good evening I'm Lisa Burke from the Department of rural Health at the University of Melbourne I'd like to begin by acknowledging the traditional owners of the lands from which which this webinar is recorded from and streamed to I pay my respects to Elders of these many nations past and present whose cultures and Customs have nurtured and continued to nurture these lands I also acknowledge and pay my respects to all Aboriginal and Torres Strait Islander people joining us this evening and I acknowledge that these lands are unseated despite being home to the oldest living cultures on the planet myself I'm here on beautiful you're the order country I'm the banks of the golden river in shepparton and I know many of you come to this meeting from cool and Country whatever wrong country and other traditional Nations throughout tonight's webinar there's a q a icon at the bottom of the screen that you can use to ask questions we'll try to get through as many of these at the end and we've also got some questions people provided us when they registered but tonight the University of Melbourne Department of rural health is very excited to bring your webinar by Professor Dave kogil Dave is the financial markets Foundation chair of Developmental Mental Health at the Departments of Pediatrics and Psychiatry at the University of Melbourne and also professor and child of Child and Adolescent Psychiatry at the Royal Children's Hospital in Melbourne Dave's research focuses on increasing understanding of Child and Adolescent mental health and recently they co-published a paper on ADHD medication for children and adolescents Professor kogel advocates for children and adolescents with ADHD a lifelong condition for many people that if untreated results in and result in serious negative outcomes ADHD is known to affect seven percent of children and two percent of adults worldwide so we have much to learn so tonight please welcome Dave kovil to speak with us on understanding ADHD why is Philip such a fidget and Johnny an airhead thanks Dave thank you very much Lisa for such a kind introduction um if just somebody lets me know that my screen is now sharing um I will open our story thank you very much and so hopefully you all came because the title was so enthralling fidgety Phil and head in the head Johnny um understanding ADHD I'm gonna come soon to who fidgety Phil and head in the air Johnny R and they're important part of of my story um not only do I have my academic um credentials and clinical credentials that Lisa mentioned I've also just um taken over as president of the Australian ADHD professionals Association I have some disclosures to make I have worked with several companies that make medications for treating ADHD and other conditions I also receive royalties from Cambridge and Oxford University presses so ADHD what is it well at the very most basic level ADHD is about group of three different types of symptoms hyperactivity and impulsivity which we tend actually to talk about together because they do attend to co-occur very much and then inattention is the third of the group but the symptoms of ADHD on their own are not enough to diagnose ADHD and this is hugely important Lisa mentioned the um prevalence of ADHD how common ADHD is actually ADHD would be an awful lot more common if we didn't have these other criteria that we need to make before making a diagnosis and this is one of the reasons why what has come to be called a Tick-Tock diagnosis or a checklist diagnosis is something that really we can't um we can't work with because in order for these symptoms to count as ADHD they need to be persistent over time they need to be pervasive across at least two different settings for children that's often school and at home for adults work and home but also we look socially they should have been present from relatively early in life before the age of 12 is the technical uh definition here and most importantly they need to be causing significant impairment to someone's day-to-day life if we didn't have these criteria then for example for children around 25 one quarter of all children would meet the symptom criteria for ADHD as it is I slightly take lower numbers than you heard before and I'll show you around five percent of children meet these much more rigorous diagnostic criteria ADHD is also as you'll hear associated with a lot of coexisting difficulties it rarely occurs on its own this is who fidgety Phil is and I talk about fidgety filter really reinforce the fact that ADHD although we've heard about it a lot more in the past few years is not a new construct it's not a New Concept this is the story of fidgety Phil as you see from Dr Heinrich Hoffman a pediatrician in Germany in 1845 if you've ever get the chance to read Dr Hoffman's book called strumple paper shock-haired Peter which has a number of I guess what we could call nursery rhymes many of them rather morbid nursery rhymes about children with different types of mental health problems or what we would now know as mental health problems fidgety fill was one of them and here illustrated by fidgety Phil at the family dining table um in the end unable to sit still pulling everything over him and there's a particularly morbid version of this last picture with knives and blood and all sorts of horrific consequences from Phillips um hyperactivity and impulsivity and then there's Johnny head in the air Johnny had in the air is in the same book He's not as often talked about fidgety fillers become a bit of a poster boy for ADHD talks Johnny head in the air gets a bit forgotten but no less important and she'll