is this the most kind of common form of neurodivergence?

I would say it's one of the most common childhood developmental disorders that continue to adulthood, that affect one's way of interacting with the world — or, as you said, neurodivergence. We estimate that almost 5% of adults in the U.S. have adult ADHD. This is about 50% or more — some estimate as many as 70% to 80% — of children continuing the condition into adulthood. In the past, we used to think that children would grow out of ADHD, but now we know that this is very much a difference in your wiring, how your brain works. That difference doesn't change for the majority of children, and so they continue to have the condition as adults.

What is the cause of ADHD?

We don't know for sure, but there's lots of understanding that it is a combination of genetics and probably environment. We do know, for example, that ADHD runs in families and there are certain genes associated with having with ADHD, particularly dopamine genes. We also know that certain factors during pregnancy or during early development can also put somebody at risk for ADHD. So, for example, smoking or exposure to lead during pregnancy can put put a child at risk for ADHD. We also know that history of trauma — there's even some research of overexposure to TV puts some people at risk for ADHD. So what we really think of it now is that it's a genetically predisposed condition that in certain environments can become amplified.

What are some common ADHD symptoms? And are they different for kids than adults?

When we talk about ADHD, we typically think of problems with focus, or inattention, and problems with hyperactivity and impulsivity. So those are the two main domains of symptoms, and those symptoms look a little different in children than in adults. Primarily the hyperactivity changes over time — so when you think of hyperactive impulsive children, that's a bit of a stereotype we have in our minds of what is ADHD like.

You will imagine hyperactive [children] being disruptive in class, doing too much running or climbing in the classroom. But that changes as someone becomes an adult. You no longer have this sort of overtly seen hyperactivity. What you may hear from adults with ADHD is that they feel restless inside, that they can't relax, that they have difficulty sitting in meetings. So there's a lot of fidgeting, there may be a lot of what we call verbal hyperactivity. Talking too much, interrupting...the hyperactivity changes and for some children with ADHD, it actually becomes less of an issue than this other domain of inattention. Disorganization becomes the area where adults struggle.

I often see children with ADHD having a lot of support as they're growing up from parents and teachers, and that helps them with the inner tension, disorganization. And as they become adults, those supports fall away. And you as an adult have to do a lot of these things yourself. So you have to organize your day, you have to manage your time, you have to start tasks. As a child, you have a homework, and parents prompt you to do it. But as an adult, there are tasks that you don't want to do — like taxes or paperwork, but you have to be the one who prompts yourself to do it. And that's really difficult. So procrastination, and difficulty keeping up with tasks, is very common with adults.

I have a few friends who received an ADHD diagnosis as an adult, and the way that they described it was feeling relieved: relieved that there was a name for something that they were feeling. I tend to ask a lot of questions of my friends about how they're feeling? Is that one way to support?

Yeah, you know, I think having a name to what's going on with you is very helpful. So the piece of education, or really knowing what's going on, is really important, especially for those who were not diagnosed as children but knew that there was something different, or they struggled and maybe compensated for their difficulties. Then as adults, things just became too much, and maybe too overwhelming to manage yourself. If you're a parent, you know as you as you enter the real world, there's a lot of things that you have to manage on your own. So once you have a diagnosis, things ultimately make sense for people.

One thing that happens with ADHD is that there's a lot of misunderstanding of what it is, and a lot of judgments that children or adults may hear from others about why they're not achieving or not meeting expectations. And those judgments can also become something that you judge yourself. "Why am I so lazy? Why am I not doing this? What's wrong with me?" So when you have the name for the condition, it can really turn things around and help people understand and then address those difficulties.

I know medications have done wonders for for a number of people on when it comes to managing ADHD. In your work, you've talked about the application of mindfulness in treating ADHD. Can you talk a little bit about that?

First I want to say that ADHD is a bit of a misnomer. There's now more thinking of ADHD as executive function deficit. And what this means is that self management is difficult: executive functions means task management, planning, organizing, time management, and also emotional regulation. All these different tasks that have to do with managing yourself in the world. So when you start seeing ADHD as this broader condition, then you have to address a lot of different things: not just focus, but think about how to support someone in developing skills, how to help someone attend to their emotions, how to help someone manage stress.

So medication has a role. Therapy has a role, and also mindfulness has a role. Mindfulness is an approach that is derived from meditation, but there's more and more application of it in psychotherapy and also in medicine, as a tool to develop skills and attention and emotional regulation. Bringing attention inward, understanding yourself having [the] ability to observe thoughts and feelings and reactions, and then having a choice [in] how you respond [to] that. [Mindfulness] is very useful [in managing] ADHD because you struggle both with attention management, but also with your emotions and reactions.

When it comes to mindfulness, what's a technique that people could use if they need a reset?

There's lots of different mindfulness practices, but I really like the practice called STOP. Every letter in the word STOP reminds you how to do the practice. So it's a nice mnemonic, and it's very brief, something that you can do in daily life. S stands for stop. T means take a breath, O means observe in the present moment — it's very helpful to observe, for example, your breath in the present moment, and then Proceed or move forward with a little bit more grounding, a little bit more awareness.

In ADHD, those brief shifts into present moment awareness are very helpful. Often what you find with ADHD is that people kind of space out, they lose time...finding myself cleaning my house because part of me is avoiding something that's cognitively difficult. So it's really important to check in, in the present moment and sort of say, well, what's happening? You know, what do they intend to do? Am I doing it? And how am I feeling inside? Is there a fear? Is there a sense of not knowing how to start? That check-in can help you reset and sort of redirect and attend to that, whether it's the task or maybe figure out any help or through mindfulness also employ other tools that somebody may have learned in other contexts.

What are some other things that that people should know?

I would say the most important thing is to trust your gut. If you are thinking that ADHD applies to me, or maybe applies to my child, it's important to have a sense of self-advocacy. Seek out a therapist or psychiatrist, or someone who specializes in ADHD to help you make sense of the symptoms. There are other things that can mimic ADHD, so it's important to have good evaluation. But it's also something that is not always addressed by clinicians, because especially in adults, our knowledge of adult ADHD only evolved in the last 10, 15 years.

The other thing I would say that's really important with ADHD is to have a sense of self-compassion, because ADHD gets in your own way. There's a lot of tendency to self-criticize, be discouraged. So self-compassion is a really important tool. Something that I often recommend to my patients is looking into an understanding for themselves.

Wellness Wednesday is hosted by Jill Riley, and produced by Christy Taylor and Jay Gabler. Our theme music is a portion of the song "F.B. One Number 2" by Christian Bjoerklund under the Non Commercial Share Alike 3.0 International License. This week's photo is by Arbyreed (CC BY-NC-SA 2.0). The image was altered: it was cropped, filtered to greyscale, and supplemented with a logo.

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