SPEAKER_00 0:00

On this episode, I'm joined by ADHD specialist Dr. John Cruz to discuss his new book, ADHD World. A quarter of adult Americans wonder if they have ADHD. We unpack how his new book addresses the gap between clinical ADHD and distraction from digital hyperconnectivity, and why they are part of the same spectrum. Our digital world isn't just eroding attention, but also a whole range of executive functions like prioritization, time management, organization, initiation, impulse control, and emotional regulation. Furthermore, tech isn't the only part of our environment pushing many of us further along the ADHD spectrum. Daily habits like poor sleep, insufficient exercise, contaminants like lead, plastics, and psychosocial factors such as trauma and loneliness all undermine the prefrontal cortex leading to ADHD symptoms. Fortunately, most of the approaches shown to help with clinical ADHD also help individuals along the spectrum. We talk about all these topics and more. Please enjoy my conversation with Dr. John Cruz. How have you been?

SPEAKER_01 1:37

Pretty busy, but good, thanks.

SPEAKER_00 1:40

I bet.

SPEAKER_01 1:56

I'd say relief, but I mean, writing a book is often compared to a pregnancy. And I think one big difference is you don't expect your newborn to be performing right away with a child with a book.

SPEAKER_00 2:27

Right, right. Well, um, it seems like a obviously a very important topic for the Times. And I did see you've got you've got a glaring review on Amazon from a one Andrew Huberman. So that can that could only help. So that's great.

SPEAKER_01 2:44

Yeah, one would hope.

SPEAKER_00 2:46

Well, congratulations. Um Yeah, I close the book if yes, beautiful. So uh ADHD world, for those who are just listening, could you hold that up again, John? ADHD world, why we're losing focus and what to do about it. And so I um I was thinking of you because I have since since I've last spoken with you on uh previous podcast, I started working with a business coach for social media. And they have really tried to push me to do these social media posts that have been distilled to literally six seconds of information, which is a blurb, a blip. And lo and behold, they perform so much, so much better to mind uh dismane a lot of times, because I am um one for long form as a journalist and maybe old school in that way. Um, but man, my my work for US News has shifted in a lot of ways where they focus in on content creators, again, who you know, put out tiny, I mean minuscule little seconds worth of information. And um they do better business, you know, they get rewarded for these little tiny blips. And uh so it made me think of you, and it kind of makes me um, I don't want to say feel uh like as if our down on humanity that we can that we can't focus longer than you know, a couple one breath's worth of information.

SPEAKER_01 4:32

Um but yeah, the algorithms are training us and we are responding to that training.

SPEAKER_00 4:39

That is that is in it. Um and it seems everyone who's maybe not even entrepreneurs, but everyone has to, if they want to brand themselves and eventually sell something, and that's just like we're stuck in this loop of having to adhere to that. Um so it's it's interesting and also, like I said, kind of painful for me as someone who uh wrote or was still apparently on the docket to write for US news, but they've really um kind of scaled work back and focused in on you know, even them on these little tiny blurbs. But it made me think of you in this topic.

SPEAKER_01 5:25

Yeah, it's certainly relevant. I think you know, I've tried to resist it on my own YouTube channel. And there, I mean, clearly, you know, Andrew Huberman, neuroscientist, a huge success. And you know, he does two to three hour long interviews and podcasts. So there's at least still some, and and people are still reading books. So, you know, it's yes, certainly not increasing in numbers, but there's still dedicated people who are trying to do a deep dive into topics. But yes, that's pushing against the tide.

SPEAKER_00 6:00

I would say so, yes. I do think we folks are hungry for depth, though. And um, and so I wanted to go right into your book, um, John. Why why did you write the book?

SPEAKER_01 6:15

So I wrote the book because there's lots of good books out there on ADHD. And the ADHD books, pretty much, at least all the ones I've seen, are written by professionals who are sometimes individuals with ADHD, but they very carefully sequester we have something unique going on here with how our brain works, and that's very different than everyday, you know, normal lapses of attention, distractability, impulsivity. And then there's another collection of books, um, maybe more by social scientists or pundits, just finished reading um Pay Attention by David Pacman. There's I mean several other notable books have been pretty, and those sort of come at things from the opposite direction. They say the algorithms, the um digital hyperconnectivity we're all engaged in are changing our brains and affecting us. Oh, but that's completely separate from ADHD, which is a clinical condition, and I'm not a clinician, so I'm gonna ignore that. And yet the concept of the ADHD spectrum sort of unites or explains these separate, apparently separate areas of interest, which are describing the same set of symptoms, are not separate. These are all aspects of the ADHD spectrum. And I think people, you know, both were discussing the internet connectivity end of things, and people in the ADHD field need to understand that. And right now in America, or six months ago, survey showed a quarter of adults are concerned that they have ADHD. That means problems with you know, sustained thought with distractability are bothering enough people that they're really worrying that they themselves have a problem that might need treatment. And again, the ADHD spectrum concept in my book, I think, helps explain some of the nuances of it and why this is a tricky, complex field and why many of us feel we have ADHD. And um, so I can start breaking that down into different pieces depending on which direction you want to go.

SPEAKER_00 8:34

Yeah, I I am curious. You know, we did touch on some of this with the previous our previous conversation. However, I think it would be worth at least unpacking um, you know, how is ADHD diagnosed? I feel like everyone, like you said, especially now, myself included, worry about the level in which our uh ability to focus has completely atrophied.