see Johnny trudged a school walking along watching the clouds not paying attention to what was going before him and then ended up drowning in the uh in in the canal and since this time since the mid-1800s there's actually been several repeated um sightings of ADHD both in the medical and non-medical literatures as we already heard several times ADHD is common five to seven percent of Children and adolescents and I think around two and a half percent of adults about half that in children it's more common at least during childhood in males than females it's more common in children than adolescents and as you see it's more common in children and adolescents than it is in adults that means that some people grow out of ADHD but not everyone a lot of people continue to have ADHD a little bit harder to interpret that slide at the bottom about the geographic location but thankfully our colleague gulami palanchik from Brazil who did this work and it's really the pivotal work in understanding how common ADHD is realized when they looked at studies that actually if you take out the methodological differences if you take out the differences in the way that ADHD was measured across different studies then ADHD is just as common in each country that has been looked in and so ADHD is one of the few disorders that has an equal presentation in Asia North America Africa Oceana Etc and if we take these figures together that means that around 800 000 Australians have ADHD this is a little technical this slide but believe me that we go from eight uh 1985 across to 2010 and what this slide is very clearly telling us from epidemiological studies from studies that look at the population rather than at the rate of diagnosis the ADHD prevalence the how common is ADHD is not increasing over time what's increasing over time is the recognition of ADHD and I'll come back to that and it's relevance in Australia in a few slides so ADHD is just as common now and actually there's data that extends from 2010 to much more recently which suggests that again there has been no increase in the how common ADHD is but ADHD is not this common you'll notice in this map of the United States that only one state Nevada has a rate of diagnosis of ADHD that's equal to or less than what we call the prevalence of ADHD so for me it's actually very clear that in many parts of the United States particularly those on the Eastern side of the country and what's called the Midwest are over diagnosing ADHD because these aren't rates of how common ADHD is these are rates of how common is ADHD diagnosed and treated and this has been a problem for us in the field because people assume that just because ADHD is being over diagnosed in Us in America it's being over diagnosed everywhere else in the world including Australia but actually we have quite good data to show that this isn't the case if you look down the right hand side here this is talking about how much ADHD is being treated in different age groups across Australia and this is very reasonable very recent data just published at the end of last year in the Australian and New Zealand Journal of psychiatry what it does show is that they're between 2013 and 2020 there was a two-fold increase in the prevalence of ADHD treatment of medication use and that increased from 4.9 to 9.7 per thousand meaning about 0.5 to 1 of all people but of course the rates were very different depending on ages very low in the under fives thankfully I would say we shouldn't be treating ADHD routinely in those under five years of age that doesn't mean under people under five don't have ADHD but ADHD is very difficult to make a definitive diagnosis on below the age of five and that should really only be considered in extreme cases and then between 6 and 12 a big jump six percent between 13 and 17 4.5 this is the percentage of people being treated but then when we start to get to adulthood drops down to 1.5 and 0.4 for those over 25 years my understanding of this data would say that actually in Australia now we're doing a reasonable job of picking up and treating children with ADHD and Adolescence with ADHD although we're not at this point over diagnosing however when it comes to young adults and adults actually where the bulk of the cases are because much broader range of um of Ages we're still very much under diagnosing so although there have been increases and although those increases have been bigger in females than males we're still very much under recognizing ADHD why is ADHD important well it's important because it has a huge impact on the people with ADHD and also their families it has a social academic impact an impact on their interpersonal relationships there's a family burden and on people's self-worth let's unpack that a little bit the impact of ADHD changes over time we start off with mostly the behavioral disturbance but then during the primary school age we start to see the academic impairments poor social interaction poor peer relationships and what we call comorbidity other problems other disorders like anxiety like Depression start to come in as we move into adolescence we still see the academic and social um interactions we start to see more of an impact on low self-esteem increases in smoking alcohol and drug use increases in anti-social behavior and different patterns of comorbidity when you get to College age these are American slides but when you get to a university or college age young adults again continuing academic failure not coping well with daily tasks why do we see this more then because of course the support of the family is much more distant when