I need to introduce the most amazing person, Edmund Barke. I'm gonna bring him on immediately. Hello. Hello. Thank you so much for being here. You are an absolutely extraordinary person, and I can't tell you how excited I am to to have you here. You've... And it's joy to have you opening our conference. We wanted to open with a big deal, and Edmund, you are a big deal. You're the professor of department of psychology, psychiatry and neuroscience at King's College London. You're a fellow of the academy of medical science in the British Academy. You're editor in chief of the Journal of Psychology and Psychiatry, one of the leading journals in the field. Your work has been cited more than 90,000 times.

You've been one of the names most cited researchers. You've recently chaired a Lancet Commission on millions of children growing up in institutions around the world. And one the things I hold dear most, Edmund has said his work is inspired by his own childhood experience of learning difficulties. And today he learns, he leads Restart research program to put young people with ADHD and autism at the heart of research, not just the people being studied, but as part of the team. And today he's asking a big question. What would it take for people with ADHD not just to cope, but to genuinely flourish on their own terms? Can always send in your questions on the q and a on globaladhd.com.

Just click on it. But we're thrilled to have you opening the conference. So without further ado, professor Edmund Sonuga-Barke.

Great. I just need access to my slides. Slides, yeah. Yeah. Oh, that's so kind. Thanks, Henry. A very kind introduction. A bit embarrassing. It's like a blushy. I'll bring up your slides.

I'm gonna hand over to you, and it'll Yeah. Slides will appear in about sixty seconds. No problem. I can I can can talk till then?

Yeah. It's a great honor to kick off this jamboree of all things ADHD. Good afternoon. Good morning. Probably good evening wherever we are in the world. I'm particularly excited today because apart from wonderful charity and wonderful opportunity to talk so... To so many interesting people, it's actually my first time talking about a particular new interest of mine, and that's a... ADHD flourishing. Now I'll... Obviously, over the next fifty minutes or so, I'm going to get a chance to explain what I mean by ADHD flourishing. But I guess the subtitle of my of my talk gives it away is how can we succeed on our own terms, not succeed on the world's terms only. Don't worry. I'm I'm not gonna give a lot of speculative sort of self help advice.

I'm not a TikTok ADHD influencer. I'm a scientist. And so what I'm gonna try and do, and I hope it's interesting for people, is build a case for a science of of ADHD flourishing. Now just waiting for my slides actually, I don't know if they're coming up.

They will, they're just processing but it's gonna take us in. Oh, okay.

Okay. So anyway, yeah, so in terms of the sort of topics that I'm gonna cover, first, I'm gonna go to a very fundamental topic, one that we never think about. We just take it for granted. Is should we intervene in ADHD? And if so, why? What should the goal of ADHD intervention be? I'm gonna contrast two goals. The one, what I call kind of a neuronormative disorder paradigm conception, which is probably held by about ninety nine point nine nine nine percent of people listening, very much a dominant formulation. But I'm gonna contrast this with a 180 degree alternative formulation. In a way, it's a bit of a mind experiment, and I'm calling that not... I'm calling that generating or supporting ADHD flourishing.

Then when I consider those two sort of radically different reasons for intervening in in ADHD or in the lives of people with ADHD, then I'm going to talk about the way that the normative view raises important questions, scientific questions. In particular, how can we manage symptoms, reduce impairment effectively? We have medication, of course. We're up. Great stuff. Now... Okay. That's great. That's helpful. That shows my working memory isn't as bad as I thought it was. So there we go. Yeah. There it is. So the second bit is is really, you know, talking about this kind of journey. I call it a scientific odyssey because, obviously, the film odyssey is quite popular. I don't know. I thought it'd be pretty good like a hat.

A It's hook to hang it on. From norm... Normalization conception to a flourishing conception, and it's really my my own scientific odyssey, I suppose, in in many ways. I'm gonna talk about that. And as I said, first of all, focusing on why do we do science? And science... ADHD science is is is not, you know, astrophysics. It's a very practical science. The goal of ADHD science is to improve the lives of people with ADHD by understanding the the condition more and then finding ways to intervene to to reduce its impacts. So... And I talk about the paradox of progress in the talk because on the one hand, we've got amazing scientists, you know, working on ADHD. We've made incredible progress to understanding, about it.

But we've not been able to translate that into benefits for people with ADHD. That raises a question, is the way we've been looking at it right? Have we, had the right sort of framework, the right sort of... Making the right sort of assumptions about what ADHD is, or can we get better progress towards, you know, implementing new interventions or developing new interventions if we try a different a different sort of framework, a different, we call it, paradigm within science. Then I'm going to basically argue, definitely worth having a look at that. Let's try a different approach to thinking about it, and let's explore what the implications would be for science if we tried a different approach. And in particular, flipping.

