William Curb: Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig in the tools, tactics, and best practices to help you work with your ADHD brain. Hey team, this week I'm talking with Dr. Maggie Sibley, a clinical psychologist and professor at the University of Washington School of Medicine. Dr. Sibley has spent over two decades studying ADHD and is author or co-author of over 120 research papers on the topic. She is also the author of Parent-Team Therapy for Executive Function Deficits and ADHD, Building Skills and Motivation. And so recently, when I was working on the newsletter for the show, I came across an article about ADHD titled, Study Describes Fluctuations, Remissions Seen with ADHD, and I felt that was like something that was worth more investigating.
While doing my due diligence and reading through the paper that was linked in the article, I got to thinking, hey, I'd love to ask some more questions about the findings in this paper. And then it dawned on me, hey, I can just reach out to the author of the paper for a conversation on the show. And so that's what today's show is all about. We dig into that paper titled, Characteristics and Predictors of Fluctuating Attention Deficit Hyperactivity Disorder in the Multimodal Treatment of ADHD, MTA Study. Yeah, I know that's a mouthful, but it looks into how symptoms fluctuate based on a review of that Multimodal Treatment of ADHD study.
That's the MTA study that is a very large, well-respected study. So we talk about how ADHD symptoms don't just disappear, but they actually tend to fluctuate and to a much greater degree than many researchers expected. We also dive into why having more going on to your life might actually make your ADHD symptoms less severe or how that could just be one interpretation of the results here, how motivation works for us and what it means to find your own secret sweet spot of structure. Plus, we get a little into the upcoming diagnostic guidelines for adult ADHD from the American Professional Society of ADHD and related disorders. So yeah, a lot in this episode and it's definitely one you don't want to miss if you really enjoy the science side of things, but it's really excessively their way, so I really hope you enjoy it. I know I had a great time with this conversation. If you'd like to follow along on the show notes page, you can find that at hackingyouradhd.com.
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It's called Climbing the Walls. It's a six-part series that investigates why women with ADHD have gone under-diagnosed for so long and how that changed dramatically during the pandemic with the diagnosis of ADHD and women skyrocketed. I've listened to the first five episodes and I'm itching to hear the six one once that comes out. This series has been a ton of fun to listen to as host Daniel Elliott explores these questions around women and ADHD and how the picture that's been painted around this topic so far isn't quite what it seems. The show asks why women, why now and how under-diagnosis has impacted women's mental health.
As I've listened to this series, it's also gone beyond those questions and is really digging into what's going on with women and ADHD. This series has gotten me thinking about how these topics are currently being handled and even how I might want to address them on my podcast in the future. It's a fun listen and if you enjoy investigative type podcasts, definitely check this one out. To listen to climbing the walls, search for climbing the walls in your podcast app. That's climbing the walls. All right, keep on listening to find out how your ADHD symptoms can fluctuate throughout your life.
All right, so so happy to have you here because the study that I had run into was this characteristics and predictors of fluctuating attention deficit hyperactivity disorder in the multimodal treatment of ADHD study. Do you think you could give the audience a little bit more insight into what that study was about?
Maggie Sibley: There was a study in the 1990s of kids with ADHD. They were at the time enrolled in six sites in North America with the intention of understanding whether these kids responded best to medication treatment, behavioral treatments, or a combination of them. That study went on for about three years and they concluded that all of the treatment strategies in the long term worked about the same.
And then they entered this period of, wait a sec, we've got this really well characterized group of kids who are starting to grow up. What if we just keep following them for over a decade longer, even though we're not answering that question about the treatments anymore, just to see what is it like for kids with ADHD as they grow up? And so this study, which is the long name as you said is the multimodal treatment study of ADHD or we call it the MTA study. This is one that people would have learned about in their psych 101 courses in college. It's sort of like the ADHD study.
And as those kids grew up, every two years we would bring them back into the clinic and have them fill out questionnaires about their life, get interviewed, their parents would come in, their teachers would fill out forms and we learned a lot of rich information about them. So our study basically reports back on what happened to those kids between age eight and essentially their late twenties with assessments every two years about the stability of their ADHD over time. When they formed this study back in the nineties, people believed you grew up and you grew out of your ADHD.
