015 - ADHD - Etiology, Epidemiology, and Differential Diagnosis

Enjoy today’s A.I. generated discussion of ADHD etiology, epidemiology, and diagnosis.

Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com

Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com

Feedback can be emailed to feedback@psydactic.com OR submitted via a form at https://psydactic.com.

This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Transcript

Resources:

“2020 ADHD Higher Prevalence Black.” n.d. https://doi.org/10.1001/jamapsychiatry.2020.2788?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamapsychiatry.2020.2788.

Abdelnour, Elie, Madeline O. Jansen, and Jessica A. Gold. 2022. “ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis?” Missouri Medicine 119 (5): 467–73.

Adams, Sydney M., Tennisha Riley, Patrick D. Quinn, Richard Meraz, Vivek Karna, Martin Rickert, and Brian M. D’’Onofrio. n.d. “Racial-Ethnic Differences in ADHD Diagnosis and Treatment During Adolescence and Early Adulthood.” https://doi.org/10.1176/appi.ps.20230113/suppl_file/appi.ps.20230113.ds001.pdf.

“Attention-Deficit_Hyperactivity Disorder - ClinicalKey.” n.d.

CDC. 2024. “Diagnosing ADHD.” Attention-Deficit / Hyperactivity Disorder (ADHD). October 7, 2024. https://www.cdc.gov/adhd/diagnosis/index.html.

Florez, Maria Camila Velez, and Daniel Chait. 2025. “Attention-Deficit/Hyperactivity Disorder.” Ferri’s CLINICAL ADVISOR 2025, 152–55.

Glance, A. T. A. n.d. “Data and Statistics on ADHD.”

Harstad, Elizabeth B. n.d. “Chapter 50 – Attention-Deficit/Hyperactivity Disorder.” Nelson Textbook of Pediatrics, 309-315.e1.

Ilipilla, Geeta, Zachariah D. Pranckun, Hunter Wernick, Grace Unsal, and Josephine Elia. 2018. “Attention Deficit Hyperactivity Disorder and Anxiety.” In Complex Disorders in Pediatric Psychiatry, 23–35. Elsevier.

Kazda, Luise, Katy Bell, Rae Thomas, Kevin McGeechan, Rebecca Sims, and Alexandra Barratt. 2021. “Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review: A Systematic Scoping Review.” JAMA Network Open 4 (4): e215335.

Koyuncu, Ahmet, Tuğba Ayan, Ezgi Ince Guliyev, Seda Erbilgin, and Erdem Deveci. 2022. “ADHD and Anxiety Disorder Comorbidity in Children and Adults: Diagnostic and Therapeutic Challenges.” Current Psychiatry Reports 24 (2): 129–40.

Koziol, Leonard F., and Michael C. Stevens. 2012. “Neuropsychological Assessment and the Paradox of ADHD.” Applied Neuropsychology. Child 1 (2): 79–89.

Mahone, E. Mark, and Martha B. Denckla. 2017. “Attention-Deficit/Hyperactivity Disorder: A Historical Neuropsychological Perspective.” Journal of the International Neuropsychological Society: JINS 23 (9–10): 916–29.

Marshall, Paul, James Hoelzle, and Molly Nikolas. 2021. “Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in Young Adults: A Qualitative Review of the Utility of Assessment Measures and Recommendations for Improving the Diagnostic Process.” The Clinical Neuropsychologist 35 (1): 165–98.

Morgan, Paul L., and Eric Hengyu Hu. 2023. “Sociodemographic Disparities in ADHD Diagnosis and Treatment among U.S. Elementary Schoolchildren.” Psychiatry Research 327 (115393): 115393.

Morgan, Paul L., Jeremy Staff, Marianne M. Hillemeier, George Farkas, and Steven Maczuga. 2013. “Racial and Ethnic Disparities in ADHD Diagnosis from Kindergarten to Eighth Grade.” Pediatrics 132 (1): 85–93.

Rosso, Gianluca, Caterina Portaluppi, Elena Teobaldi, Gabriele Di Salvo, and Giuseppe Maina. 2023. “Assessing Adult ADHD through Objective Neuropsychological Measures: A Critical Overview.” Journal of Attention Disorders 27 (7): 786–94.