From this neuronormative, nor... Disorder concept to a neurodiversity framed understanding of the nature of ADHD. Then I'm gonna talk about Restart. Henry very kindly talked about Restart. For me, it's been absolutely pivotal in my scientific career. It's very much transformed the way I do science and the way I think about ADHD. And then I'm gonna go beyond Restart and talk about the next little part of of of the, hopefully, the journey to a full understanding of flourishing, not just cutting the negative out, the impairment, the negative impacts, but actually promoting positive growth in ADHD people, taking advantage of that special spirit we have and that... Those special skills.

That that that we can bring to the table if we're only allowed to. So to intervene, why? Well, there's a... The dominant view, the view that we nearly all hold, the view I certainly hold to some degree and have throughout my career. I call it a a neuronormative conception. And the reason we intervene is quite simple. The ADHD undermines daily functioning, negatively impacts development, creates burden for patients, families, and communities, and costs for health care, education, and criminal justice systems. That's the standard line. That's why we intervene. It's quite a crushingly negative. When I when I wrote it, I thought that's quite a crushingly negative conceptualization of of ADHD. So.

The goal of intervention then, obviously, is to cut symptoms, resolve impairment, reduce burden, costs. That's the goal of the intervention. Really simple logic. And the success in a way, although it's never put this way, when I thought about it, I thought, really, this is success through an approximation to normal, removing the ADHDness of people to move us towards normal. And it's very much a biomedical framing as a disorder or condition to treat. Now that's a comfortable conceptualization, but it... The question is, is it the only one? Is it possible to have a different conceptualization? And I'm just doing a thought experiment here as a scientist and, you know, somebody with a personal interest as well. So I call.

This one a neuro affirmative alternative formulation, and it's a 180 degrees, the opposite. How about... Let's try it. ADHD people are different from the norm. We have a special spirit with distinctive attributes offering novel solutions, creating opportunities to make a unique contribution to society despite the many challenges that we face. However, the spirit and the potential it brings is often stifled by the... What I call, and it's a bit technical, neurodivergence undermining environments we experience right away from... Across our development from very early on. But it's particularly probably when we enter institutions in particular school. So this looks a bit different in terms of those little red boxes and arrows. So not.

Cut symptoms, resolve impairment. It's support ADHD authentic flourishing. That becomes the ultimate goal. Doesn't mean cutting symptoms isn't a path to that goal, but this is the ultimate goal. And it's not success success, sorry, To the exclusion or despite neurodivergence, our ADHD, but through it to some... In some way. And I'll I'll explain what that means. It's a bit radical, but I'll explain what I mean. And it's very much more a psychosocial, sociodevelopmental sort of diversity framing of ADHD, not a disorder framing. It's two ways to look at the same thing. And as I say, it's a thought experiment at this stage. So what do we mean by authentic flourishing?

Oh, just published a little... Paper, an invited paper for the annual review of clinical psychology asking... It was actually about what are the positive outcomes, you know, in ADHD because, you know, people got interested in that since the neurodiversity movement. But I thought, well, let's try and conceptualize this thing called flourishing, an authentic flourishing in particular. So we we define it as a self assured engagement with the world marked by a sense of self worth, self compassion, agency... And agency rather, creating emotional equilibrium, allowing the ADHD spirit... So I know it's a bit romantic, but let's stick with it for a moment, to shine.

Unleashing the resources that build fulfilled lives in the community despite the many challenges faced. So that's how we defined authentic flourishing in the light... In relation to to ADHD. And just a few other quotes from the paper might give a sense again of what we're trying to get at, kind of stumble towards, get at... So as grace does not destroy nature, one of the most profound things ever written, I think, according to Saint Thomas Aquinas, the angelic doctor, authentic flourishing does not obliterate the ADHD character, but rather fulfills it. Second quote, authentic flourishing occurs in the face of continuing challenges where the ADHD person, for instance, maintains a strong sense of self worth, self compassion, and agency.

Despite on all... Despite although perhaps still struggling in key domains of life. So it's not your standard notion of thriving or flourishing. It's basically all drawn on a kind of a neurotypical terms. This is specific. That's why we use the word authentic in it. Another quote. Authentic flourish is not a panacea for the challenges faced by ADHD people. As I said, managing symptoms, managing underlying impairments is part of that pathway perhaps to flourishing, highlighting the role, for instance, of standard treatments such as medication. Rather than authentic expressions, their worth and dignity lived in... Lived day to day. So that we're kinda getting at, but hopefully it'll become clearer again as I get going and keep going.

So if you wanted some little catchphrases, which are always quite good in the marketing side of things, is this different, not disordered, thriving, not just surviving, agent, a victim, an asset, not a burden. And to me, that's the one. When, you know, as, you know, a scientist in the field, people always talk about the burden ADHD brings. But let's think about it as an asset... A a potential asset within... Under the right circumstances. Okay, Ed. Eddie, Edmund, whatever you wanna call me. Is this flourishing vision that you come up with nothing more than a romantic fly to fancy motivated by wish... Your wishful thinking? How could it possibly provide the basis for an alternative science of ADHD?

