Producer:  And welcome back to Full Prefrontal, where we are exposing the mysteries of executive function. I am here as always with our host, Sucheta Kamath. Good morning, Sucheta, I’m looking forward to today’s conversation.

Sucheta:  Good morning, Todd. I’m so happy to be with you and I can’t wait for us to get started with this Big Picture episode.

Producer:  Yes, so special edition of Big Picture. This is our fifth episode in this Big Picture series, so let’s dive into it. I think today we’re going to spend some time talking about ADHD. I’m guessing that that’s a psychiatric condition. I mean, I’m curious to better understand that so let’s dive into it. Honestly, before we begin, I’ve heard this referred to as ADD or ADHD. Does it really matter?

Sucheta:  Yes. So, I’m so excited to talk about this topic because it is quite disturbing and troubling and the consequences are quite evident as well as life-long. Officially, the term is ADHD and not ADD. ADD is a more informal way of referring to ADHD. It has been coined since 1986, if I’m correct, and it’s Attention Deficit and Hyperactivity Disorder. But what’s so interesting, that the term has been around or the condition of course or our acknowledgement of this condition has been around since 1902, I suppose, and all the way until ‘80s but it underwent a lot of name-change, so to speak. People used to call it many, many things and finally we all settled as a culture particularly in the field of psychiatry with that particular diagnosis. And yes, it’s also not just a psychiatric condition as defined by DSM but it is a genetic one too. Is a specific and a finite correlation or well-identified correlation to genetics being a problem. In fact, my readings says, and I may not be 100% accurate, but that almost 25 genes have been identified that correlate to ADHD and the genetic psychologist even used the term “Hunter-gatherer gene” that means this idea of being highly alert and quite engaged in change signal has been present and that’s what made people successful hunters. They were not eaten by a tiger because they actually quickly switch their attention to multiple scenarios.

So yeah, another interesting thing that is almost 11% of the world’s population is now identified with ADHD. So, it is a condition alright and a serious one.

Producer:  11% of the world’s population. That’s over 1 in 10 people on this planet have ADHD.

Sucheta:  Yes.

Producer:  I mean, that’ a big deal. So, thinking further about this, imagine this condition was troublesome in 1700s, right? I’m thinking about someone suffering from that today with how glued we are to our cell phones and how social media and so much other noise out there has obviously commoditized our attention. So, we’re all grappling but certainly someone with ADHD is grappling with real diminished focus. I mean, that’s got to exacerbate this issue. So, walk us through how someone with ADHD, how do they look and feel different?

Sucheta:  Yeah, you point out such a brilliant observation that to pay attention itself is so hard, and then add cell phones and social media and technology and then we are basket case. So, I think what makes sense is before we talk about ADHD, why don’t we dive deep into the concept of attention? You know, attention, almost the way casually people use makes you believe that you should be able to do this thing called “pay attention” but it’s really not that easy.

Neuroscientists have identified that we have two systems in the brain — an autopilot or the default mode network and second one is called “task positive network.” So, let’s think a little about this from when did we begin to understand this? So, if we go back in end of 19th century, psychologist William James described attention. He says that attention is “the taking possession by the mind in clear and vivid form of one out of what seems to be several simultaneously possible objects or trains of thoughts, localization, concentration of consciousness are of its essence.” And what a beautifully defined definition of attention, and again, thinking that it was done by William James, the father of psychology.

So, as you see, there are few things that can capture attention that is “taking possession by the mind” and one out of seemingly several simultaneous possible inputs. And so that decision-making is what these two systems very much allow us to do.

So, neuroscientist Amishi Jha, she says that evolution has devised a solution to tackle the problem of information overload, and that is the attentional system. So, when we get overloaded with attention, the attention filter acts as a switchboard and you move between this thing 1 which is autopilot mode and thing 1 which is the task-positive network. So, “attention leads, the rest of the brain follows,” she says but attention is not a good leader because what we pay attention to is decided by attention but it leads the rest of the brain astray. So, many people have great insights into the role of attention and information processing or even big picture thinking.

Psychologist and author Alexandra Horowitz says that “attention is an intentional unapologetic discriminator.” It asks what is relevant right now and gears us up to notice only that. So, yes, so when we talk about ADHD with that lens, ADHD does not allow that intentional and unapologetic discrimination and it doesn’t really know exactly how to decipher the relevant from the irrelevant.