That was the way we thought about it, you know, back pretty much 30 years ago now. At this point, though, as we started to follow the kids and there have been more studies that are longitudinal like this, we know that's not true. But there are still some interesting unanswered questions about how does ADHD flux and change over time related to if somebody does seem to well manage their symptoms and be doing better, is that a permanent state or do people go in and out of that? Are there some people that just seem to have their ADHD disappear?
Is that even a possibility? So that's what we wanted to answer in this study. And essentially what we found was that there were different trajectories of ADHD depending on who you were. And so the study you're talking about goes into a little bit about what those trajectories were, who tended to have them and what were factors that would influence if ADHD went up and down in people.
William Curb: What kind of fluctuations did you find?
Maggie Sibley: I first went into this interested in the main question of is it really possible to completely eliminate your ADHD? Because there are a lot of research studies that suggests that that's true, but it just doesn't match what we see when we're walking around in the world talking to people with ADHD. I'm a clinician, I'm a psychologist. I see people with ADHD for hours every day. So there's like a little head scratch there. What is that about?
So at first we pursued that and we did find about 9% of this sample of kids did seem to have their ADHD eliminated at least until their 20s. It's kind of surprising to me that there are even people like that, but that seems to be possible for at least a small amount of people. But what we did not realize was the case was that the majority of the sample, so about 68% of the sample, showed prominent ups and downs in their ADHD over the years between the time they were eight and in their late 20s.
On average, the folks who sort of showed this fluctuating trajectory, they fluctuated about three to four times in about 16 years. So they had a few years where things were pretty stable for them and then a few years where their ADHD was exacerbated and it would go back and forth like that. So that was the surprise finding was that it was that many people that had that much instability in their ADHD. Now, after that, talking to people with ADHD, a lot of them look back and say that does fit my experiences, but the scientific community was not thinking like that previously. So now it's opened up this very interesting conversation.
William Curb: The lived experience versus clinical experience is a very interesting dynamic to explore because they're both important to understand because while I typically am more on the lived experience side of things, I always know like, oh, but just because that's how I experience things doesn't mean that's how everyone experiences things. And it can be hard to get my head around sometimes. I'm like, well, I don't have that issue. Oh, yeah, that's something that other people deal with.
So I think that's important for people to keep in mind that, yeah, your own lived experience doesn't match everything else. I have had tons of times where I'm like, my ADHD doesn't even feel like an issue. And then today I have had not a great day so far. Trying to get myself to do things. I'm like, oh, I'm just I'm like, and so for me, I was like, oh, I'm going to just have to dial back and be like, OK, what are the important things? Like I have this interview at one.
That's what I have to make sure I'm ready to do. And what I remember reading in this paper about the study was that the one of the surprising things people found or what you guys found was that when people had more stuff in their life, they tended to be doing a lot better with their symptoms.
Maggie Sibley: Exactly. That was another surprise. So we were really interested in this idea that I think just like popular wisdom suggests that the more you have on your plate, maybe the more overburdened your executive functions are going to be, the more exacerbated your ADHD might be. That made sense to us. So we tried to pursue that possibility with some pretty fancy statistical analyses. And as it turned out, we found the opposite. So when people had more on their plate, we measured this index called life demands just so your listeners are clear on what I'm talking about.
Right. So you could get points on this scale and you get points for different things. You get points for how many hours a week you worked, how many hours a week you were in school, whether or not you were independently living outside your parents' house at this point. Remember, these are folks in their 20s for the most part, whether or not you are financially responsible for yourself and others. So a lot of our participants were starting to have kids. So whether you had dependents, you get points for the more you have going on.
The more points that somebody had at any given period in their own life, the more likely they were to have their ADHD actually be lower and more at bay. So when we found that everyone was kind of scrambling for a reason that could have happened. And I think a couple of compelling ones came out to me based on conversations I've had with people. One is the possibility that when people are doing better, they tend to take more on, which could be true. The other one that I think is very interesting is this idea that sometimes it helps people with ADHD to have a lot going on because it kind of gets you up and going and there's sort of these external contingencies on you that you have to maintain a certain level of productivity in order to keep things together.
And if we think about what we know about the neurobiology of ADHD, it comes down a lot of it to our rewards responding. And so, you know, if there are consequences in the environment that are important to the person, that will be more likely to activate the person to get things done and behave in ways that are helpful to themself. Then if there are not things in the environment that are motivating you. And so there is like a piece to that that actually makes sense, I think, with the neurobiology of ADHD. I personally think there's probably a U shaped curve.