people are starting to individuate and often live away from home occupational difficulties low self-esteem alcohol and substance misuse and a real increase in injury and accidents and then into adulthood I'm going to expand on this a bit more so I won't I won't focus on it just now but let's just move on because these are some of the adult outcomes of ADHD when it's untreated and if you look at that left column what it says is people with ADHD receive much less in the way of an education understandably from that they also have much less opportunity and um uh positive experience in the work environment because of that they have money difficulties they have difficulty saving they have difficulty paying bills they also have difficulty with driving driving offenses and accidents are much higher in those with ADHD they have many more lifetime moves of residents and far fewer peer relationships close friends more social problems and more interpersonal and sexual difficulties one of the things that's not on here is a hugely increased rate of teenage pregnancy and if you've got poor education um attainment you've got poor employment prospects you've got little money you can't drive because you're banned you've got um instability as far as your living circumstances go your peer relationships you don't have great interpersonal and close personal relationships what do you do you spend more time watching the TV and add to this High rates of crime High rates of substance misuse and high rates of psychiatric disorder and I just want to show one more statistic that I actually find both shocking and and really um it really sticks with me this talks about two things first it talks this is about ADHD increasing your risk of dying but also it talks about the problems of our poor recognition of ADHD during childhood and the consequences of that because those whose ADHD is not diagnosed until over the age of 18 have much higher in fact four times higher rates of um of of dying than those whose ADHD is diagnosed earlier but also much more sorry four times more than people without ADHD but also more than two almost three times higher rates than those who get diagnosed and treated during childhood or adolescence that's a really big issue um we also see similar figures when we look at the rates of suicide rates of suicide in those with ADHD are 10 times higher the rates of those without ADHD but these deaths here aren't due to Suicide they're due to accidents they're due to being passengers uh sorry being pedestrians and walking out into the road or more commonly being a driver of a car that leads to an early death but these are I think really quite shocking figures that tell us how important ADHD is if you want to look at it from another perspective from the cost of ADHD we identified that the total Financial costs of ADHD were over 12 billion almost 13 billion dollars a year and then there were loss of well-being which was just over seven or seven and a half billion dollars so when you add this together the total cost of ADHD is over 20 billion dollars a year and what we know and I'll talk a bit about treating ADHD is that if we treat ADHD we can reduce these costs significantly however in order to treat ADHD we're going to need to be better at recognizing it and actually also about destigmatizing um the the the having ADHD because that's something that keeps people away from um from treatment this is a very brief part of the talk and I'll show you why in a second but what causes ADHD it would be lovely if I could give you a simple answer but there is no simple answer ADHD has a real a number of Pathways to these symptoms and these include genetic environmental brain differences in the way in which the brain develops and differences in the way in which the brain handles information and none of these pathways are independent or more prevalent than one other so I leave that there just really to summarize that genetics are very important ADHD is highly heritable it runs in families the genetics however are complex and we are never going to find the gene for ADHD because there is no 1G but that doesn't mean Enviro mental factors aren't important they interact with genes and they're probably more important actually at affecting the course of ADHD rather than actually causing it in the first place there are differences in the brain structure and function and development between people with and without ADHD but these are also very variable and you cannot and probably will never be able to accurately diagnose ADHD through the use of brain scans similarly there are many cognitive difficulties associated with ADHD these include things like planning working memory and people often talk about executive functioning but importantly none of these cognitive processing difficulties are present in all people with ADHD and the cognitive patterns just like the genes just like the brain structure and function are really variable between different people with ADHD and this is the reason why cognitive tests cannot be used to diagnose ADHD much of the rest of what I'm going to talk to you about is based on this Australian evidence-based guideline for ADHD this was published actually towards the end of last year it says July 2022 it went public in October 2022 there's a link there and um we're going to get that link put into the chat so that you can go to it and also many of you might be interested in this which is the consumer companion guide to this um evidence-based guideline this was just published last week and again is available both of these are available free online from adpa the