Welcome, Tom.

Hello, hello.

Thank you very much. Today we've got Doctor Tom Nicholson. He's Assistant Professor of Mental Health Nursing at Northumbria University. He's a keynote speaker, including being here. I was thinking like how many, the vast majority of our guests, could be the keynote of a conference of their own. And we are so lucky that you and others are giving your time at no cost to share what you know with the ADHD community via this, so thank you. It's a big deal. Also, secretly, you for all the stuff you do in the background. Again, is someone who we speak to regularly for, you know, one of the things we want to do is always put out absolutely accurate information, think through the nuance, connection to thing.

Of what we're saying, try so hard to get it right. And Tom is one of the core people to help us do that. He's a trainer. He's an advocate for ADHD. He draws on his professional experience as well as his own lived experience. He's going to talk about how we conceptualise ADHD, exploring the different models, medical and neurodiversity, their strengths and limitations, and finding the middle ground. This is a topic you were passionate to talk about. Like it's how we talk about ADHD and how different people talk. So like if I'm on LBC having a Barney with Nick Ferrari and he just thinks there's a whole load of nonsense, we're all like yeah, just wasters basically and we just need to get a bit of gumption and get on with it.

And then you talk to people who understand and have a difference. Actually I had a very recent experience. I talked to BBC Radio Manchester, being interviewed by a presenter who's in their 70s and I was forewarned that they would want to know like where does this ADHD monarchy come from? It wasn't around when I was a kid. That's the entire argument. And I was able to talk to them and we had a pre discussion. I said, well, the same place PTSD was.

We didn't And understand.

People with it were considered just damaged, broken, and it was their fault and they were weak. And not really gone through awful experiences, particularly from obviously the Second World War and the dementia that was just old people getting old and not a disease that we could treat. And the menopause was just, you know, women being old women and just needed to get over themselves and wasn't really a big deal at all. It was just absolute awful attitudes then suddenly understand treatments like HRT, the case of dementia, the new treatments going after dementia, support for PTSD. As soon as I mentioned PTSD, he said, my dad had PTSD from the second model and he self treated with alcohol and I totally understand what you're talking about.

And we didn't have any discussion on where's ADHD, like where was it before? And this conversation that you're about to take us through, nuance of how we talk about it, how we communicate, it matters. It's how Massively. Over to you. Fantastic.

Thank you very much Henry and My welcome name is Doctor Tom Nicholson and I'm here today to talk about how we can navigate nuance in our discussions around ADHD both conceptually, as a construct, as a condition, as a diagnosis and how what we're seeing at the moment is a bit of a schism in the space of polarizing views of what ADHD is or what it should be or how we should talk about it. And those polarizing views, especially in social media, leading to it being more difficult to actually have those nuanced, interesting, and helpful conversations.

For people. So who am I? I've had a bit of an introduction there. My name is doctor Tom Nicholson. I'm here today in my capacity as an assistant professor of mental health nursing at Northumbria University A neurodiversity activist advocate, I do a lot of work in organizations supporting on their neuro inclusion agendas, understanding what neurodiversity is, navigating neurodiversity, and everything from health care, social care, all the way to corporate. And I also do a lot of research on different aspects of neurodivergence, everything from my PhD, which was on the experiences of parents of children getting ADHD diagnosis, all to what I talked about last year at the conference, which was the positives of ADHD symptomology.

The the positive ADHD project. So although last year I was talking lot about positives, today I'm gonna be talking more about nuance and that uncomfortable middle ground in ADHD as a concept. That's me now. Outside before this, I was a CAMS nurse in an ADHD assessment service, so responsible for the assessment, diagnosis, and intervention of children and young people who were neurodivergent. But as we know in the NHS today and in society today, often people have failed and the system is incredibly overtaxed, overburdened, underfunded, and under supported, and that's leading to parents and families having that experience as well.

If you haven't guessed by this point already, I was also notably neurodivergent myself. I was diagnosed ADHD at five years old. I used medication as a child and then had a period of twenty years without medication, and I recommenced medication when I was 29. Also recognized that I was autistic at 29 as well so that development of understanding of that ADHD presentation, ADHD, and autism co occurring. I described my early life as attachment focused and loving in my family and institutionally abusive and traumatic through the educational system, which linking back to some of the other talks from before about how the educational system, when it's not adapted and altered to be inclusive to your needs, can be incredibly damaging.

