The ADHD Diagnostic Criteria Explained Part 2 (ADHD Used To Be Brain Damage?)

You've reread the same paragraph three times and still couldn't tell anyone what it said.

Skye and Robbie return to the DSM-5 for Part 2 of their criteria breakdown, this time on criterion B: difficulty sustaining attention. They work through real examples, rereading pages, checking out of meetings, losing focus on audiobooks even at double speed, and land on why none of it happens during a good movie or video game.

The conversation distinguishes between attention that drifts because a task is boring and attention that locks in because something is stimulating, and why that distinction matters more than effort or discipline. If you've ever wondered why you can sit through eight hours of a game but not eight minutes of a report, this explains the mechanism.

What We Cover:

• Why criterion B shows up in reading, meetings, and lectures specifically
• Why audiobooks don't solve the problem, even at 2x speed
• Why games and gripping movies don't trigger the same drift
• The difference between voluntary distraction and involuntary attention loss
• Why removing stimulation (a quiet room) often backfires

 P.S. Losing work because the admin layer around your business can't keep up with you? Invisible Systems is a 90-day done-for-you sprint where I (Skye) extract the processes from your head, build the operating layer, and find the right person to run it. Six spots left at the founding price, book a call at https://www.unconventionalorganisation.com/

Transcript

SPEAKER_01 0:00

You're gonna forget the thing that you're saying. So you want to say it before you lose it. If you don't say something fast enough, you can end up in that cycle where you didn't say it, then you forgot it, then the conversation moves on. I had the worst example of this when I was in a seminar at university. I'd put my hand up to say something. And it took a little bit of time for them to give to me. And by the time they got there, I had just gone. I forgot what I was gonna say. And that was just so embarrassing as a young student. Hello everybody, and welcome to the ADHD Skills Lab. Today I am joined by my wonderful co-host founder and co-founder and husband Robert Watterson, and we are talking about the DSM. We're gonna be going through a little bit more in terms of the DSM criteria, working our way through it, seeing how much we relate to, and seeing how much you relate to. So this is a very much hopefully going to be an interactive session because we're gonna ask you guys what you relate to and what you feel you resonate with when it comes to the DSM. A little disclaimer: we are not diagnosing anyone, we are not diagnostic practitioners, but we are simply doing the research, looking at this, sort of making it more accessible for people who maybe haven't been able to get a diagnosis for some reason so that they can have a sense of what goes into the reason that they get told that they have ADHD or not. Before we get started, as you guys know, we help business owners who feel like their whole business runs through their head, they haven't been able to get delegate. The idea of hiring somebody to start taking that admin layer off them feels impossible. We help you not only understand what's going on, diagnose your bottlenecks, but we also hire for you and take care of building SOPs, building the maps, so you can just focus on your zone of genius and getting back in the business, which is what you want to do. So if you're a business owner who runs a service business, you struggle with ADHD symptoms, and you're between 500K and 2 million, we would love to hear from you. Just book the business build out at the link down below.

SPEAKER_02 2:03

We were finished with C, going back to B, often has difficulty sustaining attention in tasks or play activities.

SPEAKER_01 2:12

Attention or inattention focused criterion.

SPEAKER_02 2:15

Yeah, we're sticking to the inattentive inattention.

SPEAKER_01 2:18

So yeah, often has difficulty sustaining attention in tasks or play activities, and has difficulty remaining focused during lectures, conversations, or lengthy reading. We both resonated with this, but you had a few more examples.

SPEAKER_02 2:30

And we've just been doing examples. I forgot. We were going to talk about some of the mechanics underlying these potentially.

SPEAKER_01 2:34

So let's jump into where we're at. So we had, yeah, like you said, gone through A, done C, and now we're going through B, which is about difficulty sustaining.

SPEAKER_02 2:45

And so like checking out of meetings without necessarily deciding to. Yeah, reading the same paragraph multiple times, reading the same page. I yeah, I remember pre-audiobooks, I would have to read physical books. And the amount of times I would find that I had kept scanning the lines, and it wasn't until I got to the bottom of the page, and it was like it's a little bit more effort. I guess it sort of wakes you out of whatever you're thinking about to have to go find the top of the next page, or especially to turn the page, and you'd be like, Yeah, I didn't read two-thirds of that. I was just scanning it.