Australian ADHD professionals Association so I flag those up for you if you want to do some extra reading what does the guideline mean for you well we developed it in order to improve the lives of people with ADHD but in order for it to be worthwhile we need people to adopt it and implement it and one of the things that's going to help adoption and implementation is empowering the community the community of people with ADHD their families and other interested parties to be putting pressure on me and my clinical colleagues and so the consumer companion is really to help make sure people are fully informed when being diagnosed treated and supported it's from the guideline include recommendations about identifying ADHD assessing and diagnosing ADHD education and information about ADHD and treatment of ADHD I'm just going to run through some of these um briefly we can discuss them more in questions if you have questions but one of the things the guideline highlights is how important it is for clinicians me and my colleague clinical colleagues to think broader about who might have ADHD and to focus on those that are within high-risk groups who is this well children in out of Home Care children diagnosed with oppositional and Defiant Disorder with conduct disorder with anxiety disorders with epilepsy or substance misuse for adults adults with any mental health disorder this is a real kind of crusade that we're going on to get my adult psychiatry colleagues whenever they see someone with a mental health problem to be asking not is it ADHD but could ADHD be part of this presentation particularly those who are experiencing suicidal behaviors or ideation those with other neurodevelopmental disorders such as autism intellectual disability tick disorders language disorders those who are born preterm those with a family member of ADHD those who were unfortunate to be prenatally before birth exposed to substances including Alcohol and Other Drugs those with acquired brain injury people in prison in the justice system people of low birth weight and as I said before people with other mental health other mental health problems one group that the guideline really highlighted is women and girls with ADHD because we might not be fantastic at recognizing ADHD in boys but we're a downside better at doing it in boys than we are in girls and women girls and women with ADHD are less likely to be referred for assessment more likely to have undiagnosed ADHD and unfortunately more likely to receive an incorrect diagnosis of another mental health or neurodevelopmental disorder such as anxiety or depression when actually a diagnosis of ADHD either instead of or as well as these other diagnoses would be more more appropriate why why does this happen because the typical picture of ADHD we have is that that occurs in males rather than in girls girls with ADHD tend not to stand out so much they tend not to be as oppositional as presenters many behavioral challenges and they can be the person who really drifts into the background in class not getting on with their work not succeeding academically but not challenging the teacher when we think about assessing for ADHD to be diagnosed with ADHD a person needs to be assessed by a trained and credentialed clinician such as a pediatrician psychiatrist or psychologist or nurse that's registered with the Australian Health practitioner regulation agency apra and who has been trained in diagnostic assessments and be experienced in the area of ADHD this second bit's a bit of a stumbling block for clinicians because actually training in ADHD has not been a core part of training for pediatricians psychiatrists or psychologists and that's something we're really fighting for is to say that ADHD should be a core part of what these professionals do in their education diagnosis should also be by interview questionnaires are not enough on their own and that counts accounts for two situations clinicians should not be using questionnaires to diagnose but also you can't diagnose ADHD by doing questionnaires on the internet and that's something that people have kind of been socialized into sometimes by Tick Tock sometimes by websites that claim come and do your ADHD assessment here why well the checklists are good at picking up the symptoms but they're not good at those other things that I said were important like is this impairing is it impairing across different situations has it been present since early on Etc cognitive testing and expensive neuropsychological testing is not a requirement for assessment I get many patients tell me that that's what they've been told by their doctor that they need to have these expensive assessments while cognitive assessments can help us understand the person and understand their strengths and weaknesses and can be very helpful in putting together a package of treatment they are never diagnostic why are they never diagnostic because as I said the cognitive profiles the strengths and weaknesses of people with ADHD are so highly variable that there is no one cognitive profile and so that's a really important message to give the message is not that cognitive testing is not valuable but that it's not Diagnostic and it's not required to make a diagnosis also important is that assessment should not just be about ADHD but should be comprehensive and include assessment for common co-occurring conditions and what we call differential diagnoses other explanations for things that look like ADHD when you've had a diagnosis really the first part of any treatment package is what we call psychoeducation it's a key component of