So this idea of a sweet spot, right, where too much too little on the demand side. We somehow in this study picked up on one side of that curve and not the other. I'd be interested in seeing other researchers look at other data sets and see what it looks like for them. Because I don't think one study closes the story, but I do think it was interesting that we found the unexpected side of that curve.
William Curb: Yeah, I mean, it's reminding me of I remember at the beginning of the pandemic when people were having all these new demands on them. I knew a lot of my ADHD friends were thriving. They were like, I can do all of this. I know how to survive in this environment. And then six months in, they all crashed because they're like, I've been doing this too long and I can't do anything now. I mean, and that's an interesting also to like, oh, yeah, that's you're having these fluctuations you can do very well. And then at certain points, not as well.
Maggie Sibley: Yeah, that's right.
William Curb: Because I know personally, if I have nothing going on, it's really hard to activate myself. But in day to day aspects, like, oh, if I have a lot of stuff to do that day, I will get a lot done. But I hadn't really thought about that in terms of like the macro of like, oh, this is like, I have a lot of stuff in my life versus like very like day to day is more of how I was thinking. Like, oh, yeah, I am good in a semi emergency, not really big ones, probably not medium ones, I'm OK.
Maggie Sibley: It's probably the case, but also hard to study and research that there's both going on. Right. You have sort of the macro level, like over the years, which years did you seem to be, you know, doing better than other years? And then also on the micro level, day to day, you know, are there certain things that can be going on in your environment that day that can just give you a worse day than another day? I think both are probably true. And it's interesting to sort of visualize what that might look like, you know, the ups and downs for a person that are kind of like peaks and troughs in a wave over the years. But then also underneath it, sort of a more rapidly up and down piece of ADHD that's happening from day to day or week to week.
William Curb: While I was joking with one of my other ADHD parent friends, like having kids was the ultimate productivity hack for me because I get so much more done because I was adapt or die in that situation. Like, I have to learn just learn how to be focused when I need to be focused for certain things doesn't always work. But in general, I'm like, oh, yeah, I have also like the enforced structure of getting kids to school and doing all that stuff has been great for just ADHD management.
Maggie Sibley: You're not the first person I've heard say that. So that's really interesting. Yeah, it's like when there's a scarcity of time, sometimes, you know, it feels urgent. And so people get it together, you know, get more done. And it may be easier to navigate sort of like the procrastination thoughts that come up for people in a situation where you don't have an option. You just have to do it.
William Curb: Yeah. And I think there's a lot to be said that yet we have this kind of interest based nervous system and, urgency is very interesting.
Maggie Sibley: Sense of urgency is a key for sort of like mastering your own self motivation. If you have ADHD, like, can you impose a sense of urgency on yourself when there's not necessarily a real one going on just because you know it'll help you gradually approach a task or do something at a better pace than waiting till the last minute. I think that's right.
William Curb: One of the things that I always try to remind people in the podcast is like, it's not laziness. Why we're not getting things done often time because I also will have trouble playing video games or I'm like, Oh, I have this an hour. I can play this game. And then I'm like, the hour goes by and I didn't do any. I'm like, Oh, how did that happen? And it feels like, Oh, that that's not like laziness or be that's just me having trouble getting the executive function up to do that thing that I supposedly want to do.
Maggie Sibley: Yeah. There's a lot of pieces to it. One analogy that I've used a lot working with folks is like, if you have ADHD, the motivation systems, you know, they're multifaceted. If you like, think about it like you think about a car, right? If your car's not running, it's not like, okay, the engine's dead. You pick up the hood of the car and there's a number of different explanations that can be happening. And you try to diagnose what it is. But really, you need all of those pieces to work together well in order for someone to appear on the outside, like they're motivated or in this case. You know, appearing that the car would be running correctly. So and it also takes a multi-pronged approach, I would say, because of that to really optimize your motivation if you have ADHD.
William Curb: And this is one of the interesting things I thought about when I was reading this day is like one of the recommendations was to like, Oh, yeah, I keep this in mind to try and repeat those good things that were going on in your life when they were going on. And I had a little bit of a disconnect there just because I'm like, oftentimes I will try and repeat those things, but they don't have the same novelty anymore. And I'll be like, Oh, no.