SPEAKER_01 3:17

That's one of the reasons why it's considered to be the worst way to study, because you're not really taking information in.

SPEAKER_02 3:24

Like it's you don't know if you're encoding it or not.

SPEAKER_01 3:26

Yeah, you don't know if you're encoding it. So to kind of come back to our encoding chat, like you really want to have something.

SPEAKER_02 3:32

Three separate occasions, three times each occasion.

SPEAKER_01 3:34

Exactly. We know it, you know it.

SPEAKER_02 3:36

Yeah, I was gonna jump back to audiobooks. I pretty much completely as much as possible switched to audio. Uh, it actually still had this issue. So at one time speed, I will still daydream out of an audiobook. Uh it becomes a total problem. I like because it's even harder to find the place where you started daydreaming with an audiobook. Now you're scrolling back 15 seconds, back 30 seconds, trying to figure out where you remember hearing this piece. At least with what you're reading, you can go back and to the top of wherever you are scanning from. But that problem pretty much solves at two times speed, I found. Depending on the narrator, depending on the person speaking. But if you can get to two times speed, assuming what you're listening to is interesting enough.

SPEAKER_01 4:17

Yeah, which is the assumption.

SPEAKER_02 4:18

Yeah. I'll daydream out of a good book at one time speed. I won't at two times speed. I'll listen to it the whole way through. Exception to that is when I'm listening to some sort of like AI slop to go to sleep to. And then two times speed doesn't matter because the content's just rubbish and it's just enough talking that I'm not background talking. Yeah, it's stopping me from going into my own thoughts, which are too distracting to go to sleep to. Yeah. I don't have to pay attention to it, so I can fall asleep to it.

SPEAKER_01 4:41

I think that's that's a really interesting point. And and that actually reminds me of one of the things that I hear a lot, because we talk about focus a lot, which is when people say there is no amount of nothing that you can do that will make me focus if something is boring, because my own mind, like anything is more interesting than what I'm doing. You know, you can't put me in a in a white room with no distractions and expect me to focus. I will just daydream. And that that I think is a real hallmark, particularly historically, I guess, of inattentive.

SPEAKER_02 5:16

Yeah, and it's why that sort of white prison room for like ADHD students doesn't work. It seems it's sort of counterintuitive, but no, increase the stimulation, make the thing they're doing more enjoyable through other through other means.

SPEAKER_01 5:33

Or increase the dopamine a little bit. Like I know sometimes people are like, I'm putting you closer to the teacher so that you pay attention. Do you think that would help? I that I I voluntarily sat closer to the teacher.

SPEAKER_02 5:44

I think it would help in the same way that putting a TV behind, like it I think in the same way that removing a TV from my peripheral will help me pay attention to the person I'm talking to because I want to listen to them and it's distracting me. And I think a classroom full of your peers in front of you, all fidgeting, is gonna distract from you, distract you in the same way. So I think going to the front, removing all that, putting all that distraction behind you probably does work. Yeah, it probably is helpful. It's not going to save you from just a really boring teacher, though. You're still gonna daydream out of it, but at least you don't have that distraction. So yeah, there's a difference between okay, so yeah, okay, when you're dopamine stacking an activity to make it more interesting, you don't put the TV on.

SPEAKER_01 6:21

Well, you do sometimes. Yeah.

SPEAKER_02 6:23

No, but you would ideally put music on and not have like a streamer you were watching.

SPEAKER_01 6:30

Yeah, sometimes it it really depends.

SPEAKER_02 6:32

I will say dopamine dials are very personal, so I don't like to say what you should or should not do as a distraction mechanism because some people To be fair, if you're trying to get through your accounting and you're like, okay, I'm just gonna allocate all day for this, and I am allowed to get distracted and watch a streamer half the time, then that's probably a better solution.