managing ADHD but as I've said here not done well and here I put up some questions that you could use to ask your um your clinician you may like to take a photo of this but what I meant to say at the beginning is I will make all of these excuse me all of these slides available so you can stop and read these at your will but these are very fair questions to ask a clinician when you've had a diagnosis of ADHD and a very important part of learning about ADHD and a really key first step to treatment when it comes to treating ADHD and I'm getting towards the end of my presentation we have medication treatments and non-medication treatments and the trick is to bring these together in what we call a multi-modal package of treatment the aims of treating ADHD are not just about reducing symptoms as I've said here they're about improving understanding about ADHD in its treatment that psycho education they are about reducing core ADHD symptoms the irritability sorry the impulsivity the hyperactivity and the inattention also reducing I would hope optimizing Associated symptoms especially the one that we call emotional ability High emotionality flaring from zero to a hundred at the slightest um provocation something that's very common we don't call it a core symptom of ADHD but it's very very common in ADHD to reduce coexisting disorders and then of course to improve functioning and quality of life home at school in the community and then to do all of these things without causing harm medications are the most effective way to reduce ADHD symptoms I'm not going to talk too much about any of these treatments in detail I can answer questions on them if you'd like but there are basically two kinds of medication stimulants this includes methylphenidate often known as Ritalin or Concerta Dex amphetamine and listex amphetamines brand name is Vyvanse and the non-stimulants guanfacine or known as intunive or atomoxetine again known as Strattera of these medications the stimulants are the ones that are the most effective and that work much more quickly than the non-stimulants they are actually amongst the most effective medications in the whole of Medical in the whole of Medicine and they're therefore usually the first recommended medication treatment seven out of every 10 people respond well to each of the stimulants and at least 90 percent respond to at least one but it's not possible to predict who will respond to what and what dose so we still need to use trial and error when we're treating ADHD that's unfortunate but it's a fact and anyone who tells you otherwise unfortunately is not telling you the whole truth we also know and um Lisa mentioned I'd published some work on this recently that these are safe medications not just in the short term but we have data now to support their safety in the longer term and that they do not lead to drug misuse in fact treatment with these ADHD medications including this stimulants reduces rather than increases rates of substance misuse the non-medication approaches on the other hand are much less effective at reducing core ADHD symptoms but they can assist greatly with skill development and improve the person with adhd's well-being quality of life self-esteem social adaptive and family functioning so it's not a competition between the medications and non-medications it's actually about them both having different targets the approaches include Lifestyle Changes parent and family training and cognitive and behavioral intervention the lifestyle changes I call them simple things they're often not simple but things like changing sleep patterns diet engaging in physical activity all impact on health and well-being and do so in people with ADHD they don't reduce ADHD symptoms but they improve the lives of people with ADHD and our guidelines say that people with ADHD should be offered Guidance with for a guidance on or a referral to a specialist who's qualified to assist with improving sleep diet or physical activity if required parent and family training this includes a broad range of different approaches that all aim to help parents meet the additional needs of Children and adolescents with ADHD I'll come back to that in a minute but to be effective what they need to do is support optimal parenting skills it's challenging whoever you are to parent a child with ADHD they need to focus on strengths and challenges and be delivered in sensitive and culturally appropriate manner and they need to do this in a balanced way and they can include education and information on ADHD symptoms and their impacts and extension of the psycho-education recommendations about modifying the environment and strategies to modify Behavior including positive parenting approaches important to note though that the offer of parent and family training does not imply that your one's parenting skills are deficient in any way it's that specific skill development is helpful for supporting children with ADHD that's a really important message again and lastly just to talk about cognitive behavioral interventions these are delivered directly to the person with ADHD they use again ways to improve an education and impact but also therapeutic interventions that help people process thoughts feelings and facilitate skill development in a range of different ways these are Specialists and skilled interventions and there are new ones coming online all the time recently heard about a great new um not idea but but process that's coming from the US using what they call motivational interviewing with parents and teens so it's actually a combination of cognitive behavioral and parenting