Well, I'm gonna try and explain how it could provide a different science with more fruitfulness in terms of interventions and more traction and impact in terms of actual people's daily lives with ADHD than a lot of the science, actually, that I've done. Let's put... Let's be personal about it. I'm not talking about Collie. I'm talking about me. So what's this journey, a scientific odyssey? Well, I use this. This is Odysseus' path from Troy to Ithaca. You've probably seen... Some of you've probably seen this mixed reviews, I think the film's got, the film anyway. And so if you see Troy, you know, where I'm starting off as the disorder, a kind of normalization starting point, that's where... That's our goal with Troy. And Ithaca.

Is where we're talking more about diversity and the flourishing. It's a long old journey, and you can see how complicated it's been. And if I think about my career, I spent most of it within the disorder paradigm, working very clearly within that paradigm, always pushing at the... You know, teasing the margins of it. You know, my research is slightly eccentric and that big focus on motivational rather than processes around cognitive deficits, multiple pathways rather than sort of unitary thing, environmental origins, for instance, well in terms of severe deprivation is one of the things I've researched. Developmental dynamics, the role of environment and genes in terms of a dynamic process.

And, of course, novel brain systems. We've identified some of them. So it's always been teasing the edges, but, really, getting involved in Restart or leading Restart or whatever, developing Restart, learning from Restart, it's kind pivotal in in changing my view or at least helping to me to interpret all that stuff I've been doing all those thirty years on this meandering journey around the various islands of the Mediterranean, fighting monsters and demons and etcetera. So it's been a long journey. But why did I start thinking that science needed an alternative when I was up in the islands? Why why was I thinking science needs an alternative to this neuronormative model? Well.

That start with the question, why do do science, of course? An ADHD treatment has changed fundamentally, almost not at all in the last thirty years. Rests on medication, obviously, efficacious and effective in many trials. Improvements in treatment aren't really down to ADHD science. They're down to better drug delivery, so that's pharmacology science, not ADHD science, or pharmacy science or what you call it, and dissemination of better practice like NICE guidelines and so forth. But there's obvious limitations with medication. We have to face it. We all know them. A lot of areas of functioning left unresolved, difficulty functioning. Quality of life benefits, unclear. Long term benefits, uncertain still if if we're talking about childhood.

Prescribing. Side effects of putting for many, for some, for most, teenagers in particular. Intrinsic barriers to access. We just heard about them from Henry. So lots of reasons why we need to carry on doing science to find out new treatments. And the translational approach, the scientific approach, offers a rational approach in doing this because if you can find the cause of the condition, then you can target it with new treatments that you can develop. So the goal of the science is translational. It's to find the cause so that you can target it. That's what it's been in the neuronormative model. However, despite the incredible scientific progress we've made on this journey within that disorder paradigm.

I say classical disorder paradigm, we appear further from our destination of translatable science than we did thirty years ago when I started doing it. That seems a paradox. I think that's a paradox. Easily resolved. The science has told us how complex ADHD is. You know, that... That's the truth of it. We thought it was quite simple. We probably thought it was a couple of genes, maybe one brain system. We're gonna easily find a way to to intervene, a nonpharmacological way to intervene, for instance, or even new pharmacological ways. It's not turned out like that. I'm gonna explain why. So there's been this block in translational science despite the brilliant scientists, the great studies, and the wonderful.

Findings that... You know, the impactful findings that we've had, impactful in scientific terms. All those whatever it was, 90,000 citations, they're not worth anything, to be honest. I've haven't been honest, unless they can help people with ADHD. And have they? I'm not sure. So I did... I I said this as much, and some of you might have seen this New York Times article. It was quite controversial. I think at the time, I got a bit of a kickback and... But I I tried to tell the truth as I saw it as a scientist. And I said, I've invested thirty five years of my life to identify the cause of ADHD, and somehow we seem further away, etcetera, etcetera, than when we started. So.

It was really... I suppose it was very personal about my science perhaps. Maybe other people's science has been more impactful in in terms of developing new treatments, but I've not really seen it, to be honest. So how do we break this block? You know, this block of this scientific block. Well, lots of people come up with lots of reasons. People I think recognize that there's this lack of translation. At least when I say it, I don't get... You know, people people acknowledge it's true. They say, well, we need better technology, better brain scanning, better genetic, you know, assessments, whatever. Probably true. We we need getting bigger data. Yeah. More data because everybody wants more data. Probably true.

Improving better, you know, better science, improving the reproducibility of our science, the quality of our science, removing the biases from our science. Almost certainly true. But I'm more interested now where I've got to in my career rather than kind of fiddling around with these things, which I kinda see a little bit fiddling around, and it sounds a bit silly, but it's... Maybe we need to look at it in a different way. Maybe we need to look at ADHD in a different way if we're going to make progress to development of interventions. Yeah. So in science, we call looking at things in a particular way a paradigm. So.