If you allow me to continue to dive deeper with these two attentional systems, paying attention is nothing but switching between these two systems by using an internal mechanism called “stop and go system.” So, we have to literally say “stop” to information that seems to invade our brain’s attention and derail it and we have to say “stop” to it and we have to say “yes” to things that really matter for a goal pursuit. So, by engaging task-positive network, we are actually getting things done and often in my field, we call that “executive control.” Is this all making sense, Todd?

Producer:  Absolutely. Before you go on, what’s the difference between someone like me who just because I’m using a smartphone or I’m distracted by social media or what have you, I lose focus versus someone who’s actually diagnosed with ADHD? I mean, what’s the fundamental difference?

Sucheta:  Yes, so the fundamental difference is that the inability versus disability is what we’re going to talk about. So, just to kind of continue to bring this idea that imagine if you are in a bus. It’s going to be hard to imagine because nobody takes buses these days but if you’re in a bus and you are looking at your phone and you have a stop where you need to get off, intermittently, you need to look up and kind of scan the context and see how far you are from the stop and then you can go back to phone of yours. So, the daydreaming system in the brain kind of allows the brain to wander, the mind to wander, and then you zoom in to focus, and that’s what paying attention with vigilance is all about.

So, with that in mind, the ADHD, it’s a myth to think that ADHD is deficit in attention only. What often gets ignored is the range of behaviors that kind of define ADHD and they’re marked by inconsistencies. They include things like procrastination or delaying a start of something new or getting even started with something but not finishing, leaving things incomplete, being disruptive, interrupting others, and being insensitive to others’ needs because you’re not paying attention to what’s going on around you. So, the driving force to not paying attention is the problem with impulse control. That impulse control also causes a lot of social faux pas.

And so, there are a lot characteristics that experts define and even DSM which is kind of a Bible that psychiatric disorders are diagnosed with. So, the American Psychiatrics Association list symptoms of ADHD which again they include making careless mistakes in schoolwork or on activities, having a hard time sustaining attention in tasks or even play, having difficulty organizing tasks and activities.

This reminds me of a story. A client of mine shared in the X Files episode that her son was at a bar mitzvah and lots of things were happening around him and he however was on his gameboy. So, finding activities in plays boring sometimes or not engaging enough, or particularly in the sea of social world where you have to insert yourself and engage having to figure out what to say, how to say, who to talk to, how to follow multiple conversations or how to follow a thread of thought requires management of attention.

So, going back to this question that you were asking — what are some of the characteristics of ADHD — they include these symptoms of inattention or symptoms of hyperactivity, and the hyperactivity symptoms often include fidgeting, squirming in your chair, or moving your chair around. In adults, you can see it if you go to a meeting, there’s always one or two people who are just rotating there in their chairs or their leg is moving or they’re tapping their pens. It’s inability to stay seated. Or such children when they’re younger, they are climbing things or doing inappropriate things such as closing and opening doors or trying to explore things or taking things apart when it’s not the right time or right place, and interrupting others or talking excessively. So, this kind of hyperactivity and inattention are the signs of ADHD.

And there’s a third type which is the mixed ADHD which means you have some of these and some of that but these kinds of symptoms are quite evident when you’re younger and they become less and less evident but they demonstrate themselves in academic contest and that often comes out as interrupting the teacher or asking too many questions on a topic, not letting the teacher lead or keep up with the flow of teaching, or taking too many, hogging too many turns. When the teacher breaks the kids up into smaller groups and ask them to work out on a book report, there’s one kid who wants to take the lead or has too many questions or too many suggestions for other people.

Producer:  I’ve heard you talk before about how you liked Russell Barkley’s model of ADHD and where he describes ADHD as an executive function disorder. So, what’s your take on that, please?

Sucheta:  Yeah, and you know, we had Russell on our show and he is a wonderful researcher and really a champion of helping clinicians understand ADHD. And what I love about the model he talks about, that he describes ADHD as more like a disorder of intention rather than a disorder of attention. So, the way to think about this, it’s not knowing how and what but it’s mainly when and where. So, to get things done, you need to have an intention and you need to follow up with that intention until it’s completely achieved, and that’s when I think people lose track of that. In a frenzy of calling it ADD or ADHD, people often overlook the core deficits of inability to manage themselves and achieving goals that they set for self.

