Episode 8: ADHD Myths Every Clinician Should Know

ADHD is overdiagnosed. Everyone is a little ADHD. Stimulants are addictive. Medication changes personality. Children grow out of it. Sugar, phones, or even the gut microbiome, cause ADHD.

In the final episode of this eight-part series, pharmacist Kate Thomas examines some of the most common myths surrounding ADHD and its treatment.

We look at what the evidence actually tells us about diagnosis, stimulant dependence, adult ADHD, intelligence, diet, screen use, probiotics and the idea that ADHD medication changes who someone is.

This episode also brings together the key lessons from the entire series. From how ADHD medicines are selected and titrated to the differences between methylphenidate, dexamphetamine, lisdexamfetamine and non-stimulant treatments.

Designed for pharmacists, pharmacy students and other clinicians, this episode encourages listeners to challenge misinformation while responding to patients with accuracy, empathy and respect.

Reflective questions:

Which ADHD myth do you hear most often in practice?

Have any of your own beliefs changed during this series?

How can you correct misinformation without making a patient feel dismissed or embarrassed?

This concludes the eight-part ADHD medicines series from Prescribe or Pass: The PoP Pod.

Transcript

SPEAKER_00 0:00

I'd like to acknowledge the traditional custodians of the land on which I'm recording today and pay my respects to elders past and present. I'm Kate. I'm an Australian pharmacist with more than 25 years of experience working across hospital pharmacy, community pharmacy, palliative care, aged care, and now voluntary assistant Deline. Welcome to Pop Pod, the clinician edition of Prescribe Orchimes. Look for me on Instagram, TikTok, Facebook, and YouTube at Prescribe Orchids. Every episode explores one medicine, one condition, or one clinical concept, explaining not just what we do, but why we do it. Whether you're a pharmacy student, pharmacist, or any clinician who works with medicines, welcome to the Pop Pod. This is episode 8, the final episode in our series on ADHD medicines. Over the past seven episodes, we've looked at what ADHD is, how clinicians choose between medicines, how methylphenidate and amphetamine medicines work, why their formulations matter, how non-stimulant medicines fit into treatment, and what managing ADHD medicines looks like in real life. This episode we are finishing with the myths. Because ADHD is one of those conditions where almost everyone seems to have an opinion. ADHD is overdiagnosed. Everyone is a little bit ADHD. Stimulants are addictive. Medication changes your personality. Children grow out of it. Your gut causes it, sugar causes it, phones cause it. Adults cannot really have it. And smart or successful people cannot possibly have ADHD. Most clinicians will encounter these claims not only online, but across the pharmacy counter, in consulting rooms, in schools, and sometimes from other health professionals. Some contain a tiny fragment of truth that has been stretched far beyond what the evidence supports. Others are simply wrong. And nearly all of them can affect whether someone seeks assessment, accepts treatment, or feels ashamed about having ADHD. By the end of this episode, you should be able to identify several common myths about ADHD, explain what the evidence actually tells us, and respond to these misconceptions without dismissing the genuine questions or concerns behind them. Let's begin with perhaps the biggest one. ADHD is overdiagnosed. You will often hear that ADHD is being diagnosed everywhere, that everyone suddenly has it, and that clinicians are handing out diagnoses and stimulant prescriptions far too readily. The honest answer is more complicated than either ADHD is massively overdiagnosed or overdiagnosis never happens. Poor quality assessments can happen. A clinician could potentially attribute concentration problems to ADHD when they are actually being caused by anxiety, depression, trauma, sleep deprivation, substance use, medication effects, hormonal changes, a learning disorder, or another medical or psychiatric condition. A brief social media checklist is not enough to diagnose ADHD. Neither is relating strongly to a TikTok video. A proper diagnosis requires a comprehensive clinical assessment. Clinicians need to examine the pattern of symptoms, whether they began during the developmental period, whether they occur across more than one setting, whether they cause meaningful impairment, and whether another explanation fits better. So, yes, misdiagnosis and overdiagnosis are possible. But that does not mean ADHD as a whole is simply overdiagnosed. Some groups have historically been missed or diagnosed late, particularly girls and women, people whose symptoms are predominantly inattentive, people without obvious behavioral disruption, and people whose intelligence or support systems allow them to compensate for years. Two things can be true at once. We should be concerned about rushed or inadequate diagnostic processes, and we should also recognize that many people with genuine ADHD remain undiagnosed or unsupported. The clinical response should not be to assume that every recent diagnosis is fashionable or false. It should be to support careful, evidence-based assessment. Everyone is a little bit ADHD. Most people occasionally lose their keys. Most people procrastinate. Most people become distracted by boring meeting, forget why they walked into a room or struggle to begin a task they do not enjoy. That does not mean everyone has a little bit of ADHD. ADHD traits exist across a continuum in the population. Inattention, restlessness, and impulsivity are not behaviors found exclusively in people with ADHD. The distinction is not whether someone has ever been