SPEAKER_01 9:03

So starting with, we have our current diagnosis is is our gold standard is the DSM, the Diagnostic and Statistical Manual, which they're going to be changing to the Diagnostic and Scientific Manual in upcoming versions. So that's um a document that's put out by the American Psychiatric Association. It's updated every few years. Um, some people consider it the Bible, but it's meant very specifically not to be a Bible. So a Bible is the word of God that doesn't change, and different people might interpret it. They've known since the beginning, and with each version, this is a scientific document. This is our attempt to understand what's going on in the brains of people with mental health conditions. And we know our knowledge is incomplete and it will need to be revised over time. But most of the last 30, 40 years of the DSM, they've based the DSM as a, for each condition, as a list of symptoms. So they were trying to be as objective as possible and not falling into whether this is a biological condition or a result of old childhood Freudian issues. So they tried to be neutral. And for ADHD, the definition for an adult is that you only need five out of 18 possible symptoms. Nine of those are inattentive symptoms, things like being easily distracted, not listening when someone is speaking directly to you. And nine of the possible symptoms are um impulsive or um hyperactive symptoms. So interrupting others could be an impulsive one, fidgeting or getting up and walking around when you're in a situation where you're expected to be seated would be hyperactive symptoms. So these symptoms have to be excessive for your peer group. So compared to people your own age and socioeconomic status and culture, and they have to be severe enough that they're leading to some amount of either distress or disability or dysfunction. And the other parts of the definition are that they have to have been going on since childhood, since before the age of seven. They have to be present most days, um, for at least the last six months. They have to be present in multiple situations, so it can't just be, you know, your boss creeps you out, so you act in a certain way there. And uh one of the last pieces of definition is that they're not attributable to other causes. Um, that one's a sort of a circular argument, because each of the diagnoses in the DSM has that disclaimer that you can't attribute other things. And in some ways, that's a really weird circular disclaimer. Because so let's say both depression or altered depression, anxiety, ADHD can all impair attention. But if you think the symptoms are from one, I mean, so but you can't use them to make an ADHD diagnosis if you think for this individual they're due to depression or anxiety. But how do you know they're due to depression or anxiety? Because you could come at it the other way and say, well, maybe this person does have ADHD and those aren't symptoms of the depression or anxiety. So there's a weird circularity of uh the ruling out clause that doesn't seem to have bothered the American psychiatric too much. So that's been our standard definition, and that's the definition that's been used for also tens of thousands of research articles that have verified or validated that this is a condition or description that fits lots of people. And the data, the research also supports that ADHD isn't just some trivial, you know, oh, there's a squirrel that it's associated with more academic achievement, lower financial achievement over a lifetime, more marital and romantic relationship distress and failures, higher rates of incarceration, and it even kills people. So ADHD is formally diagnosed. Um, if you have that in childhood, on average your life expectancy is about eight to ten years shorter than your peers. That's as big an impact as major depression, it's as big an impact as diabetes has on people's lives. So this is a serious condition, but we also know and and there's um the World Health Organization has a slightly different definition, but it it's basically a symptom-based definition, like the DSM's definition. But we know that there's lots of problems with this definition. So one of the problems is, you know, we do have 18 different symptoms, but there's a lot of overlap between so if you fidget excessively and you can't sit still and you feel like you're going on a move like a motor, lots of the hyperactivity symptoms. If you have one, you're probably meeting criteria for another one. So they're not particularly independent, and that again can make it easier to make a diagnosis and not, and the other thing is the symptoms don't cover the full range of what we know is present in ADHD. So a really big issue with people being with ADHD is um tardiness of not being on time, not managing their time well. And only one of the symptoms sort of indirectly lists that as one of the possible examples. Another two-thirds of people with ADHD have troubles with emotional regulation. That's nowhere in the list of symptoms for ADHD. So we have this symptom list, and it again maps pretty well onto this cluster of people, but we know we're missing some important characteristics and not others. So even though that's the formal definition we're using, sort of the understanding of ADHD that I'd say many of the researchers share, and um, many of the patient groups or individuals with ADHD also agree makes sense, is that ADHD is a form of neurodivergence. So it's people whose brains are wired and working somewhat differently. And the neurodivergent aspects that are affected are what are called the executive functions of the brain. So this is how we organize information, how we sequence information, how we inhibit our impulses and responding, how we regulate our emotions. So it's not our intelligence, it's not sort of the brute force power of aspects of the brain, but it's a lot of how we organize and work with information and use, try to accomplish tasks. And we also know that the prefrontal cortex is intrinsically related, is the real state involved for many of these executive functions. So they're packed into this space pretty in overlapping circuits, and we know that dopamine and norepinephrine are important neurotransmitters involved in this. Now, that it doesn't mean that ADHD can't involve other parts of the brain. You know, there's evidence that the amygdala, the base of the brain, is has important roles in some aspects of it, or the cerebellum can have some important parts, and we know other trans neurotransmitters can have some effect. But I think, and again, there isn't complete consensus, but the DSM is in the process, they've they've announced in advance, which they haven't tended to do, that we need to change our whole system and we need to do a couple things. One is we need to bring in biomarkers, because right now it's pretty much completely detached from all we learned about in the brain, and identifying specific circuits like the circuitry for switching attention or tying motivation to attention or sequencing steps of a task. All of those were more advanced in mapping out the circuitry involved than we were 20 years ago. And a lot of that seems to underlie what's going on in ADHD. So the DSM has said we need to pay more attention to biomarkers, we need to pay more attention to functional, how these symptoms are really affecting people. And that's always been a big and it's it's an ongoing challenge for um mental health. I mean, in if you have a broken bone, you can look on a scan and see the bone is broken. There's sort of clear objective evidence. And lots of really bright people have devoted their lives to creating scales for depression or ADHD or mental other mental health conditions. But they have lots of flaws, again, separate from what we were talking about of whether they're including the right range of symptoms or not. But how do you measure, let's let's say being late is a big problem you have for ADHD. Right now, our way of measuring the intensity or severity of that is to say, you know, is tardiness causing you a problem some of the time, a lot of the time, most of the time, never. Oh, let's say someone's so it's a it's a measure of trying to use the frequency of symptoms as a marker of the intensity. And that may work a little bit, but let's say you're five minutes too late to work every single day versus Joe over here. He's on time most days, but once every two weeks, he's an hour late. Which is more disruptive, which is more intense, which is more severe. If you're just measuring frequency, this guy is doing it ten times as often as this guy, but the side, and then I'm using time because we can quantify it and measure a lot of these, you know, you can measure how many times someone interrupts someone else, but even there, just the number of times is not completely um a marker of intensity or severity. You know, if you're sort of interrupting them at the end of what they're saying and do it politely, that's different than just bursting out and drowning them out in the midst of an important point. So we we're we're deficient in that area. And then the third area that the American Psychiatric Association says we need to make improvements is what are the aspects of the exposome. So the exposome are the collection of um forces, factors, issues in someone's environment from birth or even before birth, all through their life, that may be affecting the severity of their symptoms. So it's not quite the same as just a nature nurtured the whole environment, because you know, this pen is part of my environment right now. Is it making my ADHD symptoms worse or better? If I had ADHD, probably not. It's probably irrelevant. So lots of the environment. I mean, but on the other hand, maybe you could you could certainly fiddle with it. And maybe if they define uh or design pens in a certain way to make them more fiddle resistant or more fiddle prone, it could be part of the exposome. Um, but the exposome is includes your experiences, it includes um your habits, things you engage in, it includes chemical factors, um, physical factors in your environment, and particularly for a condition like ADHD. Um so one other aspect of ADHD, many of our mental health conditions are considered sort of invisible illnesses. Again, they're not, you don't have an x-ray, you don't have a visible marker of what's going on. I would argue that behavior is a pretty visible marker for many of our invisible mental health conditions. You know, at least when I was growing up, before cell phones and earbuds, if you saw someone talking out loud in a public space, you know, but not talking to anyone, that was a moderately good sign that they were schizophrenic or otherwise psychotic. You know, if you can see the behavioral manifestations of someone touching a doorway or tapping things, you have a visible sign that they may have ADHD or OCD, sorry. So, and certainly lots of the hyperactive and impulsive symptoms of ADHD do have behavioral visible manifestations. Um but getting back so so mental health in general is felt defensive. We don't have good biological tests to define who has each condition, and particularly. ADHD has been defensive for the field, both the patient field and the research field, because unlike schizophrenia, where hearing, you know, seeing things that aren't there, hearing things that aren't there, are beyond what most people normally experience. So they're characteristic or what we can say is pathonomonic symptoms that indicate you have this condition. For ADHD, all of the behavioral symptoms are things that normal people do at least some of the time. Normal people are at least occasionally missing deadlines or not listening when they're spoken to, or fidgeting, or are um interrupting others, or not being aware of other people's personal space. So ADHD fields, and this isn't to a person, but a lot of the research community, a lot of the patient community has really clung to one fact that there's strong, strong genetic evidence that genetics contribute to ADHD. And the measure of genetic contribution is called heritability. It's not many people interpret it as 80% of my symptoms are due to genetics. That's not really what it means. And I I can go into defining heritability if we need to go there, but the heritability of height, for example, which is under, is about 0.8. So a lot of, you know, most people who are tall come from tall families. Most people who are short come from short families. But we know there's short families with a tall person thrown in, and vice versa. So there are other factors, or things like famine can change the overall. So the heritability, um, ADHD has among the highest heritability of our mental health conditions. It's about 0.7 to 0.8 in most studies. That's comparable to schizophrenia's heritability. Um, it's considerably higher than the heritability for OCD or panic attacks or depression and anxiety, which themselves have a genetic contribution. So the field of ADHD has often sort of ignored that there's aspects of the exposome that affect ADHD when at a clinical level we've always known this is the case. And by that I mean lots of experts will talk about when do people show up for treatment for ADHD. They tend, there's an increased likelihood of showing up for treatment at certain transition points when either the demands of the environment have gotten bigger or the supportive network of the system has gotten small, shorter. So a classic one is a kid who's bright enough that they sail through elementary school and middle school, and then in high school, they have more homework, they have more formal, challenging assignments, and you know, brute force intelligence just does isn't enough to pass all the tests anymore. Another classic time point is going off to college. A few years ago, I had a kid who got into Stanford, which was one of the top two or three most competitive schools, clearly a bright guy. Um, he had done well in high school, and he was literally failing out of Stanford, not because he suddenly became stupider, but he had always had ADHD. But in his culture, when he was in high school and lower grades, Auntie and Mom sat in the kitchen with him before he finished his homework each day. They didn't do it for him, you know, they weren't pushing to that extent, but they made sure his work was done before he went out and played. He's at college, and yeah, he knows he wants to do well. He's smart enough to do well. But there's girls, there's boys, there's sports, there's drinking, there's 401 different distractions. And again, so there's greater pressure, probably, to perform, or at least as greater pressure and demands on him, but less support and structure to help keep him on track that he couldn't supply himself. So we've known parts of the exposome increased or made ADHD symptoms more severe. Um, but we've sort of ignored or minimized it again, trying to claim to you know, this is real, this is biological. Don't take that away by saying it can be affected by things in your environment. But again, we have a range of data. So the other thing that's really problematic about DSM is that DSM is a categorical distinction. You either have ADHD or you don't have it. Those are the two choices. And that's what all these diagnostic tests online are attempting to start the process of getting at, of deciding do I have it or do I not? And yet the concept of an ADHD spectrum makes it clearer that one, that's a pretty silly question to be asking. Because we know if you look at any of these individual traits, like how often do people interrupt other people? That's that trait is expressed as a spectrum across the population. Some people never do it, some do it a little, and a small group of people do it a lot. It's not that some people do it a lot and nobody else does it. It's so any one of those traits shows a distribution across the general population. And the number of traits someone meets criteria for also shows that trend. So it's not that some people have five, six, seven, eighteen traits, and most people have none at all. It's that many people have one or two, and fewer numbers as you go to more extreme have more and more. So again, the symptoms appear across a spectrum, and maybe even more importantly to the spectrum concept, and this is different than we realized years ago. I mean, the claim when I was in training is that kids had ADHD and they all outgrew it. That began to be seriously debunked in the 1990s. I mean, there was some clear evidence beforehand, but it was not widely known or accepted. But then, sort of, the dogma for the next 20 years was you know, the amount or degree of ADD-ness you had was probably fixed by early childhood. And if you had it as a 20-year-old, you're probably going to have it as a 40, 60, or 70-year-old. But when we've actually done studies that followed people over time, what we know is that many people who meet full criteria for clinical ADHD at one point in time don't when you follow them up a few years later. And then they may be back under full condition. And other people who had only sub-threshold ADHD at one point in time, if you follow them long enough, many of them will meet full criteria for ADHD. So we know people move back and forth in terms of whether they meet full criteria, and that's that's even separate from whether we're talking about are they on medications or not. Um a really weird quirk of how many of our mental conditions are mental health conditions are defined. You know, ADHD, if you treat it successfully with medications and don't have the symptoms, technically you don't have the condition any longer, which is very different than having the condition and it being in remission or being like treated. We don't, I mean, that's not usually how people use the definitions, but that's how the definitions are written that if you're not having the symptoms, you don't have the condition. Whereas we don't do that with diabetes. If you're taking insulin for your diabetes, we don't say, Oh, you don't have diabetes anymore, your blood sugar levels are fine. So there's some weirdnesses here. Um, but the big point is again that there's fluidity, that people move back and forth. And if we appreciate that there are a multitude of forces in our world, and again, that the internet hyperconnectivity or digital immersion, or however you want to describe that one, that one's a big one most people are aware of. But there's other factors, um, just looking at habits, um, the ways people are living today that they weren't doing 50 or 100 years ago. So sleep deprivation, frettier diets full of highly processed foods, um, lack of exercise. All of those we know affect the executive functions, affect prefrontal cortex. All of those are forces pushing everyone who's who's you know sleeping poorly, everyone who has that factor in their life, it's pushing them further along the spectrum. So some people who only who had ADHD to begin with, if they're eating poorly, sleeping poorly, others are gonna have more severe ADHD symptoms. People who were subthreshold, so didn't meet the full criteria for ADHD, some of them are gonna be pushed into full-blown ADHD now. And some people who weren't particularly on the spectrum before, because of a collection of these other factors, are now among that 25% of Americans questioning, you know, do I have ADHD? Because I'm showing these problems more and more often.