That's the first sort of technical term I've used. It's got, actually, a philosophical term, but it's not hard to... It's really not hard to understand what it what it means. And the guy who come up with the idea was Thomas Kuhn, very famous philosopher from The States. He introduced the concept of the paradigm and the paradigm shift, which I'm gonna come on to in a minute. And he saw the paradigm, like, as a framework of work of assumptions about the nature of what's being studied. In our case, ADHD. What is that framework of assumptions that's underpinned our science? Now these assumptions, they might be implicit, but they're essential for science. Because, of course, we don't.

Share an understanding of the thing we're studying. We can't actually communicate about it. We can't have a common focus for our inquiry. So they're essential, but they also constrain what we do. They limit the theories that we develop. They focus where we look, where we where we sort of point our our gaze as scientists, how we measure what we are interested in, the methods, and also interpret our findings. They're they're central to all of all of that. So they're necessary, but they've also got important... They bring important limitations to the process. Now it's very clear that the disorder paradigm, that is the neuro... The neuronormative paradigm that I talked about at the first, the 99.99% paradigm.

Is what structured our science. That's our paradigm in ADHD research for the last well, since we started doing it seriously in the nineteen seventies, I suppose. Nineteen eighties, speeded up a bit in the nineteen eighties and nineties. But, yeah, I'd say in the last thirty, forty years, it's been our paradigm. What is it? What are those assumptions that underpin it? I call it the classical disorder paradigm, and it's really the idea that we can see in most of the writings of most of the great ADHD scientists is that congenital vulnerabilities cause distinctive, discrete, intrinsic brain dysfunction within... So this... We don't really need the word intrinsic. Sorry. Within the... Dysfunction within the brain that's.

Within particular brain systems. It's not just a general impact across the brain. There are particular brain systems implicated that manifest specifically as ADHD in a way that differs from those systems in other conditions like autism, like depression, like like normality, let's say. Again, using that neuronormative framing. And this is expressed as impairment. It doesn't have the impact of creating impairment. It's it's almost implicit in the concept of disorder. Impairment is the expression of the dysfunction. It's almost completely circular, actually, if you think about it. If you've got impairment, then you have dysfunction. If you don't have impairment, you don't have dysfunction even if you have the symptoms.

Which is a... I've always thought that was a strange weakness of the of the the model. So that's the kind of paradigm that we've structured our research. And, of course, you know, in terms of, as I said, it determines what you've... Where your gaze lands as a scientist, and the gaze lands here on the dysfunction within the brain systems and their expression as symptoms and impairment. So that's what's really been our focus for the last ex... Of course, also the underlying congenital genetic factors that drive, but it's very much focused on that. In terms of interventions, translational aspects of it, the logic's so clear, and I've already kind of mentioned it. Target the brain, and, of course, that's what methylphenidate does.

More or less effectively depending on different people and so forth. But in general, efficacy and trials, reduce the disorder, symptoms, and resolve the impairment. That's that's the model. That's our core model. And, of course, everybody will know Russell Barkley, the brilliant, brilliant... Really the founding scientist. One of the founding scientists in the ADHD field, wonderful mentor in many ways, and leader for the field. And his model, of course, was classic disorder model. It was that ADHD is uncalled underlying by executive function Deficits, which everybody with ADHD has, that's then expressed in a range of cognitive.

Alterations within the brain. This leads to the symptoms. This creates the impairment or is expressed as the impairment, just to be really clear. So, you know, that... That's kind of a really... You know, very precise mind. He he identified this, and it's a perfect expression and a great example for me in this talk. But Kuhn also came up with the notion of the paradigm shift. So before that, the idea was that paradox science was kinda linear, and it just... Just kinda got more and more knowledge over time as you did your kind of experiments and so forth and tested your hypotheses. Some were found to be supported and some not, and you moved on. But Coombs was brilliant in terms of his insight. He said it was a nonlinear process.

And that normal science, which is kinda what we've been doing in the disorder paradigm, is punctuated by periods of crisis, which then lead to change. So the replacement of one paradigm by another. So it's not like just adding a little bit of evidence or information or knowledge. It's like saying we need to look at the world in a different way because this this paradigm is just not producing. So that to me, when I started thinking about this, is like, that really bad. Is that where we are with ADHD? Do we have that model crisis in ADHD given that everything that I've sort of suggested already? Well, there are two reasons why the paradigm shifts. There's two basis to the crisis in translational science are what we're doing. And.

One of them is what you might call scientific credibility. Data profoundly in... Is is profoundly irreconcilable with those assumptions that I talked about. Secondly, it's not doing the business in terms of new treatments. So we can say very easily that the disorder paradigm is being challenged scientifically. I mean, it's an it's an inconvenient truth because it really challenges many of the things we're comfortable thinking about. It's clearly a continuum and not a category, and it's one of many overlapping continuum that underpin other conditions and disorders. Those boundaries are are not as specific as we used to think. In fact, there may be no boundaries at all.