SPEAKER_01 6:49

There was a time in my life and a time in my business when a Twitch streamer was a big part of what I did. That's not the case anymore, but that's because I'm lucky enough to do a lot of what I love.

SPEAKER_02 6:57

Yeah, I think it's cast dependent. Apparently, baseline for this is just sort of drifting out of attention occasionally when you're tired, for instance, and then being able to pull it back. Yeah. Like or finding some things boring but pushing through. One of the good things about recording your lectures was probably that you could play back them, play them back at a faster speed as well. Now that I'm thinking about it in terms of audiobooks, because that's definitely one of the things, the problems with in-person. It's not like this is a universal thing. I'm not daydreaming while I'm playing a computer game. Like I'll play a computer game, I'll lock in for eight hours straight. The same is true for like a good movie, like an action movie. You're not daydreaming out of an action movie. That feeling of I need to interrupt you because if I don't interrupt you now, I'm not gonna be able to hold this thought until you're finished talking.

SPEAKER_01 7:36

Yeah. That's a working memory struggle. So one of the reasons that people but that's more of an interrupting, and we'll come into that later.

SPEAKER_02 7:44

Yeah, and then the flip side of that is, I guess, try holding on, trying to hold on to that thought, failing to pay attention attention to the conversation because you're trying to hold this thought so tightly and not lose it, or giving your attention back to the conversation and losing that thought and then not having the thing to add afterwards.

SPEAKER_01 7:59

Yeah, which is why when we've had conversations with a group of people who all have ADHD, we've ended up with a pad of paper in front of us and people writing things down.

SPEAKER_02 8:07

Again, kind of like with the lecture theater lecture scenario, that taking notes during the meeting, and now I haven't been paying attention to what's being said. Criterion D is often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workspace. E.G. starts tasks but quickly loses focus and is easily sidetracked.

SPEAKER_01 8:26

I literally had a chat with a client or potential client today, and that was the main focus of what we discussed. And because so often I'll ask people what's the bottleneck in your business, and they'll say me, and they'll use this as a description. Like I get started and then I get sidetracked.

SPEAKER_02 8:43

Yeah, and I think actually, interestingly, one of the I think one of the key insights about this one is it's not not necessarily intentional. So it's often about sort of unintentionally getting sidetracked.

SPEAKER_01 8:52

Robbie, can you give us some examples of criterion D? I know you have a few.

SPEAKER_02 8:57

Yeah, so I think I think the classic one of this is you're off to do one thing, you get distracted by something else you see, and then you get distracted by the next thing you see. I think the classic is sort of changing rooms and then starting a new task in each room because there's something in that room, you're like, oh, I need to do that, and you sort of go off and do that one next. I think I've seen YouTubers, for instance, talk about coming back and finding a house that is just a string of starter projects that are half complete.

SPEAKER_01 9:21

I think we've seen those those YouTube videos of people being like, I come home to my partner, and then these are all the things that's my ADHD wife. This is my ADHD wife or husband or something like that. And and yeah, I think that that is a pretty common criterion.

SPEAKER_02 9:36

I can definitely say the classic in our relationship is you asking me to grab make you some breakfast and coming back down an hour later and being like, Did you have you made breakfast? And I'm like, Oh, that's right. And it's either in the microwave, sort of half done, getting cold again, or it's I never quite got to the fridge to grab it because I came down and I saw that the packages arrived for the studio equipment or whatever. I started opening those, and then I went to the other room and realized that, oh yeah, I was gonna finish this DIY project this morning. Okay, I'm just gonna quickly do that, and then I'll get back to that, and then I'll get back to the thing I was supposed to do. But I've kind of lost track of the first one now. And yeah, you come down and I'm like, oh yeah, coffee.

SPEAKER_01 10:12

Yeah, I'm usually the thing that reminds you, which I think is quite funny. But I will say the other day, yesterday, I messaged you because I had three back-to-back meetings and I was like, Can I have a coffee, please? I was like in the in the studio upstairs, and you brought me a coffee, and I was like, Yes, because it's always about a 50-50 chance that's actually gonna happen.