SPEAKER_00 31:26

So I can pause there because I've thrown out a lot of information, but um it's very helpful to lay out the framework here. And I um yeah, I was I was very curious if you know ADHD is something that could be diagnosed later on in life. And and also very curious, you know, it does make sense that it would be more on a spectrum. I think everyone, even as I listen to you speak, I'm shaking my head because I see this in myself, some of these traits for sure. And I think a lot of people would be shaking their head yes, that they um they find themselves in certain uh seasons of life more affected by um their inability to show up on time or interrupt based on maybe what's going on in their life. Like you said, maybe it cycles through and then it but how does one know for sure that they should go seek out some help? Because it seems like a lot of these, like you had mentioned, are on a spectrum. Even every one of these markers um right, could be on uh different levels. And so was it something like depression where or um addiction where if it's starting to negatively affect your well-being, is when you should seek out some help, or or how does this work?

SPEAKER_01 32:57

Yeah, I I would say, I mean, and it's embedded in the in the DSM is that distress and dysfunction are the two sort of hallmarks. I mean, so so one is that there can be people with severe levels, intense levels of ADHD, who, because of either financial resources or family structure or others, can navigate most of life moderately well. Maybe for that, and another factor, so maybe they don't need to seek treatment. On the other hand, there's some mental health conditions where the burden of misery is centered on the individual. I'd say depression and anxiety, those would fit. There are other conditions where they may be impacting the individual, but they may be having a bigger impact. You know, so Joe, who I mentioned that you know was two hours late once every two weeks at work, might not bother him at all, but might really screw up his workmates, his boss, of people who are counting on him to be there at time. So there are many aspects of ADHD that the person themselves may be either oblivious of or aware of, but not concerned of because it doesn't necessarily cause distress. But as you, you know, both so both distress and dysfunction are be the triggers. And I'll say a little, I mean, there are dozens and dozens of websites who say, you know, we can tell, and some who are just advertising sort of diet, they can diagnose your ADHD. There's also clinics who claim we can diagnose you and get you started on medications in 20 minutes. I would say if you see that, probably you should run screaming the other direction. Or you can take their survey, you can take their questionnaire. Almost all of those, particularly if you're asked 18 different questions, all they've done, and there's several standardized questionnaires, but they've taken those 18 DSM symptoms and made up a question for each one. And questionnaires can give an indication of who routin needs further evaluation or work up, but they absolutely can't provide a diagnosis simply because lots of other conditions, and you need to know the context of the when this is happening and how it's affecting people and what else might be contributing to it. You know, and what other conditions are there that could also explain it? So, again, depression, anxiety, substance abuse, all can lead to a lot of executive function deficits or changes, which you could have those along with ADHD, or that you could have no ADHD, but similar symptomatology because of these other conditions.