Shi, Yu, Lindsay R. Hunter Guevara, Hayley J. Dykhoff, Lindsey R. Sangaralingham, Sean Phelan, Michael J. Zaccariello, and David O. Warner. 2021. “Racial Disparities in Diagnosis of Attention-Deficit/Hyperactivity Disorder in a US National Birth Cohort.” JAMA Network Open 4 (3): e210321.

Show Content:

Welcome to PsyDactic - CAPs board study edition.  Today is Monday, 24 Feb 2025, and  I am your host, Dr. O'Leary, a child and adolescent psychiatry fellow in the national capital region.  This is a podcast I designed to help myself and other Child and Adolescent Psychiatry fellows study for their boards.  Anyone interested in human development and mental health will likely also get something out of it.   I am using artificial intelligence to assist me with the content creation and when I first began making this podcast, I had used A.l. only to help summarize and organize the content.  Now, I have a tool that allows me to feed it high quality peer reviewed articles and book chapters and it will generate an actual audio discussion of the content.  I provide this A.I. tool with a select group of papers and then give it multiple different prompts, each of which produces about 10 to 20 minutes of audio.  I then review the audio, remove obvious mistakes, repetitive content and annoying introjections, and paste together the best sections.

Some of the mistakes that the A.I. commonly makes are pronunciation errors.  For instance, it cannot seem to pronounce the word norepinephrine, which listeners will notice.  It also is poor at citing sources.  While it doesn’t tend to make up content or sources if it often mixes up what came from where.  When fact checking its numbers, I have found it to be extraordinarily accurate, but not very precise.

I am listing the references that I feed to the AI in the show transcript located at psydactic.buzzsprout.com.  If you want to give me feedback on any episode, or just in general, you can send it to feedback@psydactic.com or fill out a form on the website PsyDactic.com.

Enjoy today’s A.I. generated discussion of ADHD etiology, epidemiology, and diagnosis.

Hey everyone, and welcome back to the deep dive.

Glad to be back.

Today we're diving into something especially relevant to all of you out there in the psychiatry and psychology world.

Oh yeah. Uh what's that?

ADHD.

Ah, yes. Attention deficit hyperactivity disorder.

A condition that's so common but often misunderstood.

Absolutely. And

and there's a lot of debate surrounding it. That's why we're going beyond the textbook today. to unpack the latest research. Okay.

The clinical consideration, all the stuff surrounding ADHD.

I like it.

We're going to start with the fundamentals, okay? The DSM5 definition.

Okay.

What we think is happening in the brain,

right?

The prevalence of this disorder,

then we'll get into the really complex stuff, diagnosis,

how to tell ADHD from other conditions,

the overdiagnosis debate,

and then finally, we'll touch on the disparities we see in diagnosis,

okay?

Which as we all know is super important for all of us to consider

it really is.

So, where should we begin?

Well, let's lay the groundwork first. Okay.

What exactly is ADHD according to the DSM5?

Yeah, that's a good place to start.

Well, the DSM5 defines it as a persistent pattern of inattention and/or hyperactivity impulsivity

that interferes with functioning or development.

Okay.

And this has to be present before the age of 12.

Okay.

And in at least two settings like home and school.

So, it's not just a kid who's a little fidgety in class.

Yeah. No, it's got to be consistent a real pervasive pattern that's causing problems.

Okay.

And you know the DSM5 also outlines three subtypes of ADHD.

Oh, okay.

Predominantly inattentive, predominantly hyperactive impulsive.

Okay.

And combined presentation.

Got it.

Which, you know, helps capture the fact that ADHD can look very different in different people.

Right. So like a kid who's always daydreaming Yeah.

struggling to follow instructions might have the inattentive subtype.

Mh.

Whereas a child who's always is on the go.

Yes.

And blurting out answers.

Yeah.

That might be more of the hyperactive impulsive subtype.

Exactly. And of course, a lot of kids exhibit a combination of both.

Right. Right.

So, that brings us to the question of why why do some people develop ADHD?

What do we know about the underlying causes?

Right. What's going on in the brain?

Is it purely biological or

Well, the research seems to point to a complex interplay, okay,

of genetic and environmental factors. Okay. Twin studies have shown that ADHD has has a heritability

of around 60 to 70%.

Wow.

Yeah,

that's pretty strong.

It's pretty strong genetic link. Yeah. But

but it's not the whole story.