So, Barkley says that the problem is not with the what and how but more like when and where. So, as we have discussed on many, many episodes with many experts, that symptoms of executive dysfunction include the dysfunction with following up with intention and they interfere with all major activities of life sparing nothing. It affects schoolwork, work if you have a job, relationships, long-term financial planning, the quality of life, following up with health goals, financial saving, and even criminality or avoiding criminality.

So, ADHD affects everything. If you let me elaborate on this, Todd, let’s talk about executive function problems and ADHD from Russell Barkley’s model. He describes top 5 inabilities, and the first one is inability to control impulses or stop and think before acting. So, it’s what I want to say or do must be related to what I want to achieve for myself. And as I‘m achieving whatever it is for myself, I must be mindful of people wanting to do the same. So, the impulse control comes into play becoming aware and keeping tabs of other people like you are right now allowing me to speak and you are literally engaged in impulse control and you are inhibiting your impulse to say something, and thank you for that by the way.

Producer:  Oh, trust me, I have a thousand questions I want to ask. It’s requiring a lot of skill to keep quiet.

Sucheta:  Yes, and I appreciate that. And the second thing he talks about is this inability to visualize the future and particularly this capacity to engage visual working memory allows you to imagine the executionary sequence, that what does that executionary sequence look like? What am I going to do next? What is the entire sequence?

So, I like to describe this to people that we have a video camera in our brain that allows us to see a movie of our future execution and the detailed the scenes are, better the ideas we have regarding how to get things done.

The third inability he talks about is inability to engage in self-directed talk or often called as using your mind’s voice or self-talk. And what is that? That’s a verbal working memory and this is a particular aspect of executive process that is impaired in ADHD that they are not able to redirect self with that self-talk. So, let’s say if I’m by myself and I’m trying to solve a very complex problem or trying to figure out taxes, I’m using self-talk to figure out, okay, so I thought I needed to look up this particular thing. Well, what does quickbook say? So when I do these kinds of mumblings to myself, I’m actually helping myself stay on task but I’m also kind of being the instructor for self. So, I am the doer with an instructor embedded in myself. And this is a very profound ability and matures as children go from their younger years elementary school through middle and high school because that self-talk can really allow yourself to navigate complex journey of completing task.

The fourth inability he talks about is inability to regulate emotions and intensity of response that you feel towards these situations where the emotions are lit up. So what is regulating emotions? Regulating emotions is to have certain feelings about difficulties and certain emotions about challenges and anticipation of failures and a discomfort that you feel about having failed. And once you feel these kinds of emotions, it can paralyze you or it can make you get angry or upset or irritable or there’s something called “affective coloring” that means an instant incident that happened two hours ago continues to interfere with my current situation because I’m still thinking about it. So, that affective coloring that psychologists talk about is something letting go that thing that happened two hours ago so successfully you can engage in new situation. But this is really, really hard for people with ADHD.

And finally, the inability to plan and problem solve for self. So, again, the word “self” is what Barkley uses which I love is — how do I direct my attention to my problems that I am facing? So, if I am late, that’s a problem for me. What am I going to do about not being late? I have not completed assignments. That’s me. What am I going to do about in the future not doing that so that I get zeros on my homework? That’s self-directed problem solving is a capacity that allows you to accomplish goals for the future and become and stay successful, but that’s a real challenge for people with ADHD.

I rambled on here a little bit, Todd, but did I make sense as to what this all means?

Producer:  Yeah, it made a lot of sense. I work with a fellow who’s on my road crew and I think he does have ADHD but this third inability, the inability to engage in self-talk, he obviously knows that he needs to engage in self-talk to accomplish what he needs to accomplish but he has to do it out loud. It’s actually quite funny because he’s talking to himself. Now, half the time I think he’s talking to me and so I say, “What do you need me to do?” He’s like, “No, no, no, I’m talking to myself, bear with me.” But he has to do that self-talk out loud for it to actually register and for him to accomplish what he needs to accomplish. It’s quite fascinating to watch.

Sucheta:  And you know, you’re pointing out something really interesting because it is not supposed to be done out loud. So, the self-talk is a quiet self-talk. It’s a self-directed speech but it’s internalized. So you are making a reference to something about failure to internalize that speech comes out as outwardly speaking as you are thinking, and that is a kind of thinking difficulty. I don’t know fully without knowing this young man whether it’s a sign of ADHD but a lot of ADHD people need that externalized. In fact, a lot of them get in trouble because they talk while taking exams or they’re talking as they’re doing assignments in the class when everybody needs the quiet place that will facilitate thinking and these are the kids who are talking out loud as they’re thinking.

