It would be super helpful for the high IQ/late diagnosis group. Many of us struggle to accept if we *really* have ADHD or not. What if we're just lazy and cheating both ourselves and the doctors? Also, other people think we're just using ADHD as an excuse and don't believe we really have it because we're smart. Please make a video about this group of ADHD.

Thank you for this video. It's interesting that such small differences are found on scans and yet the lived experience of ADHD feels like a huge difference to neurotypicals.

Oooh, I'm looking forward to this video! Timestamps: 0:00 intro 0:39 Avast! 5:57 what the scans look like 10:04 Functional connectivity fMRI 10:53 So why can't it be used for a clinical diagnosis? 15:20 WARNING: false claims from private clinics 16:06 the future

It's probably worth stating that just because these scans do not currently pick up signals that in general would discriminate between someone having ADHD and someone who does not, that does not imply that there aren't big differences going on in the brain. These scans simply do not pick up everything. A simple analogy that comes mind is taking a photo of someone from very far away. If the whole face of the person is only captured as a single pixel, you probably won't be able to tell what the colours of their eyes are. But that doesn't mean there aren't different eye colours. A question for Dr. Barkley: Do the theoretical models of ADHD make any strong predictions about how much better scanning methods would need to get to discriminate accurately? Essentially, do we have an idea about some scale, time scale and region of the brain where ADHD would be manifest?

Brilliant - exactly what I was looking for regarding SPECT scams. I mean scans. Appreciate your academic rigor, Dr. Barkley.

I'd be really interested to see a study which compared brain scans of women in their menstrual cycle, comparing ADHD against general population. Probably not practicable but the severity of my symptoms varies so wildly over my cycle, and I do wonder if that would be observable with neuro-imaging.

You're such a cool guy. You really kick butt with your humor, your caring about us crazies, and how good you are at explaining stuff.

incredible video and great information, as always. So grateful for this channel!!

Came across you on TikTok found you on KZfaq have subscribed to your channel. Very useful information as always & I look forward to future videos where I can learn more on the subject and help my adhd son. Thank you for your teachings and God bless 🙏

You're literally uploading daily. Daily Do you how big a deal that is for a KZfaq channel.That is a real achievement genuinely, (most KZfaqrs struggle to do it, even when when the channel is their only job. and despite this, everything you're putting out is really insightful and engaging And it's all OC! Like what on earth was this video omg, 😵‍💫 it sounds like something from a sci-fi film Anyhow, wrapping this all up Ive seen many, many wholesome comments thankin you for the things you've done tin the Past, and how they helped someone make sense of it all 3 years ago, about the Past, how your content helped them learn and take control of their lives. But in the present day... with this upload schedule, you're gonna get seen, and your KZfaq channel is going to help people in the Future find themselves and get control of their undiagnosed ADHD So here's a toast to the future of your channel 🍺 and all the good it's going to do :) Keep smashing it Dr B 🤙☠️🦜 You rock 🪨

Thanks for this channel and explaining in such a clean and neat way the science of this disorder :). I really appreciate it and it helps me a lot explaining my own symptoms and how to deal with them to family, friends and partner. Also your content helps me relaxing with taking medication regularly and not feeling bad for needing it :). This video is a great example on how well you explain the statistics part. Guess this concept of a statisic vs the individual can be hard to grasp and I wonder how many people have an idea what a Bell curve is if they don't have a science background.

I'd be interested in hearing Dr. Amen's response to this as he has dozens of ADHD clinics based on neuroimaging for a hefty premium fee.

Thank you very much for giving so profound information. In my work this is so much needed.

Another invaluable video. Thanks Dr Barkley! If you have a moment I’d love to hear your thoughts on an open question about language in ADHD. In the last third of the discussion section of a 2017 research review (Korrel et al; Research Review: Language Problems in Children with ADHD - a systematic meta-analytic review), the authors state that a comprehensive neuroimaging study is needed that focuses on the language centers in ADHD children. They argue this would help answer the question of whether common language impairments in ADHD are caused by neurodevelopmental deficits to language centers (Broca’s, Wernicke’s, Heschl’s gyrus, etc, + relevant white matter tracts), or whether language impairments are only a secondary effect of underlying EF deficits such as working memory and sustained attention? We know the secondary impact is at least an important contributing factor. Whether language centers are impaired developmentally could inform whether interventions should target EF or speech/language. Do you agree that this question remains unresolved (language impairments a primary or secondary feature of ADHD)? If so, thoughts on what type of neuroimaging could be most appropriate for such a study?