Of course not. Environmental factors play a role too.

Okay.

Um things like exposure to toxins during pregnancy, low birth weight, uh even just psychosocial stressors in childhood. These can all increase the risk of developing ADHD.

So, it's nature and nurture

as with so many things.

Yeah. As with so many things in mental health. But what about the brain? itself.

Okay.

Are there any specific areas or pathways?

There are some interesting findings coming out from neuroiming studies.

Okay.

Research suggests that individuals with ADHD may have differences in brain structure and function.

Interesting.

Especially in areas related to attention, executive function, okay,

and impulse control.

So, we're talking about areas like the prefrontal cortex.

Exactly.

The basil ganglia.

Yeah. Those sorts of regions.

Okay.

They found a developmental lag in cortical thickness. In children with ADHD, cortical thickness is basically talking about the outer layer of the brain. And this study showed that in kids with ADHD, this outer layer was developing more slowly compared to their peers who didn't have ADHD. It's almost like their brains are on a slightly delayed schedule.

So, it's not that their brains are damaged, just developing at their own pace.

Right. And there's also growing evidence suggesting that

neurotransmitter systems, particularly those involving dopamine

and Norepinephrine might be disregulated in ADHD,

which makes sense given that dopamine is involved in reward processing and motivation

and norepinephrine plays a role in alertness and attention.

Right. So, and this neurobiological understanding is really crucial. Yeah. Because it helps us move away from those outdated notions that ADHD is simply a matter of willpower or bad parenting. It's a neurodedevelopmental disorder with real biological underp Right.

And it's surprisingly common.

Is it?

Current estimates say that ADHD affects somewhere between 5 and 9% of schoolaged children in the US.

So in an average classroom, you might have

two or three kids who meet the criteria for ADHD.

Yeah. Potentially. And the impact of this disorder can be significant not just for the individuals themselves, but also for society as a whole. Oh yeah. The economic costs associated with ADHD are estimated to be over $143 billion annually.

That's a staggering figure.

It is

in the US alone.

Just in the US.

It really highlights the need for early identification. Yeah.

And effective intervention.

Absolutely.

Okay. So, we've got the basic definition, potential causes.

Okay.

And the prevalence of ADHD, right?

Let's move on to the process of actually diagnosing this disorder. Okay.

What does a thorough ADHD evaluation look like?

Well, a thorough evaluation goes far beyond just observing a child in a single setting,

okay?

It's about gathering information from multiple sources,

okay?

Really piecing together a comprehensive picture of their developmental history and current challenges.

So, it's not just about asking the child a few questions. It's about talking to parents, teachers, maybe even other caregivers.

Yeah. Anyone who interacts with the child regularly, we need to understand how the child's behavior is showing up in different environments and how it's impacting their functioning in those settings.

Okay?

We also need to to consider developmental milestones and rule out other conditions that might be contributing to the symptoms.

So, a child who's struggling to pay attention in school

might have an undiagnosed learning disability, for example,

or a child who's hyperactive and impulsive might be experiencing anxiety. It's so crucial to be able to differentiate ADHD from other conditions that can mimic its symptoms. And this is where

a careful clinical history and a good understanding of developmental psychopathology, right, come into play.

How do you know if someone's putting things off, procrastinating because they're afraid to fail,

right?

Like that's anxiety.

Uhhuh.

Or because they're having trouble with executive function, which is more of an ADHD thing.

Yeah. Imagine a student who can't seem to get started on a paper.

Okay.

Are they frozen because they're scared of not meeting expectations? That's classic anxiety, right? Or are they struggling with planning, organizing, and getting started on the task? things that are typical with ADHD, it can be really hard to separate them, especially with how often they occur together.

That's what I find so interesting. We're not dealing with two things that are totally separate.

Nope.

We're talking about a huge overlap. So, studies show that they show up together what somewhere between 26 and 50% of the time. Those are big numbers.

Yeah. It's more like a ven diagram with a huge area where they overlap.