Producer:  I’ll be darned. I’ll have to talk to him about that. Alright, well moving on, so gosh, thinking about and frankly being quite proud of our growing body of work on this show, we’ve talked to all kinds of psychologists and psychiatrists and cognitive scientists, multiple educators and obviously speech and language pathologists, they all have a specific take on ADHD. So, walk us through who officially diagnoses ADHD and what does that process involve?

Sucheta:  What a great question, Todd, fabulous question. And again, I want listeners to be mindful, I ain’t a psychologist or a psychiatrist, and I am not officially in charge of diagnosing people with ADHD. I’m not qualified. I’m a speech and language pathologist. What I’m able to do is I’m able to qualify and quantify functional limitations of people with ADHD and design a treatment plan for them to address their executive dysfunction. So with that in mind, there’s one thing that’s clear about children or adults with ADHD is that to get to that diagnosis, you need a thorough assessment. Sooner the diagnosis made, the better it is for actions to be taken and receiving a good advice as to why things are difficult and kind of solving the mysteries of “Is it me?” or “What’s wrong with me?” kind of giving some language to that.

So, before I answer who actually does it, let me kind of talk to you quickly about what the process is. But the most professionals agree that there are three important steps involved. The step 1, I would say, is to take a stock of symptoms and then analyze them. So, before you even administer a test, you need to kind of understand the description as to what is it that is hard for you. Many professionals use rating scales which are nothing but well-researched symptom checklists, and answers to these questions on the checklist are not answered simply by the person who is, let’s say, trying to get the diagnosis of ADHD because self-raters are not always reliable. Many checklists have multiple raters, that means an observer’s perspective on the symptoms is really incredibly valuable. There are checklist or symptom rating scales such as Brief, Vanderbilt, etc. Of course, they are administered by a psychologist or some occasions, neurobehavioral pediatricians or psychiatrists will in their practices. And so you gather the symptoms and often what I find in my work is a very thorough history. History is really, really important.

The second component is to figure out the differential diagnosis, and that’s what psychiatrists can do that. By the way, only psychiatrists can prescribe medicine, and medication we’ll tackle in a little bit but it’s a critical element of managing ADHD. You need something called “differential diagnosis.” Is there anything else that’s going wrong that’s causing these symptoms? Take example that a child who’s having significant sleep issues or child who’s experiencing a lot of sleep deprivation because there is no particular structure in the household. The child has access to smartphone in his bed and parents go to bed sooner than he does and he is watching shows until 3:00 a.m. and then next day he’s groggy and not waking up and he’s cranky. So, lot of times when we are sleep-deprived, the symptoms look like you have ADHD. And I’m not saying that sleep is not — we’ll talk about that in a second — but sleep problem can coexist with ADHD as well but that’s another issue. Sometimes there may be the child is anxious or depressed and is not really a true ADHD but it’s anxiety disorder, and this worrying about, hyper-focusing on a task, unwilling to let go a task may appear like a intense stubbornness or something but the reason could be something else. There could be a death or even divorce, change in family structure that may be causing a lot of stress which is causing symptoms of inattention or just kind of dreaminess or checked-outness that people may notice in the child. So, it’s really critical to look at the history and see if there’s anything else that is causing this and not the true ADHD.

And the third step experts recommend is to look at the comorbid conditions. ADHD is known to have comorbidity and sorry to use a technical word but that means it doesn’t occur in isolation. There are some other things that coexist with ADHD such as in some cases oppositional defined disorder or in some cases OCD which is obsessive-compulsive disorder or sometimes anxiety, and sometimes anxiety coexists because of ADHD symptoms which is not understanding why am I having so many struggles when other people seem to be doing just fine? So, as I made this clear that there are specific steps that one needs to take and there are more formal tests such as neuropsychological tests that actually do the IQ assessment, intellectual assessment and certain sensitive tests that point out the patterns in learning as well as executive function, that gives a clear picture of the psychological profile and behavioral relationship, and that’s done by psychologists.

So, psychiatrists and psychologists are the most fitted experts who will make the diagnosis.