SPEAKER_00 35:47

And so, would someone seek out help by reaching out to their primary care physician who would then link them up with like a psychologist, psychiatrist, or yeah, I'd say usually it's a psychiatrist or psychologist who's going to do the formal diagnosing.

SPEAKER_01 36:02

I mean, ADHD is a little unusual in the mental health world because a fair number of pediatricians, a fair number of um family practice doctors had become some of the um prominent clinicians in the field. I mean, much more so than I don't know any family doctors who are the lead speakers for depression or anxiety or other mental health conditions. So, I mean, part of it is these are conditions that pervasively affect lots of realms of life. And I guess historically it was a neglected field or one that wasn't taken as seriously. Um, so but but usually it's psychiatrists or psychologists. Psychiatrists are individuals who do have gone through a full medical training program and have medical expertise, and most are capable of prescribing medications if that's needed. Um, but there's some psychologists as well who specialize in diagnosing. Um, and again, beyond the sort of simple 18 question questionnaires or surveys, we don't not only do not have any biological markers, blood tests, brain scans that definitively define ADHD, we don't have any neuropsych exams. So often, and I think maybe to this day, but some of the medical associations, the lawyer associations, if you wanted accommodations, you not only needed a letter from a doctor that said you had a diagnosis, but you had to undergo specific testing to confirm the diagnosis. The problem or issue is the testing can support a diagnosis, but it's it doesn't prove it, it doesn't disprove it. Um, it's subject, even though they try to be objective to interpretation and qualifications. Um, but and some of them can more precisely measure, you know, how long is your attention span, how easy it is for you to not respond to one stimulus when given to conflicting stimuli. So we can measure some of these executive functions fairly well. The problem is in a laboratory situation, measuring executive functions doesn't correlate well with who really appears to have ADHD in real life. And the context is different. The structure, I mean, you're you're almost always in this environment that's removing distractions, that's providing structure, that's keeping you on time. So um, so most of the time, people who genuinely have ADHD are scoring within a normal range on many of these neuropsychological tests that are designed to measure these brain functions. So the gold standard is still considered a clinical evaluation by someone who knows what they're looking at.

SPEAKER_00 39:03

Okay. Um maybe it's just on my radar, John, but there's a lot of people on my um social network that I think kind of maybe maybe nonchalantly, maybe not, throw out the fact that I have ADHD, I can focus, and uh maybe just kind of throw them out there like just willy-nilly. But is there an effect kind of um I'm thinking of for men like um similar with I feel this pressure by even like family members, like go get your your colonoscopy. Like I'm after a certain age, there's you know, unless like there's other factors, you have it earlier. If there's not, you know, there's this age range that you've given it done. But there's this real push, and I think social pressure and like raise rise of cancer cases that you know, there's a real seemingly pressure to go in there and say, oh, just tell them you have a whole family history so that you can get your colonoscopy early. And so is there any sort of effect you think in uh the ADHD world of um maybe it's just because I talk about this topic frequently that it shows up for me a lot? Or is there a push to go in there and with the idea already that I definitely have ADHD? And do you think that has any effect on um diagnosis?

SPEAKER_01 40:30

So there's a lot of different levels or layers in there. I mean, one is just objectively looking what are among the most popular topics on TikTok or Instagram or YouTube. Um, I mean, not only is mental health over probably represented, but specifically ADHD and autism are among the most hot topics for the last five, six years. The disappointing thing is several different independently done studies where they tried to evaluate the quality of the information in those, and it's like something like 70% of them contained either outright falsehoods or distortions of information. So, you know, having in our culture a large amount of information about this topic circulating and a large amount of misinformation is certainly influencing people's willingness to acknowledge that they have it, or people's willingness to use it as an excuse on an intermittent basis, or at least people's awareness of it. Um, so so one other thing I was rather angle is that there's clearly a cohort effect. So if you talk to 20-year-olds, 30-year-olds, none of them have any quest. You know, they know that ADHD exists, they know that adults can have it. And when I was living in San Francisco, I gave a couple talks at senior centers. And these are the Bay Area, so highly educated, highly professionals who did really well in their lives. And virtually none of the 70 or 80-year-olds, and this wasn't that long ago, knew that an adult could have ADHD. I mean, it's part of it, is they grew up in a world where it wasn't even acknowledged in kids, and they're just maybe less involved in a lot of the online culture. But um, I mean, there's clearly a gradient, the older you get, the less aware of ADHD. And one of your earlier questions, can you identify it or diagnose it late in life? So there's two different embedded questions in there. One is, are there lots of people who have ADHD their whole life who it only gets diagnosed late in life? And I can say absolutely. And I mean, one of the people who bought my first book um bought it because they buy books by MD PhDs, which I thought was a pretty weird thing to, and it wasn't till this is according to their email, and I had an extended conversation, it wasn't until after they bought it that they realized the book was about, so the book was called Recognizing Adult ADHD, What Donald Trump can show us or teach us about ADHD attention deficit disorder. He said it wasn't until after he bought the book that he learned that it was about Trump, which he was interested in reading more about. And then he read the book. This is an engineer who had retired a decade before at the age of 80, was a widower. And when he read the book, he said, you know, each chapter, each discussion of symptoms perfectly described why he had such an erratic, unusual trajectory through life. And it actually gave him some peace of mind for understanding himself. So that's an example of someone at 80 who had symptoms his whole life. My other example, and this is the other, you know, even more extreme, maybe. I had a guy who was referred by his orthopedic surgeon after he had broken his arm in an elevator fall. And the well-meaning surgeon thought he was anxious about all and wasn't recovering well because of his anxiety. And I wound up working with this guy the last three years of his life to, and absolutely he had ADHD and had had it his whole life and was just a constant unfiltered chatter box, you know, saying whatever. But we could go back and look at how his life diverged from his brothers. They were both intelligent. They both grew up in New York City, but this guy was kicked out of two different Catholic schools because he was playing, you know, he was a prankster, he was acting out, and not just acting out, but getting caught on some of his less ADD, you know, they might throw the snowballs, but they know which they planned ahead, which, you know, hedge to hide behind, and he's out there sticking his tongue out at the cop and gets picked up or arrested. So he had a history that supported, you know, decades, nine decades of ADHD before I got to working with him. The other question though is can ADHD arise anew in adulthood? And that's, I mean, by the official DSM definition, no, because you have to have had symptoms before the age of seven. Um, but we know there are individuals with traumatic brain injuries who pretty good record taking and information from family, friends, collaterals that had no previous ADHD symptoms and gun injury to the head, uh traumatic other car accidents, other injuries to particularly to that very large prefrontal cortex, which is a big target, can replicate the entire range of ADHD symptoms. Um, we also know in COVID, there are individuals with long COVID with long COVID, the most common collection of disabling. I mean, we think of it, this is a lung virus. I mean, we know it goes to other parts of the brain, our body, including the brain, but the most common debilitating symptom of long COVID is brain fog and associated symptoms, which have a huge overlap with ADHD symptomatologies. And there's um studies, including from the British Brain Bank survey, where they have a huge collection of brains of people with health, you know, before and after COVID, and where they can see um changes in prefrontal cortex that are associated with some of these people who have long COVID symptoms. So I think again, if DSM really starts moving to tying things to real brain circuits and looking for biomarkers, and we change our definition, we will have much less resistance to accepting if you're damaging the preforcing cortex in these same executive function circuits and getting the same range of symptomatology. You know, just because you've fell on the sidewalk and hit your head, that's no less a valid version of ADHD than if your parents both had it, and there's a strong genetic connection and you're displaying signs from childhood. And then the third level of why I say this is so is in general, and this is kind of a sweeping overgeneralization, I'll make it, is that the same medications and cognitive and behavioral and other therapy approaches that work for traditional DSM-defined arising from childhood with a strong genetic connection, ADHD, those same approaches seem to help people with ADHD from different etiologies or origins.