In terms of a d... Between ADHD and normality. Look. It's truly a continuum. At least in our research, we we can't find evidence of of of discrete cut points in terms of underlying biology, for instance. And secondly, it's very heterogeneous. Multiple pathways within multiple brain circuits with different individuals, different ones of us having different brain circuits implicated. They're called heterogeneity. So the idea that it's a single classical disorder, discrete and distinctive, doesn't... Isn't supported by the science. Inconvenient truth.

Does that constitute a crisis in our science? I don't know if we need to resolve that, really. Even if it's not a formal crisis in a... In in Koon sense, we can say that it's at least an opportunity to reflect on the best way forward. So in terms of interventions, we have developed some based on our science. We got cognitive training. Some of you might have tried it. We got neurofeedback. Some of you might have tried that. The difficulty is that when we, the European ADHD guidelines group, have done systematic reviews, really rigorous, the evidence suggests they don't actually work, unfortunately. And there's been some really good trials now.

That are very good, well controlled and so forth. And so they might work at the individual level, we're not saying that, but at a group level in the way that medication works, these these don't seem to work on core ADHD symptoms. So what do we do? Is this a crisis? As I say, if not, we've got... We still got a choice. Do we want to stick with the neuro... Let's call it a neo disorder paradigm that's taking account of all those... That science that we've developed, or do we wanna twist, like in '21, and shift to a different paradigm? Now I think both of these options are tenable, but... So it's a kind of strategic decision for each scientist what they wanna do. And it's kind of very, very practical, down to earth decision.

Each one of us has only got a certain number of years left to make an impact on ADHD people's lives, and so deciding which way you wanna go is kinda crucial when when you get to a certain stage of your career. Let's put it that way. So, you know, you want the most tractable. You want the most potentially impactful way of doing science. And so in my own choice, I kind of... I'm... Probably carry on with quite a lot of the the the kind of neuronormative frame science, but, you know, I wanna explore different options. So so what option should we explore? And this is where Restart really came in and and changed my view of of things or at least often... Offered an alternative to this putative crisis in in my thinking, least, in the field.

Restart is regulating emotions and strengthening adolescent resilience, and it was part of a big investment by the UKRI. That's the British government funding body. I think was 38,000,000 or something like that for seven programs. We were one of them. We were very fortunate to get the funding, and our focus was on mental health in ADHD and autism in adolescence. Why it's occurring and what can we do to help? And so we went in with a very much neuronormative view, and that is that ADHD people are vulnerable to depression and anxiety because they can't regulate their emotions. And you can see that's very clearly framed within that neuronormative disorder dysfunction impairment sort of not paradigm. But.

The saving grace here, at least the real inspiration here, actually came from the funders because they said, we're not gonna give you the money unless you actually do two other things. First of all, we gotta be multidisciplinary, and they didn't mean to bring a psychologist, psychiatrist together. They meant art, humanities, sociology, etcetera, as well as science. And that's what I did. I I put a great I put a great multidisciplinary team together. They also said, you've got to have youth participating in meaningful ways in your study.

And I was like, oh, yeah. Sure. You always say that, but, you know, we just get... We just ask ask a few people a few questions about some of the questionnaires or something. But my colleagues, my multidisciplinary colleagues, they had a long tradition of authentic participation in their research, and they explained to me that actually the benefits of that can bring. So we then, in folk motivated by these multidisciplinary youth participation, we kind of created what I like to think of as a a band of neurodiverse adventurer scientists. I like... You can see I like a bit of drama and poetry. But the... And together, we were... We would try and forge a new translational science of neurodivergence.

From the neurodiversity perspective, and that was their suggestion because I didn't really know what neurodiversity was. I'd never heard of it. I was very much in the traditional frame... Framing of ADHD. And so I thought, that's interesting. Let's have a look at that. And so what is neurodiversity? Well, of course, it's a sort of human rights, very humane way of thinking about ADHD, you might just say. Rights based approach or movement. Promote the dignity and value of people with ADHD, the empowerment of their empowerment, the self esteem, the removal of stigma, etcetera, etcetera. But I noticed... When I read read a bit about it, I noticed, interestingly, it was also underpinned by some of these assumptions about the nature of ADHD.

And you remember, they're essential for a paradigm, but they were very different from the assumptions that I've been working with that I just described. What were they? So let's think about that. Moving from the disorder model on the left... Is it left hand side to you? I suppose it... We're the same, aren't we? So you're looking... No. We're the left hand side to me. And then we flip to this neurodiversity paradigm, and you can see it's very different. So we don't assume it's the brain's disordered. We assume it's atypical when we're thinking from this perspective. We don't think about disordered actions and symptoms. We think about neurodivergent, and we think about different ways of acting and being.