Are there any like red flags, any clear signs that can help us separate ADHD from anxiety? There are one of the key things that sets them apart is where the attention is focused. ADHD a lot of times it shows up in outward behaviors like you can see it. Things like fidgeting, interrupting, having trouble staying on task. But with anxiety, it's mainly an internal thing like feeling distressed, worry, fear, that kind of apprehension. Think of it this way. Someone with ADHD might blurt out answers in class not because they want to, but because they have trouble controlling those impulses. But someone with anxiety might not say anything at all. They're avoiding participating because they're afraid of being judged, being evaluated negatively. It's an internal thing that's making them act that way.

That's a really helpful way to think about it. But in real life, how do you actually tell those two things apart? What if a student doesn't participate because they're struggling with impulsivity and they're also scared of being judged?

You're right. It's not always so black and white. That's why it's important to look at another thing that's different. How consistent the behavior is across different settings. ADHD symptoms tend to show up everywhere. Home, school, work, social situations. Anxiety, while it can be generalized, is often tied to specific situations. The symptoms get worse in certain places or situations.

So, okay, as a kid's having trouble focusing and they're hyperactive at home and at school, that might mean it's ADHD. But if it's mostly happening when they're performing, like at a piano recital, it might be more anxiety about that particular event.

Exactly. You're getting it. And keep in mind, these are just general trends. Every person is different. There are always going to be exceptions, but these patterns can be really useful when you're trying to figure out what's going on. And then, of course, we have to look at when these symptoms first show up, the developmental trajectory, you know,

right? Like the timeline of when these symptoms first appear.

Well, as you probably know, ADHD symptoms usually show up pretty early on in childhood, like before a kid turns seven. Anxiety can also start early, but it's not unusual for it to develop later, maybe during the teenage years or even adulthood. Often, it's triggered by specific events or life changes.

Yeah, that makes sense. We can't ignore the big issue here. How often ADHD and anxiety happen together?

Absolutely not. That's really where the challenge comes in. I remember those numbers we talked about before. Studies are pretty consistent in showing that somewhere between 26% and 50% of people with ADHD also have an anxiety disorder.

Statistically speaking, if you're working with someone with ADHD, chances are pretty good that they're also dealing with anxiety. One of the things that really jumped out at me when I was going through these studies was how anxiety actually makes ADHD symptoms worse. It's not just that they happen at the same time, but they seem to make each other stronger.

Yeah, that's a big thing you found there. Research shows that anxiety can make those core ADHD symptoms worse. You know, the inattention, the hyperactivity, the impulsivity, it's like throwing gasoline in a fire.

So, someone who has both ADHD and anxiety, they might have even more trouble focusing, getting organized, and managing their emotions compared to someone with just ADHD.

Exactly. And that really changes how we think about treatment. Studies like that big MTA study have shown that for kids who have both ADHD and anxiety, the best approach is usually a combination of medication and behavioral therapy. So, you're treating both things at the same time.

That makes a lot of sense. You can't just treat one and hope the other one just disappears.

Another common one we see along with ADHD is oppositional defiant disorder or OD. Kids with OD are often defiant and argumentative. They might even be hostile.

Yeah, I could see how that could be hard to tell. Apart from ADHD, especially the hyperactive impulsive type. How do you know which one it is?

It's subtle, but there are some important differences. Impulsivity and ADHD is often because they have trouble controlling their impulses, like they can't hit the brakes. But with OD, the defiance is more intentional. It's like they're trying to challenge authority or push the limits. And that difference is really important because if they have OD, it can change how you decide to treat them. The MTA study found that kids with ADHD, anxiety, OD, and conduct disorder order actually responded best to a combination of medication and behavioral therapy.

What about mood disorders? Those seem like they could easily be mistaken for ADHD as well.

You're right. There's definitely some overlap. For example, both ADHD and depression can make it hard to concentrate and can cause problems with sleep.

So, how do you avoid getting those mixed up? What should you be looking for?

Well, both can cause low motivation, but the reasons behind it are often different. In ADHD, the problem might be with executive function and attention regulation, like their brain has trouble getting started and staying focused even on things they enjoy. But with depression, the lack of motivation is usually tied to feeling hopeless or sad or losing interest in things they used to love.

So, you need to be asking about how the child is feeling, not just how they're acting.

Exactly. And you should also be on the lookout for other signs of depression that you wouldn't typically see in ADHD, like a consistently sad mood, feelings of worthlessness, or big changes in their appetite or sleep patterns. It's all about looking at the whole picture, not just focusing on a few symptoms.