SPEAKER_00 48:03

And I can belabor that point or get a different angle of it, or we can move on to something on the well, uh, I wanted to get a sense of, you know, you brought up the older age range and being diagnosed later in life. Um, but it seems as if uh children, younger folks would be uh more susceptible to at least hyperconnectivity with their phones, digital, uh constantly on the social media TikTok. And TikTok more so than any other social media app, in my opinion, is very I've never realized this till my little niece made me get on TikTok. And I could see there goes two hours of my time, and you could just quick swipe, and it's the note, and it's this. Yes, and I really understood that uh completely once I did. I mean, immediately when I got on, before I posted anything that didn't have any, I don't think, information on my to govern my algorithm yet. And it was just wow, this is so so uh addictive, totally. And so do we know how this is affecting younger folks? Is it a younger, is it creeping into a younger demographic or or do we know that?

SPEAKER_01 49:27

Yeah, it's a it's a mixed question. I mean, one is our research is still limited because it's a fairly new field, but there is a considerable amount of research. I mean, one is that most of the research is just asking people about symptoms, like, you know, are you distracted? Do you have trouble concentrating? Are you more impulsive? Are you more emotionally volatile? And we know there's a pretty strong correlation between the amount of time either children or adults are spending in, I'll call it digital hyperconnectivity, um, versus you know, the hours spent in the the time itself is a factor. Um, some of them studies identify that there's an element that it's not just the time, it's the how problematic it is. And problematic is, you know, were you unable to put it down, or you're not, you know, were you so what's tricky? We also know though that children with ADHD are more prone to get sucked into some of these devices. So there are, I mean, very clearly feedback loop elements. Um and there's less but some growing studies showing that if you actually measure some of these executive functions like attention span, you can find measurable, so not just subjective, I feel my attention's bad, that you can measure that attention, different aspects of attention or impulse control are impaired. And you can even see that when people take a break from these, um, that some of those functions improve. Now, you know, there's problems with placebo effects. You know, it's hard to unplug or plug someone into the internet without them knowing what's going on. Um, and there's so much acceptance or awareness that this is having some detrimental effect on my brain. So the belief that being unplugged from it might be helping could contribute to some of the effect, but it's clearly that it's it's more than just placebo effects. What we don't, and again, some of these we can measure in terms at least of brain activation and brain connectivity patterns. And what I'll just say with brain connectivity, lots of times we talk about it like it's the wiring for an electronic device, that new wires are plugged. But but our brains are highly overconnected. I mean, each of the hundreds of millions of cells in our brain are connected to hundreds or thousands of others. And when we look at major pathways, we're looking at sort of the strength of connections, but probably most cells are getting at least a few irrelevant or other connections in and out. Um, so when we're talking about changes in connectivity, it's not usually that we're building a completely new pathway or completely eliminating an old one. It's a relative strength. Um, but that's functionally really important because the more brain cells and neurons fire together, the more likely they are to keep firing together. So, but the big question is how I mean, we know again with digital detoxes, some of those changes are reversible, but we don't know. One, are kids more susceptible to permanent damage, or are they more susceptible to being impervious to it because their brain is still in a changing state? Are are adults more? And again, this isn't just the digital world. So a really good example is sleep apnea. So condition, um, and I mean there's brain origins to sleep apnea, but most of sleep apnea are the structures of the throat are collapsing and causing cessation of breathing temporarily multiple times during the night and deoxygenation. And again, partly because the prefrontal cortex isn't just anatomically very vulnerable because it's such a big structure right at the front of your head. So trauma and other things are um, it's sensitive to oxygen deprivation, it's sensitive to other other issues I can get into if we want to get into some of the neuroscience. Um where was I going with this? Oh, sleep apnea. We know that there are numerous studies looking at adults with sleep apnea, at least some significant subset, display a whole range of ADHD symptoms. Or kids with sleep apnea, it's that's less common in kids. And in several different studies, if you treat the sleep apnea completely, thoroughly, you completely alleviate the ADHD symptoms. So, again, that's one more aspect or part of our exposome that, and and I mean, sleep deprivation itself is one of the most reliable, quick, and easy ways to replicate ADHD. You become an all-nighter and you're more scattered the next day, you're more distractable, you're more emotionally volatile, you're less able to control your impulses. Um and usually you go to sleep, you know, that night and you recover. Your brain isn't in a perma. But we don't know, nor is a year of sleep deprivation, is you know, getting by on six hours of sleep a night for 10 years having some lasting impact. We just don't have good data. And again, part of it's gonna be really hard to sort out because we're those people who thought they were really getting away with something by. I mean, in American society, it's a huge proportion of the population that's probably getting by on inadequate sleep. Yeah. So there's so we have lots of aspects of our exposum that are that are each themselves feedback loops, again, with the internet. The more ADHD you have, the more likely you are to be sucked into that. And the more you're sucked into that and spending, the more ADHD symptomatology you have, or with sleep deprivation. You know, people with ADHD to begin with have a number of problems with sleeping well. So, but then that sleep deprivation itself is accentuating ADHD symptoms, and most of these feedback loops are interacting. You know, people are getting poor sleep are more likely to be spending more time on the internet the next day, chronically. So it's a complex, messy feedback set of feedback loops.

SPEAKER_00 56:09

Yeah, and probably related. Um you had brought up in reaching out to me the um the effect of of our culture and and loneliness. And I'm it could definitely be, I'm assuming, this also part of this cascade effect of being more online, uh more isolated in that way. And how does that affect or is that part of the whole uh bigger picture?

SPEAKER_01 56:38

And again, much of this is we know there's correlations. It's hard to know for sure whether it's causative, but but when you try to eliminate depression, eliminate socioeconomic factors, eliminate physical health factors, we know people who just and loneliness is different than being alone. There's a high overlap, but alone just means how much time you're spending with yourself versus others. And loneliness requires a feeling that you are missing out or you're wanting to connect more than that you are experiencing. So loneliness, I mean, that Vivek Murtha, the surgeon general during the Biden administration, I mean, he only released two major, I'm forgetting what they're called, statements on public health. And one of them was on loneliness. Because there's so many physical health factors that are clearly associated with it. But some of the studies also find a range of executive function deficits correlated with time people spent feeling lonely. Um, so that the implication, again, is that loneliness itself is causing damage to those prefrontal cortices. And, you know, we can come up with reasonable hypotheses of, you know, whether it's stress and cortisol, which cortisol at too high concentration is toxic, but one of the areas that's most susceptible are these prefrontal cortex neurons. Um that's I would say speculation that that's a mechanism of action. Um, but it does seem that loneliness does contribute to deterioration of prefrontal cortex circuits that underlie um executive functions.

SPEAKER_00 58:31

So if someone is maybe struggling with some of these symptoms, there are lifestyle factors that they could um potentially improve on to help alleviate some of the symptoms potentially, then okay. And um and let's see, there's so much of that that it had come up as you were speaking. Um, you know, you brought up this impulsive, like impulsive control and emotional regulation. How does ADHD uh contribute to those um factors? Is it similar? Um, you know, just kind of a cascade downstream effect, like uh or or how does how do they come into play?