And when we think about impairment, we don't think about it as an expression of underlying dysfunction. We think about it as a product of a misalignment between that atypicality that we have and the environments with which we have to inhabit or deal with or manage or navigate or whatever you want to call it. So it's... You can see it starting to frame a very different science. So that's the first answer to the question. I think it can... This this flip can give us a very interesting science, and I'm hoping that it'll be more productive than the the slog through genes and brains. Not saying that that's not important. We should carry on with that. I'm just saying that this could deliver within my time frame.

Something really, really important for for ADHD people. So, yeah, you can see it switches the focus of the science from the the core dysfunction to that interplay between the person and their environment. Doesn't mean you ignore the person, the neuro... The neuro atypicality, the neurodivergence. It doesn't mean you... But it it means you certainly include a focus on the way that the environment modulates that. In terms of the second thing switching... Sorry. The second thing switching to this or flipping to this neurodiversity perspective is it gives a much more, and you might even say, optimistic view about outcomes. Because dysfunction isn't expressed as impairment within this model. Impairment.

Comes out of that interplay between the environment. So positive outcomes as well as negative outcomes can arise out of that that atypicality that ADHD people have interplay... Interacting with those environments. And you can see we've gone from an arc of deterioration in the prior slide to an arc of flourishing in this slide. So it's the first time I've mentioned flourishing. So not just the removal of the negative, but the actual genuine promotion of the positive developmental growth, not just removal of ADHD and its consequences. So, again, you can see it's it's it's challenging. It's radical, but I do think it's an interesting alternative to the standard. So the other way it changes the science, both what we do and and how we do it.

Is the neurodiversity movement strongly aligned to what what might be called a phenomenological view of science or phenomenological view of knowledge and how it's developed. And it places people as active and conscious subjects building meaning. We're building meaning from our experiences as we grow, maybe consciously, but also unconsciously over time. And so, clearly, that pushes us to study how we interpret our experiences and how that shapes how we think about ourselves in broad terms. So bringing these two things together, first of all, the focus on the environment and the interplay between the atypical individual and the environment and this process of meaning making developed a a model of of.

Flourishing or deterioration and flourishing that hopefully captures where the science will focus. On the one hand, we've got the arc of deterioration that within neuro, what I've called here is a bit of a word, a word teller, but what neurodivergent undermining environments, negative and destructive. It's extreme, but I'm going to the extremes to illustrate the difference. But extreme, but not impossible. Certain experiences can be very tough. That means, obviously, the expression of that environment is criticism, rejection, and so forth. That then is interpreted by the ADHD person when they're thinking, who am I? Am I trusted? Am I valued? Am I accepted? Through a process.

And that leads to what I've argued is the emergence of two aspects of the self. One is what I call the existential fracture, and that is really about how you feel about yourself, your value, and so forth. The other is emotional vulnerability, and that's how you feel in terms of your emotional life. And that creates a sense of... Oh, can create. Familiar as I am probably to that sense of self hatred and emotional burden that you carry as a neurodivergent person. On the other hand, flipping the environment, you can create an arc of flourishing. And you can think about those environments. Maybe they're rare, but they shouldn't be as neurodivergent nurturant environments, positive and constructive, creating this sense of.

Existential coherence about yourself and your worth and your validation and emotional... What I call emotional equilibrium. So the power within the environment in the light of the interaction with the ADHD person's character or nature, whatever you wanna call it, within the model, one can shift from the deterioration arc to the flourishing arc with the right environments. Now, obviously, early on, if we can create those environments from the earliest days with preemptive interventions, that's gonna be more powerful and it's gonna be more tractable. Obviously, many people have had lifetimes of undermining environments, and that's more of a therapeutic, I suppose, challenge in many ways.

But I think at at least recognizing the goal and the possibilities starts to motivate the search for interventions. So I've only got a few minutes left, I've noticed. This is very typical of me. Sorry. Anyway, so you can see that these two arcs... And they're, as I say, they're expressed as extremes just to illustrate the the the the potential power of the environment within this harp... This is a working hypothesis. This isn't a fact. Although many of the aspects, of course, within those emergent self, we know features of ADHD... Can be features of ADHD people and so forth. It also changes as well as changing what we study, which is what I've just talked about. That's how our working hypothesis we're gonna investigate, it it also changes.

How we study. And this is the bit that Henry talked about, and that's bringing the neurodivergent people right into the heart of the study as co investigators, not as advisers. And that's what we did in this paper that we published in the British Columbia Psychiatry, and we got the paper of the year award, which we were pretty chuffed about. Probably, I shouldn't show off, but I'm showing off for the restars, not just for for me. And the key part of this procedure was, in fact, setting up the youth researcher panel. These are young autistic and ADHD people who became crucial advisers... Sorry, crucial participants in the research, crucial investigators. And we can see we can see their contributions.