Maggie Sibley: But that's exactly right. Now novelty is the thing that you can identify that you need, right? And so it may be that you just have to zoom out a little bit, but that pattern is there. So, you know, yes, like I need certain things, but the things I need are actually variable. You've probably heard other people say the same thing, but I love how people say if you have ADHD, learn to write your own owner's manual. Because what you have to do is essentially notice the patterns of what works well for you and just try to leverage those factors when you can in your life in order to just live your healthiest version of yourself, essentially.
William Curb: It was funny when I very, very started this podcast, I was like, I'm going to focus on all these tools and stuff. But I'm like, Oh, I need to have these like fundamental strategies to implement those tools. That's could be like, okay, I'll talk about this like very specific like app or something. But that's not helpful in the long run. I need to know the underlying method of why that's a fact helpful because I know I'm not going to just keep using this forever.
Maggie Sibley: Yeah, like really kind of doing a lot of extra work to be very insightful and know about yourself in a way that helps you sort of like crack your own code in certain ways. I think that's makes a lot of sense.
William Curb: Also thinking about this study, where do you think kind of the research should go from here? Because often I've seen like a studies build upon each other. What do you think is kind of like the future here with this understanding of these fluctuations in ADHD?
Maggie Sibley: I'm starting a round of focus groups actually Thursday, we're doing the first one with different adult ADHD support groups where we're going in. My students and I were presenting this study and we're asking people in a recorded conversation where we're going to transcribe and summarize their findings. How they interpret this in terms of their lived experiences with ADHD. Because I do think that the quantitative data and the qualitative experiences like you were alluding to earlier have to talk to each other to even kind of determine what the next steps are.
So I think that's what we're up to now is just sort of like filling in some of these holes, exactly the kinds of things you're mentioning right now. Like getting a lot of people to reflect on these questions about fluctuations and the environmental aspects that influence them. The other obvious limitation of our study is that we only followed people through their 20s. And so there is a lot to be asked about the stability of ADHD and its changing evolution in nature over time in the rest of adulthood. Because what has happened is we have all these childhood samples that were ascertained in like the 90s or the 2000s.
And then it costs a lot of money to keep collecting data from them. Usually the federal government is funding that. And most of the time once those folks got to their 20s, the funding agency said, OK, well, they're adults now, we know what happened to them. We know if they have ADHD or not, we don't need to fund this study anymore, which has left our field with like almost no really solid studies on how ADHD affects people as they enter their 30s and 40s and 50s and beyond. So I think also just really working to understand more of the life experience for a longer period of time.
William Curb: Like I have received many emails from people in their 50s, 60s, even 70s. And it is very like difficult to be like, yeah, we just don't know how ADHD really affects you in that long time. Because while we see this effects of ADHD as like this developmental delay, we kind of have this catch up. But we also don't know if we ever like truly catch up to our peers in that sense.
Maggie Sibley: Yeah, there's some really interesting research starting to come out about ADHD and a few things that have to do with the lifespan. So for one, how the hormonal transitions that women experience can actually impact their ADHD over time. And you might have talked about this previously on other episodes. But if oestrogen in particular is a neuro-modulator and kind of can turn up or down the volume on how somebody's dopaminergic functioning is going.
Then it's not surprising that whenever there are hormonal fluctuations, whether that is transitioning to menopause or transitioning through a pregnancy or even just in somebody's monthly cycle, like that ADHD can express differently for people in different periods of their life because of that. So that's one really interesting piece.
The other is, you know, there are some researchers, especially out of Brazil, that are starting to notice possible linkages between ADHD and certain forms of dementia as people get older. And is there a vulnerability there? Right. And those are really important questions for us to get to the bottom of for people and prevention strategies. And so if we don't have research on ADHD after 40, like how are we ever going to clear all that up and figure out what needs to be done about it?
William Curb: Yeah, we don't only want to have Farclay's thing talking about how we're more likely to die younger and stuff like, well, yeah, but there's many of us that don't. And we need to know how to deal with their ADHD when they're older because I mean, I think there's also there's so many different life demands at that point. Oh, that's really interesting to think about. Because we were talking about this like kids aspect. how your ADHD might be affected by those big life changes going away. Like, you know, the emptiness people with ADHD, that's got to be...