SPEAKER_01 59:27

Yeah, well I'll say a little so again the executive functions, and it's a loose concept. So every brain researcher has a slightly different set of functions, like you know, and and even something like attention isn't just attention because it's directing your attention at something is different than sustaining your attention, is different from unhooking your attention and moving on to the next thing rather than getting sucked on the rabbit. So there's aspects of attention, of working memory, of emotional regulation, and a lot of the circuits for these different functions are mapped out, and many of them involve big parts of the prefrontal cortex. So, a couple things about the prefrontal cortex. It's a the youngest evolutionary part of our brain, it occupies a huge amount of space, so it's a huge energy drain. So, one is lots of things that would deprive the brain of oxygen or energy, you know, sleep deprivation, the prefrontal cortex is going to be more vulnerable. Um, with traumatic brain injuries, we often focus on, you know, thinking of it as a bruise. You know, that's why you wear a helmet for football and it's padded. But most of the damage from blunt force trauma, and so separate from gunshot or projectile trauma, but blunt force trauma is much more shearing forces. It's sort of like shake and baby syndrome. And the prefrontal cortex, again, is one of the most vulnerable areas because it's where the longest projections from the base of the brain out to that prefrontal cortex. And if you're shaking, it's those longest neurons that are most vulnerable to being attacked. So lots of the aspects of um CTE, the chronic traumatic encephalopathy, that at least a quarter of pro-football players. And I mean, there was a study that was came out earlier this year, and it got promoted. I think the NFL pushed it that a quarter people, but but the range of how many professional, I mean, could be as high as 95% from that study. Saw that looked at different, but again, lots of those symptoms are symptomatology, you know, why people change in the change in and their you know, identity, you know, change, you know, that person's not acting like they would before. Lots of our traits associated with individuality are tied in with the executive functions and other prefrontal cortex networks. So there's anatomic reasons those areas are susceptible. There's also neurochemical, and probably the easiest one is glutamate's a really abundant neurotransmitter throughout the brain, but particularly prefrontal cortex is really rich in what are called NMDA receptors, which is one set of glutamate receptors. And glutamate, I mean, we talk a lot about dopamine, serotonin, norepinephrine. All three of those systems together represent less than 1% of the neurons in the brain. Um, that's made them easier to study because you could pinpoint very precise neurons. Glutamate's the opposite. It's so abundant that it's hard to tease things out. And it's also, because of its abundance, a system that has not just pinpoint synaptic level importance, but it can, if you really mess with glutamate, you can cause reason regional changes because there's just so much of it flooding the brain. And there's aspects of the NMDA receptors that make them fatigable. So I'll get into this a little bit because it's a we often compare the brain to a muscle, and you know, if you exercise, it gets stronger. And and in some levels, some of the analogies don't hold very well. And one is fatigability. So you may be looking at things all day long. Your optical cortex, your processing of visual information doesn't fatigue. You don't start, the color doesn't start draining from what you're seeing or the edges get fuzzy later in the days. I mean, your eyes might get dry, that might affect if you really stayed open, particularly if you're scaring, staring at a screen. And similarly, your motor cortex, your sensory cortex, those areas don't fatigue. Again, your muscles might fatigue, but which muscle, at the end of the day, if you're trying to do a curl, you don't suddenly start flexing your fingers instead of so most of the brain, most of the neurons don't fatigue. But a lot of the circuitry in the prefrontal cortex involves an MDA receptor systems that are fatigable. And we know this, you know, you can't pay attention, even if your life depends on you know driving cross-country. If you're too tired or staring, you know, your fit, your your alertness goes down. Your ability to respond, your reaction time goes down. So lots of the executive functions are fatigable, and a lot of them bleed into each other. So again, we don't see bleeding in other areas of the brain. I mean, we we see, you know, if part of the brain is damaged, there may be in the long-term growth of functions into other pairs of the brain to take care of some of that in some situations. But usually adjacent areas of the brain aren't affecting. But we know a lot of these executive functions, you know, if you're more emotionally involved, you're also probably less able to pay attention. You're less able to, so there's unique aspects of the prefrontal cortex, anatomically, neurochemically, that make many of these symptoms sort of glom on together. But one other aspect of the ADHD spectrum I didn't explicitly mention earlier is we have 18 different symptoms. Again, there's even other realms that aren't in that. But part of it is that that allows a lot of different um patterns or appearances. Some people, eye management is their biggest issue, some it's blurting things out, some it's just physical restlessness. So there can be a wide variety of ways that what we call ADHD now manifests or expresses. So I'm not sure if I answered the question or I've gone too far astray.

SPEAKER_00 1:06:05

No, I think in a very in a neuroscience way you have. I um you know what came to mind when you bring up CTE and uh TBI is like you brought up sports. And um do we know if athletes are more affected by this? Or even do we know the demographics around are more boys and men affected by or or struggling with ADHD than women? Or do we do we have any sense of those numbers?

SPEAKER_01 1:06:42

So I mean, the if we go back to the 70s and 80s when it was only a childhood condition, it was diagnosed at least twice as often in boys than in girls. And the early adult studies were also skewed that way. Um, there's probably both social reasons and maybe biological reasons. But that I mean, one is traditionally it's been more okay for boys to run around and blurt things out and not behave. And a girl who does that is a major troublemaker or an outcast. So there's more pressure on girls to hide or mask their symptoms. Um and I think there's also, and things vary in different eras, but girls were just considered less important and more likely to be over, you know, it didn't really matter whether Nancy was passing algebra or could read because she was just going to be a housewife. I mean over stereotyping. Um so there's some that some people claim, and I think it's on pretty weak evidence that it's equally distributed among the genders, but I mean, some of the neonatal um during pregnancy factor, you know, during pregnancy specifically, we there's a pretty good body of research that higher levels of testosterone during pregnancy that the fetus is exposed to do result both in boys and in girls in higher rates of ADHD 10 years later. So I mean we know there's other pregnancy-related factors, low vitamin D and the mother's hypothyroid or hyperthyroid, all of those result in higher rates of ADHD decades later in kids. So there's clearly, again, part of the exposome is chemicals going. So I think there are social biases and filters, but I think that there are probably reasons just in terms of testosterone and apinephrine or apestrogen, sorry. Um both of which have multiple receptors in the brain and can influence brain circuitry, that it's probably more common among boys than men. Um you didn't directly ask about exercise, but we know and it's a there's a lot of studies, but there's not a lot of studies that use the same um experimental designs. So again, one of the feedback loops, the more sedentary and the more out of shape people are, the more likely they are to display ADHD symptoms, and that there's um not just in the moment, that's predictive effects that the more sedentary you are, the more likely you are five years down the line to be expressing ADHD. And we know, despite its connection with AD with hyperactivity, that ADHD kids are spending more time plugged into screens and not being active. Um and we also know there's some experiments just looking at sort of indirect or you know, kids or adults who seem to exercise more regularly. That does seem to reduce some ADHD symptoms. Um clinically, it's it's really commonly observed that you get someone or the patients will report, oh, you know, I went to my what's the orange, there's some chain of orange theory.

SPEAKER_00 1:10:23

Yeah, orange theory.

SPEAKER_01 1:10:24

You know, yes yesterday, and I'm more alert and more focused throughout the day. So, you know, many patients notice direct impacts of exercise. And there's a handful of studies, um, somewhere they actually measured attention and concentration until people are on a treadmill and found measurable positive impact, and more so in people with ADHD than the control. Um, that there can be improvement in executive functions, reduction in ADHD symptoms directly from exercise. So there's probably both slow, gradual impact, probably tied to you know better brain oxygenation and health in the body, but also more specific immediate effects of exercise on ADHD. But we don't know, you know, some looked at biking, some looked at horseback riding, some looked at jump rope, some looked at we don't have any, we don't even know whether it's aerobic training or anaerobic, or whether if you put in a coordination component that's requiring greater focus, does that help? Or is that a distraction or more? We we just don't yet have enough studies done enough different ways to know what is particularly helpful.

