5010 ADHD sam lecture

PY5010 ADHD lecture 190324-20240319_090552-Meeting Recording

March 19, 2024, 9:05AM

59m 40s

Sam Wass started transcription

Sam Wass   0:03
Even though he was out of the lessons, having made progress and they were supported, but they was helped Newfield the gap to in between.
Above on every subject, but in the movement for healing has gone, not just level. He's way below everything. He's not reached target on anything. That's my team, because certainly doing a bit.
Yes, it's a massive shock.
Yeah. Yes.
That's what we're just trying to figure, not.
To pass, yeah, but it doesn't. It's back down. It's the banter as well. He's searching for a friend.
That's not working.
Friendship with that's that's not exactly. And get a laugh and loves that feedback.
There's one person who wants to come back to you. Is this normal numbers to disc for us?
Is what?
The deadline.
Oh, OK.
Yeah, I met someone on the way out and said he's got resets as well. I mean, well, I just do it and then we can record it. I can record it if I watch it afterwards. OK. And then there's one person I just need to keep a chat on who I just sent a link to because she said she wanted to come. But she's not here yet. OK, so hi, everyone. Can you just so I'm. I'm. I'm Sam. All of you. Lots of you look familiar. Just remind me, what, what lectures I've done for you guys before.
When was, it must have been last year. Was it this year?
This year, turn 1.
Oh, OK, fine. Now that's good to know. OK, 'cause, there's quite a lot of overlap with this, obviously.
Mm hmm.
Yeah. OK.
Fine. OK, so tension is gonna be quite a lot of overlap with. We're gonna start with the recap. Did I do one on that basics of brain development? Can you remember if I did one on? Yeah, yeah, yeah. OK, fine. All right. OK. So we'll start with some recap of that and then go on to different areas, OK, is pitched. Don't worry if you can't remember it. It's pitched at a level that hopefully you can just pick it up just to sort of refresh it. OK, so we're talking about ADHD.
Which these are the diagnostic categories. So you know what DSM five is, right?
Yeah. OK. So these are the DSM 5.
Classification system for ADHD. The system pattern of inattention and hyperactivity. Impulsivity that interferes with functioning or development. Six or more of the symptoms have persisted for six months.
And it's been and we've got two sole gaps besides 2 subtypes in attention, which is pretty much what you'd expect it to be. And hyperactivity, which again expected to be kind of fidgeting and talking excessively.
And that type of thing, and the reason I'm interested in this is because everyone in my family, including myself, definitely has a lot of these symptoms. This is my son, Freddie. These are my 4 nieces and nephews, Naomi, Leah Rubin and Hazel.
And you know, particularly this hyperactivity subtype, we're very, very much kind of at that extreme and actually related to this.
One of the things that I've talked about doing it because a lot of ADHD researchers.
Like myself, a very ADHD and a lot of them are really, really successful people. But there is nothing you know. So when you had the autism lecture, who gave you the autism that show Georgia. OK, so presumably she would have talked quite a lot about how, you know, attitudes to autism have changed quite a lot. And it's much more focused on, you know, autism pride and recognising that a lot of the most important inventions in the history of humanity have been come up with people by autism. We shouldn't be defining it just by deficits, that type of stuff.
So that's quite well developed and also you can see there's nothing at all about ADHD pride. There's just, it's just not out there as an idea. And I think that's a real shame because I really do think a lot of really, really successful people are very ADHD. You know, that idea will kind of drive and determination and how much energy you've just got just to do stuff in life is very related to ADHD, but it's just one of these weird areas where it's just nobody's looking at that at the moment because, you know, just like you were saying with this bounce idea went away in.
This idea about how much drive and determination and energy you've got is very hard to measure. There's there's not very many objective ways of measuring it like it's different to just how much you're moving. And so, so this idea that, you know, this is a positive and it helps to get far in life just isn't there at all. And at the moment it's defined just purely as you see by deficits. Yeah. So that's one thing to start with, thinking about. The other thing is, you know, if you read these these criteria, they sound pretty much like a description of an average child.
Yeah. What child doesn't, you know, make mistakes sometimes. What child isn't easily distracted by extraneous stimuli. What child doesn't interrupt? You know, you when you're talking. Yeah. This is just in a lot of ways. It's just a description of what a child's like. Yeah. So we're going to be talking about that in the context of overlapping with some stuff that we talked about earlier about brain development and tension and how children pay attention differently. Yeah. And then the messages are going to be 2 take away messages, hopefully illustrated with the take away bag.
Thinking like that.
Take away message. Like most mental health disorders, ADH isn't really a thing that so we're going to be talking about like in the olden days, like quite recently like 10 years ago. We used to think that there was like, one thing that causes ADHD and now we know that's not the case. It's just kind of a messy group of multiple different types of problems that will get lumped into one category. So that's kind of one of the things that we're going to be talking a lot about. And specifically, we're going to be used to be thinking about the core problem with ADHD is something that traditionally thought to be inhibition.
Executive control. Yeah. So we're going to be talking about exactly what that is. Have you heard who's heard this phrase? Executive control before? Yeah. Someone want to define it. Do you know, come up with.
Yeah.
Yeah. So what, that's yeah.
Yeah, exactly. Yeah, that's really good. So, like, how in control you are with your own behaviour basically. So this is something that psychologists love to measure because unlike this thing I was talking about about drive and energy and determination. Yeah, which is very hard to measure. Executive control is very easy to measure. We're going to be talking about some experimental tasks.
That that people have done to measure it. Psychologists love to measure it loads and loads and loads of studies are measuring it. But what I'm going to be saying is, you know, even though there's a lot of findings that executive control is worse than ADHD.
Yeah, the conclusion that most people have jumped through as a result of that, which is ADHD, is caused by problems in executive control. That conclusion is wrong. Yeah. And in fact, the evidence is that executive control problems might be downstream consequence of problems elsewhere rather than a cause of it. So that's what we're going to be talking about. So it's actually. So it's generally, you know, we're covering wide aspects of ADHD epidemiology. Anyone know what that means?
No, it's quite nice. I don't like it for teens. Yeah.
No, not quite.
It's more like who, which types of people tend to get ADHD, like how it, what pattern, what symptom, what other conditions it tends to Co occur with that type of thing. I can't even need this, but that's what it is. Basically. Yeah. So it's like epidemia of reduced of a disease. What type of people tend to get that disease? So that's so gender, age, comorbidities, genetics of ADHD. And then we're going to be talking about this. This is one of the classic tasks that we used to measure ADHD where there's little red guy pops up.
And you have to press it and then sometimes the purple cabbage top pops up and you have to inhibit the urge to press it. Yeah. So there's loads and loads and loads of evidence for, you know, performance on those types of tasks. Then we're going to be talking about a little neuroidaging. That's the picture that you remember seeing from last time treatment of ADHD. And then we're kind of pulling together those ideas into this key idea that I talked to you about, which is, you know, there's lots of evidence that can inhibition is, is.
Atypical in ADHD, but is it a cause of it, or is it a downstream consequence?
And then if we've got time, just this is mainly just for, you know, a little bit of kind of fun little bit different at the end of a lecture and we're going to be talking about evidence which is something obviously that's quite relevant to you. I'm sure about this discreet, I've called ADHD and how do we find out the answer to that. And that's the thing. So that's the kind of you know little kind of sweet bit of kind of fun stuff you're putting and then this is the main forms, all right, sound good so far. Yeah. Let me just check this person who's been joining teams as it turns.
No. OK.
OK, so but before we start, just do a refresh. So this is a picture that that you send, you remembered watching from earlier.
Should I just? Does anyone want to talk through what this shows? Or should I just talk it through?
Yeah.
Oh.
So that's one of the things. So basically this is these are bits of the brain. We only switched the brain data. From what angles. Yeah, right on top of my balls. But here. So this is a bit of the front. Here's the back here and these which are being taken from the razor camera.
Yeah, it's on the side, yeah.
What's up continues to get it's out there. And then here. Yeah. And basically it's blue on this. If it's finished developing and it's red if it has to finish developing. So yeah. So so as you're saying, this is one of the things is that we even switchable experience to part of gradability. That's one of the things that's important. And the other thing that's really important about this picture, this picture shows us. Anyone. Yeah.
But I mean it's a little bit more complicated than that, but yeah. But but basically, yeah. So in a in a child's brain, this part of the brain here, anyone remember what this part of the brain here does right at the back?
Yeah. What's that do?
Yeah. Well, it's it's a really low level vision. Yeah. So information comes right from my eyes straight to the back of my brain, and then it just basically gets processed. So that is pretty much finished maturing. And even in a 5 year old, this part of the brain up here, can you remember what that is?
Prior to words and what's prior to really course to do.
Yeah, yeah. Propose section movement. Yeah, that's up to be. So that that is pretty much finished materially before everyone's brain.
In the sense that they've been doing a lot of development, you know around 234, but then the key thing is that these parts of the brain here in particular here, this bit here and this bit here are still are still a complete building site for five year old and they're still slow developing. And So what these parts, so there's 22 chords to CC this bit under the forehead is there.
Trying to go to say word done and that does very closely.
Yeah, the executive control and planning and then these parts under my temples here, temporal quartet and they do, yeah, kind of early language. Yeah. So kind of get a language basically. So basically. So those are the parts that are still really slow to learn. Yeah. So the really important picture to Lucy is, you know, I look at my son's hand and his hand is basically the same as my hand, just a smaller version. Yeah. And we used before we had this these images about 20 years ago, we used to assume that kids were the same. Yeah.
Their kids brains are the same, so their brains are just like a smaller version of my brain. But in fact we know that in a 5 year old play some parts of the brain are really mature at a time. In other parts of the brain. Still a building site there.
That's really important. All right. OK. So that's just a refresher. A Charles rain isn't just an immature version of an adult's brain. Different parts of the brain develop at different speeds, so there are early developing or we didn't talk about that because you can't see so much, but a sub cortical area. So those are the bits that you can't see from those outside pictures of brain. Yeah. Those bits that where the spine comes up into the brain. Yeah. The really coarse. What do those bits right on top of the brain stems? What do those bits do?
Yeah. So there's some memory stuff. Yeah. So basically the the really the right on top of the brainstorm stuff here does a lot of the really basic keeping your heart beating like regulating your temperature, giving goosebumps if you get cold sweating, if you get a heart that's up to start breathing, sending your signal to your heart to be's and massive stuff. And then the bit kind of on top of that does a lot of the kind of what you normally think the limits are kind of emotion. So it's obvious there's emotions.