distracted, it is the pattern, persistence, severity, and functional impact of those difficulties. ADHD symptoms are developmentally inappropriate, occur repeatedly and interfere with functioning. They might affect education, employment, relationships, finances, driving, healthcare, household management, or emotional well-being. Think about the difference between being short of breath after running up several flights of stairs and having a respiratory disorder. The symptom itself is not unique to the disorder. What matters is why it is happening, how often it happens, and how significantly it affects the person's life. Saying everyone is a little ADHD may be intended to make someone feel less alone, but it can have the opposite effect. It can minimize a disorder that for many people has affected almost every part of their life. Stimulant medicines are addictive. This myth needs careful wording because stimulant medicines do have misuse, diversion, and dependence potential. In Australia, dexamphetamine, Liz dexamphetamine, and methylphenidate are controlled medicines. They require appropriate prescribing, storage, monitoring, and review. They should not be shared. They should not be taken in larger doses than prescribed. And clinicians should assess factors such as current or previous substance use, unsafe alcohol use, diversion risk, and patterns of medicine-seeking behavior. But saying that stimulant medicines can be misused is not the same as saying that a person who takes a therapeutic dose for ADHD will inevitably become addicted. Addiction is not simply defined by taking a medicine regularly or experiencing a physiological effect from it. It involves features such as impaired control, compulsive use, continued use despite harm and craving. When stimulant medicines are prescribed appropriately, titrated carefully, and taken as directed, the goal is not to produce euphoria. It is to improve ADHD symptoms and everyday functioning. The available longitudinal evidence does not show that treating childhood ADHD with prescribed stimulants increases later risk of developing a substance use disorder. Some studies have found no change in later risk, while other observational research has found lower rates of substance-related harm during periods of ADHD treatment. That does not mean the medicines are risk-free. Immediate release stimulants can be particularly vulnerable to misuse or diversion, and some people require more intensive monitoring or a different treatment approach. But this medicine has misuse potential and this medicine automatically causes addiction are not equivalent statements. As clinicians, we need to communicate both sides accurately. We should not trivialize the risks, but we should not allow the language of addiction to frighten people away from appropriate monitored treatment. ADHD medication changes your personality. Parents sometimes worry that medication will make their child less funny, less creative, less spontaneous, or somehow less themselves. Adults may worry that medication will turn them into a different person. The aim of ADHD treatment is not to erase someone's personality, it is to reduce symptoms that are impairing their functioning. Ideally, the person still feels like themselves, but finds it easier to begin a task, stay with a conversation, regulate an impulse, remember an instruction, or move through the day without quite as much internal chaos. However, this myth persists partly because some people do experience emotional or behavioral changes on medication. A person may appear unusually quiet, flat, withdrawn, irritable, or disengaged. They may describe feeling numb, robotic, or unlike themselves. Those experiences should not automatically be dismissed as imagination or resistance to treatment. They may indicate that the dose is too high, the formulation is not a good fit, that the medicine is wearing off abruptly, that sleep or nutrition is being affected, or that another condition is contributing. A meta-analysis of mood and emotional adverse effects found that these effects vary between stimulant classes and that symptoms such as apathy or reduced talking can occur in some patients. The appropriate response is not. Medication should improve function without unnecessarily suppressing emotional expression or quality of life. If someone no longer feels like themselves, that is clinically relevant information. Children grow out of ADHD. ADHD was once treated largely as a childhood behavioral disorder. The assumption was that children became less hyperactive during adolescence and eventually grew out of it. For some people, symptoms do reduce with age. A person who was constantly climbing, running, or leaving their seat as a child may no longer show that same visible hyperactivity as an adult. But ADHD can change its appearance without disappearing. Physical hyperactivity may become internal restlessness. A child who constantly calls out in class may become an adult who interrupts conversations or makes rapid decisions. A child whose parent manages every school deadline may struggle profoundly when they leave home and are expected to organize university, work, bills, appointments, and meals independently. Whether ADHD persists also depends on how researchers define persistence. Some people no longer meet every diagnostic criteria in adulthood but continue to experience residual symptoms and meaningful impact. Longitudinal studies have found that a substantial portion of children with ADHD continue to have symptoms or impairments as adults. So it is more accurate to say that ADHD follows different trajectories. Some people experience substantial remission, some continue to meet full diagnostic criteria, others retain fewer symptoms but still experience enough impairment to require support. We should not assume that someone no