Keep up the good work dr Barkley!

Dr. Barkley! Thank you so much this video is exactly what I was looking for! I have been asking this question and you are the first to give an answer with an explanation! I also appreciate greatly your work and advocacy to expand knowledge and understanding of this disorder that is indeed non-fiction and not just an excuse for poor behavior. People with ADHD can be more tenacious than their peers and still not get anywhere, and neurotypical people see them as just a "screw up". Story of my life- because it's not a visible condition like a broken leg or Down's Syndrome, people assume one just wants an easy way out. No. I just want to be normal and I try so hard it is exhausting. Why would I CHOOSE to not get the passing of time in my head, resulting in great stress, day after day, despite the notes, alarms, medication, etc. Yeah if I could just fix that and be timely, that would be great 👌

If I was about to get my brain scanned I'd be super excited and very focussed and attentive!

Thanks for addressing this.

Hi Dr. Barkley! I appreciate all your effort and devotion to knowledge. What are your views on accommodations for ADHD (or Executive Function siblings like ASD) adults during graduate studies? ADA and inclusion often need updated guidelines to help neurodivergents succeed. Yet, the parties involved have an heterogenous scientific understanding of what helps and what does not.

Thanks so much, Dr. Barkley. This information will save me time, energy, and money. Sadly there are counselors/therapists who use Amen’s seven types.

Very interesting! Thank you!

I wish diagnostic neuro-imaging was legit because people still don't believe ADHD is a real disability and that it can be quite debilitating. Maybe someday it will become a reality with advances in technology.

Thank you Dr. Barkle for your video. From your video essay, it seems like Diffusion Tensor and fMRI scan have the most potential for ADHD diagnosis in the future? I'm a Computer Engineering graduate student, and I want my future study to be focusing on using deep learning algorithms to analyze neuroimaging on ADHD. I'm trying to find which neuroimaging technique would be the best to study and improve

Thank you sir.

Very informative! I appreciated how you explained why this imaging is useful in aggregate but isn't individually diagnostic. I do wonder what role AI will play in this. I'm not sure if it's actually been rolled out yet, but there is/was supposed to be a public release of an AI program that can identify sex, smoking status, approximate age, and whether a patient is diabetic based on retinal scans. I wonder what - if any - patterns they might pick up on that we've missed in neural imaging.

Thank you very much, again, Dr. Barkley, for this helpful account on what brain imaging can and cannot do with respect to ADHD research and diagnosis. I wonder if you could say something about HDFT, high definition fiber tracking. My understanding is that it is a higher-resolution version of DTI - diffusion tensor imaging, albeit working somewhat differently. Developed at the University of Pittsburgh and CMU (based on ideas from a team in Taiwan), it is used to find fiber trajectories in the connective brain tissues, and to spot interrupted fibers due to brain injuries. It has also been used to map differences in connective tissues in people on the autistic spectrum. I am not aware of any uses for ADHD, so far, though. But maybe you could speak a bit about this? Does it have any value in ADHD research, or maybe even diagnosis, due to its higher resolution? Btw, I believe that this is an expensive technology, so maybe it is only available at the University of Pittsburgh, so far? Also, it seems difficult to find information about any potential improvements to spatial and temporal resolutions of brain scans that may be on the horizon. Is there anyone who could speak about this? Thank you again.

Thank you for this video Dr Barkley! May I ask for your opinion on Functional near infrared spectroscopy (fNIRS)? I understand some clinicians may be using it to complement their assessment of ADHD. Thank you!

Dr. Barkley, is it weird if: 1) I agree with your explanation, especialy when comparing singular modalities, but 2) have seen neuroimaging research from Dr. Tim Silk et al from Deakin university showing a multi-modal neuroimaging model having significant predictive validity, even on a data set falling outside of the study. Am I missing something in my understanding here? Thank you so much for your work, and for making these videos Dr. Barkley 🙏

16:10 I think that furthermore to those imaging devices becoming better, in order for them to be viable methods of diagnosis, theories of the brain need to become more accurate, and by accurate I mean empirically viable mathematical models that could explain those group differences. So I believe DTI + Topology from math should do it. Future clinicians will have to use a computer to analyze the data and extract useful parameters or graphs that should tell the differences.

