Professor Esme Fuller-Thomson is cross-appointed to the Faculties of Social Work, Medicine and Nursing at the University of Toronto. She is also Director of the Institute for Life Course & Aging.  She has published more than 150 articles in peer-reviewed journals including the New England Journal of Medicine, The Lancet, and Cancer. Her research examines ADHD and mental health, the association between early adversities and adult physical and health outcomes, and disparities in health. Her work has widely cited in the media including the New York Times, Wall Street Journal, Time Magazine and CNN. We’re talking about why the number of Women with ADHD are underreported, about the dark side of ADHD, depression, how to lookout for warning signs in your child, and strategies for making a positive difference. Enjoy-

***CORONA VIRUS EDITION***

In this episode Peter & Dr. Fullerton-Thompson discuss:

1:12-  Intro and welcome Esme!! 

1:53-  Is it true that there is a big difference between males with ADHD and females with ADHD?  Ref: (requires log-in) https://onlinelibrary.wiley.com/doi/abs/10.1111/cch.12380

3:07:  Ref: More Play, Less Problems?? Episode with Dr. Debbie Rhea. LINK Project

3:10-  How ADHD is looked at differently between males vs females and how they act and react with it?

5:38-  Without strategies to manage your ADHD things can go terribly wrong; women with ADHD have substantially higher odds for things to go wrong than men. How do we address this from early-on in a child’s life?

9:00-  On the need of structure and how it’s a key component of managing your ADHD

10:15-  Ref article: The Dark Side of ADHD: Factors Associated With Suicide Attempts Among Those With ADHD in a National Representative Canadian Sample

11:45-  As numbers of suicide are higher than before, what can parents, teachers, doctors do to be aware/on the lookout for signs, and how to move forward once diagnosed?

13:14-  On addiction and depression.  15:18- Ref: Cognitive Behavioral Therapy  Impulse Control

16:35-  Dr. Thompson, how can people find more of your studies of your research? Just type in Fuller-Thompson + ADHD, HERE on Google Scholar, or via https://socialwork.utoronto.ca/profiles/esme-fuller-thomson/

17:40-  Thank you Dr. Fullerton-Thompson! And thank YOU for subscribing, reviewing and listening. Your reviews are working! Even if you’ve reviewed us before, would you please write even a short one for this episode? Each review that you post helps to ensure that word will continue to spread, and that we will all be able to reach & help more people! You can always reach me via peter@shankman.com or @petershankman on all of the socials. You can also find us at @FasterThanNormal on all of the socials.

18:02-  Faster Than Normal Podcast info & credits!

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TRANSCRIPT: 

Hey everyone, happy day, Peter Shankman here, welcome to another episode of Faster Than Normal, I'm thrilled that you're here, as I always am.  We are going to touch on a subject today, we're going to talk about ADHD, um, it's not as happy-go-lucky as my normal episodes, but that's okay because sometimes they can't all be happy-go-lucky., and sometimes you’ve got to talk about stuff that is, um, a little disturbing to sort of get along and to make sure that people understand all aspects of ADHD, I highlight the good points all the time.  But you know, it's, there are times where they're not so good, and I think we all know that, and so I am thrilled today to be talking to Professor Esme Fuller Thompson.  Um, she's cross-appointed to the faculties of social work medicine and nursing at the University of Toronto, and she's also Director of the Institute for Life Course & Aging. She's published more than 150 articles in peer reviewed journals, including New England Journal of Medicine, at The Lancet and Cancer, her research…. examines ADHD and mental health, the association between early adversities and adult physical and health outcomes and disparities in health.  She's been quoted in New York Times, Wall Street Journal,  Time Magazine, CNN… whole bunch of others. And I'm, I'm, I'm really, I'm honored that you took the time to come in today professor. Thank you so much. 

Thank you so much for having me, I'm delighted to be here. 

So what I found... you, because there was an interesting article, um, that came to my attention and I think,, there were a couple of them.  One of them was in child health care, uh, development, and that was attention deficit hyperactivity disorder, casts a long shadow findings from a population based study of adult women with self-reported ADHD. We don't talk about gender breakdowns that much, um, I, I think no one does really…. does, um, in the ADHD/ADD world, but there is a big difference between, uh, males with ADHD and females with ADHD.