In terms of new hypotheses, in particular what I'm gonna talk about, new methods that we develop together, new interpretations of the data, and a key role in implementation and dissemination. I mean, it's it's... I've never been in a study that's been so brilliantly disseminated, particularly by a youth researcher panel. But Restart, of course, focused on depression. So all our model, we... Restart was really focused on emotional vulnerabilities, destructive experiences, not the positive experiences, negative reactions, and emotional burden. So what did we focus on very quickly? Out of that collaboration with the youth researcher panel, we identified after interviewing lots interviewing lots and lots of, neurodivergent teenagers.

ADHD and autistic teenagers, that it didn't look like emotional dysregulation. That is the inability to main... To regulate our emotions was the key. It was the fact we were exposed to twice as many upsetting events in the classroom. Yeah. We call those common upsetting events. They were twice as likely in the ADHD and the autistic kids as in the neurotypical kids. And interestingly, we reacted twice as strongly to those in different ways in autism and ADHD, but the intensity of emotional response was twice as much. And we together caught that emotional burden. And we developed the hypothesis that neurodivergent kids or or adolescents are at risk from... For depression and anxiety because of this high level of emotional burden they carry.

This is a study we developed to questionnaire called the messy, very happy to distribute it, it's free to use, where we explore these common upsetting events. And there you can see on the graph on the left that we had twice the level of upsetting events in the autistic kids, in the ADHD kids, and in the kids with both autism and ADHD diagnoses. And crucially, that did predict anxiety and depression. So what are we going forward? I've got two minutes to tell you how we're going forward. But, anyway, obviously, what we wanna do is we want to extend Restart from looking only at the negative experiences and only looking at the emotional vulnerabilities to extend that to looking at the existential aspects of self and.

Promoting the positive aspects. So a more thoroughgoing exploration of flourishing. And we're gonna look at a particular period because it's very important in in in studies and intervention to try and identify hotspots, sweet spots within development where it'd be most effective to intervene in critical periods. And so we're very interested to promote authentic flourishing in ADHD and autistic people, transitioning between primary and secondary school. That's what we call them in in The UK. I'm not quite sure in everywhere else, but, you know, when you're about 11, going from that small school to that big school. And we know that this transition represents a massive challenge to and test of neurodivergent.

Flourishing. It's a period they really... Kids really struggle, but it also represents an opportunity to intervene, to promote flourishing in a way that can create benefits across development. And so that's gonna be our focus. Promoting flourishing by, first of all, understanding, better understanding it and the role of the environment and how young people can navigate that environment more effectively, but then applying it to this transition so that we can... Our our benefits can resonate across people's development. So I think I'm just about... Wow. That's not bad. About on time. Sorry. So I think the time is right to explore alternative paradigms for ADHD translational science that can bring new.

Spelling mistake. First, that's my first spelling mistake, can bring new ideas and a greater real world dividend to our research or even some real world dividend to our research. The neurodiversity paradigm represents one potentially fruitful alternative. I'm convinced of that now. Refocusing inquiry on the way individuals build meaning out of experience to drive either an arc of deterioration, the negative side, or flipping that to an arc of flourishing. And at school transitions, actually, of course, the primary to the... Sorry. The.

Preschool to school transition might even be more important, but it's much harder to research and to develop interventions for. I I mean, my recollections of going into primary school, the first time we had to sit still, I mean, an absolute nightmare. So I've got kind of these flashbulb memories of the trauma that that that that brings. So that might even be more important than later on in that set primary to secondary school, but I think that's more tractable in terms of research and intervention. So we're really gonna focus on that. Thank you very, very much for this chance to talk to you all about these new ideas.

Thank you, Edmund. And just absolutely... Yeah. Absolutely. Well, very, very interesting. And thank you again for opening the conference. Now we've got quite a few questions. We've overrun, but we'd like... We're taking the blame on that one because you obviously did a... Yeah. You did a job. Good. So, yeah, it's just technology unraveled the presentation. The... We've had a few questions. So for those who... On globaladhd.com, you can put questions to our speakers. You can then upvote them. We don't have a downvote button. We're positive only for flourishing reasons. Self worth. Yeah. We've had 30 questions. We're not going to do them. I'm going pick with the top three. Okay. And the first one is it feels like it hits home for me a bit.

Is it too late for those of us who were diagnosed in our forties? Gosh. Can you build self compassion as an adult or is it mostly set in childhood? Which obviously risks very well off what you just said around school So.

I think they're both open questions, actually, you know, whether you can build it through preemptive intervention. We don't know that. You know? We don't know how it is that those structures might be so, I don't know why, immovable that... And people's attitudes might be so cast in stone that you can't move move that. But I do agree that that's probably more easy to do than with people who've had that lifetime of bashing away at their at their core sense of self. And I can and I can sympathize with it. But the... There are therapeutic approaches that that we're exploring, taking a very... I suppose you'd say a humanistic approach to get people.