approaches and also these can have a great role in addressing co-occurring conditions like anxiety and depression just want to mention ADHD coaching there's not much evidence around about ADHD coaching but those of us that are engaged with ADHD coaches have really found their work to be helpful with our patients um and so the clinical guideline group The and the guideline itself actually says people should think or could think about coaches and there are some very good ADHD coaches across Australia when you're planning treatment really and I think this should be obvious now you need to think about multi-modal treatment you need to put these pharmacological non-pharmacological educational and coaching approaches together into a package thinking about which treatment will be most effective in which aspect without overwhelming someone with maybe introducing everything at once we have a famous saying about medicines the pills don't make skills and it's true but often treating with a medication first can help put someone in a position where they can make more use of other other types of supports and so in summary this is my final slide I want to say the Ed's second final slide I want to say that ADHD is a common complex neurodevelopmental disorder affecting a large number almost a million uh Australians there's a really very significant impact on individual lives and costs over 20 billion dollars a year in our country it's currently under recognized and under-treated particularly in girls women and adults assessing ADHD is a skilled task cannot be conducted through questionnaires and videos and treatments for ADHD are when delivered properly very effective that are however currently significant issues facing those with ADHD in Australia particularly with access to treatment and for this reason really support the fact that the Senate has initiated an inquiry into ADHD to address a wide range of issues about services and their accessibility the response is quite soon June the 9th and I urge everyone to consider making a representation the details are here and I hope this is going into your um into the the chat or the Q a so that you can think about making a submission if you're interested so thank you very much indeed I know I've run a bit over Lisa I haven't looked and people have probably been telling me shut up shut up um but I think I wanted to try and give that rounded story so thank you for your Indulgence and thank you guys for listening I hope that's been helpful to you thanks so much Dave that was terrific really insightful um uh great to hear from the expert and I think um great to hear it in language that uscon medicos really understand um I just wanna I've got some questions here if you don't mind I can um just ask some of some of the questions that have come in so um how what sort of things would you suggest a teacher might um do or adapt in their classroom just to support um you know children in the class that might have ADHD yeah I think that's a really really important um question it differs at different stages during um during schooling the one I get asked about most at the moment is at the end of schooling when people are doing their um vce Etc and can people get extra time on tests and um extra support and certainly that's something that is important it's actually quite difficult to navigate and we're currently in argument a bit with the education department to say it's good to give people quiet spaces it's good to give people breaks but actually they need extra time but when you're in the classroom if you're a teacher teacher managing a class with t in with children with ADHD one of the important things not to do is to put them at the back another important thing is not to put them all together but if you sit them at the front um if you give them written instructions as well as verbal instructions quite often kids find it helpful and I like the fact that almost every school in Australia has an oval kids a get out of class card where when things just get too much they can actually go out run around the oval use up some of that energy and come back all these things are quite helpful and if you are a teacher then actually there are some great um bits of advice on the Internet it's one of the areas where the advice is good one of the things teachers say to me though is it's not fair I can't put all this time to the child with ADHD day when everyone else suffers well one and I can't provide special um sort of treats and support for the child with ADHD and one of the answers to that is that get everyone on board get everyone supporting that child with ADHD so if the child with ADHD does well does better reward the whole class and so the whole class knows that if they support then actually everyone gets something from it so I think there are a whole range of ways I'm not pretending it's easy um and and there's a lot more work needs to be done but the simple things actually often do work yeah okay great and what about for parents and siblings and you know in the home environment what sort of things can help their support well so for parents of children with ADHD understanding that a child with ADHD often can't do it to the level that you would expect by their age and their intelligence rather than won't do it and so actually taking into account that ADHD does mean that children with children with ADHD have delays in being able to achieve particular tasks and therefore they require more scaffolding so the kits with ADHD that do well do well because of the understanding of people around them because they're not always expected to act their