Well, I think women with ADHD tend to be under the radar screen. Most teachers and health professionals are not really thinking about women and ADHD, and you may present a little bit different, uh, in a different way, so the majority of people with an ADHD diagnosis are males, and for sure it is higher in the... among men, but I think because women often present more, um, distractible rather than the hyperactive, they're… they really don't get noticed enough, and our research is indicating that the women with the diagnosis of ADHD are quite vulnerable with respect to a variety of mental health concerns. 

Yeah, I, and I believe that, you know, we had a professor [Episode with Dr. Debbie Rhea] from the  University of Texas on the podcast who, uh, spent a semester in a junior high school, um, giving I think elementary school or a junior high school, can’t remember which one,  giving, um, they changed the, the workout schedule, the recess schedule from 20 minutes a day to 60 minutes a day. And they changed the lunch, the lunch, uh, options from, uh, primarily carb-based to primarily protein based, and they saw a drastic, not only decrease in ADHD outbursts from boys, but addressing increase in, um, girls who were willing to participate in class.  And that, that struck me, that's always stuck with me, you know, we don't, we don't look at ADHD as the same thing. And, and there are a lot of differences between... between male and female, boys and girls and how they, and how they act and react with it. 

Absolutely. So, I mean, there's two things. One possibility is that women with ADHD are doing more or doing less well, which is what our data seems to indicate, but it could also be that if anybody, there's a whole spectrum to ADHD, like there's a spectrum to everything… and it might be that the, only the women who are at the far, far upper end of the spectrum with the most symptoms, are the people that are being actually diagnosed. So these negative outcomes may be more true for men who are at the upper end, but it's just that men along the whole spectrum may have been diagnosed.  Um, the other piece of what you raised that… isn't particularly, um, from my data, but other research exercise,  is so key exercise structure, organization, it just makes life more livable for sure, for people who have, um, impulse control issues and, and, and disorganization, personal coaches, there's all kinds of positive things that can really make a difference because I think these mental health outcomes that we're looking at, are partly because there's a cascade of negative, um, outcomes, relationships, uh, income, uh, that all of these things, if you can't get yourself completely organized. So, um, being physically active, having lots of structure, having some, maybe some personal coaching, there's all kinds of strategies to minimize the negative, um, outcomes related to ADHD and also to be able to maximize the positives, which I know is your major emphasis on this podcast. 

Right. And it really is a question of getting those strategies in place. I mean, you know, there was, there was a study that showed that, um, a much, much higher number, and I wrote about it in, this, in the book a much, much higher number of incarcerated males have ADHD that are just not diagnosed.  And, you know, if you look at that from the, the bigger, the 50,000 foot perspective sure. You know, they do something wrong, they get in trouble, you know,  they, they, they forget about their court date. Well, now there's a warrant out for their arrest, they get arrested, they can't afford a lawyer, you know, and it just, it just goes on and on.  And so.. so looking at the concept of ADHD, um, you know, from things that we don't often notice, right, and, and ADD and ADHD do things we don't often notice is, is huge. And you know, this, the kind of research you're doing is, is, is so needed. Um, I want to read something that, that, uh, from the results on your, on your, uh, study about, uh, adult women, self reported ADHD, women with ADHD had tripled the prevalence of insomnia, chronic pain, suicidal ideation, childhood sexual abuse, and generalized anxiety disorder and double the prevalence of substance abuse, current smoking depressive disorders, severe poverty and childhood physical abuse in comparison with women without ADHD, even after adjustments for age, race, education, and income, women with ADHD had substantially higher odds of a wide range of problems. What does that tell you, uh, that we need to do? How do we start addressing this um, from the perspective of, of at a, at a younger age, teachers and, you know, moving forward. 