longer needs treatment simply because they have reached a particular birthday. Treatment should be reviewed according to current benefits, harm, symptoms, and functioning, not according to the belief that ADHD expires at adulthood. Sugar causes ADHD. Sugar does not cause ADHD. ADHD is a complex neurodevelopmental disorder with a strong genetic contribution. Its development cannot be reduced to a child eating lollies, drinking soft drink, or having cake at a birthday party. Some parents are absolutely convinced that sugar makes their child hyperactive. But consider the context in which children often consume large amounts of sugar birthday parties, holidays, celebrations, sleepovers, places where there are other children, games, noise, novelty, excitement, and fewer normal routines. It is easy to attribute the behavior to the food while overlooking everything else happening around it. Research has not established that ordinary sugar consumption causes ADHD, and prospective evidence has not found an association between childhood sucrose intake and subsequently developing ADHD. That does not mean nutrition is irrelevant. Children and adults with ADHD still benefit from a varied adequate diet. Food intake becomes particularly important when stimulant-related appetite suppression is affecting growth, energy, or nutritional adequacy. Blood glucose fluctuations, skipped meals, poor sleep, and inadequate nutrition may all affect how a person feels and functions. But that is very different from claiming that sugar caused the neurodevelopmental disorder. ADHD is caused by an unhealthy gut, and probiotics can cure it. The gut brain axis is real. The gut and brain communicate through several pathways involving the nervous system, immune system, hormones, and microbial metabolites. Researchers have found differences between the gut microbiomes of some people with ADHD and people without ADHD, and this makes for a genuinely interesting area of research. But it does not establish that an unhealthy gut caused ADHD. Most microbiome studies are observational. They may find an association, but they cannot tell us which came first or whether another factor explains both. Diet, sleep, stress, genetics, medicines, geographical location, age, and many other factors can influence the microbiome. ADHD itself may also affect food choices, eating patterns, and sleep, which could then affect the gut microbiome. So the relationship could operate in several directions. We also need to be careful with the phrase the ADHD microbiome. There is currently no single microbial pattern that can diagnose ADHD, and there is no established definition of what a perfectly healthy microbiome should look like for every person. What about probiotics? Small studies have investigated probiotics, prebiotics, and microbiome-targeted dietary interventions in people with ADHD, but the evidence is preliminary and inconsistent. A 2024 meta-analysis found no significant overall improvement in ADHD symptoms with probiotics compared with placebo. Other reviews have concluded that there may be signals worth investigating, but the available studies are too small and varied to establish an effective strain, dose, combination, or treatment duration. And remember, a probiotic is not one interchangeable product. Different organisms, strains, doses, and formulations can have entirely different effects. Evidence involving one particular strain cannot automatically be transferred to every yogurt, fermented drink, or expensive supplement labeled gut health. Eating a varied, nutritious diet that includes adequate fiber is good general health advice. Treating constipation, supporting sleep, and addressing nutritional deficiencies may also improve someone's overall well-being and ability to function. But probiotics are not currently an established treatment for ADHD. They have not been shown to cure it, and they should not be promoted as an alternative to evidence-based treatment, behavioral support, or appropriately prescribed medication. The microbiome may eventually teach us more about ADHD, but scientists are investigating a possible relationship is very different from your gut caused your ADHD, and this supplement will fix it. ADHD is caused by phones. This is the modern replacement for the sugar myth. People see children and adults switching rapidly between videos, notifications, and apps and conclude that smartphones have created ADHD. Again, we need more nuance. Heavy, poorly regulated screen use can affect sleep, displace physical activity, interrupt sustained tasks, and make distraction more likely. Digital platforms are deliberately designed to capture and retain attention. Someone who is repeatedly checking notifications may certainly find it harder to concentrate on a slower or less stimulating activity. Studies also find associations between high levels of screen use and ADHD symptoms, but association does not prove that phones caused ADHD. The relationship may operate in both directions. People who already have ADHD may be particularly drawn to rapid, novel, and highly rewarding digital content. They may also have more difficulty stopping, shifting away from a device, or regulating how long they use it. Family stress, sleep disruption, and other factors may influence both screen use and symptoms. Current evidence does not justify telling parents that giving a child a tablet caused their ADHD. ADHD existed long before smartphones. Screens may amplify difficulties, interact with symptoms, or complicate daily management. They are not a complete causal explanation for the disorder. Adults cannot have ADHD. Adults can and do have ADHD. ADHD is classified as a neurodevelopmental disorder, which means that its origins lie in the developmental period. That does not mean every adult with ADHD was diagnosed as a child. Many