So interesting! So what exactly are clinicians who use neuro imaging diagnosing??? Bit scarey that! Mind you, out of sheer fascination I'd love to have some brain scans, not for my diagnosis but just to see how my brain looks 😊 What are the conditions that are actually diagnosed with scans?

Are there other neurological diseases where such small differences have such a heavy impact on an individual's life? I fear that the statement brought by this video indicating that neurological differences between individuals with or without ADHD are too small to be identified without averaging over a group could easily be misconstructed by laymen as there being no disease at all.

10:53 There is a more fundamental point to be made here, which is that ADHD is a behavioral problem, not a physiological one. If somebody showed all the symptoms of ADHD and the brain scans DIDN'T show anything unusual, they would STILL need treatment. And vice versa: if someone showed all the signs of ADHD in the scan and none of the problematic behaviors, they would NOT need treatment. What that would mean is that we were wrong about the causes of the condition in the first place. Same can be said about depression, schizophrenia, autism and every other psychiatric and neurodevelopmental condition. Reducing a diagnosis to one scan or test implies we know a lot more about the human body and brain, their variation, and the mechanisms of a disorder than we actually do.

Developments on structure vs. function… MRI resonance (structure)vs. pet scan ( minor radiation tracking),,, reanalyzing of MRI (and water movement), connectivity/ activating in function … diffusion tenor shows regional … Dr. Amen uses scans (? To identify for 7 types ?)).. functionalMRI.. various groups identified on types of ADHD ? Group comparisons vs. Individual..

I am 35. I found out a year ago I have adhd. When I was a child I had a lot of issues. They done brain scans, all kinds of things. Couldn’t find anything wrong with me. But obviously I had something going on 😢

What about urinary phenethylamine analysis? I've actually read some research and regard that as the seemingly only real potential Biomarker for ADHD. Thoughts?

How about brain mapping and Neurofeedback ..?

With the studies showing differences using these machines, have they been reproduced or is there an issue there?

What are your thoughts on Dr. Gabor Mate n his statements on Adhd and trauma? Do you have articles on it? Seems like a connection but what do u say?

Hi doctor! My psychiatrist prescribed me with Ritalin after seeing me for 30mins and hearing my symptoms (I believe I have ADHD and all of my symptoms fit pretty stereotypically across the board for all traits of ADHD). He told me instead of making me slog through various different tests with exorbitant costs he would rather prescribe the meds and see how I respond to them. He told me to finish a single pack of Ritalin (roughly 3 weeks supply) and keep in touch with him about the symptoms. After watching your video on JP's claims, wherein you mentioned that the paradoxical reaction was not a criterion for diagnosis, I began doubting the competence of my psychiatrist, however. Is there a cause for concern in my case?

What do you think about the research about tDCS for adhd, as a possible future treatment? 😄

Have you heard of the similar "neurotransmitter testing" services which are presumably as unreliable? Even if the levels they measure are actually accurate, that's not particularly useful information without knowing how the brain uses those neurotransmitters and what their distribution throughout the different parts of the brain is, right?

Hehe - love the pirate 🏴‍☠️ 😆😊💛

Unless certain imaging providers have proprietary methods that offer more specificity? Corporate medicine isn’t obligated to publish, is it? In computing, industry gets ahead of academia on a regular basis. Dunno if this happens in medicine. PS: Update on my case. Gf is newly diagnosed as Sjogrens. So her legacy ADHD diagnosis may be long-term misdiagnosis of Celiac and Sjogrens.

I have sever adhd and sluggish cognitive tempo, I am very forgetful now I am very anxious that I might have alzheimer's I am 39 years old , if you give me 5 words to remember I only remember 3 words, doese this happen to anyone else, please reply to my comment . I do remember 3 words or some times 4 words but, not 5 words.

Well shoot. I just forked out $200 bucks for one trying to find help with treatment. This impulsiveness sure can cost. There isn't any legal recourse for those making these types of claims?

Dr my son is very immature for his age. He has been correctly diagnosed with severe add. He has no friends in his grade. I have noticed that he likes playing with younger kids. Will he perhaps benefit from repeating a year at another school to be with peers more emotionally on his level? I am desperate.

Well, I guess the future is now.

How about fNIRS?