SPEAKER_02 10:32

Yeah, I was gonna I was just gonna say the same thing. Like, yeah, it's about 50-50, and it generally comes down to whether or not I lie to myself and say, I'll remember to do that. I'm just gonna do this first.

SPEAKER_01 10:45

Yeah, which goes into like working memory remembering things, which we talked about in other episodes.

SPEAKER_02 10:51

One of the other recent examples I had is I've got an alarm for bins need to go out the night before, and I snoozed it once, and then it's one of a very few number of alarms, but I'll yeah, I'll snooze it, and then I'll be like, oh, okay, I'm gonna go do that now, and I'll dismiss it. And I haven't actually gone like I should, and I know, and I I 50-50 remember to do this. Even if you're off to do it now, snooze it so that when it goes off in 10 minutes time, you can dismiss it when it's done, not when you're about to go do it. Because otherwise, yeah, we spent a week with a totally full rubbish bin, and so all the rubbish was going into the recycling bin, and then I had to remember to swap it over, and yeah, just uh I don't do that now, but it's one of the reasons why instead of having I used to have like one alarm.

SPEAKER_01 11:38

You know, people are like, you just need one alarm, you wake up immediately. I used to have one alarm and then I would snooze it, but then one of the things that would happen was every now and again I would forget to snooze the one alarm I had and it wouldn't go off, and then I would obviously sleep in. So now I have multiple alarms because I can't risk the reality that I forget to snooze the alarm that I'm waking up to.

SPEAKER_02 12:03

So and then sometimes when you're really tired, you just snooze them all, and I'm just like, why are so many alarms going off? The next criterion is E often has difficulty organizing tasks and activities. So, for example, difficulty managing sequential tasks, difficulty keeping materials and belongings in order, messy, disorganized work, has poor time management, and fails to meet deadlines.

SPEAKER_01 12:25

That feels very generic. That feels like it's as a description of ADHD in general. That's interesting. I guess it I would say it's the criterion that I would almost consider to be the definition of ADHD in terms of generically. It's like if I said to you, what do you think ADHD is? you'd be like, it's struggles with organization.

SPEAKER_02 12:44

Yeah, I suppose I mean we now have combines predominantly inattentive and predominantly hyperactive. This is on the inattentive side still. So I suppose in theory, you could have hyperactive, predominantly hyperactive ADHD. And potentially not have this criterion.

SPEAKER_01 13:02

I I would be surprised if anyone doesn't get a get a high score on this one if they have ADHD of any kind.

SPEAKER_02 13:08

I can imagine it. Yeah, I'm not saying I've met them, but I I think like an archetype of sort of a lot of that impulsivity and hyperactivity, but then is still a very organized person, maybe. I don't know.

SPEAKER_01 13:17

Yeah, I mean, if you're one of those people, let us know. But yeah, I mean, uh the examples just everything, you know. Like for me, particularly right now, I would say it's databases. Like I'm working with so many clients who have like giant drop boxes, and to be fair, I have my own just full of stuff, you know. Just like I everyone thinks about physical are not disorganization, but more and more I think about digital disorganization, digital mess, because it's it's so prolific and even at a pretty organized physical space.

SPEAKER_02 13:48

The physical space has limits on I mean, unless you're sort of a hoarder's house, but like there's there's a limit to what you'll generally speak, yeah.

SPEAKER_01 13:57

There's a point at which people will tend to clean it, but the digital space does not have that limit.

SPEAKER_02 14:03

Yeah, we got to the point where the garage was barely walkable and I've sort of pulled it back again. I think the other classic example of that criterion I have is similarly to the cloud storage, all the project management systems in existence uh are currently graveyards to me, and now I'm on Notion, but there are abandoned to-do lists everywhere.

SPEAKER_01 14:23

It's actually a a struggle when I'm working with somebody who wants me to revive an abandoned space, an abandoned digital space, because there's a lot of it's quite an emotional thing to look at all of those old lists and know that they're gonna have to be let go. But at this point, I I've worked across everything. Click up Monday.