Maggie Sibley: The transition to retirement as like a whole uncharted piece that I know clinically from people I've worked with is super hard for people with ADHD because a lot of them have lived very busy professional lives as part of the, you know, energy level that they've had and then to retire and then suddenly both be coping with maybe the loss of physicality if you were somebody who was very active physically and then also the loss of a profession that kept you busy and not knowing what to replace it with. There's a lot to unpack that we are just only starting to start thinking about.
William Curb: Yeah, I think there's going to be a lot of interesting research it sounds like that, again, one is great because we don't know what we don't know. Even with the stuff we've talked about with like people talking about their lived experience, we also don't have many people in those age groups that are talking about their lived experience as much because although that is increasing as more people are getting their late diagnosis and being like, oh yeah, we have already always existed. We just didn't know we had this group in that number.
Maggie Sibley: Oh, absolutely. One of the great joys of being a researcher is like getting to connect with the people who are, you know, coming in and sharing their stories, especially the late diagnosed group because they have a very interesting pathway to where they got to today. And, you know, I think that there's a lot of uncharted territories still in understanding their experiences because one of the things that may very well need to happen in the next edition of the ADHD diagnostic criteria is to clarify that there are ADHD pathways that can appear a little bit later, even though it was always sort of there, what the factors are that might be likely to lead to that pathway.
And if we're not talking to people and hearing about what happened to them in their life, we won't be able to chart those pathways and create diagnostic criteria that can I think reassure like providers that like, hey, it's okay if the person wasn't a full-fledged case of very severe ADHD as a child, you can still diagnose it, you know, and here's what that might look like. So, yeah, there's a lot of research that needs to be done, like you say, and then that research needs to go and be translated into better standards of practice because there's a lot of providers out there that can be invalidating to people with ADHD just because they're either they don't know enough about adult ADHD or they're shy about it because they're afraid of the stigma of being a provider who maybe overprescribes or gives too lenient of diagnoses. So, there's a lot to unpack on that side too.
William Curb: Yeah, and especially with like the current political climate around ADHD stuff, I'm like, oh yeah, that's something that, yeah, you don't want to be labeled as a doctor that's just pushing everything through right now.
Maggie Sibley: People are worried about that. And adult psychiatrists historically do not receive training on ADHD in adulthood because it's sort of been allocated over to the childhood psychiatry space. And so, then with this huge demand we've had, especially post pandemic of people who are questioning if they have ADHD and want to get assessed and diagnosed and they go to an adult psychiatrist, and a lot of the adult psychiatrists don't sort of feel confident. They want to play it safe and they maybe just won't see you or they'll attribute what you're experiencing to anxiety or depression because that's what they were trained to look for instead of ADHD.
William Curb: And since those are such common co-morbidic conditions, they're probably going to find it.
Maggie Sibley: That's the trouble. Yeah, you know, a lot of times they stop looking for something else once they find one of those co-morbidities, but we do know that anxiety and depression can develop secondary to ADHD based on the experiences that you've had in life. And that's really important for people to understand that interplay.
William Curb: I think we can also jump a little bit more into the diagnostic part we were just talking about before you'd be telling me that you were the chair for the new diagnostic guidelines.
Maggie Sibley: Yeah, so there's an organization called Apsard American Professional Society for ADHD and Related Disorders that is currently drafting new diagnostic and treatment guidelines for adult ADHD. We're the only major country in the world that doesn't have adult ADHD guidelines. We only have child right now. So the guidelines are not rewriting the criteria for ADHD. They're just giving guidance to clinicians on how to implement the current criteria. Our charge is not to reconceptualize ADHD.
But we have important work that we're trying to do to help alert clinicians to folks who might go under the radar and making sure that they use the best methods to be thorough in their diagnostic assessments and understanding some antiquated practices that people still use that may be giving the wrong answers about whether people have ADHD or not. So trying to clear a lot of that up. Those guidelines should be coming out later this year. So I think that'll sort of nudge the providers who maybe don't have as much training in adult ADHD to have a solid source where they can go to and get training and kind of have clear best practices. So that's what the guidelines initiative is seeking to do.
William Curb: Yeah, it's not going to change it, but it's going to kind of like just clarify like how things look differently as adults.