But nonetheless, what we're gonna be exploring today is the context of the two dominant not dominant ways of thinking about ADHD. There's two main sort of concepts. They are the biomedical, medical perspective of ADHD, and this emerging neurodiversity movement. I say emerging because it's still finding its feet. It's still developing. It's still altering and changing. And these two perspectives positions of the strong medical and the strong neurodiversity perspectives seem to be completely at odds. There seems to be little shared ground between the two, and I want to bring a bit of shared ground to that space because fundamentally, how we think about ADHD, how we think about it as a concept, as a diagnosis, what whatever we think ADHD is.

Will massively shape societal response. So for instance, for researchers, for academics, it determines what methodology, what type of research we're even going to use, what we're going to fund, what we're gonna pay money for, whether or not there's gonna be a readership for us. So historically, lots and lots of the research focused on negatives and very little focused on positives, and we saw a shift in about 2019, 2020 to more positively based ADHD research. So that changed. For clinicians, for educationalists, for teachers.

It's our patient care, it's our care in the classroom, it's what interventions we're going to use, how we're going to think about it, what advice we will give, and what language we will use to even talk about ADHD in our classrooms, in our hospitals, in our MDTs, in our homes. And thinking about homes in the wider society, how we talk about ADHD as a society directly impacts on what we're going to do, what we're going to do in business, in law, in what we're going to accept, how we're going to acknowledge and support neurodivergent people, and what we're going to fund and where the money goes because all ultimately funding is relevant to what support is available.

So if we take a line of sort of positions, you know, we've got the ADHD is a superpower and is a normal variation of human experience and there's and that's that's a strong position. And on the other side, we have ADHD as one of the most disabling conditions in childhood, which was a quote from a research paper from a very prominent psychiatrist in the ADHD research space. So these positions are obviously naturally very far apart. But what I'm interested in talking about today is this bit here, this bit in the middle. What can people in this camp learn from this side, from the from this new neurodiversity perspective? But, also, what can the ADHD is a superpower perspective?

What can that learn from the medical side? What can that learn from the other side of the argument? Because as I say, there's nuance, and not everybody fits into these comfortable boxes. So we're gonna explore that. We're gonna explore that, like, theoretical tension, that tension that seems to boil into lots of arguments on LinkedIn, on Twitter, on Reddit, on social media generally, and how we can maybe develop our own understanding of what ADHD means to us because fundamentally, everyone is developing their own understanding.

Very brief introduction. I'm not gonna go into any detail on this whatsoever, but, you know, ADHD being the most diagnosed childhood condition in psychiatry between three and seven percent of school age children fulfilling the criteria. The stats in adults are slightly shakier because of, you were saying, a rise in diagnostic rates. We know that ADHD continues in the adulthood, but adult ADHD is a construct, a concept, as a diagnosis, was not allowed to be given in The UK until 2013 when the diagnostic and statistical manual fifth edition came out. So again, our diagnostic understanding changed in 2013 just like ADHD and autism couldn't be co occurring as a diagnosis until 2013. So we've got these developmentally atypical.

Levels of inattention, hyperactivity, impulsivity. So I wanna stick with the the medical model first because what does medical thing medicine and the medical world think about ADHD? What is the psych kyrie perspective of ADHD? You know, the basic premise is that ADHD is a heterogeneous neurocognitive or neurodevelopmental disorder. Now what heterogeneous means is it can look very different in lots of different people. It's not homogenous. So you have very different presentations of ADHD as the saying goes. You meet one person with ADHD, you've met one person with ADHD. So we know that ADHD seems to develop in early development, and the diagnosis of ADHD for all purposes within psychiatry.

Is a valid diagnosis because it fulfills the threshold for the criteria for disorder under psychiatry's perspective of disorder. So under the perspective of any disorder that's in these manuals, ADHD reaches that threshold. So it reaches threshold to be a diagnostic disorder. Now, of course, I'm gonna challenge on this language later, but we also have to bear in mind that this this language developed for a reason. So those with ADHD according to the medical model have neurocognitive deficits or impairments, and those impairments and deficits can be reduced and ameliorated by effective medical treatment. So the medical model has predominantly focused on medical treatments, you know, methylphenidate, stimulant medication, certain.