So I forgot to mention. So they're also early developing because obviously they're the very first thing that's online in a newborn. Baby is their breeding. Yeah, because otherwise they're not not going to be around for the very long. Yeah. So that's the very first developing part of the brain. And then some cortical areas, the occipital, that does early vision paraso that does movement and then late developing temporal and cortex. OK and then. So that's one thing to say. Yeah. And obviously we're going to be talking about how this. I mean, we already talked in the last lecture about how this is the reason why all children.
Find executive control hard.
So an average 5 year old, they're not in control of their behaviours as much as an average adult, and This is why, because that part of brain hasn't developed yet.
Yeah.
Mm hmm.
But that's a really tricky question, so I used to work at this at brain Research Centre in Cambridge.
And a big study came out looking at gender differences in the brain, and it was about 5050 men, women, this research centre, Cambridge, and the women in particular. There was like a group chat, like, 100, like neuroscientists. And they were really going mad, like tearing apart this study. Like they were really clever people. They were really like tearing apart, like, carefully. But I I don't know. I just didn't. And there's a whole book this woman called India fine. Sent a whole book like tearing apart the idea of gender differences in their brain.
I don't know honestly that just strikes me as you know, like you cut off an average arm. Yeah. And you can tell the difference between an average man's arm and an average woman's arm. Like most parts of the body, you could say, why wouldn't the same be the true for the brain? I don't know. Personally, you know, I think that there's no need to be like that. Reveals a bit of, you know, insecurity, which I just find a bit weird, you know, like, average women. Average men think slightly differently. That doesn't mean that one's better than the other, obviously.
You know, there's lots and lots of things that women, you know, in all these tests show on average women are better than men. A lot of really, really important stuff. You know? So. So yeah, so I'm quite comfortable with the idea they've been gender differences in their brain. But a lot of people are quite uncomfortable.
Yeah. So that's a really tricky question. There's this woman. I'm just organising this baby neuroscience conference up in Glasgow in July. There's this woman from clever. She's coming, who's shown gender differences really, really soon after development after birth, like within a couple of hours of birth in really simple tasks. Obviously, that's what you can do with a 22 week old, but she's been again. There's a lot of kind of, you know, anger coming to her. She's like, I'm just a scientist. I'm just doing my studies.
But, but yeah, so she's yeah. Interesting. Yeah.
But we'll get a little bit more into that in ADHD and voicing first at, yeah.
Yeah. So that's one of the big yeah, so so the like 'cause, you've heard of this thing about the autism is the extreme male brain. Yeah. So one of the ways in which, you know, they think it's different is that you have, like, men. One of the ways in which people say that there's differences are that men per load have got more neurons and more connect, more connections. But the connections between the crosstalk between the different parts of the brain is weak. Yeah. But again, yeah, that that's, you know, contested. But that's what some studies show.
OK. So we've been talking so far about how it's parts of the brain that do let me just take you just sent me an e-mail. So she really wants to come to section this night. We've been talking about how the different parts of the brain that do kind of executive control and late developing and and This is why definitely all these things kind of executive functions we're going to be talking more about what these are. But very coarsely we've been talking about them as you know control how we could thrall you or with your behaviour. Yeah.
So there's loads of evidence that these are the slowest developing aspects of behaviour. Yeah. So even between like 8 and 16, there's quite a lot of development, whereas a lot of other things are starting to, you know, plateau by then. So these are thought to be the slowest developing aspects, which is exactly as you would expect. Yeah. And this, as I say, is true for all children. Yeah. So that's one thing that we're going to be talking about, you know, is it just that ADHD is a question of, like, do they delay development? Yeah. Are people with ADHD like, just at an earlier stage of their development, they're completely OK.
Good, right? Let's crack on.
OK, so part 10.
Sorry, I moved around part one and Part 2, Part 2 gonna be on epidemiology then.
Yeah, sorry. Yeah. I've stayed with that. So part one's are genetics, part 2's, OK.
So how do we find out about the genetics if I catch it to sort it? So who's who? How? What address have you done? So you. So do you want to know about genetics? So is it predetermined from my genes whether I'm going to get a condition or not? Yeah. So how do we answer that question? Have you done any of this before?
I don't have anything on that.
Yes, I.
This is. It's often. Yeah, that's always the conclusion. But it is, you know, there is still a question that we can test. Have you done? Have you heard this phrase twin studies before? Yeah. All right. So what's twin study?
Yeah. So there's one thing in really particular that they look at, it's not my next slide actually. Yeah, alright. OK. So we're we're going to work up to that. Actually we're going to work out that, OK. So the first thing is parents and siblings are people with ADHD have got a 5 fold to 10 fold increased risk of developing the disorder compared to the general population. Yeah. So if I'm a baby and I've got a sibling and a parent or a parent with ADHD, I'm much more likely to get it myself. Yeah. So what does this tell us on its own? It's fact.
Well, not necessarily because.
So why is that not necessarily genetic, just from the fact that my parents got it?
Yeah, exactly. Yeah. So they're going to have the same. So so if I'm being parented by a parent with ADHD, they might be interacting with me differently and now might be one of the things that 'cause it. Yeah. Or if I've got a sibling, you know, my home environment's gonna be different. So that might be one of the things that causes it. Yeah. Or it could be that I've got the same genes as my sibling. And I've seen centuries of my dad. So you can't actually tell very much on that. It's usually in terms of what causes it. Yeah.
So that's why we can say something or you're just going to say that.
Yeah. Yeah, yeah, yeah. That's a good point. Yeah. That is a good point. So it can't be well, actually, yeah. Because you only say half your teams with your siblings. So. But yeah, I see what you mean. You kind of get the variability. OK, so that could be genetic or environmental. OK. OK. So twin studies show that ADHD has a heritability of 70 to 80%. So they saying that you can say 70 to 80% of ADHD is caused by your genes. Yeah. So how do we tell that? OK, so one of the key things and you are getting there with your thing. So one of the key things is.
This idea of identical twins.
Versus non identical. So what's the difference between identical twins and non identical twins?
Yeah, good. So DN as the same in identical twins. And there's different in non identical twins.
I don't worry. So we put that MZ behind. So that says monozygotic. Yeah, so that the zygote is the very first.
Time when the sperm fertilises the egg and that turns into a zygote. Yeah. And what happens is sometimes that's I go, then splits into two. Yeah. And then two babies develop. Yeah. So they've got identical genes. And diesyygotic is where you get 2 eggs coming at the same time, being fertilised by two. Two bits of sperm. And they've got different genetics for they went through. OK.
So how do we tell the? How do we tell from this? Can anyone guess how this is useful in telling us how genetic conditions are?
Yeah, yeah, exactly. Words and yeah, so basically, so we assume and this is the part of twin studies that's a bit controversial, I'm going to get to this, but we assume that all twins have the same environment when they're growing up. Yeah. And so all terms of the same environment, but in monozygotic, they've got the same environment and the same genes. Yeah. And diabyotic. They've got the same environment in different genes. Yeah. So we just look at the difference in what we call the concordance rate. Yeah. So identical twins have got identical genes and identical environment.
Since they've got not identical genes and identical environment, yeah.
Yeah.
See I am.
Yeah, yeah.
Yeah, yeah, yeah, that would be fine. Yeah, I know. That's exactly what people are arguing this now. Basically, we've done loads of science of this, and now there's a backlash where people arguing exactly that that is not. They're not sure that you give doing studies that show that identification. Don't say twins don't always have identical numbers. Yeah. Yeah, yeah. No, I know. I do. I do. See what you're saying. OK. So. So but say, though, just forget forgetting that point for a second.
Are you just scratching the well, no, no, no. It's pointing out. I do know, obviously if 110 has ADHD.
So, say, with identical twins. Yeah, if one twin is ADHD, there's an 80% chance that the other one does. Yeah, but for non identical twins, if one twin is ADHD, there's a 30% chance that the other one does. Yeah. So this difference between 80% and 30% is the thing that tells us how genetic it is. All right, don't worry. Yes.
Yeah, yeah, yeah, that's another problem with this. Yeah. Yeah. Another problem. No, no, no, it's fine. It's like, no, it's really good to be criticised in the methods. Yeah. No, it's really good to be criticised in the methods. But there's a lot of science to be done of this, but definitely problems with it. Yeah.
Yeah, we're getting to that. I've gotta study. No, no, no, it's good. It's good. It's good. I've gotta study. It's done exactly that. Coming up in a few studies. Yeah. So that's, that's another converging. OK, so just just to without. Yeah. So the difference between these two figures tells us how genetically determined something is. Yeah. So is that clear? Is that the basic principles? We've been jumping ahead to talking about the problems with this method, which is great.
And but as the basic principles that make sense to everyone, yeah.
OK so.
OK, So what I've said so far, how do we find about the genetics of psychiatric disorders? Yeah. So we if if my parents and siblings have it, then I'm more likely to get it myself. That doesn't actually tell us very much about what's causing. Yeah, from that, it could be genetic. Or it could be environmental because both are the same. Yeah. I've got the same genes as my parents. I also grew up in the same environment. Simply. Yeah. And then this. So that's why we have to do a twin study. Yeah. To look at this thing. And we call this concordance rate. So the concordance rate is, if I've got it, how likely is it that my twins also got it? Yeah.
And the twin study showed that concordance rates in ADHD are much higher in identical compared to non identical twins. Yeah, and from this we've got this idea that it has an heritability of 70 to 80%. Yeah. So that suggests that ADHD is strongly genetically determined. Yeah. OK. We've already been jumping ahead. Some of the problems with this method, but that's what. That's what we've been doing. OK, so there's another thing. So has anyone heard that phrase AG was study?
No, you are. You can do much of lunch in a 68 times. I know if you do.
But anyway, I work with colleagues at kings and this is what they do. A lot of the time. GW studies. So a GW study is a genome wide association study. OK. So basically the way has anyone got an idea how does anyone to guess how you might do a genome wide association study?
So I did says yeah, yeah.
Yeah. You take the blood sample? Yeah. Oh, yeah. Actually, you do a saliva now it's gonna spit spit into a tube.
And then and then you basically it's a really, really simple study. You basically you break down their DNA into. I can't remember how many they're called snips, the individual genes. I can't remember how many there are, but there are a lot like 10s of thousands I think of all of the different genetic code. Yeah. And then you just look very, very simply at between people with autism.
And people who don't, are there particular genes that are more common? Yeah.