Maggie Sibley: Yeah, so we have clarifying information about there about special groups that can fly under the radar and how to better help detect ADHD in those folks. We also provide guidance on what to do, for example, if somebody really seems like they have ADHD, but you're having a really hard time establishing like that childhood history guidance on what to do when somebody comes in and you can't tell the difference between if they have ADHD or if they have another condition that can mimic ADHD, like what's the best way to kind of sort through that. And believe it or not, clinicians need a ton of guidance on that. You know, I think sometimes people with ADHD seeking care, like they take for granted that their provider will be well versed in adult ADHD, but it's not true. A lot of providers really don't have that background. So this is supposed to guide that.
William Curb: Especially if the provider is basing their information on what they have from those childhood criteria, which especially with like the hyperactive impulsive side looking so much different in adults I find, whereas I'm like, oh, yeah, I have all these impulsive habits, you know, with like opening 15 tabs at once. I'm like, oh, that's an impulsive habit. That's not anything or, you know, being like having friends that are like compulsive shoppers or that kind of stuff. Oh, that's also impulsive. And that is dopamine seeking behaviors, but you never classify a child as having a shopping problem.
Maggie Sibley: I'm on the same page as you. One of the sort of projects that longer term work, that's not going to be quick that like our lab at University of Washington is doing is trying to help identify some of these more adult like manifestations of ADHD. And I've been on this path for a long time. But I think we're getting a lot more interest now in this work being done. What's tricky about it is that a lot of times, if we crowdsource novel adult ADHD symptoms, I mean, I can go onto a Reddit thread, right, and read all these ideas people have, right?
And there's some great ideas there. But a lot of them won't hold up to the test of who else says yes to these questions. So like, what if a lot of people with anxiety also say yes to that question, that's not going to help us tell the difference between ADHD and anxiety. So one from our paper we did like 15 years ago was I think has trouble staying motivated when the task is very boring. Turns out like 45% of people say yes to that. So it doesn't help us diagnose ADHD. So that's what we're interested in is sort of like crowdsourcing all these ideas.
I love the browser one, that's beautiful, those kinds of ideas crowdsourcing them from people, and then putting them to the test, where we sort of compare what extent of people with ADHD endorse these experiences, to what extent to other groups, endorse these experiences. Is it specific to certain demographic characteristics within ADHD? If we can map all that out and get a better sense, then we can make good recommendations for the next diagnostic criteria about like, hey, here's some some solid symptoms that you might want to consider, including for adults. So that would be like the long game, essentially.
William Curb: The number of co-morbid conditions and then like, yeah, like the ADHD subreddit has like a million people on it. So like, if you say like, this is one thing, they're going to get so many positive responses to it. Even if it's just, oh yeah, there's a lot of people that also have anxiety here, or depression, or autism, or OCD, or whatever it is.
Maggie Sibley: Exactly. So that's super important work. Other people are doing it too. To your listeners, anyone can get involved in our stuff. So if you're interested in partnering with us, if you want to tell us about your symptoms, just Google me, you know, go to my website, MargaretSibley.com and express interests. So always trying to get out the word about that.
William Curb: I know I started this podcast with my light diagnosis and then eventually taking care of my ADHD and being like, oh, I want to provide more resources. And I know so many other people have been emailing me like, hey, what can I do? And I'm like, not much for me, but there's I'm sure there's a lot of people out there that could use help.
Maggie Sibley: So yeah, that's great that you have like an invested community of people. I think that's really important for folks with ADHD to like just kind of finding that community and sharing ideas with each other. It's critical.
William Curb: Yeah, I think that's one of the things that has often helped me the most is knowing that I'm not alone in my symptoms. This is why I think having a diagnosis is so important is because often, before that diagnosis, everyone's self-talk is just like, oh, I'm just kind of broken. And it's like, oh, no, there's there's a reason behind all of this. Even if you don't have a diagnosis, there is a reason behind what's going on. No one's just a broken person.
Maggie Sibley: Yeah, I think you're right. Like basically, the purpose of diagnosis, one of the main purposes is just, you know, getting an understanding and explanation for what's happening. And some people want to first do that formally. And some people feel like they have what they need just by recognizing what they're learning about, you know, online or in talking with other people. And if you feel like you need treatment or you need external supports, go get an evaluation and really try to understand exactly what would be the best supports for you. Because I do think there's a lot of effective treatments that we have now for adults with ADHD. And it's not just medication. So there's a lot of different ways that people can connect either through formal or informal supports to get the help that they need.