Now, what about tech disorders? I imagine those to be confusing, too, especially if you're not used to seeing them.

You're right. Text, those involuntary movements or sounds can be really distracting and disruptive both for the child and everyone around them. And that can sometimes lead people to think it's ADHD, especially the hyperactive impulsive type.

So, how can you tell the difference? What are some key things to remember?

Well, the most important thing is to remember that texts are completely involuntary. The child can't control them at all. While a child with ADHD might have a strong urge to move, move or talk impulsively. They can usually hold back for a little while or find a more acceptable way to do it. But texts just happen whether the child wants them to or not.

Right. They might be able to suppress the urges for a bit or choose to express them in a way that's not as disruptive. But with ticks, they just happen no matter what the child wants.

Exactly. Also, ticks often follow a pattern or have a trigger. While ADHD behaviors tend to happen more often and don't seem to be related to a specific situation,

and ticks don't usually cause the inattention that's a hallmark of ADHD.

Now, it's worth mentioning that a child can actually have both ADHD and a tick disorder. In fact, Tourette's syndrome, which involves both motor and vocal ticks, often occurs with ADHD more often than you would expect by chance alone.

So, you need to be careful to check for both, especially if you see any signs of ticks. Now, we've been talking a lot about differentiating ADHD from psychiatric and neurodedevelopmental conditions, but what about the times when the real cause is a medical problem?

Ah, that's when your detective skills really come in handy. It shows how important it is to get a complete medical history. and do a thorough physical exam. Sometimes what looks like ADHD is actually a sign of something else going on medically.

What are some examples of medical problems that could be mistaken for ADHD?

Sleep disorders are a big one and they're often missed. Things like obstructive sleep apnea where your breathing repeatedly stops and starts while you're sleeping can make you sleepy and irritable and have trouble concentrating during the day.

And those symptoms could easily be mistaken for ADHD, especially the inattentive type.

Exactly. And it's not just sleep disorders, hearing or vision problems. can also cause behaviors that look like ADHD. Imagine a child who's always asking people to repeat themselves or having trouble following directions. If they can't hear well, it's no wonder they seem inattentive or frustrated.

That's a good point. You have to make sure you're not mistaking sensory problems for attention problems.

Absolutely. Another thing to consider is side effects from medications. Some medications like certain anti-vulsants or high doses of steroids can cause changes in behavior that look a lot like ADHD.

So, checking the child's medication list is a must during the evaluation. You have to rule out any medications that could be causing the problem.

Now, moving on to some less common but still important things to think about. We have genetic syndromes that can present with symptoms similar to ADHD.

Things like fragile ex syndrome, clients alter syndrome, and Turner syndrome come to mind. These are complex disorders that can affect development in a lot of ways.

And some of those effects can include problems with attention impulsivity and hyperactivity. For example, fragile X syndrome, which is the most common inherited cause of intellectual disability often involves behaviors that look like ADHD along with anxiety and problems with social communication.

So, you need to be extra careful to check for ADHD if you see a child with developmental delays or other signs that suggest a genetic syndrome.

Exactly. Now, it's important to remember that not every child who shows behaviors like ADHD has a biological or medical condition causing those problems. Sometimes the key to understanding what's going on lies in the child's psychosocial environment. That's an important point. We can't forget about how much a child's experiences and environment can affect them.

Think about a child who's been abused or neglected or who lives in a home with a lot of stress. It's completely understandable that they might have trouble focusing and controlling their impulses or regulating their emotions.

Their behavior might be a reflection of their trauma or a way of coping with a really difficult situation.

Exactly. It wouldn't be right to say that those behaviors are solely due to ADHD without considering the impact of their experiences. It really shows how important it is to do a holistic evaluation, one that looks at every part of the child's life.

So, we've talked about how important it is to make the right diagnosis, but what are some specific tools and strategies that can help us do that? You mentioned rating scales and clinical interviews before, but what else do we have?

Another useful tool is neurosychological testing. While it's not always needed for an ADHD diagnosis, it can give us a really complete picture of a child's cognitive strength and weaknesses.

So, it can help us find learning disability problems with executive function or other cognitive factors. that might be contributing to their struggle.

For example, a child with dyslexia might have trouble with reading and writing, which can lead to frustration, avoidance, and behaviors that look a lot like inattention.