SPEAKER_02 14:44

Generally speaking, the urgent stuff resurfaces anyway. It's kind of like when you take your entire desk, put it in a box, and go, I'll come back to this if I need it, which is obviously a very common experience. Yeah. And yeah, apparently this is, I think the idea behind this one is basically organization requires a certain amount of self-regulatory scaffolding that we struggle with. And you can kind of mask it with not having kids.

SPEAKER_00 15:06

According to Marie Condo.

SPEAKER_02 15:08

More like higher intelligence, but eventually the sort of complexity of the work and your life will exceed it, and then you'll hit that breaking point, particularly relevant for business owners. I think another example is email. I'm on over 3,100 unreads.

SPEAKER_01 15:22

Inbox zero, baby. I got that EA.

SPEAKER_02 15:27

I think it's worth noting that our solution to this is basically get someone else to do it.

SPEAKER_01 15:32

Or AI, if you're that way inclined, but it's a good it's better to have a combo, to be honest.

SPEAKER_02 15:38

I did start with Menace, but yeah, I don't fully trust it to.

SPEAKER_01 15:42

I think I've I know somebody who's used Incloud Claude co-work to do this that's been having good luck, but it's only been a week. So But somebody else, not you, whether it's digital or a human person or a combination of both.

SPEAKER_02 15:54

Yeah, I started the process, but it is still time consuming if you're not happy to just archive the entire history and start fresh. Yeah, I think basically what's happening is the system, the new system feels like it's working, it's great, and then eventually the overhead builds and builds until the cost of maintaining it sort of exceeds your ability to I don't know, exceeds the dopamine of using it, I think is a little bit simplistic. It's more like exceeds the gain or the organizational benefit of using it. You're sort of spending more time maintaining it than it's actually saving you in terms of losing things. We're gonna skip the rest of inattention and jump to one last one from hyperactivity, which stood out to me, which is often blurts out answers before a question has been completed.

SPEAKER_01 16:35

This one is me.

SPEAKER_02 16:38

It's me too, though. I think actually one of the nice things about dating someone with ADHD or being married to someone with ADHD as well, is I don't think we find this as offensive because we both do it. I think it can be seen as very dismissive or impatient. But I think we both relate to it so much that yeah, anytime someone's struggling to find the word or has lost their train of thought, if the other person can see where they were going, we'll just fill it in and be like, yeah, yeah, let's keep going.

SPEAKER_01 17:07

Yeah, this one's really hard. It's a working memory struggle where basically the impulse it's impulsivity, but it's also just you're gonna forget the thing that you're saying, so you want to say it before you lose it. You know, you can end up in that if you don't say something fast enough, you can end up in that cycle where you didn't say it, then you forgot it, then the conversation moves on, now you've forgotten what you've said. And I ended up, and I was telling Robbie this before we jumped on air, I had the worst example of this when I was in a in a class seminar at university, and I put my hand up to say something, and it took a little bit of time for them to get to me. And by the time they got there, I had to just go, I forgot what I was gonna say, and put my hand back down. And that was so embarrassing as a young student, and this was not one of those, like, oh, we're all having fun, just exchanging ideas, classrooms. Like, this was a seminar where it was very important, and like they graded you partially on how you communicated and all this stuff, so it was oh, it was the worst. And I had no idea I had ADHD at that point, but I just remember being like, Yeah, I lost it. And and that for a lot of people with ADHD who are like, This is me, but I yeah, there's a reason, like that's usually the reason, and often it can be solved by writing things down, which means if you ever are in a meeting with me and you see me writing things down, like I'm using that as a working memory support for not interrupting.

SPEAKER_02 18:36

Yeah, just riffing off that. It's even more embarrassing when you're mid-explaining a story or whatever and you lose track of it right in the middle.

SPEAKER_00 18:43

That's a bit mean for the people listening to it. You're like, and uh did he get away? What was it?