Therapies that have been adapted for instance. A lot of research on ADHD has shown poorer outcomes for people in all areas of life and that these outcomes continue into sort of the adult life and and throughout the lifespan. And that once diagnosis is met, ADHD according to medicine becomes a medical problem. It is now a diagnosis. It's a medical issue. So they're they're the sort of underlying assumptions. Now what why is this helpful? Because often I hear people really say sort of poo pooing the medical model and really challenging it, and I and I will do that shortly. But there are some real benefits to this model. For instance, there is a strong evidence base for a genetic component to ADHD.

If we look at fMRI evidence, we see that there are there's evidence of altered brain structure, maturity, connectivity, dopamine levels, noradrenaline levels in our ADHD brains. So from a medical perspective, our ADHD brains are different. Medicine might use the term disorder here or deficit here, but regardless of that, they are in some way different. There is a high heredity, you are if you have a parent, you're a parent with ADHD, you're significantly more likely than average to have a child who's ADHD. Just like if your twin has ADHD, unbelievably high likelihood that your or that twin will have ADHD depending on whether they're dizygotic or monozygotic twins.

So the benefits of this model means that if you can get a diagnosis, if you are deemed as having a disorder, you can now access evidence based effective treatments. Brilliant. And the evidence based for those stimulant medications for instance is quite powerful. It's quite strong. The evidence shows that there are improved outcomes for those who begin medication and use medication and the earlier you use it, the the better the lifespan. A recent meta analysis showed that ADHD medication reduces suicide risk and also reduces lifetime substance use risk. That's really helpful stuff. There's significant evidence of quality of life improvements that people talk about sort of qualitatively. So people talk about how their life improves after ADHD.

Medication. That's not everyone, of course, but for a large subset of people. Medical diagnosis as well, what it does is it legitimizes the requirement for intervention and support. When something becomes a medical problem and we are using a medical perspective, we can then, as a people, as a group, argue that we require interventions and support that are that are additional to the the average or typical person. I heard in the one of the talks earlier about the legal perspective of ADHD, we get to use disability legislation, and disability legislation becomes relevant to us only by nature well, partly by nature of becoming a disability under the legal justifications.

Those legal protections, and that medical perspective is what's helped give that. So it has these real genuine benefits. This also justifies funding. It justifies us to put research into treatment recognition, better assessment, more effective assessment, and the like. So these are some really powerful benefits to seeing ADHD from a medical perspective, from a psychiatric perspective. But, of course, there's some criticisms here. There's some negatives here, some difficulties. There's a big argument that medical perspectives of ADHD are completely reductionist, that they discount extenuating factors, that they ignore.

The impact that your environment might have. They ignore the impact of society, of your family dynamic, of the way you're being treated. So for instance, if a child's struggling to pay attention and listen for a fifty minute lesson, a medical perspective might prioritize medication so that the child can perform in that context. Whereas a different perspective might say, maybe the lesson's rubbish. Maybe we need to change the lesson, the lesson structure. Maybe they're not in the right environment, and a medical perspective can ignore this, this biomedical perspective. You know, it's devoid of contextual data, contextual being the context, the environmental context, the social context, etcetera. There's arguments on subjectivity.

And value based in the diagnostic process. So what do I mean by that? Well, what constitutes impact in functioning? Because you need evidence of impact in functioning for a diagnosis. It needs to impact on your life, your ADHD symptoms. But what is impact? How often is often? How's what does it mean to be severe versus not severe in terms of symptoms? And different people might have different positions and perspectives on that. This variation has led to problems of underrepresentation and underdiagnosis in large groups, minoritized groups. Obviously, we've seen a massive rise in the discussion of ADHD in women.

And we're also seeing a failure to appropriately support people from minoritized groups or minority groups thinking of black Asian minority ethnic communities or LGBTQ plus communities, etcetera. So there becomes this lack of real clarity between what is a diagnosable level of ADHD and a non diagnosable level of ADHD. What is the threshold? And I think this is a quite a valid criticism of the biomedical model and where we've seen in the ADHD task force that came the report that came out a few months back that they talked about ADHD, the diagnosis, as being separate from ADHD, the experience. So there's some interesting sort of changes happening in the world here. Put two pages of criticisms.

I'm not biased to one position, by the way. What I will say now is I don't believe one position is significantly stronger than the other. I think they both have merits and benefits to different people at different times. There's linguistic problems with a medical perspective. You know? Even the the label itself, attention deficit hyperactivity disorder, we have two labels in our title of what is wrong with us. Did the it prioritizes the dysfunction, the deficit, the disability. And that, for some people, can be really helpful to that they go, oh, people see the struggles that I have. But for others.