Well, I mean, our finding is that there was a very high link between childhood sexual abuse, childhood physical abuse,  and ADHD, both in men and women.  It's just that women were much even more vulnerable than the men. Um, certainly says at a minimum, we need to be protecting these children. So it, that ...that abuse may not have happened inside the household, but children, who are…  have impulse control issues, tend to be a little more vulnerable in the community as well.  They may not be quite as thoughtful about, um, you know, where they're at, what time they're out, those types of things. So there's a lot of concerns even right at step one about keeping children safe with respect to, um, almost all of these outcomes, if the young adult has made it through university or college, they're much less likely to be suicidal, to be depressed, to have anxiety disorders.  So anything we can do to provide an infrastructure, to keep children in school and, and, and, or, you know, in the trades or something, but getting something, um, post high school that gets them a good job because not my research, but others have indicated that the serious debt is associated with suicidality and those with ADHD as well.  So how do we, help people manage their funds, learn... learn basic financial management and organizational skills around that.  So basically from child on up, keeping them in school, having them actually get lots of exercise, um, to kind of keep them saying, providing as much structure as possible, personal coaching, uh, there's all kinds of ways to make life more livable and therefore allow people's strengths to come through.

That's a phenomenal point. I find a lot, almost always, it has to come back and focus on structure... it’s so much, I mean, this is the one thing I realized more and more, the more research I do on this. And again, you know, I'm not a doctor, you are, but the more research I've done on this and the more,...and the more I read and read studies like yours, you know, structure is just such a key component.  And, and I remember when I got diagnosed, I spent the next several years trying to figure out exactly what it meant, you know, I can put most of the times where I went to a bad place or a dark place or, or, or a period of time where it was, where I look at it upon that now as negative, all, a lot of which had to do with, I didn't have any structure.  I didn't have, um, you know, I wasn't focusing my days, it wasn't scheduled. It wasn't organized, it was, it was just, you know, things happen. And, and I guess there's something that, you know,  better scientific way to put this, but when you're ADHD, you know, it tends to be, uh, you tend to find things to do that most of the time or a good portion of the time aren't necessarily beneficial right, and, you know, it's, it's the joke I always make about, I won't do this and it's true. I won't do a speech in Vegas where I have to stay overnight, uh, because I don't, I don't want to be, um, I don't want to be unstructured for 12 hours in Las Vegas. Nothing good is going to come of that, and let’s move a little...  you recently published a study that came out in... I believe the end of December., uh, yeah, December 21st, 2020, um, the dark side of ADHD factors associated with suicide attempts among those with ADHD and a national representative Canadian sample and the results... ADHD, adults with ADHD were much, much more likely to have attempted suicide than those without. 14% versus 2.7%  That's a huge number….. That's a huge,

 It’s unbelievably distressing information. And when we divided it by gender again, what you started with as well, we need to think about women in particular, the women, 24%, one, almost one in four women with ADHD had attempted suicide. Now our previous research has shown almost 50% had thought about it, but luckily likely most people would think about it and never attempt.  So, this is a really very vulnerable population., among men, it was about 9% who had attempted, so we're very concerned. Um, you know, that's that, that's why we called it the dark side, but, um, I I, before we go on, I just want to say... flip that, remember that the vast majority of men, like 90% of that, of the men with ADHD never attempted suicide and 3/4 of women have never attempted, so it's not inevitable at all. I'm just coming at it as a social worker saying, what kind of interventions can we do to make these numbers go down dramatically? 

I mean, I mean, it is, you know, granted 75%, you know, of the, of the, of the population is not {indistinguishable}  There's just not looking at suicide, but it's, it's still, you know, a much higher number than, than those without ADHD, and I wonder as we move, you know, as you look backwards on that, is, is there, I mean, I know that that when I was a kid, I say this all the time, I wasn't diagnosed because it didn't exist, right?  I was diagnosed with sit down/you're disrupting the class disease and, um, you know, I remember some really difficult times for me in high school and I, it, it, never came to it... came close to it, but it never came to that.  And I wonder, are there, what can, what can parents, teachers, doctors do to be better on the lookout for this? And, and I mean, even to be aware of this, right? So say, oh your child might have ADHD. That should start a, a, a, a chain that says, let's look at these things. 