William Curb: Yeah, one of the other supports that I thought was really interesting was reading about your STAND program, which I know is for teens. First, could you just say a little bit about that?
Maggie Sibley: So you all now know I'm a psychologist and I started in this field about 20 years ago. At that time, we were just sort of opening our eyes to the fact that ADHD persisted past 12 and that we would need to have treatments that were different for people who were past 12 than we might have when they were children. And we're not even really getting into adult ADHD at that point. We're just trying to make a case for we should treat teenagers differently. And that's where I sort of got on this path of like trying to develop ideas for how to help people with ADHD as they got older through the lifespan. So this is a family-based approach that was actually my dissertation originally.
And we've gotten a lot of National Institute of Mental Health funding over the years to really build it out and do it with communities. But what's key here is it's basically a cognitive behavioral approach where we're teaching strategies to people to try to help them in different domains of their life with teenagers, it's mostly like with their family members and academically, we teach a lot of kind of organization skills, etc. But the piece that's unique here is the integration of this therapeutic tool called motivational interviewing, which some of your listeners maybe have heard about.
But essentially, what this is is it's a process of self exploration that you help the person you're working with go through so that they can decide what they want to learn for their own reasons. So they can kind of figure out what their own goals are and that you're just sort of a guide to help them figure out what they need. Instead of this sort of like traditional top down approach, which was the way behavior therapy for ADHD started, which is like, you know, the clinician analyzes the person and figures out what their, you know, chief problems are and then prescribes like a treatment plan for them based on what they think they need. And this is flipping that on the head and saying like, look, we're serving you.
So what do you want help with? And especially in teenagers who often are brought in for help by their parents, not by their own like interest, you really have to sort of like make the work feel valuable to them by using these motivational approaches. So I've been like knocking on the door of anyone who works with people with ADHD saying, you know, use motivational interviewing, even prescribers, right? Because a lot of times prescribers have choices to make with the clients about how long acting the medication will be, whether the person even wants to take it to begin with and by sort of like helping people contextualise why they're doing things and what their goals are, it'll be a more collaborative and a more meaningful experience, I think, for the clients.
William Curb: Yeah. And I think motivational interviewing is such a great way to interact with teens, but just with people with ADHD in general, because having that like sense of like, oh, I can control my destiny here. And because so often it's hard to figure out exactly what you want, especially on your own. And having this process of like, oh, we're going to go back and find out what you need help with, what you really want to get out of these experiences. And I think it's something a lot of the listeners can do it to apply of like figuring out what they actually want to do. Because I know sometimes I find myself just on autopilot and I'm like, what am I even doing? This is why I'm not getting anything done is because I'm not doing anything I want to do.
Maggie Sibley: And I think for people with ADHD, the follow through can be so hard. And so really to be able to continue to have those conversations throughout the process of working with someone to help them continue to anchor back to those things that are priorities and goals for them. It helps with follow through, you know, if you're consistently keeping in the front of your mind, like, this is why I'm doing it.
And this is what I care about. And like, helping people sort of create space for reflecting on the benefits of the changes that they're making. That's helpful for people, I think, in general, but it helps with people with ADHD too. And working memory can be challenging to kind of, as a clinician, providing extra supports to help summarize like where you've come from and where you're going and help people hear their own thoughts. It's a process that seems to, I think, be really well received.
William Curb: One of the things I always feel very silly about is like being like, oh, yeah, I need to remind myself what my own goals are. Because I will forget I'll be doing something and be like, man, this goes against what I am trying to accomplish right now. And I'm just doing it because I wasn't thinking about what my overall goal was. And so it's like, I'm like, oh, I do like this is kind of like a daily habit to build in for viewing where I want to be going.
Maggie Sibley: Yeah, I like that. And that's something that I always train like providers to do is to make sure you're always checking in with people about what their goals are and whether they've changed. And if they've noticed themselves taking any steps towards those goals, either consciously or subconsciously, you know, in the last week, because if you keep that at the forefront of the conversation, I think it just helps feel like there's some order to everything that you're working on.
William Curb: I fight against having structure, but it is so important.