It felt like the medical perspective completely ignores the potential strengths and benefits that come from having ADHD from being neurodivergent. And so this nuance perspective, we're seeing some medical research coming out now that's exploring much more of the strength based perspectives, but majority of the research is coming out in psychology and in sociology and not in our psychiatry research, for instance. Some have argued that we are over medicalizing the normal experience and then there'll be people arguing, do we need this label for everything? Do we need to say every that ADHD is a thing? Do we need these boxes to put people in?

This and there's a big piece of research and a bit of piece of discussion in sociology around this about the colonization of medicine into everyday life. We don't all need labels. We don't all need this. Medicine itself is being argued to be steeped in sort of patriarchal power dynamics of normality about what is normal. You know, what was normal sixty years ago is very different to what is considered normal or typical today. And Henry said earlier about how our understanding of diagnosis like PTSD, of menopause, of dementia has changed over time and that the medical construction of ADHD has been steeped in sort of white male perspectives of what ADHD looks like, hence the under diagnosis of women.

And what about those who don't get a diagnosis but do have ADHD? What about those who are because this medical perspective in part assumes that we're capturing everyone, in part assumes that this perspective is really helpful because everyone will eventually get a diagnosis. But that's not how it works. That doesn't happen in practice. In fact, we're seeing real inconsistencies in diagnostic trends. So these are our sort of main strengths and criticisms of that biomedical perspective. Again, I've I've wrote a research paper on this that's currently under review, so which goes into a bit more detail, but it's it's thinking about how can we recognize and understand these strengths and these difficulties of each position.

So then we come to the neurodiversity paradigm. So we've we've sat with that medical perspective. We've argued that medical perspective. It seems to have some real strengths, it seems to have some real challenges to it. And so many people will then navigate and meander over to a neurodiversity paradigm and they'll often the discussion of neurodiversity is very steeped and this is the correct paradigm, there is no benefit to any other paradigm but this. Now I'm a neurodiversity advocate. I am an advocate for this position quite strongly. However, there are criticisms to it, and as a community, as a collection, I think we really need to respond to some of these for fear of doing harm to the community itself, doing harm to the movement itself.

Because we do have things to learn from perspectives other than ours. So what is the neurodiversity paradigm? I'm not gonna go too much into defining it, but, you know, it stems from a social model of disability. This idea that those with neurodevelopmental conditions, we are different, but we are not disordered or disabled or deficient. We are not broken. We are different. We are part of the natural variation of humanity. And that normal variation of humanity registered a different and sort of a little part of that overarching spectrum. And we'll we'll touch on some benefits to that and some negatives to that shortly. But often, this neurodiversity paradigm has been dominated and led by neurodivergent people themselves, which is fantastic.

A lot of the time. One of my criticisms in this position is actually the neurodiversity paradigm itself has been dominated predominantly by autistic voices for a long period of time, and a lot of the researches on neurodiversity and the discussion around neurodiversity has been from a an autistic neurodiversity perspective and not an ADHD one. That's changing slightly, but that is a criticism that I've heard a few others bring up is how do we ameliorate this? How do we consider this in our discussions? And it's the neurodiversity movement is similar to other social justice movements where we're seeing in intersectional spaces where we're seeing people sort of coming out, more celebrities talking about their neurodivergence.

The normalization of neurodivergence of ADHD, people talking about it and sort of across the board from in our classrooms, in our sports teams, all the way to in the research world. I'm stood here as an assistant professor talking about the fact that I'm neurodivergent as well to normalize that, which is something we've seen in other social justice movements. The neurodiversity movement should be acknowledging impairment. It should be acknowledging that people who are have ADHD or fulfill the criteria for an ADHD diagnosis do have difficulties and do have impairments, but it prioritizes the societal, the systemic, the environmental, and the psychological barriers to seeking support.

So for instance, you might say that someone has ADHD and struggles with inattention, hyperactivity, and impulsivity, but the neurodiversity movement might prioritize looking at the school structure, might prioritize looking at the barriers within a job or the barriers within a workplace. And that the perspective and the paradigm very much says that neurological diversity or neurodiversity is inherently valuable. And you're not gonna hear me criticize this particular one because I believe it is. It is inherently valuable, but we need to be able to express that value in a safe way. The neurodiversity movement also challenges those dominant power structures. It challenges.