So it's it's a really simple study. You need a massive a massive sample size to do it. Yeah. And this is one of the things I don't know if Georgia covered it in the lecture and autism, but there's there's been like, a big rebellion. Simon Baron in Cambridge was doing a leading a big. He needed like a sample size of like 100,000 or something to do this. Is there a gene for autism and the autism community really got together and we're trying to rebel against this. And we're trying to stop this study from happening because they were like, you know, what are you going to do with this information?
Widely philtres and that type of stuff. Umm, there's still loads of these studies have have been done and they've told us this quite strong finding that there is no single gene that causes ADHD. Yeah. So how do these two facts fit together? Has anyone got a clue how these two facts fit together? So there's no gene for ADHD. So in that case, how can it be genetic? Anyone want to?
So it's partly because it's a component of genes. Yeah. Partly because.
Anything else?
Yeah, yeah, yeah. But that's the type of thing that would be picked up by a twin study. But you're absolutely right. So, you know, we. Yeah, like if you're if you have a serious, serious problems with the with the as you're giving birth to a child, then that type of thing can cause ADHD, you know, traumatic brain injury can cause ADHD. But that would be picked up by a twin study. Would you say something about that?
Yeah, yeah, yeah. So we I've got again. I've got some studies coming out that look at exactly that question. A really good question. So that's the thing. I mean, I guess the point I was going for and this is I think it's important to be like sceptical about genetic studies in this way is genes build proteins. Yeah. So all the gene does is it sits there and it's a series of.
What they call these nucleotides and then basically like a little molecule comes across the RNA and that spreads off and that is used to actually build a protein, yeah.
So genes are involved at a really, really low level of brain function. Yeah, there are other, you know, a lot more complexity there. But they're basically so this idea, you know, we used to be really obsessed by things like finding a gene for language. Yeah. And finding a gene for homosexuality and all of those types of things. Yeah. And we now know that that's just much too simplistic than I do. Yeah. So. So genes cause ADHD in the sense that I can tell, you know.
Identical twins are much more likely to have it than non identical because they share environment because they share genetics.
And but it's very we. So we can tell we know that, but we can't yet tell from looking at someone's genes whether they're gonna get ADHD or not. Yeah. Because genes interact in very, very complex ways. Yeah. So they're now doing studies saying if I've got this gene and this gene and this gene and this gene, does that make me more likely to get ADHD? Yeah, but that the maths becomes very, very complex. And you rapidly get to the point where you need to be sampling, you know, like a billion genes to be able to tell the things. So it's a really, really tricky stage anyway. That's where we're at in terms of our genes. Yeah. So we so we know that it's genetically genetic, but we can't tell from looking at someone's genome whether or not they're going to get ADHD.
OK.
Good. OK. So that will make sense. Everyone happy with that? Yeah. Let me just check again this person.
Right. OK.
OK. Yeah.
Yeah, I know some people that are doing exactly that at the moment. I just was out examining APHD in Sweden and they're working on that, that that thing, yeah.
I don't know what the results are shown actually yet, but yeah, they're doing it.
OK. So OK. So we've been talking about genetics. We got to this point that we know it's genetic, but we can't predict from someone's genes whether they're going to get it yet. But that's just because of, you know, issues in our understanding of this, OK. So if it's genetics, does that mean it's not environmental? Yeah. So we know, for example, that what we call hostile parenting is more common in parents of children with ADHD. Yeah. So how much you shout at your kids? Yeah, for example.
But is it? Is it the case that more hostile parenting causes ADHD? Yeah.
Or it could be that, yeah, we mask it. We learn to mask it, OK.
So prevalence rates of ADHD also vary wildly between different countries. So in the US, 11.11% of 4 to 70 or 17 year olds have diagnosis of ADHD. In France, half percent have diagnosis. OK, So what does that tell us?
So yeah, again, this could tell us lots of different things. So one, it could be how much pop we drink as kids, how many sugar we drinks, we drink as children, how many of those amazing. I love it when you see those those pint mugs, those like 4 litre things of fizzy drinks that they change. So it could be something that could be that. What else could it be?
Yeah, yeah. So it could be, it could be something that's that's that's cultural and to do with what we're defining ADHD picking up something. Yeah, so that yeah could be right. Yeah.
Yeah. So those are the two things. There could be something specific to the US, yeah, that is causing ADHD in the US like fizzy drinks. Or it could be something that's cultural, that the ways that we're looking for it don't don't tell us very much yet.
Yeah, yeah. Would I love medicate? Yeah, yeah.
Yeah. Yeah, yeah. Yeah. Yeah. So that's the thing. So this is obviously getting to this thing that you know, is it actually a thing or is it just something that we diagnose? Yeah. I wish we're gonna be talking. I'm doing another lecture later by picking out lots more of these patterns across developmental. We can talk a lot about that then. Yeah. OK. But what I've said so far, ADHD effects that more children than adults, which we talked about how that can mean lots of different things. And it's diagnosed at extremely varying rates.
Across the world, again, that can mean different things. OK, so next question, so.
More an epidemiology of ADHD. So there's four to one. So four times as many boys get diagnosed, ADHD as girls. So again, what can we tell from that?
Yeah.
So it could be the same point. Yeah. Go. Yeah. So it could be that girls get it as much, but it's underdiagnosing girls. Yeah. Or it could be. What? Yeah.
Present. Stephanie. Yeah. Yeah. No, that's really good. And we're gonna get onto this. So I I think I think this maybe there's not. So one of the things that's I'm just writing a book on concentration for early years teachers.
And one of the things we're talking about is so ADHD tends to show a much more hyperactivity in boys. Yeah. Whereas ADHD girls tend to be much more inattentiveness. Yeah. So you're sitting looking at me, you know, as you know, you're sitting there with your eyes on me. I can't tell which I'm looking at you, whether you're thinking about where you're going to go next holiday or whether you're actually paying attention to what I'm saying. Yeah. And that that type of inattentive subtype.
Where you might you sit really still and you sit and you've got your eyes on the teacher is more common than girls. Yeah. And that's much, much harder to diagnose for obvious reasons. Yeah, I can tell if someone's chippy's picking up and chucking my chair across the room and it's disruptive to the other kids. Yeah. So that could be why.
Yeah, yeah, yeah.
That's no problem.
Yeah.
Yeah. Yeah, yeah. Yeah, yeah. Yeah. So that, that, that can be a big part of it. But equally, there's a very different possible explanation for this, which is the there's something about boys and the way that boys brains develop. Yeah, that means that they're more likely to get it than than girls. Yeah. Some more similar to autism where, you know, there's also this big gender difference. Boys are much more likely to have an autism diagnosis. And girls. Yeah.
We're gonna go on to that.
Now that's a good question. I don't really answer to that one, I'm afraid, but this is the slide on diagnosis. So, so basically and in in the in the talk that comes up on comorbidities, I'm going to present this really, really good. It's actually a 10 minute lecture, but it's well worth watching by this person and they've they've done this really groundbreaking study showing that if you have one mental health diagnosis, yeah, you're more likely to get every possible different mental health diagnosis. Yeah, we used to think that there are some really neatly defined categories. Yeah, there's one thing which is awesome. There's another thing which is ADHD. There's nothing which is dyslexia.
We now realise that it's much, much messier than that. Yeah, so people with ADHD, only 33% have got ADHD, only 33% have got one or more disorders, along with ADHD, 60% have got two or more, 18% have got three or more. And basically so this is showing slightly different. 31% have only got ADHD, 50% have also got discount, clear discount disc, calculia, dyslexia, non specific learning difficulties.
11% of course.
I said like Tourette's, like a 50% have got motor disorders, only 25% I've. I've heard seen other bigger figures for autism and PDD not otherwise specialised. 40% have got oppositional disorders, 35% have got anxiety. So anxiety is very, very, very common in ADHD, 4% of depression. But that's probably to do with age and 40% have got other different disorders. Yeah.
So. So it's very, very heavily comorbid and we're going to be coming back to this later. Yeah. Anyone got any questions on that? Make sense.
OK, so right, So what we said to so far, ADHD is more common in children than adults, is diagnosed at extremely varying rates around the world, is more common in boys than girls. And it's heavily comorbid with other conditions. Yeah. So, so those are all true. None of those give us a really clear idea of what's causing it. But they're all things that I'm going to be talking later about how we can bear those points in mind when we're thinking trying to work out.
What causes ADHD, which is what we're going to be getting to in chapters in part six? Yeah, happy. OK, good. So now we're going to be talking about behavioural deficits, as I say, I would love to have a section of this lecture on behavioural strengths, but there just isn't a research at the moment. Yeah.
Yeah. So there's what? Well, yeah, but it's what I was saying earlier. It's just really, really hard to measure. Yeah. So it's just like, you know, I'm very ADHD. And I just get, I get up at 5:00 o'clock in the morning. And I do work. Yeah. And I never have problems like dragging myself out of bed.
Just because I want to get stuff done. Yeah, but that's the type of stuff. It's just there's really, really important for life. Yeah, it's just really, really hard to measure. And so that that, I mean, that's what I would say is behavioural strengths of aggst. I don't know what about you?
Yeah.
Yeah, yeah, yeah, got overstimulated, he said. Yeah. Yeah, yeah, yeah, that. Yeah, that's that's true. And that's always too. I mean, I was doing this. I was doing this breakfast TV and then breakfast to present. There's a table there just right below the table. You can't see it. They've got three monitors that they're looking at. She's got two earphones with different things talking. One's a galley, one's a microphones coming in and then she's looking at you. And then there's like monitors behind that. And just how you have to split your attention for, like, 4 hours to consume all these different piece of information.
So what I know, I know that's why I'm in bed by. OK, so right. So now we're going to meet Russell Barkley. OK, so this is an idea that we're going to be arguing against for the rest of the lecture. I already mentioned earlier. So just as we used to have really neat explanations for autism have what have you done? The neat explanations for autism and autism nation.
Do you remember that? Have you had this theory of mine deficit?
No. Did you not do that in the old system that show? Yeah.
Yeah. Yeah, yeah, yeah. So so everybody still learns it. I learned it as an undergraduate. This thing that, you know, someone Simon, Vancouver in 1985 suggested that problem with autism. People with autism. They have this thing with theory of mind deficit. Yeah, that they find it hard to represent the mental states of others. Yeah. And we now we teach this because it's a nice simple explanation, but we now know very comprehensively that that's wrong as an explanation for autism. There's too simple. Yeah. So similarly, this guy, Russell Barkley, this has got, you know, a lot of citations.
At the in academics terms, this is a lot.
He's a very popular because it's a simple idea. Yeah. And we now know that it's wrong. Yeah. So he says the problem with ADHD is that they have a problem in behavioural intuition, that they can't stop themselves doing stuff. Yeah.