age or behave their age but they're scaffolding and rewarded for doing the best that they can and again just rewards always work better than punishment and how can I reward one child and not the other well reward them all and again get them to support each other it's that same thing but again the specific parent management programs are designed to try and help people learn the tips and tricks they're again not things that you can do boom boom boom at the end of uh end of a lecture they're things that take time and so understanding that you're not it's not being suggested that you do this work as a punishment or a criticism system of your parenting it's a recognition this is a bloody difficult task it's it's hard to help and you know you need to have extra skills and extra support yeah okay and we've got some questions coming in so Jasmine has asked about the relationship between childhood trauma and ADHD um is it common um it's a great question the answer Jasmine is yes it's very common but the direction of relationship is often not what people think it's often about trauma and ADHD rather than trauma or ADHD so we now have a lot of research which shows us that children in fact people with ADHD are much more likely to suffer a wide range of traumas compared to people without ADHD and that includes traumas such as sexual abuse physical abuse neglect and so it's usually not a discussion about whether this is trauma or ADHD but how the ADHD and Trauma are related and there's some interesting work that shows that trauma itself increases ADHD symptoms but rarely tip someone over into the diagnostic category so if you meet the diagnostic criteria for ADHD it's very likely that you have ADHD now nothing certain but also that treating the ADHD can help people manage the experience of trauma and we've shown recently even with sexual abuse that children with ADHD who are treated are less likely to be sexually abused than children with ADHD that isn't treated and that's actually not just about who gets treated that's within the individual trial and so it's um it's a really fascinating question but what I would urge you Jasmine is not to get caught into the is it this or is it this but to think about the possibility that it's both okay and Craig's asked about are there any benefits in medicating suspected ADHD and then sort of based on the response to the medication um you know deciding around that's a really sneaky question Craig um and and a difficult one that the straight answer uh and and is no uh people without ADHD respond to those medications in the same way as people with ADHD to a degree so all of us would be able to focus and concentrate better so treating ADHD looking at the reaction isn't a way to decide whether or not someone has ADHD but more controversially more controversially we're realizing now that some people who don't quite meet the diagnostic criteria for ADHD and usually that's they haven't got quite enough symptoms but they do have impairments actually have as many difficulties as people with ADHD and so that's going to throw up the question for us in the future and if we treated those people with what we're calling sub-syndromal ADHD would we improve their lives and would that be the right thing to do that's not an answer that says yes we should be that's saying that's a real question that we don't have an answer to yet so at the moment I would answer quite definitely no to Craig's question you need a diagnosis you need an assessment and you get that before you get treated but it's not quite black and white like that okay thanks for that very considered response um car has asked if it's is it common for Johnny the Airhead to exist without symptoms in the other categories yeah and another great question tomorrow was it um Cara Cara sorry Cara um it's an important question Cara and I didn't go into that it's very rare to get hyperactive impulsive ADHD without concentration problems but it's actually relatively common to get Johnny head in the air in attentive Taipei the HD without the hyperactivity and impulsivity it's said to be more common in girls than in boys but it certainly occurs in boys as well not infrequently and likewise there are many girls who have full-blown what we call combined ADHD and not just the inattentive bit but yes you can get inattentive ADHD without hyperactivity and impulsivity and interestingly it responds to treatment exactly the same as the combined full-blown ADHD so our treatment of those um people is exactly the same as our treatment of people with the full-blown ADHD hey um and Danielle here has asked um talking about Danielle's 13 year old son who's been diagnosed with ADHD um but Daniel's son has never accepted the diagnosis and refuses any help is this part of the symptoms um and what can be done to support teenagers to adjust I said another great question it's not really part of the symptoms Danielle but it is part of being 13. and there are many teenagers who at least initially reject their ADHD and it's really challenging part of that psycho-education that I say isn't always done well by uh Healthcare professionals is to try to work with those feelings and that understanding and I guess it's tried to break through um with the young person who's not accepting to try and understand what is it about the diagnosis that's difficult to accept are there things that that person does accept aren't going well if not then one needs to keep chipping away and one of the things that I've often had to do is sometimes with young people immediately after diagnosis but very often with adolescents who've been