The what has always been, the structures that have always been. It's challenging the school system to say, as we've heard in the last talk, the exam structure is unfair. The exam structures are unreasonable. And wonderful organizations like ADHD UK are challenging from a legal perspective and as well in a very public forum, some of these dominant power structures like health care, like education, like social care to say we need to do things differently. So this model, this neurodiversity perspective has some wonderful benefits. It can be really beneficial to people. It can allow us to avoid putting people into groups of you're the disabled group.

You're the nondisabled group to we are all neurodiverse and we are all in this group, but some of us are neurodivergent. Some of us just diverge more from the the typical or the psychological norm than others. It prioritizes those neurodivergent strengths. And it this is an area that's really close to my heart because a lot of my research is on what are the actual evidence based benefits of ADHD, of autism, because we've gotta make sure that they're evidence based because sometimes people talk about strengths as if every single person has them who's autistic or who has ADHD, and that's just not true. Not everyone.

Who has ADHD is hyper creative, but there are links to creativity and ADHD. We see more creativity, and we see different types of creativity and out of the box thinking, but not for everyone, but for large proportions of people. See high levels of enthusiasm in areas that the person is particularly interested in. We might use terms like hyperfixation or hyperfocus. We see improved performance in context. Now what that means is, for instance, in comedy, we see comedy is is dominated by ADHD voices. There's a significantly statistically high likelihood that you will have someone in comedy who's a comedian with ADHD than in the general public. But that's because comedy itself and the the job of comedy is incredibly beneficial contextually.

Environmentally for someone with ADHD. You're on stage, the center of attention, you if often if you're hyperactive and you have lots of sort of energy and and passion, and you can think on your feet, which is linked with impulsivity of being able to respond very quickly to, you know, people shouting out or heckling, and also the inattention leading to sort of more novel unexpected creative thoughts. So inattention is linked to higher creativity because people aren't paying attention to one thing. They're thinking of lots of different ideas. That's really helpful for authors, for comedians, for people in jobs like myself, you know, as a public speaker. So there's the the movement of neurodiversity prioritizes.

These strengths. It says, let's put these front and center, and then people might start using terms like ADHD is my superpower. Come back to that in a minute. The neurodiversity movement challenges these beliefs of being broken, disordered, or less than others. And for me, this is massive in terms of self esteem, self worth, anxiety, and depression. When people get diagnoses, they often talk about they knew who their tribe are now. They know who they are. But notice I said the term diagnosis there because people are often at odds and unsure until they get that that cut medical confirmation of diagnosis. And the movement zooms in and focuses in on those societal barriers as I've kind of mentioned earlier.

Now these superpower conceptualizations can be helpful for some people, but there's a negative side to this perspective. There's a negative side to this neurodiversity perspective that I think we don't respond to well enough. There's a few well, there's a few criticisms, really. The first is the neurodiversity movement, when we're talking about people with ADHD as having all these strengths and all these superpowers and just being different and and not being disordered, can actually completely ignore that for some people with ADHD, it's blooming hard. They feel disabled. They feel disordered. They feel impaired. The lived experience of having ADHD for some people is that it's a nightmare sometimes. They might have some wonderful strengths.

In sports. They might have some wonderful strengths when they're on stage, but they're struggling massively in their relationships, in their friendships, and when they're at home by themselves, they can't relax. They can't wind down. And so this positive perspective can end up invalidating the lived experience, lived reality of life being extra hard because of you feel like you're fighting against your brain sometimes. This has been called, like, a Pollyanna perspective, this overly positive perspective. And one of the criticisms the big criticisms of this movement is, you know, what about those.

Who actually are really, really impaired? I'm thinking about the types of people I used to work with when I was in CAMS, and it's one of the benefits of me having worked with so many people with ADHD at varying levels of support needs. That those who have very, very high support needs, do who those who feel significantly, consistently, severely impaired, they don't often feel like the neurodiversity movement captures their perspective. It doesn't capture their belief of their experience. That that movement's for people who have less needs, that's not for me. And there's I was reading an article today about, the term and again, I there's queries around even the terminology of the concept of sort of profound autism.

And those who have significantly impaired needs on a significantly high support needs because of their they have quite profound autistic traits, well, are saying actually the neurodiversity movement isn't capturing their experience, and there's a few sort of dissident voices talking about this a bit more now. So it's less accessible to those with high support needs, both the people and their families and parents. The new diversity movement itself, and again, I'm I I'm criticizing myself in this perspective as well. It's often dominated by those who are successful or and I don't like the terminology of higher functioning. This is a quote from a research paper.