So. So what we're going to be arguing against is showing that there is a lot of evidence that people with autism perform worse on tasks of behaviour and inhibition, but that's not the same as saying that this is what causes the problem. Yeah. So it's a really key, like, General Point. I'm trying to make using ADHD as an example.
A really, really key point for understanding like developmental disorders. OK, so we do tasks like this. So this is called a go no go task. So you have to look at this cross and then this guy pops up is a whack a mole task. If those of you who like playing whack a mole go am using arcades. Yeah. So. So this guy comes up and then you have the whack him and then this guy comes up and you have to whack him. And then this guy comes up and you have to whack him and then the purple cabbage comes up and you have to stop whacking. Yeah. And then and then it's comes up and you have to whack it. Yeah.
So they do, so that's gonna go. No go TOS for obvious reasons. So.
Well, all different sorts. And they they make it more complicated.
Earlier on, like I've tried to do tasks like this with babies and you can't. They're just. They're all. Everyone's at floor. Yeah. So none of them can do it at all. And then so you could just make it easier and easier and easier for harder and harder and harder to get older. So to keep moving. OK, so it's definitely true that people with ADHD do worse at this time of task. Yeah.
So that's been shown many, many times that people with ADHD score worse on performance of inhibition, yeah.
But that's not the same as to say that this causes you to have an ADHD diagnosis. OK, so this is quite tricky. OK, so why what? What has to be true in order to say if I have a problem with inhibition, it causes me to have a UHD. Yeah. What has to be true in order to defend this?
What? That what? What's opposite then?
And I was quite tricky questions.
Yeah, yeah, yeah, that's excellent. Yeah, that's really good. Yeah. So ADHD. So trying. So one thing is what might disprove it. OK, what has to be true for this to be true? Everyone who has impaired dissipation has ADHD, and everyone who has ADHD has impaired inhibition. Yeah. So to say that one thing. So it's different to say that on average, a group of people with ADHD do worse. Yeah. And in fact, both of those are not true. So there are people with ADHD with, with impaired individuals who don't have ADHD. And there are people with ADHD who don't have impaired inhibition, like, as a group, they're different. But not everyone has it. Yeah.
And and also there's this other thing going back to this thing that ADHD Co occurs with pretty much every other disorder that you can possibly think of. Yeah. So people with ADHD also have a whole load of other problems, like temporal information processing, speech and language, memory processing, speed, response time variability, arousal, activation motivation. Yeah. So there's lots of other things that are unrelated. OK.
So yeah, people, they get your worst hitting box control. If you're back to this again, you go throughout the lecture. But this is not the same. Saying that ADHD is caused by difficulties people with athletic have problems other than impulse control and not everyone with ADHD has impulse control. Simply. So we're going to be coming back more to that later. OK, but make sense. Everyone that clear for everyone. Yeah. OK. Good. Right. So neuroimaging. OK, so.
What? So what would this simple explanation that I just talked about?
People with ADHD have a problem with impulse control, and that's what causes them to have a condition, yeah.
So what would Russell Barkley, whose idea this was if we looked inside the brain someone with ADHD, what would he predict that we're going to fight?
Exactly. Yeah. So Russell Barkley would predict that this is. Does anybody knows what this picture is? So this picture is the one that we saw earlier.
Yeah. Yeah. So it's cut through. It's cut through in the right. And this is the the inner heart. Like, I'm here. This is the. This is my right lunge. Yeah.
So there. So he would predict that people with ADHD would show a density and everywhere else in the brain would be fine. Yeah. So in fact, that's not at all what we find. So we find deficits or atypicalities across the whole brain. Yeah. So we do find out typicalities in the first report. Six. Yeah. But we also find it in a whole load of different areas too. Yeah.
So we do find that at working memory and shifting attention and executive control, but we also find that we don't need to worry about that.
Lots of stuff about kind of planning areas, planning and initiating motor responses. We're going to get on to kind of arousal modulation. Are we going to find that later? So basically, pretty much everywhere we look in the brain, we find evidence for kind of atypicalities like atypicalities are everywhere across the brain. Yeah. So this is kind of another thing, which is another area where, you know, since I've been.
In neuroscience, our understanding has changed, so we used to think that when you look in a brain, you would find really, really simple patterns. You know, the brain of someone with autism would look different in, you know, the theory of mind area. Yeah. The brain of someone with ADHD will look different in the central cortex. Yeah.
And in fact, every condition that we've looked at, we found that the patterns of how their brains are atypical are really, really complex. And there are a typicalities across the whole brain.
So we started off, you know, when we started off doing this 20 years ago, we started off thinking there was going to be a simple answer. Yeah. And in fact, we now know that it's a much, much, much more complicated answer and at least simple explanations. You know, one problem causes one thing isn't true. Yeah, which is kind of, you know, sad in some ways, because if it was simple, you know, it would be easy to fix. Yeah, just a passport to the end of the lecture. Actually, all ADHD is one thing where, you know, we do have some drug treatment, but, you know, everything else.
Pretty much every other condition we can't really fix it yet.
Yeah.
Well, yeah, yeah, that, that that's the other that way of thinking about it. Yeah. I mean, that's exactly what I'm writing in this book. You know, you you talk about kids with poor concentration, and we tend to think of it as a problem with that child. But it's about the fit of the environment to the child. Yeah. Which is obviously tricky for teachers because they've only got one environment. They've got 30 kids in there. But anyway, yeah. But yeah, yeah. But there are some things that cause a lot of distress. Yeah. And that we would like to be able to fit, but we basically can't fix anything. You know, we're conditioned to be really bad. OK.
So OK, so don't worry about that, OK?
So so basically so there's not a simple pattern of atypicalities in one area of the brain. OK. But there's another idea that we can look at nicely from brain scans.
Which is this idea that we had it come up earlier. Is it the question that when we were talking about how ADHD is diagnosed twice as often in kids as adults? Yeah, it could be that the kids that get ADHD and then grow out of it. Yeah, they're just at a slower rate of development. Yeah. So that's something that we can look at quite easily in a brain study. Yeah. So that's exactly what this study did. It took people with ADHD, and it took some typical controls. Yeah. And it basically said, you know, do you get these forward relationships? So the brain of a child with ADHD.
Looks a brain of a 7 year old with ADHD. Looks like a typical 9 year old.
So so the answer is for some parents. For some kids, yes, that is the case. Yeah. So some kids, their brain does look like an older child's brain, but most most children with ADHD don't show complete catch up. So it's not that simple. Yeah. And there's another way in which this is actually more complicated than that, which is that there's research showing that if you give a child a very rich, stimulating environment.
Yeah, that actually slows down their brain development. Yeah. So I don't know if you've learnt to if you'd have the brain lectured. Do you Remember Me talking about how you have this over proliferation of synapses? Yeah. So you get loads and loads and loads of connections between the neurons in the brain. Yeah. And the number of connections between neurons in the brain peaks somewhere between two and five. Yeah. And then it goes off. So the graph goes up and then it goes down. Yeah, round about the time when we're learning language. Yeah. This is why when children, kids brains are much faster at learning language than adults, brains are.
So, but it also explains a lot of the things that kids are really bad at. Yeah, like, be consistent and be fast. Yeah, they're much slower. They're very much slower. Yeah. So there's evidence that if you raise from mice, if you take one group of mice and raise them in an enriched environment where they've got, you know, toys to play with social partners, to interact with, yeah, they have more branches, more connections between neurons in the brain. Yeah. So it makes this kind of branching. So. So that is that is one way in which actually slows down their brain development. Yeah.
So from 5 onwards development is about like getting getting fewer connections between your runs. But if I'm in a very rich stimulating environment then I keep on going for longer. Yeah, and it slows down my brain development. So. So this idea of like speed of brain development is complex. Yeah. And certainly I think about this a lot with my son Freddie, who's like really bright and really stimulated. But it's definitely worse at impulse control than a lot of the other kids in his class. Yeah, he's just, he's just started reception. And I do think about this like he he he's he's at his brain is at an early stage of development because there's so much going on.
So they might be related. Yeah, but we don't have much for that. Makes sense. Anyone got any thoughts on that?
Nope. OK, good. So yeah, just to say what you said, OK, so lots of different brain systems are a typical in ADHD, not just a frontal cortex. Yeah, there is evidence that people with ADHD show slower brain development. Yeah, but only so that should say some people with ADHD show slower brain development, but most patients with ADHD don't show complete catch up. OK.
Good. Everyone happy with that? OK, I'll just, let's take 10 minutes now because we just covered quite a lot of stuff and then we'll come back, let's say. So it's 10:00 o'clock now 10 past 10. Yeah. You got a question as you just wait. Everyone listening to the question, then we'll do.
But that's a really tricky question. I mean, this looks excellent for my daughters, but almost three and the IT really annoys me. It's a star. She's going through like a, you know, two sister got upset and she'll cry and and the people in the nursery, there's one person in particular said yes, she had a good day today. She hardly cried at all. Yeah. And it annoys me because a lot of the other kids in the nurse, I still have time observing kids nursing. They got them. They're just sit there, like, burpsy and nerd during the whole day. It's just not really interacting, just sitting there like that. Yeah.
Whereas she's always like up, she's trying to do stuff and you're trying to interact, and yeah, she gets frustrated. Sometimes she gets a bit overcooked, but I'm much, much rather as a parent. She's actually trying to do stuff. Yeah.
And then get frustrated, getting upset and just sitting there blankly saying, awaiting. But I don't. So it's so, yeah, it's trivia. Right. And like, a lot of education, you tend to focus on the outlier. Yeah. And teachers just want an easy life. So they want everyone to sit there and keep their bum and seat and not, you know, not move them muscly. But, you know, the best outcomes aren't necessarily.
But that's another really good question and it's really tricky and that's actually why we moved to. We moved out of London to Lewis because my son is quite wide, but really right. And we made it better in the small town where the kids are calm and you can just like, you know, we can come up and just ask and he will do that. But if no one else is doing that, we won't start doing that. But it is like still quite high. But focusing on learning.
Focusing on the things I think, yeah, it's tricky though it definitely varies between, yeah.
Countries where they started to pitch in later. Yeah. Then do you know, like their breaks to diagnose this? So that's a really good question.
I don't know. I don't know about that. Yeah. Yeah. It's a good question.
Yeah, yeah.
Yeah. Yeah, yeah, yeah. I guess the rates are, but they they give medication. You know, the reason it's so high in America is they love medicating. You have to get medicine.
Yeah.
Yeah, interesting. Alright. OK, let's say 10:15. Alright, 10:15 will restart.
I mean, it's one of the reasons, yeah.