So, um, I think with both women and men, but perhaps even more with young girls, um, part of the problem with ADHD as it can make social relations difficult, right?  It's harder to fit in. There's more likely to be social rejection, and that is very tough, but particularly in your younger years, as people are trying to make their way in life., so the social rejections, so, um, you know, ADHD medication can help calm the symptoms down, but you, but there has to be a lot of guidance and training around social skills, opportunities to socialize and healthy socialization starting at a young age can make a difference.  Um, the other two factors that we found were pretty important, uh, with respect to risk for having had an a, um, an attempted suicide were addictions and depression. So as a parent, uh, uh, you know, as a parent of somebody with ADHD really cau… um, thoughtful and cautious approaches to minimize, um, substance abuse is really key because once people are involved in substance dependence or substance abuse, there is a cascade of negative, negative outcomes of social academic career, life, everything.  So, and then from that, uh, comes depression and suicide, so I think addictions, uh, or avoiding addictions, um, avoiding substance dependence is really key and parents doing whatever they can on that front to help, and as an adult, um, you know, not some people can drink or use substances in moderation and some people can't, and I'm guessing most people with ADHD are on the all or nothing kind of level about it.  

No question about it.

And the other piece is depression. So the rates of depression were very, very high  um, among women, um, just looking at my numbers, but I, you know, it was well over a third, had... almost 40%...  had major depressive disorder and lots of anxiety. So they're really good interventions for everybody, not just those with ADHD. Cognitive behavioral therapy is a calming talk therapy, but it's really designed to help you catch those dysfunctional thoughts.  You know, if you're, if you're giving yourself subliminal messages that I'm useless, I can't do this sort of really negative messages. Nothing that, uh, is going to change that until you start catching those thoughts and reprogramming your brain basically. So it's a very simple, straight forward, uh, intervention.  It can be given in a group setting and it is very effective basically, um, in the general population for every three or four people who take it., and it's eight to 12 weeks, not a big thing. One person moves from depression to, uh, to recovers from depression that wouldn't have otherwise. It is a solid investment of your time and energy.  So cognitive behavioral therapy is one particular type in general that short, and can work with depression and anxiety.  So obviously depression and anxiety are key risk factors for suicidality. The other piece, of course, is impulse control. So if you have a negative thought, which we all do or, uh, would in many people be a fleeting thought, uh, I just want to end it all kind of thing, you know, somebody with ADHD, they may not be able to put that aside, go on and see something better the next day, that.,,,,,,, that's where the impulse control issues come into play. 

No question about it. Um, I want to be, be mindful of your time. Um, doctor, how can people find more of your studies of your research? If, if they, if they're curious, I'm sure they're gonna want to read more. 

So I typically, uh, release sort of media releases on the information. So you can kind of get it all in one page, which works well for most people, including those with ADHD…  So if you just type in Fuller Thompson and ADHD, probably it'll all pop up. Um, we've covered a lot of the research I've done in this discussion with respect to early adversities, with respect to women in particular and suicide, and I have several more papers underway looking at anxiety disorders and also looking at resilience. So it turns out a lot of people with ADHD aren't just free of mental illness, they're actually happy and satisfied with their life. We're trying to figure out the flip of this who's doing well and why, and how can we help more people get there 

What a phenomenal way to end the conversation, because there's no question that we're going to have you back on to discuss that once that research is done.  So Dr. Fuller Thompson, thank you so much for taking the time today, I really appreciate it. 

My pleasure, thank you for having me. 

Guys, you’re listening to Faster Than Normal love that you're here. Tune in next week for a brand new episode. If you like what you heard, feel free to leave us a review on iTunes, GooglePlay, Spotify, wherever you listen to your, your podcasts. We will see you next week with a brand new episode on ADHD and neuro-diversity as a whole.  Stay safe.

Credits: You've been listening to the Faster Than Normal podcast. We're available on iTunes, Stitcher and Google play and of course at www.FasterThanNormal.com I'm your host, Peter Shankman and you can find me at petershankman.com and @petershankman on all of the socials. If you like what you've heard, why not head over to your favorite podcast platform of choice and leave us a review, come more people who leave positive reviews, the more the podcast has shown, and the more people we can help understand that ADHD is a gift, not a curse. Opening and closing themes were performed by byrom.squarespace.com/musix">Steven Byrom and the opening introduction was recorded by Bernie Wagenblast. Thank you so much for listening. We'll see you next week.