SPEAKER_02 18:51

Yeah, I can't think of a good example of that, but I know I've had that happen a few times. It is particularly mortifying to be mid-story, holding especially like multiple people listening to you and realizing you sort of completely lost track of what your next very important thing that you have taken everyone's attention for.

SPEAKER_01 19:09

I really struggle with this in group settings because I'll be talking to somebody and then uh someone else will start a conversation over there, and I'll get distracted by their conversation, and then I'll be like, no, we're having a conversation, like stay in here, stay in this room, and then you try and listen to both of them at the same time. Yeah, it never works.

SPEAKER_02 19:28

So the examples from this criterion are completing people's sentences and can't wait for your turn in the conversation. And yeah, that's basically a response inhibition failure.

SPEAKER_01 19:36

Although I think again I argue it's also a working memory failure.

SPEAKER_02 19:40

Yeah, and and I would say it's also sometimes just a choice. Like, I think there is an element of yeah, like I know where you're going with this.

SPEAKER_00 19:48

Like which I guess is that is inhibition though.

SPEAKER_02 19:52

That's like I could I could exert self-control to be very polite, and instead I'm yeah, I'm curious where the line is between I couldn't help it and I didn't want to help it, is with these.

SPEAKER_01 20:06

Well, I think that's the whole conversation about ADHD, and they don't really go into that in the DSM. It's really just a diagnostic criteria. I know that for myself, I don't want to interrupt people. And I am way better than I used to be, but it's really hard. It's sort of like being a little bit uncoordinated is the best way I could explain it. Like you're doing a dance and you're trying to like do like the back and forth, but sometimes you're like, oh, sorry, and you're like accidentally.

SPEAKER_02 20:33

I don't I think there is a big component of impatience and expediency there.

unknown 20:37

Yeah.

SPEAKER_02 20:37

Like I think that we're just trying to like get things moving. Like, yeah, and I know you're going this like okay. Yeah, I think the classic sort of school example of this for studio quintessential hyperactive ADHD would be shouting out the answer rather than putting your hands up. And so constantly having that that pushback of where you put your hand up, but you're like just the polite version of that. Yeah, I would I would actually argue that that losing what you were gonna say is probably it's probably more in line with B and C that we covered last episode. That's more the working memory, sort of inattentive side of it to do with losing what you were planning on saying. Probably closer to like not listening when you're spoken to kind of thing.

SPEAKER_01 21:18

It's not referenced in the inattentive criteria.

SPEAKER_02 21:22

No, not explicitly. But I do think this one is much more about inhibition and blurting out the answer.

SPEAKER_01 21:30

Bluring out the answer. I see what you say. Yeah, okay. I agree with you, but I would argue that often blurting out, at least for me, is like a little bit of the inhibition, but it's also a bit of a working memory if I don't say it now, I'm gonna forget it thing. Which I just don't think they're covering in the DSM. I just don't think it comes into it.

SPEAKER_02 21:53

There are some other great ones, like also often talks excessively.

SPEAKER_01 21:57

Well, tell us what your favorites are. Like the nerdiest thing ever. What is your favorite criteria in the DSM? So we've gone through the DSM.

SPEAKER_02 22:05

I think we got six out of 18. Third of the way. That's a good effort.

SPEAKER_01 22:10

It's pretty good. It's very long. We wanted to touch on the ones that we most relate to.

SPEAKER_02 22:15

We're going to skip the rest. Feel free to request them, but we thought it was going to take too long to get through all of them in one big go. And we want to get onto strengths and weaknesses and a bunch of interesting papers on genetics. So I was going to go through in more detail, but let's just speed run the things the DSM doesn't sort of yet cover. You kind of touched on it with um things you thought we're missing there.

SPEAKER_01 22:37

So they don't cover RSD. So rejection sensitivity dysphoria is more of a sort of colloquial thing. Emotional dysregulation, they do cover a little bit. The fact that they do not cover time blindness blows my mind because of how we found research on time blindness and how how important a factor it is for ADHD.