Producer:  Got it, alright. Well, thank you for clarifying that. So, gosh, a lot going through my head right now. I’m still trying to process this notion that 11% of the global population —

Sucheta:  Don’t quote me on it. That’s what I last read so I could be wrong.

Producer:  Well, it sounds right to me but it leads me to wonder this thought — because of so many people, myself included, worrying about our lack of focus sometimes and our ability to get things done, are we over-diagnosing ADHD? Are we under-diagnosing ADHD? I’m just wondering about that. And then with all these complaints out there about lack of focus or poor time management, I mean, any words of caution when it comes to investigating some of these complaints?

Sucheta:  Yeah, and again, I want to warn you and our listeners that I’m not an expert in the way psychiatrists and psychologists would be diagnosing ADHD but my experience comes from having worked with people with ADHD for 20 years, that diagnosing doesn’t really mean slapping a label or giving somebody drugs and in that sense because the first line of defense or so to speak, intervention, seems to be recommendation of medicine a lot of times people feel people are over-prescribed. But there’s a very specific logic that goes into it and things that experts are thinking about is — does the child and adult meet the criteria? ADHD is not diagnosed on a whim or somebody goes there’s not drawing of blood and you determine ADHD but it is a thorough assessment of behavioral presentation, symptom assessment, history-taking, and implications to life.

So, people have to meet 5-6 criteria out of 9 symptoms that are presented and the symptoms must persist in multiple context. It is not adequate to say, “Well, when the child is doing this, he’s having a problem so he must have ADHD,” no, no, no. It should be translatable to many context and observable by many, many people who are functioning in those contexts. So, a teacher should be noticing it, a parent should be noticing it, and tutor should notice it or dance teacher should notice it. There’s this kind of that quality of consistency is very, very important, and there may be possibility that some symptoms are exaggerated in some context and not the other but these symptoms also must have persisted over a long time.

So as I was explaining earlier, if a family is going through divorce, the children having incredible amount of distress and uncertainty because who are they going to live with, are parents ever going to talk to each other, and what’s going to happen to me, the child may lose sleep over it, child maybe lose interest in studies, and that child symptom of that inattention or disinterest in academics may go away once the parents’ divorce becomes final and the parents have now a good agreement and the child knows that he has a room in dad’s apartment while he still has a room in mom’s house. So, these symptoms don’t just vanish when the trigger vanishes.

So, knowing that about ADHD diagnosis, I don’t think the ADHD diagnosis is happening rampantly. What may appear to and we have heard this, Todd, and you have been with me when I’ve interviewed my clients that it was in the common practice to have these labels for children 20 years ago, 30 years ago, 40 years ago. We just called them “different.” And so we are actually taking care of people’s struggles in a more careful way and we are paying attention to the description with which the child presents and runs into problems in learning, and that’s why the diagnosis seems to be happening more so like appropriate way but more often because we have greater knowledge. At least that’s my take on things.

Producer:  Yeah, and it’s interesting, as you know I’m a student of history and so I read a lot of history books and they talk about the youth of a lot of these famous people that you read about and it was obvious that these individuals had ADHD. They didn’t call it that then, they did call them an odd individual, and unique. So, it’s funny to see how history treats these individuals. So I guess, in closing, two final obvious questions to address with you is obviously — when managing ADHD, I mean, are there any important treatment considerations that we should be thinking about? And then I guess the final question — for someone who’s diagnosed with ADHD, I mean, is there any hope?

Sucheta:  Of course, I mean, wow, we wouldn’t be having this conversation if there was no hope. I mean, first of all, I think it’s a human condition to be resilient and so ADHD folks are some of those individuals who are innovators, artists, performers, and they have created something sensational and extraordinary. So yes, their minds may be wired differently but their capacity to influence the world is just the same for those without ADHD. So yes, I bring a message of hope for everybody.

So, there are few things that we can do as a collective society, of course, just to change our view about ADHD. Barkley calls ADHD as diabetes of psychiatry and I really agree. What he means by that, that we need to consider this as a serious element requiring treatment, otherwise, having some dire consequence, you know. We need to remember that it’s a genetic condition. It is not something that is under conscious control for a person to not have ADHD, so that’s a misnomer. Because if you define ADHD as having difficulty with attention, then a colloquial wisdom may say that it is easy for you to control your attention — no, it’s not. And it is particularly very difficult for those with ADHD problem and they don’t have just problem with attention, they have problems with executive function.