were not. Some grew up when ADHD was poorly recognized. Some were considered dreamy, disorganized, lazy, talkative, emotional, or not living up to their potential. Some performed well academically but only through enormous effort, strict routines, anxiety, parental support, or repeated all-night deadlines. Some managed adequately until the demands of life exceeded their coping systems. Moving away from home, beginning university, entering a complex job, becoming a parent or going through hormonal changes may expose difficulties that were previously being compensated for. When assessing an adult, clinicians still need to look for evidence that symptoms were present earlier in life, even if nobody called them ADHD at the time. An adult does not suddenly develop a lifelong neurodevelopmental history on the day they see a TikTok video. But equally, the absence of a childhood diagnosis does not prove the absence of a childhood symptom. Adult ADHD requires careful assessment, not automatic dismissal. Smart people cannot have ADHD. Intelligence does not protect someone from ADHD. A person can be academically gifted, highly educated, professionally successful, or extraordinarily creative and still have significant impairment from ADHD. In fact, high intelligence can sometimes delay recognition. A bright student may understand new material quickly enough to compensate for missing in the instructions. They may complete work at the last minute and still obtain high marks. They may rely on memory, urgency, perfectionism, or intense anxiety to meet expectations. From the outside, they look successful. Behind the scenes, they may be losing belongings, missing appointments, working through the night, forgetting meals, paying late fees, and using every bit of their energy to maintain the appearance of coping. A diagnosis is not based on whether someone has achieved anything impressive. It's based on symptoms, developmental history, and impairment. And impairment does not have to mean failing every subject or losing every job. It may mean that maintaining those achievements cost the person far more time, distress, and exhaustion than anyone else can see. Being intelligent can help someone compensate for ADHD, it cannot make them immune to it. What have we learned over the past eight episodes? So what have we learned over the past eight episodes? We began by establishing that ADHD is not simply a shortage of dopamine, a childhood behavior problem, or an inability to pay attention. It is a neurodevelopmental disorder involving difficulties with the regulation of attention, activity, impulses, and executive functioning. We learned that medication is not selected according to how severe someone's ADHD is. Clinicians consider the person's age, symptom pattern, required duration of effect, other medical and psychiatric conditions, previous responses, adverse effects, preferences, and daily life. We looked at methylphenidate and learned that Ritalin, Ritalin LA, and concerta may contain the same active drug, but do not deliver it in the same way. And modified release formulations are not automatically interchangeable simply because the milligram number looks similar. We looked at dexamphetamine and LISDXamphetamine. We learned that vivance is not simply a slow release capsule. It is a prodrug that must be converted in the bloodstream into active dexamphetamine. We challenged myths about protein, vitamin C, and the idea that every difference in response can be explained by someone having a fast metabolism. We explored atomoxetine, guanfacine, and clonidine. We learned that non-stimulant does not mean ineffective, risk-free, or pharmacologically simple. These medicines have different mechanisms, different time courses, and different adverse effect profiles. And we looked at what happens outside of the textbook appetite suppression, growth, sleep, exercise, driving, travel, storage, roadside drug testing, missed doses, medication shortages, and the practical reality of fitting treatment into an actual person's life. Most importantly, I hope we have learned that ADHD treatment is not about choosing the strongest medicine or forcing a person to conform. It is about improving function while protecting safety, identity, autonomy, and quality of life. For this episode's reflective practice questions, consider which ADHD myth have you heard most frequently in your own practice? Have you ever repeated or accepted one of these ideas without examining the evidence behind it? And when a patient expresses a misconception about ADHD, how can you correct the information without making them feel embarrassed, dismissed, or foolish for asking? You might also reflect on the entire series. What did you believe about ADHD medicines before episode 1? What has changed? What are the remaining gaps in your knowledge? This brings us to the end of our eight-part ADHD series. Thank you for joining me across all eight episodes. I hope this series has given you not only more information about individual medicines, but a clearer framework for thinking about ADHD, prescribing, and patient-centered care. Because good medication counselling is not simply knowing the active ingredient, the dose, and the side effects. It is understanding why the medicine was chosen, how its formulation affects its use, what the person is trying to achieve, and what might make treatment safer, more effective, and more realistic. You've been listening to Prescribe or Pass the Pop Pod, our ADHD series. I'm Kate Thomas, and next we're turning our attention to menopause hormonal therapy, a topic that is professionally fascinating and, at nearly 49, increasingly relevant to me personally. We'll keep asking what we prescribe, why we prescribe it, and whether the evidence says it should pass the test. I'll see you for the MHT series.