So the differences aren’t obvious and stark enough. Also probably because EF deficit can be caused by different causes then. I was wondering about why imaging wasn’t used yet. According to the researcher in the following TED talk Lifelong Behavior problems may sometimes be explained by neuro imaging, but maybe because it has costs, and clinicians and hospitals can't just spend (machinery maintenance) for every cases. Québec (Canada) health regime is covering a lot. We get free healthcare, but the boundaries is about making sure people aren't suicidal. It must be a hard job to have to diagnose without doing every tests. In case.

They use this to read our minds 😳

I think the progress is very slow because research funding is low as the sufferers are a minority. When can we expect a solid objective diagnosis for cognitive disorders? Few decades or few centuries? General public's opinion that these are just 'will-power' issues is infuriating.

10-25% percent difference in activity is not small. Especially because it can be compared for an individual between tasks and mental and arousal states in various ways. Also individual areas differences are bigger. Besides, there is spatial pattern as well. SPECT is not about a single scalar value for overall brain.

Bottom line answer-/ NO!

Would love to hear your opinion on Singapore using fNIR and eye tracking to confirm #adultADHD diagnosis.

Could it be that the reason neuro-imaging isn't an option is because ADHD is more about difference rather than disorder?

So take individual that has been clinically deemed to have ADHD and do the scans.Then scan the brain of the neuro-typical individual and compare the two. If the resulting activity of the ADHD brain is conformally showing the same across the set of people with ADHD then it should be obvious on the scan. If not then that states there isn't a glaring difference between the brain activity of neuro-typical and Neuro divergent brains. I'd say that there is a difference between electrical activity within the brains of people with ADHD, but I don't have the luxury of conducting the large swath of scans on both types of brains to validate what I'm saying.

As someone who studied statistical analysis, I would strongly question the conclusion that the differences between averages are even relevant if the overlap is large enough to discredit the diagnosis of individuals. Overlaps of data clusters are even more relevant than the averages here because averages aren't physical things, averages are cherry-picked data points combined together as an aggregate value. Combining any amount of data from 2 subjectively picked categories on data that doesn't accurately correlate to the 2 is bound to have so much noise to signal ratio that even a difference in averages is meaningless. An analogous scenario would be to have a bunch of boxes of different colors containing either dark chocolate or white chocolate distributed within them by company affiliation of who makes the boxes and chocolates. Categorizing the boxes by color to assess the type of chocolate will give differences in averages with strong overlaps by pure chance without the color of the boxes or of the chocolates even being directly correlated because of the third factor of ''company affiliation'' making some statistically significant clusters of box colors/chocolate colors. The point is we subjectively observe ''behavior'' (box color) and try to determine an ''internal state'' (chocolate color) with a representation of the internal state such as brain scans (analogous to opening the boxes and recording the data for regressions) and the large overlap of data is indicative that the subjective observations of behavior are not directly related but indirectly correlated (by being subjective and not capturing an objective distribution, the observation doesn't capture the true underlying categorization, for the chocolates, the true categorization is the company affiliation that someone can't see, at least in this analogy). A large overlap likely means that psychologists and psychiatrists are so bad at categorizing objective behavior clusters accurately that a bunch of people within and without an objective brain structure cluster were both diagnosed and undiagnosed, meaning it's a game of coin toss as to if a ''professional'' even categorizes behavior properly and objectively. What this specifically tells us is that one should be extremely wary of any diagnosis around ADHD and behavior clusters. What it *doesn't* tell you is that studying averages between diagnosed and undiagnosed people shows the groups are distinct. That would be statistical mumbo jumbo, averages can tell you anything if you make them speak enough because they *aren't* tangible data.

This should be the ONLY way to determine, if legit. Too many misdiagnoses and fakers for meds.

Well, what this video shows is actually that perceived statistical relevance does not translate to real-world relevance. Meaning that these studies on ADHD produce bogus science, nothing else. We are still touching mud in relation to the very classification of what might be ADHD. This is far from one condition only, and it is mostly behavioural. We can't even be certain in saying that these brain differences are causation; they can very much be just the result of brain plasticity responding to environs. Dr. Barkley's effort to make science out of ADHD is respectable, just like every other scientific effort. However, the now-popularized discourse about brain activity and ADHD still needs many decades of refining to become something truly useful to clinicians.

That is very disappointing. Thank you