in treatment and then suddenly decide nope I don't want this anymore I don't like it is to make sure that we keep the door open and so one of the problems that I've seen is that Health Services push people to discharge you if you're not taking medication for example we've always tried to resist that and just to keep that door open to keep that conversation going and almost always people will come back and either accept treatment or you know start to accept the fact that there's an issue I don't know you're 13 year old so I can't be any more specific than that but I think persistence in an open door and accepting attitude is is something that people need to have okay thanks for that contribution um M has asked about um workplace accommodations for adults with ADHD particularly adults who appear to be performing well on the surface but are struggling with organization time management they may have a lot of anxiety about their competency but colleagues and managers sort of think they're doing okay yeah any suggestions for those workplaces lots of suggestions but most of them come off the top of my head rather than any evidence it's an area that people haven't done a lot of good good work in many of the same things that we would be advising for schools would be appropriate for the workplace and the people who do this stuff best are the ADHD coaches and many of them are starting to move into that more corporate field as well to help workplaces so I think I just came back well a month or so ago from New Zealand and there's the bnz the Bank of New Zealand has taken a really positive attitude not just to neurodiversity but to ADHD in particular and have started to put in those accommodations and supports so I think being understanding and helpful and as I said 12 million dollars of the cost to Australia is in productivity so I was fortunate enough to be speaking with Minister shorten yesterday about the kind of things that we should be looking at and my view this is um controversial at times is that I'm not asking for ADHD to be considered as one of the list diagnosis for ndis but that in areas like employment support and accommodation that's where ndis can play a big part in helping not just the individual but helping the organizations the corporate organizations to actually become more friendly and I asked a question or rather um I hadn't actually looked to see whether it was answered a question to some people in the sort of more autism neurodiversity space to ask them um if it's possible to actually make neurodiversity about neurodiversity and not just about autism because actually often when we talk about neurodiversity it's shorthand for talking about autism but of course ADHD is a part of that neuro diverse spectrum of of issues and it would be great if the people who are putting all of their energies into making workplaces more accommodating for neurodiversity would consider ADHD now you can call me cynical or mischievous or whatever but I think it is an issue that um you know often ADHD isn't considered seriously enough as something that impairs but again Minister shortened yesterday was um you know really Keen to hear more and I hope that we can work with him and with other people in Parliament to actually get employment as one of the things that um that that is looked at okay um we've run a little bit over so some people might need to go but I'll just ask you one more question um because I think there is a lot of interest in this topic and Joe has asked um they're suggesting that as a community we're doing quite well to destigmatize um autism how do we achieve this with ADHD okay well I would say as a community Joan we're doing much better with ADHD than we were when I came to Australia seven years ago and I don't take credit for that but with few exceptions we're actually now getting much more positive stories in the Press than we were before we've got a senate inquiry into ADHD that I think is going to help we've published some papers on stigmatization and ADHD which think about ways forward my colleague Lou Brown if people want to have a look at the adper website you've got a couple of links to it there for the guidelines but Lou has also published a a guide to speak it speaking about ADHD so getting our language right when we talk about ADHD and I think all of these things can help she also recently put together and I think it's published I think it's on the ad for website a um a little guide on how to tell your story about having ADHD so to help people tell a positive story and so I think you're right to to really focus on this Joan I don't think we're doing a bad job at changing attitudes we've gone a long way to go and people like you hopefully people like everyone who's um who's been listening today can really help us with that um with that message um well thank you so much Dave for sharing for sharing wonderful insight for directing us to a range of resources to help us all become more informed and answer our questions and yeah thanks for putting it in in terms that I think we've all been able to understand and learn from so I really appreciate you can I can I think oh can I thank you and the school for inviting me and for everyone for coming thank you so much yeah and I'd like to thank everyone for coming for those who put forward questions always good to hear your um queries and and dilemmas um di will be sending out an email with the slides from tonight which contain a lot of um resources and and areas for us all to seek out more information so thanks to it thanks Dave thanks to everybody and have a great evening thank you [Music]