Those higher functioning voices, those who are already quite successful, who already have platforms, platforms, who who already have measures of success in their life, they are the ones who will have more ability more voice and are the ones who are dominating the discourse around the neurodiversity movement and the positives of ADHD and the strengths of ADHD and how wonderful it is and how it's not a disability. But are they are they always representative of everybody, and is everybody being represented by this movement? As I said, those were severe manifestations. It's I'm thinking young people who have very severe impulsivity that puts their life in danger regularly because they struggle to conceptualize.

The risks when crossing the road or they don't even think about crossing roads and and the day the real immediate dangers that can happen. There's also a dichotomy. There's an uncomfortable dichotomy that doesn't quite fit as a paradox Because as a movement, we want to celebrate and frame strengths and benefits, but what we also want need to do is fight for support and interventions for those who need them, and that can be a bit uncomfortable. That's sort of, like, push pull of how do we fully conceptualize this? Is is it a positive? Is it a negative? How much of a positive? How much of a negative? And it becomes hard to.

Really have a conversation where we're on the same page because people have such very strong and different opinions on what ADHD is. As I said, this contradiction of if ADHD is natural variation, then why do we need our definite differences to be recognized to such a strong degree to be involved in legal representation? And this isn't my argument. These are one of the arguments that I think we need to respond to. These are the arguments that I think we need to be able to discuss to have helpful conversations so that those of us who are maybe more leaning towards the neurodiversity movement can have helpful conversations with those who have a more medical perspective.

And as Henry said, those who have a belief that ADHD doesn't exist whatsoever, sometimes it's hopeless, and I wouldn't even talk with them. But we also have lots of arguments that we can make about the history of ADHD and the evidence that we have and the fMRI studies we have so that medical evidence becomes more helpful to justify that ADHD even exists. Some of our criticisms, again, I've tried to be balanced and have two pages of criticisms for each position. In 2018, there was a paper by that talked about neurodiversity light. And for those of you who've never heard of it, neurodiversity light is this perspective where the general population adopts the feel good, fuzzy, lovely language of the positive language of neurodiversity.

As a form of lip service. So people will, you know, celebrate neurodiversity celebration week. They'll celebrate ADHD awareness month without actually implementing any real systemic change or real accommodations or actual inclusive change in their workplaces or their schools. So people are using the the I the argument of someone goes to work and says they would like some reasonable adjustments because they're really struggling. And their boss says, what are you talking about? You don't need reasonable adjustments. You've got a superpower. You told me yourself. ADHD is a superpower, and superheroes don't need reasonable adjustments.

Again, I've had conversations with people who think like this, and I've had conversations with people who have experienced those types of responses. So we need to be really careful that we're not having this do we talking about all the feel good language without actually recognizing the real difficulties and putting in place things that actively and actually help people? There's a big argument at the minute that we're seeing develop about is neurodiversity as a paradigm itself, just a white Eurocentric global North paradigm. Is it dominated by white European voices and broad global North voices, but what about sort of the majority South perspective on what ADHD is, on what neurodiversity is?

There's a one a friend of mine, a wonderful friend of mine called who talks specifically about this and about how we can't understand ADHD unless we understand the world's perspective of ADHD. Does it truly acknowledge the impact of things like racism, ableism, patriarchy, colonialism, etcetera? And this is one of my biggest worries. And I'm like Henry, I'm in conversations with lots of people who have the power to make quite big changes in the medical world. And this is a question that's starting to be asked and where we need to be so careful as a movement. So if neurodiversity is normal human variation and it's not a disorder, it's not a medical problem, then why should the NHS or why should health care fund it?

Why should we fund people's assessments if it's not a disorder? And this is really scary to me because what this means is that those who need support won't may not be able to get it. And people are starting to ask this question. People are starting to say, well, we can save money by using the neurodiversity movement to say we only see those with the most severe severe impairments. I heard someone say recently, we only see level four ADHD. I have no concept of what level four ADHD is. I assume it's significant impairment. It's made up construct. We don't have levels of ADHD in the diagnostic manuals yet. But what this looks like if we're not nuanced in how we talk about ADHD, it's the defunding of services. It's the removal of services.