And neuroscychological testing can help us understand those complexities and make sure the child gets the right support whether or not they end up being diagnosed with ADHD.

These tests provide a more objective, right,

and standardized measure of a child's cognitive strengths and weaknesses.

So, you might use these tests to look at things like attention span.

Exactly. working memory, processing speed,

executive functioning.

Precisely. And the results can help us not only to confirm or rule out ADHD, but also to identify any co-occurring learning disabilities or other cognitive challenges that might be contributing to the kid's difficulties. One tool that can be really helpful is the continuous performance test or CPT. It's a computer-based test that measures a child's ability to pay attention and stop themselves from acting impulsively.

So, it's a more objective way to measure those core ADHD symptoms.

Exactly. And it can help us separate ADHD from other conditions. For example, research showed that children with ADHD and anxiety were inattentive on the CPT but not impulsive.

So that suggests that their inattention might be more because of worry and distractions in their head than a problem with controlling their impulses. It's a subtle but important difference.

I know there's a lot of debate,

yeah,

about the diagnosis of ADHD,

particularly overdiagnosis,

right? What are your thoughts on that?

Well, it's a valid concern. It's definitely a conversation we need to have. There's a possibility that in some cases, yeah, we're too quick to label kids with ADHD, maybe misinterpreting developmentally appropriate behaviors, right? Or overlooking other contributing factors.

So, a kid who's just a little more energetic or impulsive than their peers

might get slapped with an ADHD diagnosis.

Yeah.

When in reality, they're just

when they're just a normal kid. a normal kid.

Yeah. And there's research that shows the relative age effect.

Oh, okay.

Can play a role in diagnosis rates.

Interesting.

Younger children in a classroom

are more likely to be diagnosed with ADHD. Okay.

Than their older peers.

Interesting.

Potentially because they're just less mature.

Oh wow. Yeah.

So it might not always be a true ADHD difference, but rather a developmental one.

Exactly.

It tends to even out over time.

Precisely. That's fantastic. And this underscores the importance of careful and thoroughal. valuation, you need to consider the child's age, their developmental stage, their individual context before jumping to conclusion.

It's about seeing the whole child.

Exactly.

Not just a set of symptoms.

That's a great way to put it.

And I think that's a perfect segue into the issue of disparities in ADHD diagnosis.

Right.

We know that certain groups of children are less likely to receive an ADHD diagnosis than others even when they have similar symptoms.

Yeah.

Why do you think that is?

Well, there are several factors that could be contributing to this.

One possibility is that there are cultural differences in how we perceive and interpret behavior.

Right?

So a child from a culture that values quiet attentiveness

might be seen as inattentive. Yeah.

In a classroom that expects more active participation.

Oh, that's interesting.

And it highlights the need for clinicians to be culturally sensitive in their assessments. We also need to consider factors like access to healthare, social economic disparities, right?

Children from marginalized communities might face more barriers to accessing mental health services and getting the proper evaluation.

That's a systemic issue that needs to be addressed at multiple levels.

Absolutely.

But I think another piece of this puzzle

Yeah.

is clinician bias.

Absolutely.

Unconscious bias can influence how we perceive

and interpret information.

Yeah.

And it can lead us to make assumptions about a child, right,

based on their race. their ethnicity or socioeconomic background.

And this can have a profound impact

Yeah.

on diagnosis rates.

It's a sobering thought.

It is.

It means that we as clinicians

need to constantly be questioning our own assumptions and biases

to make sure that we're providing equitable care.

Absolutely.

To all children.

I completely agree. We have a responsibility to advocate for systemic change. Yes. But we also have a personal responsibility to examine our own implicit biases. and strive for cultural humility in our practice.

This deep dive has really highlighted the complexities of ADHD diagnosis

and the importance of a nuanced and individualized approach.

For sure.

We've talked about the diagnostic criteria,

the underlying causes,

the role of testing,

the overdiagnosis debate,

and the disparities that exist in diagnosis rates.

A lot to think about.

It is.

And I'd add that it's also important to empower people with ADHD and those who care for them. to understand their own path with knowledge, compassion, and most of all, hope.

That's a great way to end our conversation. Thanks for joining us on this deep dive. We hope you found it informative, thoughtprovoking, and most importantly, helpful for your practice.