Sam Wass stopped transcription

PY5010 ADHD lecture 190324-20240319_101847-Meeting Recording

March 19, 2024, 10:18AM

35m 0s

Sam Wass   0:06
We might as well pack on, OK?
But that I know we've got to turn off these and then we just double check and save. I know about this.
Yeah. OK.
Umm.
Recording has started OK.
So that's so it.
Yeah, start recording. OK, fine. Good, right. So.
You can see that we've got turn off these subtitles. OK, so Russell Barkley, remember, who's this guy who's got this nice, neat, very popular theory, that inhibition is the cause of ADHD. Yeah. What would he predict for how we fix ADHD?
Actually, 'cause, we're gonna get onto the route through Mitch. Meditation works, but more as a behavioural thing. So he would predict that his theory is that inhibition causes ADHD. So he he. So we would predict based on that that I guess that.
Like training, people's inhibition would stop them getting their dhtr case. Yeah. So this is a very, very well.
Kind of with research idea, this is quite close to my own heart because I actually spent quite my time. Have I got some stuff coming on it.
Oh, no, I think I've got some. Maybe. I talked about it a little bit before, so I did my PhD. Don't worry. So so this is this idea that just training inhibition stop you from getting ADHD. Yeah. And I did my PhD design in these computer games for babies.
To try and improve your kind of inhibition. So how in control you are of your eye movements in babies and we actually had a quite a big almost £1,000,000 grant.
Where we were doing it with babies at risk of ADHD to look at just playing these games that are designed, does that stop you going on to get ADHD symptoms? Yeah. And so that's been done. And the short answer was no, it doesn't. Also on a much larger scale, there's this, I don't know if you've seen them, these working memory training games, you might have seen for those of you who work in schools. So basically, this is a game where, you know, the pig lights up and then the sheep and then a horse and then the dog.
And you have to click on them, then in the in the order that they lit up, yeah. Or they hear the different lights flash up on the telephone and you have to click on them in the order they lit up. Yeah.
So this is working memory which is different to executive control but very, very closely related. Yeah, so it's this part of the brain under the frontal cortex here and there's a lot of evidence that, you know, there's there's, there are a lot of associations between working memory and executive control. And there's this guy who I actually know quite well called talk called Klingberg. He's a very slick Swedish operator. And he basically designed these. Did a couple of studies showing that they stopped children from getting ADHD.
And then sold the company for a really a lot of money to to a company called Pearson's. And just as loads and loads of other studies were coming out showing that in fact they don't, they don't stop you getting ADHD. Yeah. So he's made really a lot of money off of doing this.
And and now this company has spent a lot of money buying these things and now is realising that they don't in fact make very much difference. So they're still using them. So lots of kids have to do these in school like number of times. And I was like so someone says, Oh yeah, my kids been doing that's going on. It doesn't work. That doesn't want it and it doesn't work. I need it in prisons. They do it everywhere and so it works at making you better at memory but it doesn't work at causing everything else. Yeah. So it doesn't work and that's quite well proven now that this type of training doesn't have an effect on other aspects of behaviour. Yeah.
Just as as we showed in my study that training babies to be more in control of their eye movements makes them more uncontrolled of their eye movements, it doesn't make a better other stuff. Yeah, OK.
So that's interesting and we could be talking later about why that is. Yeah. So yeah, yeah.
I mean, yeah. So yeah, that that's what we've been writing a lot about in this book about stuff you can do. Yeah. Things focus on things like concentration and understanding and that type of stuff, I think. Yeah. It's like repetition. That's where I think, like is there's a lot of stuff to be done, you know, helping messy early brains to, like, just do the same thing again and again and again. So they get really practised at doing the same thing again and again and again and again.
And that means you find it easy to pay attention to stuff. That that's where I think the field's going. But there's not very much evidence of that.
Yeah.
I hate it. Yes. Yeah, yeah, yeah. Definitely. Yeah. Yeah. The problem is a lot of other houses went frantic and spent a whole block down shouting each other.
But yeah, but those he did? Yeah, but it it's tricky and there's there's not not very much evidence on on that type of stuff like protective things. OK. But there is a lot of evidence for this again because it's easy to do studies on. Yeah. So just as I was saying, like, upsides of ADHD virtually not explored at all in the literature because it's hard to do science on just these types of like family factors, how much time you spend in puzzles very hard to do science. So we don't have very much. This is very easy to do science on. So we've got a massive amount of evidence trip. Yeah.
And Ritalin.
The formal name of methylphenidate.
Is one of our most effective psychiatric medications.
It doesn't like everything. It doesn't quite work for everybody, but it does work for a lot of people, a high proportion than other things. It only works for as long as you take it, but it is effective and it's like they have a ritling rule. So it's like 1 standard deviation or something like 1.1 standard deviation. On average it moves your ADHD symptoms, so it has a much, much bigger effect.
Than most of our other psychiatric medications and still, though, let me just. Yeah. So still though, we pretty much don't have a clue why it works. Yeah. So this is our state with all psychiatric medications that we.
We discovered them by accident. Yeah, so like antipsychotics. Glaucomazine, we gave it as an antihistamine. So to reduce swelling and then a doctor just noticed that if you gave this in thing to reduce allergic reactions to patients with psychotic symptoms, it made their psychotic symptoms get better.
I can't remember what methylphenidate was originally. It was something to do with the heart or something like that, and again it was designed as something else and someone just noticed. Am I going to see it makes a difference to ADHD and now we've prescribed it for ADHD, but we still don't have a drug. That's our level of understanding. We still don't have any psychiatric medications that were designed to do what they do. Yeah, everything is just this. Happy coincidences. Yeah.
Like, that's an area I don't know very much about actually.
I know that there's problems, there's there's research on that. Would like antidepressants and stuff like that that, you know, it can. And again, I don't know that literature very well, but there were some studies that increase suicide rates and giving antidepressants can increase suicide rates.
Mm hmm.
Yeah.
Yeah. Yeah, it's really hard to tell that cause people like that are, you know, we were. We're very ADHD in my family and we all had really angry adolescences. So that's why it's really that's why it's really hard to be sure. But but yeah.
Yeah. Yeah, yeah, yeah. It becomes reinforcing. Yeah, well, also you you get a document, but also you get stuck in this, like, all this stuff, all the brain about it is newer ones that fire together wire together. So the more you do it, the more it becomes reinforced as a patent and you get into this stuff. Yeah. Yeah. No, there's there's, there's, there's a lot to talk about that. That's the story of my family.
So yeah, OK. But back to this, so it works. It's it's one of our most effective medications, but we still don't have a clue why. Yeah.
And the reason is because it the brain chemistry is very, very, very complicated. Yeah. So methylphenidate acts by blocking the dopamine transporter and the norepinephrine transporter leading to increased combinations of both. But then this this leads to increases of dopamine and norepinephrine, but it also is a weak serotonin. So there's a one particular type of serotonin receptor that it does. But just to give you an idea of how just to show you here.
So these are just the, so the Red Arrows here are the dopamine circuitry and the blue arrows here are the noradrenaline circuitry. Yeah. So that then expresses itself throughout the brain, but also just every single neurotransmitter is regulating the amounts of other neurotransmitters. So it could be that, you know, the core action is on dopamine, but then that effects, you know, some other thing, some other downstream chemical. And that's what affects your ADHD symptom, is very, very, very hard to be sure why it's working. Yeah, people have done, like, 30 years of science on it, and we still don't have a clue why it's working.
OK, so this is, you know, quite depressing in a lot of ways because it is really, you know, at the moment, you know, it's literally just try everything. Yeah. See if it makes your symptoms better. Yeah. And I don't know. It's hard to see a route by which we're going to get better at designing drugs to target the brain just because the brain chemistry so complicated. Yeah. You.
Yeah. So I don't know. That's like, yeah, but that is a complicated.
A question you know, I think in a lot of times we as we were just talking just before like a lot of children's behaviours off their own self-image. And if they think of themselves as the naughty kid in the class, then they behave as a naughty kid in the class. You know, that's why I like parenting influences so strong, you know, that's why that, you know, non identical twins can actually be really raised very differently if you think you, if you pay, if you you ask parents to describe their kids to you. Yeah. And sometimes they say, oh, he's a naughty one and she's the nice one or like that like that. And then that in turn influences how you respond to them. Yeah. So once the parents perception gets in, that can then influence how the child subsequent development. So. So in that sense it might help. Yeah. So if you're getting into, you know, with depression, obviously.
You're depressed. You tend not to go out so much until you tend not to see your friends so much, which then makes you more depressed. Yes, you get into these spirals. Yeah. So if you're in a happy mood, then you have lots of friends and you have lots of people texting you, you know, saying, how do you want to go out for drink many more days go out for drinking more? Like to stay happy so it can help in that sense. Yeah. Can help a kid today gets you to stop thinking of themselves as the naughty one in the class which then helps them to behave different. So. So I guess so. Yeah. Over long periods of time.
Yeah, you can see. Yeah. Sorry. I'm not being quickly beautiful.
Parents very much like or they. They get home and have they where's on their absolutely crazy. What's the mental state that the child to have this plan? Two different types of personality that they can help me. Yeah. Yeah, yeah, yeah.
So that so that's another area that I think about a lot with my own kids that so. So like part of it obviously is just, I'm tired at the end of the day, yeah, again, we really, really don't understand. You know, we know it's like the hypothalamus like hangry. So we get really strong when we're hungry, we get really angry at my family. Yeah.
And I've taught my 4 year old I would like to say I'm just angry daddy like, even as he's like hitting a sister. It's the same retired. Yeah. So it's partly just, you know, cumulative during the course of the day.
But it is partly this whole idea that you behave as you expect people to as the people around you expect you to behave. Yeah. So like, you know.
With, you know, like my son would, you know, he'll he'll still, like, be quite violent, you know. And I'm like, if you're gonna come up and hit anyone, I'd rather you hit me. If you've got it in there. Yeah, but he finds it hard because I'm, like, just hit the cushion. But he thinks that he's angry with Daddy and I'm trying to say to no, you're not angry with Daddy. You're just angry like that. He's very reluctant to do that. He he'll want to hit me. He won't want to hit a Christian because he thinks of it as focused on someone else. Like it's what I'll say to my wife when she's anxious. You know, you're not anxious about this. You're just feeling anxious. And that's what you've latched onto. You know the difference between those two.
But anyway.
Right. OK. So so don't understand why? Because the brain chemistry is complicated. OK. So, yeah, there's other things that are called non stimulants that also work for some things. And then there is also evidence for dietary changes. So in some people.
Things like avoiding fizzy pop fizzy drinks can help to reduce ADHD symptoms, but it's probably only for a subset of people. Those who've got intolerances to them. It's the same with autism. I don't know if you did it in the autism lecture like heavy metals. There's evidence that some heavy metals, people with areas with higher rates of rainfall have higher autism.
And the reason is because there's something when you spend more time indoors, you get some particular chemical in you.
And then some, some chemicals, some people are genetically predisposed to be unable to break that, break it down, which then causes autism. So it's just one of the, like, many pathways. Yeah. OK. Yeah. And there's some evidence for parenting interventions, but it's pretty weak, and it's much weaker than the evidence for risk of them. Yeah. OK.
I'll skip over this because I don't really need to go to this. OK, so that's on treatment, yeah.
Good question. I don't. So I know that evidence for like nature exposure. So there's evidence for going on a walk in the woods, there's a few studies. I don't know how like good quality those studies are, but there's evidence that going for a walk in the woods does help it, but whether that's actually exercise or exposure to nature is quite tricky. There are some studies that just putting up pictures of leaves.
Reduces, you know, ADHD symptoms as well.
But again, it's probably for something different, but I don't know short answer for you know, just going on a jogging machine indoors. I don't know that.
That's not a really complicated question, though, like so it's the same with like violent video games. So. So it like this is a massively controversial area that it's possible that violent video games.
If you're doing something violent on screen that gets it out of you, yeah. So there's evidence that people who do more violent video games have more violent thoughts immediately afterwards. Yes, but there's no evidence for the long term. So is it just something that you get out of you?
Yeah, yeah, yeah, yeah.
Yeah. Yeah, yeah, yeah. It's a stronger argument. It's a stronger argument we make. Yeah. Yeah. Yes.
Yeah. Yeah, yeah, yeah, yeah. Yeah. Yeah, yeah. Yeah. I'm sure that is the case. Yeah. Yeah, yeah. But weird. I don't know why that's not on the list. This was actually taken from a study that looked at all these behavioural interventions and compared them. So there must not be, like, formal, good quality studies for that. But it's the typing must be true. Yeah. OK good. So so now we're going to get onto the. The trickiest part of the lecture, which is just this idea of, you know, how is it the case?
The ADHD has deficits in executive control, and yet it's not caused by deficits. Yeah, so this is the like, trickiest bit to get your head around about. And it's some really basic things about how disruptive development happens. Yeah. And it's very recent, as I say, like 10 years ago, you would have just had a lecture that, you know, inhibition causes ADHD. It's nice and simple. Yeah. But then we just got a lot of evidence now that that's that's not case. Yeah, we've got we've got the evidence from the brain studies.