It's the loss of the support that you may not need because ADHD is more of a strength to you, but someone down the street might really need. The kids I used to work with might really need. Your children might really need. And so continue to advocate for your perspective, but be mindful of how that might be heard by those on the other side and what the long term impact on the movement might be. So just a really quick sort of heuristic simple table about the different paradigms. I'm not gonna sit on this for too long, but there are there's sort of this biomedical paradigm is diagnosis focused. It talks about ADHD as being biologically based. It focuses on medication, but has these criticisms of being reductionist and medicalizing.

In our neurodiversity paradigm, we're celebrating difference. We're celebrating diversity. We're celebrating identity. We're finding personal identity identity in our collection as being a neurodivergent person. We're seeing more self identification and self diagnosis and lots of strength based advocacy, but a kid that can minimize impairment, and we run the risk of losing support for those who maybe need more support than us. So how can we in this concept then, how can we develop our own ideas of ADHD? And this next slide is part part of a research paper that I've written where I'm trying to find a sort of framework for everyone with simple questions to ask. If your position on ADHD, what is your position?

What are the biggest criticisms to your position, and how are you responding to them? So for instance, which of the paradigms most closely reflects your experience? Are you more in that medical paradigm, or are you more in that neurodiversity paradigm? I suspect the majority of people in this audience will be more neurodiversity paradigm. Not everybody, of course. So if you are in this paradigm, what are the benefits to diagnosis and medical treatment? Because there are real benefits to that from a lot of people. What about those who have the most severe impairment who feel like the neurodiversity movement doesn't actually reflect their needs? How are we not going to lose them? How can neurodiversity light be avoided?

And for those who want to think about it a bit more, what impact have sort of colonialism, Eurocentrism, racism had on developing your paradigm of neurodiversity? And are you considering different perspectives even in the social paradigm? On the other side, if you're a medical practitioner, a psychiatrist, and I and I train psychiatrists and I talk about this, What impact do social environments have on the success of our medical treatments? Some medical treatments are more effective in one context to another. So why don't we do some research on those contexts? When does ADHD medication work the best? When people aren't filled with shame, when they feel supported and included, when they have friends and support networks.

When they feel psychologically safe, when they are loved, ADHD medication works better because it's more complex and nuanced than just dopamine levels and just more complex and nuanced than just inattention levels and hyperactivity and impulsivity. What can be done from a medical perspective for those who might never seek or get diagnosis? How do we support them? How is your own and the wider diagnostic criteria subjective? We know. Right? I'm I'm talking to however many thousands of people right now. We know the diagnostic criteria for ADHD is going to change. It changes regularly. It's changed many times since it's since.

Nineteen o two when it was classified as a morbid defect of moral control, and then it became post encephalopathic behavior disorder, and then minimal brain damage, and then hyperkinetic disorder, then ADHD. Then in 2013, we realized that ADHD also exists in adults, and then we realized you can also be autistic. So we're not we're we're definitely not perfect right now. We definitely haven't perfectly encapsulated the diagnostic criteria of what ADHD is. So how might it be different? How might it change? And how might that affect how we think about it ourselves now? Might emotional dysregulation be added to the criteria? Is RSD.

Something specific to ADHD, or is RSD its own thing that people who have also experienced trauma who aren't neurodivergent might experience? Is the RSD rejecting sensitivity to dysphoria? Is it specific to ADHD? Or is it something more ubiquitous that a lot of ADHD has also experienced? We don't have the answers to this yet, not the evidence based strong answers that we need research to be able to justify and prove, but the answers will come. And, ultimately, what I want you to ask yourselves based on your position right now is what are the main strengths of that alternative paradigm? What benefits does the other way of thinking give to people that maybe you don't see those benefits, but other people might.

So that we can have less of a polarized argument and more of a helpful nuanced discussion. Because ultimately, we're all here to support people with ADHD. We're all here to support neurodivergent people. But I don't want the movement to eat itself from the inside. I don't want it to happen here because we can make a massive change, and we have seen monumental change in this space. But we've also seen some real damage as well. And for me, the implications of this are massive from a research perspective, from a researchers. We have more nuanced research with people saying what their paradigm is in their introductions to the research project so that we can understand what someone's bias might be or their interpretation.

Clinically and educationally, we can have clarity on treatment and language and patient care and expectations for our children and young people and for our adults. We can if we know if you're a nurse who works in an ADHD service, you're gonna have a very different perspective of ADHD than a social worker who's never worked with people specifically with ADHD. Although I guarantee you have worked with at least some people with ADHD because we're at five percent of the population. And for those with lived experience, those of you who are neurodivergent, thinking about how identity is constructed and how that identity work, and what I mean by that is so many people get benefit from that diagnosis, from that label, which is a medical thing.