We also need to remember that people with ADHD are not lazy. This is another big perpetuating myth. It really, really makes me upset when I hear an educator or parent describe their child to be lazy. Lazy implies that you are intentionally desiring to sabotage your life’s success and I haven’t meant a single human being who wants to destroy their life because they are lazy — no. Not having enough activation to engage, not having enough motivation to sustain effort, and not having enough wisdom to know why mundane things matter is something I’ve see with ADHD, and that may be misinterpreted as laziness.

Another thing I want people to remember before we talk about road to hope is that people don’t outgrow ADHD but they may mature in a way that their symptoms become less intrusive and the support that they need maybe much more different in nature but yes, ADHD needs treatment just like diabetes needs treatment. And you would never dare to tell a diabetic, “Why don’t you just get over it?” or “Why don’t you suck up your sugar levels?” We don’t say that to them, right?

Producer:  Right.

Sucheta:  So in closing, what I want to say, that there’s a combined treatment approach that one must consider when dealing with ADHD — medication, medication, medication. I often get in my practice, the first question is, “Do I really need to medicate?” And I use this example, “If your child was unable to see, would you say, ‘Do I really need to get him glasses?’” I said, “Where did you come to this agreement with yourself that glasses are essential?” It is a matter of taboo, isn’t it? So, I think there is some internal framework or some internal thought process that makes people believe that needing medication is somehow a shameful thing and I do not believe that. I feel it is a neuropsychiatric condition. The biology of the brain with ADHD is such that it is not producing certain chemicals that we need to intercept but helping the brain by introducing those chemicals. So, if it’s a neurogenetic disorder, it does certainly need a neurogenetic intervention, so let’s do it.

Secondly, no ADHD treatment is complete with medication. I often use this analogy that imagine you live on the 5th floor in a New York City apartment and you do groceries a block away but you have bought these 5 bags of groceries and you’re walking up the stair, imagine — ADHD is like having very poorly constructed bags and the simple fact of climbing up, the bags tears and all the stuff falls out. So by the time you reach your apartment, you have barely one bag of groceries left. So, similarly, information processing lens says that information doesn’t reach the brain because half of it is lost in inattention. So, medication is installing an elevator in that building so from 1st floor, you go straight to the 5th floor, so at least you are successful in bringing the information or the grocery bags as my analogy goes into the apartment. What medication does not do is it does not teach you how to organize your pantry versus the refrigerator. You still need discernment or executive function skills to know that the ice cream bars go into the freezer, dry pasta goes in the pantry, and kale goes into the crisper in the fridge. So that discernment is executive function. So that is not remediated by medication. For that, you need three approaches — one is behavioral therapy, emotional counseling, and practical support.

My work lies in these three areas, so CBT has been proven to be extremely effective that a lot of successful CBT training approaches because ADHD is a chronic condition that’s why practical support is essential. Changing the environment when the ADHD person functions is very critical. You cannot really tell the person to “wake up on your own” without an alarm. No, use an alarm prolifically. Use wall calendars. Why don’t you set timers? Why don’t you use texts to remind oneself or remind your children? So yes, providing support is an integral part of integrating practical strategies but the true essence in my opinion is developing strategic thinking and that should have a central focus of meta-cognition.

In one of my Big Pictures, I’m going to soon talk about meta-cognition. But what meta-cognitive approach with ADHD is devising strategies with self-awareness. Let’s make children self-aware. Let’s make people aware of their deficits so they know why they need to use strategies. Often when strategies are brought to a person with ADHD, it is somebody else’s idea and it may not sit well with the independent-minded ADHD person. They may reject it thinking that you are stifling my creativity or my individuality and that’s when this explanation of the logic of I and how needs to be explained and instilled with people with ADHD in order for them to succeed in their lives.

Producer:  Alright. Wow, Sucheta, an awful lot of really amazing stuff to think about. Thank you for sharing all of this. I thought I knew a bit about ADHD. You really clarified some things today so thank you for that. Alright, that’s all the time we have for today. If you know of someone how might benefit from listening to today’s Big Picture episode, we would be grateful if you would forward it to them. So, on behalf our host, Sucheta Kamath and all of us at Cerebral Matters, thank you for tuning in and listening today, and we look forward to seeing you again right here next week on Full PreFrontal.