SPEAKER_02 23:00

Yeah, I will say it comes up in criterion E that we just covered poor time management and fails to meet deadlines. So it comes up to as a part of it's not missing completely, but I mean I guess it's a discussion around Yeah, criterion E in attention, poor time management.

SPEAKER_01 23:17

So fails to meet deadlines. Well they do cover it.

SPEAKER_02 23:20

Yeah, I mean that's sort of one of the many examples off the back of has difficulty organizing tasks and activities. So yeah, it's not that it's not covered completely, but it is a little bit it doesn't have its own criterion, I guess I would say.

SPEAKER_01 23:32

Yeah, yeah, which is, you know, it's it's a big part of when people come to me for struggles. It's like working memory, time blindness, transition times. Impulsivity doesn't really feature as much as you would expect, given how much how important it is in the DSM itself.

SPEAKER_02 23:49

It's often forgetful in daily activities, doing chores, running errands. You could maybe argue that that one is often forgetful, but like that's working memory, that's not really time blindness. And then hyperactivity fidgets, leaves the seat, runs about, climbs, unable to play or engage, is often on the go, talks successfully, blurts out answers, difficulty waiting his or her turn, and interrupts others. So yeah, no. So I mean, aside from sort of a brief mention, it it doesn't feature as prominently as you would expect.

SPEAKER_01 24:18

Especially when you look at the research where there are is a lot of stuff around time estimation, time reproduction, all of these different elements of time blindness itself.

SPEAKER_02 24:28

Okay, just uh and sleep dysregulation again, I think we've discovered highly correlated with ADHD.

SPEAKER_01 24:34

Yeah, it didn't get discussed. It might be somewhere else in the DSM as its own thing, possibly. I'm not sure.

SPEAKER_02 24:40

It definitely seems like something you could look for in particular when making a diagnosis. And then I think hyperfocus as well.

SPEAKER_01 24:46

Yeah, I I was curious about that because yeah, they have inattention, but yeah, they don't really discuss hyperfocus, they do discuss like being forgetful and also difficulty sustaining attention more so than like being really good at sustaining attention in other areas.

SPEAKER_02 25:07

Yeah, I think it is fairly well established that the flip side of that inattentiveness is also losing yourself in sort of the tasks you do find compelling. So brief, brief, brief, brief history of how the DSM got here.

SPEAKER_01 25:23

Just because it's really fun. So how many versions? So five versions of the DSM? Six versions?

SPEAKER_02 25:29

Five, but there was a revision of the third one and a revision of the fifth one.

SPEAKER_01 25:35

Okay. So seven.

SPEAKER_02 25:38

Yeah, I suppose so. The first one I don't think had anything interesting.

SPEAKER_01 25:41

Well, the first one said that it it was a brain trauma.

SPEAKER_02 25:44

I'm pretty sure it didn't show up in the very first DSM. And so there's some there's a bunch of pre-DSM papers. It sort of had a variety of names: minimal brain damage, minimal brain dysfunction, hyperkinetic syndrome, minor cerebral dysfunction. So like, and I think largely at that point it was assumed that like hyperactive, inattentive children had probably sustained neurological damage, like birth injury, lead poisoning, something along those lines. And then it wasn't until DSM II that we actually got like hyperkinetic reaction of childhood, characterized by overactivity, restlessness, distractability, short attention span, especially in young children, usually diminishes in adolescence. At least that's what they thought. And I think the word reaction there was sort of softening the brain damage framing, suggesting that they were responding to something, not that there was something inherently wrong with them.

SPEAKER_01 26:37

When did it become closer to the ADHD we know today?

SPEAKER_02 26:40

So we got attention deficit disorder in the DSM3, 1980.

SPEAKER_01 26:45

1980. Wait, sorry. 1980 was the first time we started talking about this.

SPEAKER_02 26:51

Yeah, yeah.

SPEAKER_01 26:52

That's crazy. This is our whole job. And when I was born.

SPEAKER_02 26:56

To be fair, that's 46 years ago now.

SPEAKER_01 26:58

But that's crazy. Like it had really only it was it had just been recently discussed around about the time that we were born.