SPEAKER_00 1:11:45

That's interesting. I um I have I'm obviously partial to going to something like a yoga class where someone else takes the mental wheel for an hour where I have to listen. And there's something about that that feels meditative and just wow, for an hour I was able to completely sense focus or or in other words, in other ways, let go of others like the TikTok reel of idea and thoughts coming up kind of go that kind of thinking goes away for that hour. But I I'd be curious if they maybe someday ever uh research different types of exercise and and its effect on ADHD.

SPEAKER_01 1:12:32

Well, I again there's not much comparing directly, you know, two different approaches, but but also tying in it's not what well when we're getting into yoga and meditation, there is a collection of research on meditation having benefits for people with ADHD. And we know, again, this is oversimplifying, but an alert, awake brain can be in a task-focused salience network mode. It can be in a default mode, ruminating, inwardly directed mode. But we know that the meditation mode is a different mode than either of those two and has particular good benefits health-wise and mental health-wise for the body. Um, so I often recommend meditation to patients with ADHD. And I also start with, you know, probably the standard, you know, if you haven't done it before, sit there and think of nothing, clear your mind, is one of the most difficult tasks for people with ADHD. But we know that meditative state is accessible through other ways. And yoga is one of the best because you're giving them something to do with your body. Um and you know, there's also, you know, for many yoga, you know, a guided, you know, someone is telling you what to do so you don't have to control your thought. Your thought can it's been scripted for you. Um, mantras are also a way that for some people, particularly with ADHD, it's easier for them to get into a meditative state because it's simpler.

SPEAKER_00 1:14:13

Yeah, I I know your friend Um Andrew Huberman has spoken at length about Yoga Nidra. I don't know if you're familiar, but it is an absolute beautiful practice where you're just asked to lay down and be fully guided and kind of give you permission to not focus on a breath, not focus on a mantra, not focus, but allow just yourself to listen. Um, and the that I don't know if you've ever practiced that, but it's it's really a beautiful meditation in that way. Um, and there's a weird sense of feeling refreshed and as if you had slept um afterwards. It's it's a beautiful one. I love that.

SPEAKER_01 1:14:58

Yeah, my my usual advice to people with ADHD, because again, some of these techniques may work particularly well for them, or some may just never work, is you know, at least try it a few times and don't let your very first experience. But if you've tried it a few times and it's clearly, you know, if the Yoga Nidra is is just leading your mind to wander or you're rebelling against it, try something else. There are other pathways into these states, and if the pathway that works for your neighbor or everyone else in your family doesn't have to be the one that works for you.

SPEAKER_00 1:15:34

Yeah, yeah. And to this point, John, you know, how do we handle this now? Because it seems as if our entire culture, society, world is pushing more towards less shorter attention spans and more online, more alone than ever, um, things that might push people to develop or find themselves more on the uh the spectrum of ADHD. Um, what are your thoughts on that? And it seems like that genie's out of the bottle. Um, but how how could one handle it like that?

SPEAKER_01 1:16:15

So I mean, if you're if you're a park ranger in Denali, or I don't know what we're calling it this day and age, but I mean, maybe you can get away with being completely unplugged, but most people can't. But I think, and it might seem cliched or 90s-ish, but I think mindfulness is a big part of the answer. So it's not avoiding these things completely, but it's knowing why am I using this now? What am I trying to achieve or attain? And I'd say, particularly given that many of us are already sliding further along the ADHD spectrum, mindfulness without a schedule is hard to enforce or stick with. So lots of people see schedules as anathema that you're asking me to do something I can't do, or you're forcing me to do something I don't want to do. And what I tell people, what is a schedule? Schedule is a system that helps you align in the moment what you're doing in the moment with your own lifetime values, goals, desires. That's what it's not forcing anyone to do something they don't want to do. Um, so and and I have a whole on my YouTube channel, I have 300 videos on different topics of ADHD. But one is on scheduling. And I I tell people to start with the four basic. You don't put your work assignment in first or your school class, or you put in sleep, you put in eating, you put in some type of movement or exercise, and you put in some amount of downtime, knee time, that might be meditation, yoga, relaxation, but you put all those in place first because all of those you need to sustain a healthy mind and a healthy body. And for many of us, you know, if you don't have ADHD or aren't very far along the spectrum, you don't need to schedule sleep. You know, you know, I sleep every night from 11 to 7 or whatever it is. But if your schedule is erratic, and many people with ADHD, it's erratic, that itself, I mean, good quality sleep isn't just about the duration of sleep, the timing of sleep is every bit as important as the duration. So you put the basics in place, and again, including some of that downtime or rest time, because if you know that that's in place and you know you're gonna get it, that helps you. Okay, I'm gonna take this task for two hours. And I'm not saying you have to micromanage, I'm doing this for five minutes and this for five minutes. You should know, okay, I'm working on work this morning. I do have playtime this afternoon, so I don't have to worry or be distracted, or and I mean, there's also cognitive tools. I mean, and I had some videos on how to cope with around the last election season or any of the recent ones, but one is realizing most of what's news isn't news. One, it it's not new, they're just repeating the same thing over and over again. Even if it's something dramatic like the Twin Towers falling down, once you've seen that once or twice, you've got what happened. You don't really need to see it over and over and over again. You don't need to hear Trump making the same comment or some other politician. Um, so one is lots of the news isn't news. Two is lots of the news isn't information, it's commentary, it's opinion or projection of what's going to happen of, you know, if this this party takes over the Senate or this party loses that. Well, I'm not saying it's bad not to think about it or be aware of the ramifications, but so much of the blather isn't even things that are happening. And among the stuff that is happening, almost none of it is instantly actionable. I mean, yes, if there's a wildfire that's a mile from your house, you might learn that from the news and get out in time. But all the rest might be interesting, might be important, but none of it's urgent for you. So if you learn an hour from now or six hours from now that four more school kids were killed here or there, what did you gain from knowing that four hours earlier or later? I would argue, and and David Pacman does, and and he's a he's makes his career in news punditry. And you probably benefit from learning later because you actually learn more of what really happened instead of was it a black separatist gunman? What is an Irish nationalist create? Was it a woman? Was it I mean, there's so much garbage in the initial telling of most stories that and then the one other aspect of that is even if you're a news junkie, um you give your friends a gift if they're the ones who get to tell you about some breaking news instead of you having to know all of it first before that. So those are all tools to help people unplug. And I'm and I'm someone who thinks that politics are extremely important to the quality of our lives and the life of our planet. So I'm not saying it's silly or irrelevant or or that we shouldn't care or be involved, but being plugged in 24-7 doesn't achieve that.

SPEAKER_00 1:21:37

Yeah, yeah. I I will say this is also bled into social media. I've noticed, boy, the two recent examples, John. Um, the Cornell 7 stuff and the Shane Gillis only this past weekend on Saturday Night Live. Um apparently his monologue uh was distasteful for a lot of folks. But let me tell you, it was as if it was just a constant people commenting or commentating and not necessarily the truth by any means, but all over social media. Yeah.