That they don't just have a deficit in the frontal cortex. Yeah, the deficits are all over the brain. We've got evidence from the behavioural studies that, yes, there were certain inhibition tasks, but they do worse. Lots of other tasks as well. We've got the evidence from the treatment studies that training inhibition doesn't stop your ADHD symptoms. Yeah. So. So it's pointing to this pattern that it's not as simple as we thought it was. That inhibition causes ADHD. OK.
So Rasta Barclay says that ADHD is marked and caused by deficits in top down control. But we've presented lots of evidence inconsistent with this, including behavioural evidence, evidence from treatment studies and neuroimaging studies. OK, so how is it that lots of different initial ways of disrupting development can all end up having the same effect? So so this is what we call a funnel in problem. So this is where, like, our understanding of mental health problems is just starting to develop.
So my brain can be atypical in lots and lots of different ways. Yeah. And any type, lots and lots of different types of root cause. Yeah. Can all funnel into this idea that I have problems in paying attention. Yeah, for long periods of time. Yeah, because paying attention is one of the hardest things that our brain has to do. Yeah. We have to, like, coordinate for attention between different patterns of the brain. And basically the idea that we we think we're getting to is lots and lots of different, you know, things can go wrong.
That can all cause a problem in paying attention, cause paying attention is hard. Yeah. Similarly with autism. Yeah. And what? What social interaction is one of the hardest things that our brains have to do? Yeah. So lots and lots of different root causes can cause problems with social interaction. Yeah. So these two things Penguins interaction and social detection. I like the highest level functions of our brain. Yeah. So they're the part. You can tell that that's the parts where we're most different from other animals. Yeah.
Like ability to control what we pay attention to and the complexity of our social interaction. So it's not surprising that like a huge number of different initial problems.
With a development can all cause problems with those two areas. Yeah. So that's where we're at the moment. Yeah, paying attention is hard. Lots and lots of different problems can cause paying attention, but we it's really hard to get beyond that. Yeah, into, like, how do we fix the problem? Yeah. Beyond this, like, fluke that we've got this one drug that works. We don't really know why it works, but we know that it works. Yeah. Yeah.
Pharma coach Pharmacogenetic OK.
What's happening? They basically looked at the efficacy of drugs.
Or her specifically. And then they found that like she was responding to certain medications.
Feature Taylor.
Yeah. And the yes in principle. And that idea has been around for a while. I remember reading about that idea when I was doing my PhD 15 years ago.
The problem still is that the brain chemistry is really complicated because one thing causes something else which causes something else which causes something else.
So.
So it's not just a question that like if I'm predisposed to have, you know, a particular type of brain chemistry, you know, there definitely is, you know, for example, like an SSRI. So antidepressant medication.
The that they, they don't. They're only effective for about 30% of people with mild mild to moderate depression and anxiety. But for my wife, they're just absolutely wipe out her depression anxiety symptoms for her sister too.
So they're like, really, really, they work really, really well. But, you know, and there's something there's definitely something genetic there. That means that antidepressants just work really well. And I just keep saying why if you got so grateful, you know, she's always wanting to come up a person and you just go great for they work. So there definitely is something there, but it's just more complicated than that because, like, it's not. This is what I'm about to get into. Like, it's not a question that we just have one problem. Yeah. Things emerge over development.
And so that's why it's hard it. Yeah.
Yeah, that's interesting. Do you guys have a lecture on the microbiome? Actually, you haven't got a team. I talked to Elena 'cause. There's been a lot of really interesting research in that. Yeah, we should do. We should do.
We should do a lecture on that at some point.
Yeah, it is the. Yeah, I guess so.
Again, with studies, I mean the microbiomes even more complicated than the brain chemistry in a lot of ways we've got like 10,000 different bacteria in our brain. But I can see what you're saying. If I have a strong gut and I'm more able to cope with new stuff in that.
OK. So so yeah, so so we've had this idea that.
Paying attention and interacting socially at some of the hardest things that our brain has to do, yeah, they're the areas where we're most different from animals and it's just a tricky thing and it requires us to coordinate activity between spatially distributed areas of the brain and to job with lots of different information at once. And that type of stuff. So lots of different ways of messing up brain function can all converge on causing problems in paying attention. Yeah. So that's what we call a funnel in. Yeah, lots of problems converge on one problem over time.
But you also have the opposite type of thing, which again makes things even more complicated. Yeah, I'm definitely not giving you any easy answers in this lecture because there aren't any easy answers. Yeah, but we also have this thing that what we call the opposite problem, which is a funnel out problem. Yeah. And which is 1 initial.
Problem can cause lots and lots of different problems over time. Yeah. So for example, one of the things that I did for my post doc was looking at kind of rapid attention in autism. Yeah.
So when I'm a child and I'm paying attention to someone like I'm a 2 year old sitting in a room and what one of the things I'm doing is I'm listening to what you're saying and I'm following your gaze onto the things that you're looking at as you're speaking. And I'm using that to work out what words map onto objects in the real world. Yeah. So kids with autism, that there's evidence that they find it harder to rapidly shift the focus of their attention like that. Yeah. And you can pull that out in a really simple experimental task where you're just saying, look here, look here. Look here. They were slower at that task. Yeah.
So that simple problem in shifting attention rapidly round a room can then cause problems in language. Then yeah, because I can't use this tool that I use otherwise for language learning. Yeah. And then, you know, once I've got worse language then I can't pay attention so well in class. So it causes poor geography skills. You know, scores of my geography lessons as well as in every other lesson. Yeah. And then I don't learn so much about talking about mimosas, other people. So I'm not so good at emotion regulation and so on and so on. Yeah. So that's an example of how one really simple problem. Yeah.
I can't shift my attention fast around the room can cause loads and loads of other problems over time.
Yeah. So that's another reason why studying developmental disorders is really hard. Yeah. And coming up with simple explanations is really, really hard. Yeah. So just to give a slightly more specific example, so I work a lot on early life stress.
Kind of looking like not at the extreme stress that they're looking at in this study, adverse childhood experiences and stuff, but like mild to moderate, stress of growing up in a city. Yeah, and.
There's evidence that if you have early life stress, certainly severe early life stress, there's no one condition, you're more likely to get get later in life.
Possible different condition? Yeah, every possible single mental health category. Yeah. You're at elevated risk of if you have a early life. Yeah.
So again, it's not this simple. I've got one problem and 11 solution. I've got another problem. I get another diagnosis. I get another solution, it's just much, much messier, much more interrelated. Yeah, we've got funnel out one problem causing lots of different problems and we've got funnel in you know lots of different original problems causing kind of one thing, OK, all of which is pretty depressing.
Because it means these problems are really, really hard to fix. Yeah, This is why we're so, so, so bad. OK. Yeah. So I've said it with this, actually.
Yeah. So another thing is, yeah, so executive functions are one of the later developing areas. So like everything builds on the executive functions like the information comes into the brain and then it's only when it's been processed by the brain that it ends up in the frontal cortex. Yeah. So that's also relevant. OK. Yeah. So that's what I've been saying. I'll skip over that. OK. So that's that on that. OK, that that's the main like message of the lecture, the last, the last part is more of a screen time in ADHD.
Which is important and but also thinking about how we do these types of studies. But I wanted to get to the main part of the lecture, you know, here before you start to get too full. So that makes sense for everyone. It's it's quite an academic point. It's really, really important for, you know, understanding developmental disorders. I think it's practically relevant for anyone working with kids with ADHD. Anyone with kids in the family, that type of thing. But as I say, it's definitely not an upbeat point because I honestly don't see, you know, how we're going to get past these difficulties.
In terms of like fixing stuff.
OK, happy. Yeah.
That one of you, is there any lapses and seeing where the if there are any deficits that were originally or if any of the deficits in the blood are causing those using symptoms?
I don't know. That's a really interesting question. So I was.
Yeah, yeah. I don't know much about that. So there, there definitely is evidence for autism. So there's this idea that one of the big things is like a neuro inflammatory reaction. So basically we have like, you know, plasma, whenever there's something atypical, then basically the amount of plasma, it basically effects neuron and function in complex ways. And there is evidence for neuro inflammation amid autism.
It's actually quite interesting because I was doing it, so I do a lot of talks about early years teachers and I tend to, I used to always really talk about like wired, you know, city kids and ADHD city kids, you know, because like, we work a lot in the Newham Learning School. So it's like 40 schools in this area and that's very much what you get like, no one can sit on the floor. Everyone's bouncing off the walls, that type of stuff losing if you know that technique. And as soon as talking corn or like the middle part of Cornwall. So the middle part of corn was really poor, like the southern coast was really rich and the northern coast is quite rich.
So the middle part is really poor and I actually ended the talk with just bombing and and someone came up to me afterwards and said, well, actually our kids are completely different to that. We it used to be a tin mining community. So there's a lot of heavy metal poisoning in the in the in the soil that's happening and their kids and it's very quiet rural area and they say their problem is they just can't get anything in. So they'll just sit there like really quiet the whole time like that and they just can't communicate with the kids like they would just sit there like and then just nothing will go in, nothing will retain. And that type of thing. So I don't know, you know, that's anecdotal, but I don't know about, you know, evidence for that, but it's very possible.
I bet it would cause a particular type of, you know, thing of, you know. Yeah, yeah. You know, you can say, yeah, you say. Yeah. Yeah.
Yeah. Yeah, yeah, yeah, yeah, yeah. Yeah. This is back to what I was saying. I did. So I'm doing another lecture for you guys later on about, like, covering all the different conditions that we haven't covered yet in a specific lectures in this course. And I was going to say this video I mentioned earlier about virtually everybody moves between different diagnostic categories during the course of their life. Like, if you do a study where you just you take so this donating code or they basically small town in New Zealand and they basically scanned everybody in the town.
Every like four years or so for their whole life. Yeah. And they didn't do what we do, which is someone comes in and they say I've got ADHD. And that's what you look at. They just did a completely neutral, you know, every possible different diagnosis. Like, what's this person got? And they found that everybody moves between different diagnosis attemts. Yeah. And there's not like that you have one part of it and that's it. Like, it's just. And the more the earlier you start showing atypicalities like the more like you are to be having them throughout life and that type of stuff.
Like and also the other amazing thing for that study was like, I think like 90% of people pass the diagnostic category for one mental health disorder at some point in their life like that. So it's like almost everybody's got something. So yeah, you're absolutely right. It's really messy. Yeah. All right. So you guys can hear you go.
Look up, then the town. Yeah. Expect children to be where? Yeah.
Yeah, it's right. Capitalism. Yeah. Yeah.
If I don't think I need to be back in the negative thing. Yeah, because it was a survival fact. It can actually.
So I I don't know if it's it's a performance now, but it wasn't there. Yeah. Yeah. So. So there's some interesting stuff. So I'm so I'm just doing this Medical Research Council grant on babies developing ADHD. And one of the things that my colleagues have been doing it doing is they've got a task where they do like creative problem solving and they find that it's like a little box and they have to try out different 2 year olds have to try out lots of different ways of opening the box.
That's the typing they find out. Kids with ADHD do better at.
But it's quite hard to think why that they're just more likely they're just less likely to keep on trying the same thing again and again, and they're more like to try out random different combinations of stuff. Yeah, yeah, yeah, definitely. But we don't until we get an idea of like, a neat explanation for why they do better that task. So that's what we're working on now. Like, so. Yeah. But yeah, that that, as I say, I bet you do an ADHD lecture on 30 years time.
And it's going to be much more like autism has changed. Now, you know, we realised that this used to be defined by deficits. We now realise that it's much more about strengths and weaknesses, you know, different cognitive profiles.
Yeah, yeah.
Yeah. Yeah, yeah, yeah, yeah. I mean, there's loads of stuff on that about adapting to environments. Yeah. And if you live in an improbable environment, if you live in an unpredicted environment, then your optimal behaviours are different. Yeah. Yeah, yeah.
Yeah, but.
You don't. Let's say he had. He started devoting them and then he was diagnosed for the HD. But you don't drop the autism, you still have it. So that that would add to that there they all Co occur because.
Although you just collect them, they don't tell. Well, you don't reach that anymore. You don't get re diagnosed. Yeah, yeah, yeah. Just to connect more. So that would add to that. How they. Yeah, yeah, yeah. That's funny. Yeah. There's a lot of really odd racing, which.
That you might do if you agree. Yeah. Yeah, yeah.
The traumatised brains is difficult to determine. What actually it's not. Yeah, one thing.
Good. OK, that's nice. I'd suggest we take just five minutes just to let that all sink in.
And then we start again at 2 minutes to 11 and then the last bit as I say is really I think it's really interesting and I think it's important and I'm just doing some work on it, but that that it's the like interesting part of you know, how do we find out the answers to really important questions.
But it it? Yeah, it's very specific on this like how the screen time give you ADHD.
OK, right. See you see you in 5 minutes then.