SPEAKER_02 27:06

Yeah, the same decade we decade we were born. I mean at the start of it, but yeah.

SPEAKER_01 27:10

That's why when I talk to people who are older and I interview them sometimes, they just say, like, well, we didn't have a word for it back then. Just like this is the problem child. What did it say? What was the you know, in the 80s?

SPEAKER_02 27:21

So this was the biggest conceptual shift where inattention, not hyperactivity, became the sort of defining feature. And we got the so we got two subtypes, adh ADD with hyperactivity and ADD without hyperactivity.

SPEAKER_01 27:34

Interesting. Oh, so it was ADD uh that is yeah, because sometimes I have like older people and they'll say like ADD, I have ADD, and they'll say it for everything, and that would be why. They keep changing it. Now it's called ADHD, type one, type two.

SPEAKER_02 27:51

Yeah, well that was that was the revision, so they reversed and called it ADHD for the first time.

unknown 27:58

Yeah.

SPEAKER_01 27:58

When did they call it ADHD for the first time?

SPEAKER_02 28:00

So that's 1987. They really went through quite a bit of years before you're born.

SPEAKER_01 28:04

Yeah, they they really went through a couple of revisions in the 80s.

SPEAKER_02 28:08

And I think a DSM three was the first time that sort of a residual adults ADD was discussed as well.

SPEAKER_01 28:15

Oh, interesting. Yeah, I forgot that that that wasn't considered to be something adults could have.

SPEAKER_02 28:21

It is worth mentioning. I mean, in the DSM2, they said usually dismin diminishes in adolescence.

SPEAKER_01 28:28

So But initially there was a consideration that this would dissipate as you got older.

SPEAKER_02 28:33

The so the DSM three revision 1987, it gets collapsed back into a single category. So ADD without hyperactivity sort of disappears as a first-class diagnosis, kind of gets demoted to a vague, undifferentiated attention deficit disorder.

SPEAKER_01 28:48

And now, and then it gets changed back.

SPEAKER_02 28:51

Yeah. Because at that point they're using one pool of 14 criterion with which eight must be present. Yeah, and so then DSM4, 1994, three formal subtypes, which I think we still have now, sort of restored. So we've got the combined predominantly inattentive and predominantly hyperactive. So this is also when I think adult ADHD is being a little bit more acknowledged, workplace examples, I wouldn't even say a little bit more acknowledged. This is this is when adult ADHD is being much more acknowledged because workplace examples are actually being um added alongside school examples in the criterion. And then DSM 5 2013, this is when for older adolescents and adults 17 and over, we have actual sort of this formally included as diagnosable with lower symptom thresholds.

SPEAKER_01 29:37

Oh, that's interesting. Yeah.

SPEAKER_02 29:39

And then lastly, 2022 text revision, one notable change, which is that emotional dysregulation appears in associated features for the first time. So yeah, it's not part of the criterion yet, but looks like it will be.

SPEAKER_01 29:52

Yeah, that's so interesting. And and you know, it's funny because I remember that that came out and it felt like we were gonna get the next version of the DSM pretty soon because it'd been kind of like bam, bam, bam, bam, bam.

SPEAKER_02 30:04

But then they just didn't, you know, it's 2026 and Yeah, to be fair, if we look at the timeline, so roughly 70s, 80s, late 80s, mid-90s, DSM 4, mid-90s to DSM 5 2013 is quite a large gap compared with previously. And then another nine years isn't quite as long for the 2022. But yeah, you're not wrong.

SPEAKER_01 30:32

If you've never heard of the DSM outside of maybe getting asked a few questions that were apparently related to it, that is what it is. It gives you a little bit of a sense of what it is, what it's for, how it's changed. And yeah, I'm excited to um to kind of use it as a basis for some of the interesting conversations we have going forward. Thank you so much for listening to this episode of the ADHD Skills Lab. If you liked it, leave us a five star review. It helps other people learn more about us. And thank you so much to our wonderful team for making us sound good, look good. We couldn't do it without you.