To kinda dig deep into their sense of of self. I'm not a... By the way, I never said this, and I always say, I'm not a clinician, but I'm working with two very interesting humanistic therapists to develop an intervention. It's not available just yet, but it very much aligns with this flourishing notion and the the need to kinda recast your your sense of self. I'm not saying it's simple, and I'm not saying it's easy because it always comes back to haunt you. Or even if you're terribly vulnerable, one is terribly vulnerable to them scars no matter how how you do, for sure.

Yeah. The...

But I can... What I can do actually, if it's okay with you, Henry... I mean, if it's possible, we... Because actually, mentioned this in a chat... In a in a paragraph in that paper I talked about, the flourishing paper, I talk about what do we do with our adults who've had this whole lifetime of being battered down. So we've got a paragraph on that, and that points to some papers. So that that... I could circulate it if you That'd be great. We'll put it on the page. Yeah. Yeah. It's it's accepted for publication now. Be very kind. Yeah. I promise.

The people who are next that Oh, sorry. Too much. I'll do a really short answer. History tells me that we've gotta be... Yeah. But I've I've also now said we're doing three questions, and I don't want to be a liar. Well, could compromise one more. Well, let's do them quickly, because I'm gonna do them reverse order just because it seems like relevant. So I'm recently diagnosed. I'm age 46 and female. My child is currently being assessed. I find myself not wanting to tell people due to the eye rolling, the judgment, and others jump... And others saying that I'm jumping on the bandwagon. I'm eager to fight for my daughter, but not myself.

There's such limited evidence to support my daughter's very real sensory needs at school immediately make her feel defiant as opposed to her feelings being really real and always asking for medical evidence. What can you advise?

Well, I think it's hard to make... Give individual advice, but we really need... And I'm hoping out of the the review that Peter's leading, I had a little role in it. I know he need... Other people have had a little role in it for talking. We need to rethink this absolute requirement and for... I know you talked about the symptoms and so forth previously, Henry, but I think a needs based approach is so much more beneficial.

Particularly in the context. I'm guessing the school is a big issue here. It's usually an issue, and I hear this so often. Nobody takes me seriously. Nobody tries to adapt or adjust the classroom for my for my child, etcetera, etcetera. I'm just talking to the kids as well. You get the same the same feeling. So in a way, it's a structural problem. It's Yeah. The team can put in adjustments without a diagnosis, but they always Well, you you need... So... Exactly. But the problem is it's a it's a catch 22 situation. Unless we kind of release our grip on the disorder concept, nobody's gonna do that because they're gonna be driven by that disorder notion. So it's really... It's a real catch 22.

And so And our and our next segment is is actually about when people have essentially come forward and they're wrong. They don't have ADHD. And and then they need to work out what to do next to understand themselves. And.

It's an important point, you know, that that... It really is. But also it's very important to know and and I'm absolutely convinced now, it is actually part of mainly... So a lot of our research has shown it. It really is a condition of thresholds.

And so when you say you've not got the disorder, what you mean is you haven't met the thresholds. It doesn't mean you don't have needs. Recently, I just had to put my blood pressure in for... I take ADHD medication. I think... They need blood pressure. And, obviously, that actually is... Again, it's a threshold value based on medical views. I'm gonna push to our last question.

Sorry. How can we be more helpful? You'd be great.

It's been wonderful. I've to do that next. How can we raise our value in the workplace to flourish? As a teacher, I get positive feedback from my teaching, and in particular, the support and progress of individual students. My inability to consistently complete admin and not challenge not challenge the norm always appear to hold greater value in a mainstream secondary school. Yes. Yes.

Well, you know, I think again, there's a structure. I just... I don't mean to laugh. I I I... Because I I understand the situation. You know, admin is not a great strength for people... Of ADHD people. But the the school might be hard to flourish when they're hammering you saying you're failing at this. Admin, but you're doing the job. But, again, again, that's an issue for... In a way, I know it's kind of not addressing the particular individual needs, but it's really... If schools want to promote great teachers, then they've got to support... I mean, this is exactly what I'm saying essentially. There are so many skills. There are so many aspects of our... Of the of our character that are so beneficial to where we are.

That without that adaptation, helping to... So simple adaptation in the workplace would be to help people with their admin... Admin. It would be so simple, and it would allow flourishing. Not not because that's a distraction, but because it's such a burden to people with ADHD. Anyways, so I I I.

.. On three... All three questions, I've not actually been very helpful. No. Well, it's been interesting. You've been you've been candid and wonderful, you've presented your research and understanding and put it out there, is fantastic. And I thank you for opening the conference. Thank you for all you're doing. And really, you know, very grateful. Thank you. And we'll post those things that we just talked about. Yeah, sure. Great pleasure. Thanks very much, Henry. Well, you. It's absolutely our pleasure. I'm gonna see if we can do this. This may or may not create an applause. I don't think that...

Heartfelt.

Okay. Edmund, you've been amazing. Thank you so much. It was a pleasure. Say goodbye. Thank you very much. Cheers.