Sam Wass stopped transcription

PY5010 ADHD lecture 190324-20240319_110036-Meeting Recording

March 19, 2024, 11:00AM

46m 16s

Sam Wass   0:07
And I've gotta turn it off. OK, let's go. So I'm actually just writing a grant on this exact topic at the moment. So this is very much part of my.
Kind of stuff that I'm thinking about. So so basically.
Yeah. So basically.
But let me just see.
OK. Yeah. So basically what I mean what let's start with like what are your so basically this grant I'm writing is talking about it starts from this idea that the way.
Every time since we started making screen media, cutting speed has gone up. Yes, you know what a cut is like when you jump from the viewing and see you from one and it's a really strong graph that like if you watch like an old movie, it's amazing how like slow paced visual storytelling is. Yeah. So like nowadays you really jump from like 1 cut to another. Yeah. And also there's a lot of you know if you go tips or you get a lot of this shaking camera work yeah for those people like doing that a lot of movement around the edge of the frame. Yeah so that's also another way of driving like a lot of movement happening in the thing.
People are definitely talking faster as well, yeah.
And all of these things mean that, like the rate of change of movement and colour and sand in what we hear is going up overtime, yeah. And basically I was just writing looking at that in babies to say, you know, something not. I've been interested in my own cases like do, you know Coco Madden, this like cracker came for two year olds and like YouTube stuff. And my two of them just kind of sit because it's really like with brightness, with movement happening and that thing and just sit like she can't take her eyes off it.
But it's a very different way of paying attention to stuff to my 4 year old where he's not in. If he's if he doesn't understand what's going on, he's going to pay attention. She'll just sit and watch. You mean she doesn't have a clue what's happened? Yeah, because it's so it's it's movement and it's triggered these kind of, like, automatic look at the movement. So there's not very much research in this. So I'm just in this grand at the moment on this. So if you had the attention of Lexa from the earlier, you would have had this. We I think we probably would have talked about this difference. So I started calling these attention capture now.
I think it's a bit easier than a bottom up base attention driven by external properties in the outside world, so movement and noise, yeah. So you know, just as a refresher for those who might have missed the lecture, like, if you think of if you go around to your auntie's house and you don't know her very well, she's got a telly on in the background. Yeah, in the corner of the room. But you don't really know her well enough to go through and have so much telly. So you're trying to talk to her and you've got this movement happening in the corner of your field of view. It's really hard to keep your eyes off the telly. Same as, like a video advert on a website. Yeah. If you're trying to read, like, the newspaper or some text and then you've got some movement happening here, it's really hard not to move.
Yeah. So that is attention capture. So we have these low level mechanisms in it, yeah that we've developed because for most of our development is a species they used to be useful for us. Yeah. So if I'm a lizard sitting on a leaf and there's movement somewhere in my visual field are more likely than not, it's either something I can eat or something, something to eat. Me. Yeah. Most of our development is a species life has been pretty hard and life has been pretty dangerous. And it's the same thing. Yeah. If I'm if there's a movement anywhere in my visual field it might be something I can eat. It might be something come to eat me so it's it's an advantage if I have my tent scheduled. Yeah.
So that's why we've developed these very strong preferences to pay attention to movement. Yeah, nowadays, we live in worlds where, luckily enough, there's very there's nothing out there that's going to be there's, if it catches this and we would never have to chase after our food before we eat it. Yeah. So there's paying attention to food, which is no longer evolutionary useful proofs, but it's still, you know, deep wise in our brain. Yeah. So we're now at this stage when, you know, advertisers relentlessly exploit this. Why? By designing these very carefully targeted.
Kind of.
Things to make it very hard for children not to pay attention to. Yeah. So we talked about this kind of potentially capture like bolt them up, automatic detention in the attention. We also talked about how this is called bottom up and it's actually physically in the lower part of our brains and where we're more similar to animals. Yeah. And then we talked about this, like, pure form of concentration. So from the small attention control, yeah, which is happens in the frontal cortex here, which is where we're most different from other animals together. And that's what we think of as concentration. Yeah.
So that's us choosing to pay attention to one thing and not something else. Yeah, OK. So TV, as you might guess, yeah, is very bottom up. Yeah. So there's always movement happening in TV. Yeah. This is why it's easy to pay attention to this. Whatever. Watch TV when you're knocking. Yeah. And it's not just that it's easy to pay attention to the screen because it's moving. Yeah. I've actually done some research that that kids TV. So one of the reasons that cartoons.
Really like it is that.
This TV uses movement, yes. So this is just the frame. The part of the frame where there's movement happening. Yeah. So KCB uses movements. Funnel your attention to where you're supposed to be looking. Yeah. And so it's easy for a kid to pay attention to parties because they just have to look at the part screen that's moving. But that doesn't happen so much in adults. OK, so that's one reason why watching a lot of TV might not be very good for our attention development. Yeah, because.
All it's easy to pay attention.
Yeah, which is why we like it, which is why kids like it. Yeah, that they're at a time when, you know, as we were saying earlier, their frontal cortex hasn't developed. Well. Yeah. So they find it harder to do this type of feed. The T vs just something that you can just tap into with these low level input mechanisms. And they don't have to work really hard to painters to it. Yeah. So that's one reason why TV might not be very good for our attention. Yeah.
But that's a really interesting, really, really interesting question. Yeah. So that's one of the things we're planning to look at in the grant.
Like how so we so we can do this technique where we measure the brain activity and the kids they're watching the stuff on screen and you can just look if you look at the volume fluctuations in the speech and then you can just see how well they predict the brain activity and that works like it's quite hard to get something that works, that does actually work and you can similarly look at the life changes when it gets light and dark and how that predicts the brain activity.
So one of the the main things we're planning to look at in the grant is, is our ability to track fast-paced information. Has it changed in younger kids versus older kids?
And I don't think it was something that would be really interesting to look at for ADHD. Like is it higher in video speed. But the other thing I think.
No. So what? So what have you read? I was gonna say so. What have you read? Because I'd be interested to.
Yeah, alright. OK. Yeah, there is. I can imagine. Yeah, there's some. There's some slides that I I had last year that I took out that were on something like that. Yeah. Yeah, it does link in a bit. Yeah. So. So the. The other reason, though, that. And I was presenting this to teachers the other day and they just hated this idea. But it's definitely true that. So the reason that stuff's getting faster and faster paced, I think, is because we have these very in built learning mechanisms. Yeah. So we we, we, we our brain develops by like, learning to predict what's going to happen next and then testing it.
And and kids when they're watching TV, they're getting better and better at processing really fast information, so aid. So the the screens are training them at working really, really fast. And that basically taps probably the reason that they like it is it taps into these inbuilt reward mechanisms. So we're actually learning by watching a lot of TV. We're learning how to process really fast information. But teachers hate that because they're so tapped into this idea that learning is about learning what the captain of France is. Yeah. And this idea that learning is processing really fast and complex information.
They just hate it. 'cause like it's exactly the opposite types of things, yeah.
So that's. Yeah. Yeah. Yeah, yeah. So that's that's more getting onto so, so. So that's so I'll come back to that in a second. So this is one reason why TB might not be very good for your like pure attention control. Yeah. Tension driven by what you want to. Yeah. And another reason. And and I can't remember if we if we talked about this have you had a stress lecture for me can anyone remember having had a stress lecture. OK you might as you later on there's a stress that sometimes too where we talk about this so we've got some data from my lab but lots of other people do that so a lot of.
Task puts in a situation of imagine danger where I'm controlling a character who's in imagined danger, and similarly watching telly, you know, oxen or some even something like oxen or my kids watch all the time. There's danger and peril. And then the people to come in and save the day. And there's evidence that when we're in a situation where when kids are in a situation where they're controlling a character in imagined danger, their bodies get tricked and they respond to the imagined danger as if it's real danger.
So oh, I haven't got off. I haven't got a thing of the fight or flight stress system. So. So basically we have these two stress systems. Our fight or flight stress system, which is all about readying our bodies to cope with actual physical danger.
So it's all about our heart beating faster, a lot of energy released from the muscles and that type of thing.
So when kids have been playing a lot of, you know, computer games or watching TV with characters and imagine danger, yeah, there's a lot of evidence now that they're fight or flight stress systems are high. Yeah.
So you know, you might notice that they've been sweating even though it's not cold, not hot inside. Yeah. And that's part of your fight or flight stress systems to be doing that. Yeah. So that's why you get to come down after. So what? Almost all parents say with kids at home is straight after school. They're really ratty. Yeah. And that's because they're in fight or flight mode? Yeah. And then a while after they'll have this come down. Yeah. And that's because being in fight or flight mode, they're getting a huge amount of energy release. Their stomachs are working really hard to break down all their memories. Yeah. And then and then.