Maggie Sibley: Yeah, you got to find the structure that like works. And just like what you were saying before about zooming out and knowing that novelty is important to you, like some people zoom out and realize that flexible structure is important to them. So like the structure is there, but you have to be flexible with it. And sometimes I think that helps, you know, people find that sweet spot, which is the whole part of optimizing how you're doing with your ADHD is like just finding the sweet spot in anything, whether it's the structure you need versus the freedom you crave, you know, the novelty that keeps you interested versus the fact that you do need to kind of consistently follow something to make progress. And you're just always trying to find that sweet spot to keep yourself moving in the right direction.
William Curb: I was wondering if there were any final thoughts you wanted to leave the listeners with?
Maggie Sibley: Well, I think, you know, nowadays, a lot of the people I talk to are sort of questioning if they have ADHD or they know they have ADHD, but they haven't been diagnosed yet, or they feel like they're not being listened to by their providers as much as they wish they were. And so if I'm a provider coming on, I feel like I need to represent that to people and just say, you know, if you feel like you're not being listened to or you're not being heard, like don't be afraid to find a different provider, right?
Don't be afraid to kind of meet someone and find somebody that sort of feels like they get you because honestly, in order to really understand anyone, you really do need to spend time with them. So, you know, here's for advocating that we find providers that we can spend time with and that can get to know us and really help us get through the day. So, that's my message to you all from the provider side. Thank you for having me on and just keep doing what you're doing because I think this is a really great way to reach people.
William Curb: Awesome. Thank you. Earlier, you mentioned people should go to your website, MargaretSibley.com. Is there anywhere else they should go to find you online or?
Maggie Sibley: That's my like sole window to the online world, but you can send me messages through there that I always respond to via email. And also, yeah, you can learn about what studies my team is doing. And if you feel like you want to sign up for one, just give us your contact info in the sign up form and we'll reach out to you.
William Curb: Awesome. Well, it was a pleasure having you on. I think a lot of people will get a lot out of this.
Maggie Sibley: Thanks for having me.
Thanks again to Dr. Sibley for coming on the show and thank you for sticking with us all the way to the end. Before you go, though, let's do a quick rundown of today's top tips.
One, ADHD symptoms don't always follow a straight decline or improvement. Symptoms can often fluctuate, sometimes improving for years and then intensifying again. Expect waves, not a straight line. And don't blame yourself when experiencing higher than normal symptoms.
Two, when you're in a phase where ADHD feels more manageable, that's a great time to try and take on some more meaningful responsibilities like work, school or possibly parenting. With proper implementation, these can help create external structures and reinforce good patterns for when your symptoms do intensify.
Three, while having more life demands like busy schedule, work responsibility or kids can improve ADHD functioning by creating natural urgency and external motivators, it's important to make sure that it doesn't tip over and overload.
Four, not all clinicians are trained to recognize ADHD in adults, especially when childhood histories are murky. If your concerns are dismissed, it's okay and important to seek out a more knowledgeable provider. And on that note, look out for the updated diagnostic and treatment guidelines for adult ADHD from the American Professional Society for ADHD and Related Disorders.
While these guidelines won't change any of the diagnostic criteria in the DSM, they will help give clinicians clear evidence-based advice on how to apply them when evaluating ADHD in adults.
Alright, that's it. Thanks for listening. I'd love to hear what you thought of this episode. Feel free to connect with me over at hackingyouradhd.com slash contact. Or you can find me at Blue Sky at hackingyouradhd. If you'd like links or to read this out of those transcripts, you can go to the show notes page at hackingyouradhd.com slash 222. If you'd like even more Hacking Your ADHD, be sure to sign up for my newsletter, Any and All Distractions, which comes out every other week. In it, I give out my best distraction of the week, be it what I'm reading, what I'm playing, or what I'm watching. I also try to give a few bits of actionable advice in each newsletter, although your mileage is going to vary there. If that sounds like something you're interested in, head over to hackingyouradhd.com slash newsletter to sign up. I also wanted to let you know about our Patreon that I've been reworking. You can easily find that at hackingyouradhd.com slash Patreon. We're going with a pay what you want model, meaning that all levels of the Patreon will receive all the same stuff.
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And now for your moment of dad. Did you hear about that restaurant on the moon? Great food but no atmosphere.