SPEAKER_01 1:22:15

Yeah, I'll I'll be a little more detailed about the Cornell thing, and it may or may not get me into trouble, and I won't go too far into it. But and I am not immersed too much in social media. So this was these were the news organizations, like whatever broadcast news and the radio. For the first two days with the Cornell hearing, every version of the story suggested or implied that Cornell had done absolutely nothing towards these seven people. And again, we can discuss what would be appropriate punishment or one of them, you know, a few mentioned they had to write essays, as if that was the only, and that was it took me again several days to hear there was a variety of punishments, and we can you know we can have different opinions as what would be appropriate punishment. And again, again, the behavior was atrocious. That I've I mean that that's the other. There's so many sexual scandals these days that different degrees of intrusion violation of other people are being lumped in similar categories. Again, the Yale one seems pretty clearly completely inappropriate, violent, and abusive. There's others that there are lines which our society doesn't always, you know. So there have been candidates who were accused of certain things, and we still don't even know what actually happened, or right.

SPEAKER_00 1:23:49

Yeah, the truth definitely doesn't really come out, or maybe never does fully, but not immediately. Like you said, everything was miss, we were misled, even by like legacy media. You know, it's just so that more it's just the more you watch it, it it is like a very much like a soap opera, though. It's very hard not to watch, I think, once you get sucked in. Um yeah, I I um yeah, go ahead.

SPEAKER_01 1:24:22

Again, a part of it, and and having just read David Pacman's book, pay attention, I probably shouldn't be shilling for him because he has a big enough audience anyway. But but he emphasized, I mean, so often we think that the algorithms focused on the information in our lives. You know, are you likely to buy a blue Lexus or a green one, or do you want a fast zippy car now, or do you want Springle's potato chip? You know, it's that it's identified who we are to identify our needs or wants or desires, but what it's really doing is just figuring out what keeps us scrolling on online, and usually that's some amount of conflict, you know, create an argument, create a or some other strong emotional fear or clan membership. And it knows, so if you hear, you know, you're much more likely to be sucked in if there's outrage. Cornell didn't do anything to this we're defenseless girl who's only now finding recourse. You're much more likely to keep listening than if they just present what was done or not done.

unknown 1:25:35

Yeah, yeah.

SPEAKER_00 1:25:35

And there were a few on the other side of that, very few, but a couple of young men who went outraged the other direction. And that also they went viral, and I'm sure that's all they wanted. And they came out with some nonchalant apology afterwards that was also bogus and got a ton of views because it was so obviously to further tick off people. It's just, yeah, it's very true. Um John, is is there any other um components on your your your book that you'd like to put out there that is new and exciting? Or I don't know if we should give out too much. But yeah.

SPEAKER_01 1:26:16

Well, I'll just I mean, so the book is divided into the thirds. So the first third is called ADHD world spelled this way, and it's just about how the ADHD spectrum is there, and and the rates I do believe are really rising. It's not just artifacts of how we measure it, and and then the second section is is jumping into the exposome, those parts of the world we live in. And that I call ADHD world spelled W-H-O-R-L-E-D, because it's like the whirls of our fingertips, these complex looping feedback loops between our sleep, between our internet exposure. I mean, there's evidence that not just warm weather, but extreme high temperatures that we're being exposed to, those undermine executive function. So there's a host of things, some of them, you know, the plastics in our environment, which are in everyone's brain these days. At least in kids, there's some evidence that those undermine. You know, most of the work there is focused on endocrine function and reproductive effects, but but there are brain effects of those things. So the middle third is and it's not comprehensive because there's probably factors I haven't identified, and I was also constrained by a word, you know, I had to keep it to a certain number of words. Um so there's there's additional online free chapters of the book. Um and then the third part of the book is ADHD world spelled W H I R L D, like a whirling roller coaster. Um because there are approaches that can be helpful to get people out of this mess. And although I devote a few words to medications, which The same medications that help someone with ADHD that's genetically driven in there from childhood have been shown to be helpful for people with COVID-driven ADHD or traumatic brain injury ADHD. But but most of the chapters on things like scheduling. How do you schedule, what do you do, or how do you avoid procrastination? So there's and very rough outlines as to how to eat better, sleep better. And I would say for most people, the two big factors are the internet and and sleep. Those are far and away. I mean, for some individuals, their diet or something else may be really, really important. But I think at a public wide level, it's it's sleep and it's the internet. And the other, and I think I said this earlier, but the really important thing with the internet is we can see improvements with just reducing what you're doing, particularly if it gives you more a sense of control. Or I don't know if it's control or actually mindfulness again. You're there because you want to and you have the time to explore this, then a rabbit hole can be fun to go down there. But if it's interfering with paying your taxes or date night with your spouse or getting your assignment in for school or work, then that's detrimental.

SPEAKER_00 1:29:26

Well, it's yeah, it's a uh topic that is very much on the top of everyone's mind, I feel, these days. And I think we could feel we could feel it that it's affecting us in a more profound way than ever before. And so uh it's a book for the times, no question. And I um I started in on it, but I can't wait to really dig in to uh to it more. And um, congratulations again.

SPEAKER_01 1:29:55

I've enjoyed talking with you. There are great questions, and I hope your audience gets something out of this.

SPEAKER_00 1:30:00

Absolutely. And yeah, thank you for your time, John. And is there anything else you want to put out there? Where can folks find the book and find you and support you?

SPEAKER_01 1:30:09

Yeah, so AHG Worlds on Amazon, Barnes and Knowable Target Book Store. I'm the publisher's new harbinger. You can get it from there. Um I have my fixed up website, just went up today. So that's drjohncruz.com. On my YouTube channel, I have I think more than 300 videos, usually 20, 30 minutes long, about different medications or different approaches or aspects of ADHD. And I also write on, I've been writing for seven years on Medium. I'm slowly moving that to Substack. Medium does have a paywall, but if you're I mean, if you paint the paywall, then you can get several hundred thousand different writers there. Um and Substack is I'm intending to keep free forever, and I'm slowly migrating the 300 plus stories I have on Medium onto the Substack. That's that's the Substack is also called ADHD World.

SPEAKER_03 1:31:13

Okay.

SPEAKER_00 1:31:14

I will I will link all of that in the show notes for for listeners, John. And I really commend you and uh uh support your work. I um it's it's really uh refreshing, and I I appreciate your uh willingness to unpack this with me. And so so yeah, thank you.

SPEAKER_01 1:31:36

Yeah, I said just to echo or over-summarize, I mean, another thrust of the book is that this isn't just something that's affecting us as individuals, it's affecting us as a society. And if we look at the political realm, many of the figures that are important now are inconceivable in a world where we paid attention and concentrated and remembered context and what had happened four years earlier. And many of those individuals are themselves the ones who are best at making us more distracted, forgetful, impulsive, and working in a way that's reflexive rather than reflective. And my worry is that if our executive functions get undermined too much, we're not going to be able to work together to change our society in better ways, to reduce some of these factors in the expos zone.

SPEAKER_00 1:32:30

So you see this in a much bigger picture here.

SPEAKER_01 1:32:35

Well it's both. I mean, individuals are being profoundly affected, but it's our society.

SPEAKER_00 1:32:45

It's a very important topic. Folks, go pick up ADHD world um and give it a read. And John, thanks you again for for all your time and and your work. I appreciate it.

SPEAKER_01 1:32:59

You're welcome. I've enjoyed this hour. So thanks.

SPEAKER_00 1:33:03

My pleasure. Yeah, I'd love to do it again soon. All right, take care. Thanks for tuning in. If you found my conversation with Dr. John Cruz to be informative, if it got you thinking, if you learned something, please give the podcast a like, a five-star review, and share it with everyone you know. You can find me on social media, especially Instagram at Yoga with Jake, and on my website, yogawithjake.com. Until next time, take care of the city.