The evidence is really clear. My research has shown this as well that diagnosis helps to legitimize people people's difficulties and needs. So let's not take that away from those people just because you don't believe in medical diagnosis, you don't feel like it's helpful. Can we give nuance to people in this world of polarization? And ultimately, neither paradigm adequately supports everyone. Neither paradigm effectively is helpful to the needs of every person. We need both paradigms. That I don't think there will ever be a really firm clear answer on a correct one or a wrong one. I don't think that's gonna happen. We need both for different people. And in the social media space, TikTok and Instagram.

We're seeing a doubling down of this. If you don't agree with me, then you're completely wrong. If you don't agree with me, then you're part of the problem. And we see that on both sides. So we're going to see our clinicians double down. We're going to see our services double down. We need this flexibility because it's scary. And as I say, behind these closed doors of conversations with people who make quite significant decisions on ADHD care in various different fields, We need to be able to convince them as well as being able to convince ourselves that we're on, like, strong theoretical ground. It's valuable to be constantly learning and constantly self reflective.

And be critical of your own position. My own position has changed over the last six years of research that I've been doing. It may change some more as time goes on, But that's okay as long as we're not being too overly critical to the other side to the point where there's no conversation. And with that, thank you very much. Really hoping that we can, as a movement, change the language and direction over time. And if anyone wants to get in contact with me, I my LinkedIn is the easiest way to get in contact. Instagram, I post three times a week on all things ADHD. For any university related emails, my uni or research related emails, please email me on the top email for business and training inquiries on the second one.

And, Henry, that's me. Me.

Well, that's absolutely fantastic. Thank you. A really interesting and important discussion on how we're talking about ADHD and how those different voices are are, in some cases, complementing, in some cases clashing and challenges. It's that great. It's a it's a huge it's a big deal that I think few think about, and it's great that you brought it out and allowed that discussion today.

Thank you. Well, thank you very much. Thank you very much. Again, we see we see part of this whole problem any lack of training training for professionals and being able being able to have conversations with their ADHD. So people are making social media? Social media. And I think with a good neurodiversity training, we're able to have more robust conversations and more robust thoughts about what ADHD means to us or means to our organization. I've just seen one of the comments about how the police aren't trained in neurodivergence and, you know, they're not the only ones.

Nurses often Yes. Don't Have a very high percentage of neurodivergence and deal with a lot of neurodivergent people.

Yeah. Nurses trained in neurodivergence as standard. ADHD is not included as standard in PGCEs. It's not included as standard in our training of medics. It's not included as standard in our training of social workers, of consultants, of psychologists. It's inconsistent, the training approaches that we see on ADHD in all areas of all spheres of professional lives. And that's led to really strong opinions and very disparate opinions where I think we can have, as I say, more more to learn and more nuanced discussions. Let's let's navigate some nuance.

And I I thought I thought it was very interesting talking about how the successful have the voice, and particularly how challenging that is when we're talking about ADHD being a disability and the sort of superpower narrative. We've got Sam Thompson talking later, which we're very excited about. So that's something we've recorded already, so I don't know what's in it. But I can tell you that because I know that he's an example of that where he's talked about ADHD as a superpower and tried to and caught a lot of flack for it, because he is in a different position. I can tell you that he has a much more nuanced actual view. And I think a lot of the superpower actually comes from how hard he's found life.

And he's just trying to help other people feel Okay. Yeah. And that's really what he's trying to do. So even in our internal, in our heads, we've got these clashes. And it is difficult. We had a wonderful comment, which I just thought expressed a lot in a very like a very ADHD. This bit's not very ADHD. This is just nice about you. It says, Tom is brilliant. Thank you. And then they continue to say, sorry, I'm late. It's just like, welcome to our ADHD Conference. It's just wonderful. Yeah. Exactly right. But lots of lovely comments on. I can't go through them all. We're out of time. That was absolutely spectacular. You are an extraordinary voice for the cause of ADHD, both in expanding knowledge through your research, in your.

Campaigning and offices, you know, there's a lot of support you provide ADHD UK, for which we're very grateful.

So thank you, and thank you for doing this. That's it. I have to say goodbye. Yeah. Thank you for having me. Thank you very much. Thank you. I I loved it last year and I've loved it this year. Just want to share what we can to help others.

Well, we've loved it too. So thank you. Thank you.