They get to this state where they can't sustain it themselves without something coming at them to keep them in that state.
Yeah. So suddenly this thing which has been sustaining them in that high state is taken away. Yeah. And also they're tired because their bodies have been in this high alert state for a long period of time. So they then have a come down.
Yeah. Yeah, yeah, yeah, yeah.
OK.
Why? Yeah, I mean, I I, I. That's what I've made that as a strong prediction. So. So the so this type of study is just, you know we did it in the lab. Yeah. We just put kids on iPads. You might. I don't think this is actually no no. This was just a picture but we had kids on iPads and we measured their heart rate while they're in it but what we're planning to do in this grant is to use these home wearables to these home stress monitors so we can look at stress around screens as well.
That's been any planning that's that's been. Yeah. Yeah, yeah.
Yeah, yeah, yeah. Definitely. Yeah. Social coordination. Asia. Yeah. Yeah, yeah, yeah.
That.
Yeah, it says it's a really interesting question. It is virtually no research on at the moment, but how long being being in flight or flight mode now there's, there's really little on. There's amazingly little research on stress and screen time. I've just been looking at reading the literature on it.
It's really weird how this research, isn't it? But yeah, what being in front of front for long periods of time does to you long term.
I don't know. It's a really good question, I mean.
So yeah, the thing I would normally say for that is going outside because you can run off the energy and also nature really has exactly the opposite effect. So nature really puts us out of fight off right now, just very fast. We're going out of fights right now.
She didn't find a lot of those that starting to stop those.
Dates. Yeah. I don't know. Actually, the differences between different types of home environment. Yeah, I don't know. There must be some stuff on that.
Anyway so.
So just we were talking about stress and screens putting us in fight to flight mode. Yeah. And another thing that I talk about a lot in this stress and attention lecture, which you haven't had yet, is when we're in a high stress day that also effects our concentration. Yeah. So if I'm in a high stress state, I'm more attention capture becomes more strong. Yeah. So I don't know. I noticed I said, I'm often working on the train on a way. And when I'm in a hurry, yeah, I find it much harder to put the zone out on a conversation that's happening right behind me.
And so when I'm when I'm so I'm more distractible. Yeah. And this is a learning mechanism. So I'm in a high stress that I'm in a dangerous situation. So it's more important that I'm looking out for danger. Yeah. So more important that I'm paying attention to Moon. OK, so those are two kind of good reasons why.
TV's screen time might not be good for child concentration development. Yeah, some of our attentions with screen media, eg TV, involve mainly bottom up attention, so attention capture.
Yeah. And some of our interactions with screen media, EG computer games, increase our stress. Yeah, and stress also makes us more driven by attention capture. Yeah. OK. So is it true? So what's the evidence that screen media is bad for top down. Attention. Yeah. Is it so? Is it bad for top down attention and what? So. OK. Oh, yeah. I was going to show this. I mentioned this earlier.
If you might, I mean, if you want to watch this, this is just the cutting speed.
So if you look at a top cut, so there's a cut in SpongeBob.
And now there's another car, and there's another car. And there's another car.
And now there's one cut in the old one. And then there's another cut in SpongeBob. Say what?
Yeah, yeah, yeah, yeah.
Yeah. Well, it's yeah, I I was thinking about it when you see people reading books and stuff like once you get old. Yeah. Yeah. 'cause. You don't need them.
No, I thought, I mean, when you go, I don't know what it's like.
I'm just saying, like I just need. But like kids, yeah.
But they yeah.
Yeah, yeah, yeah. But this gets back to what I was talking about with this virtually no research like these different routes to concentration. Like, I think it's really interesting. Like, yeah, like, kids will just sit and just stare at YouTube, not having to do what's going on.
Yeah. Yeah. So YouTube's got really good at holding their attention. Attention caption. Yeah, targeting the smacking soups.
Yeah, it's weird. I think about it. I was reading something about people who make cocoa melon because I do a lot of research on what drives attention and then and they've they've made so much money. They've sold us, like £2 billion back and they just worked out that.
Baby shark. Yeah, yeah, yeah. And I was thinking I could really. Because, like, the way they do it is actually quite crude for working out what attracts people's attention. And I was like, I could easily get a job at these guys. Like, I could really teach them something. They went. But then I was thinking, like, on the one hand, that would make a lot of money on. On the other hand, would that would be one of the worst things you could possibly do of your time? I don't know.
I want to.
OK.
Yeah.
OK, so there's like, yeah, yeah, there were some. Yeah, yeah. Anyway, so cutting speeds increased over time if we just say, you know, so why is this getting there? OK, so I'll skip over that. OK. So that's so there's lots of reasons why TV might be bad for your attention. OK. But is it OK? So now we're going to think about this just a slightly different way of thinking. So how do we actually answer this question? Yeah. So I'm going to be talking about just one of the things which is important in apply science. And I'm thinking about this a lot at the moment.
In terms of designing a study to look at how screen exposure effects children's brain activity, so how could we answer this question? The How does screen exposure actually relate to attention problems actually so how? What are the different techniques that we've got in our toolkit as scientists to answer this question? Yeah. So if it works for something very fast based, then move to something slow. Are you learning? It's boring because it's not.
As much intensive fun or it was fun.
Therefore, they are only announced to participation. Oh so sure you're talking about short term.
Yeah, but it's all very quick. But that's. Yeah. All right. I'm skipping this because that's exactly what this is. So that's actually method two. I do method one first. So method two is the same design as a drug trial. Yeah. 64 year olds did concentration test then for 9 minutes, 20 watch SpongeBob 20 watch the nature documentary. 20. Did drawing then all three groups repeat at the same concentration tests. OK.
And these are results. So better after exposure, weaker after exposure. This is the drawing, the slow TV. This is an H documentary and this was SpongeBob. Yeah. And this is basically, they're both the line. If they got better and they're below the line. If they got worse. Yeah. And this is showing quite big effects. OK. So what? So now let's do a little bit of sceptical thinking. What's this show? So what are the problems with this study design?
What do you mean?
Oh, I see this. This was actually between subjects though, so they did. So they just randomly assigned a group, which isn't a very powerful engine. I don't know why. So there's more subtle problems than this.
So it's the same as when we were talking about violent computer games, and I was saying immediately after you play violent computer games, you have more violent thoughts, but it could be that the more I get to act out my violent thoughts, the more the lower they are longer later, later on. Yeah, it's the same as jogging. So if you want to find a study of the effects of jogging on your heart rate, if I measure the effects of jogging on my heart rate immediately after I've been jogging, I'll conclude that jogging increases my heart rate. But in fact, long term jogging decreased my heart rate. Yeah.
So it could be that they were concentrating really, really hard on a SpongeBob, so their concentration muscle was tired out, yeah.
And so that immediately after, they weren't so good. But then the more practise they get then the longer. Yeah. So that's one of the problems with this type of study. There's another much more subtle one, which you'll only get if you watch a lot of SpongeBob, which is how Long's the SpongeBob episode?
No, it's 14 minutes. Yeah. So they were stopping a SpongeBob episodes 2/3 of the way through to do. And I only discovered that that's such a naughty thing to do. Like a lot of people, this particularly in America, that the dialogue, the debate is like, really shrill and it's just really hateful. And you just do stuff to prove the other people wrong. So they did it and they Can you imagine how annoying it would be if you're a kid and it they suddenly stop it. And it's such a really cheap way of doing it.
So that's like another problem, like it's just a badly designed experiment.
So yeah, so that so so the the.
Stop the SpongeBob episode halfway through, and also it's very hard to be sure. Is that the pacing, the, the OR the thing? So. So that's one thing that they can do. Yeah. And so that so the clue for that was a drug trial thing like that because it's the same thing. You get a group of kids, none of whom have ever had the drug, which is what she tellly. Yeah. And then you give it to half of them and you don't give it to half of them. Yeah.
Obviously the problem with this is no kid out there who's never not watched telly. Yeah, but you can take that same thing of just giving it to 1/2 and not giving it to the other half. And looking at how it affects it. OK. So that's method 2, which is I say it's got some quite strong findings that's a bit inconclusive. Yeah. So what's method or some the clue for method one is it's how we worked out smoking's bad for us.
Yeah, yeah, yeah. So how would you do that for tally?
Yeah, yeah, exactly. So there's actually more sophisticated ways of doing it. So like, we're gonna put a little give them a special tablet with a special app on it that just tracks everything that they do, whether on the tablet. So you can just measure it more objectively than getting the parents to report that. Yeah, but loads and loads of studies have done, and it's really, really strongest effect. I've got a mate who's just analysing on these big notion of my birthday ports. And it really comes out as a strong effect TV watching age. Bit 3, for example, in this study correlates with more likelihood of attention problems aged 7.
You can say yeah, but alright, good.
So why does this not prove to watching TV 'cause its attention problem? So I've got slightly different example. Change the labels on the graphs, the number of body biases and how large you listen to your music. Yeah, and you'll get the same thing. Yeah. You get the same association, and it doesn't mean that, you know, getting your ears pierced makes you turn deaf. Yeah.
It's not.
Say what?
Everybody said to me like that.
I'm.
That's interesting. Yeah.
Yeah.
Yeah. Yeah, that's interesting. Yeah. So that goes back to this area that when I redo this lecture in a bit, I'm thinking those about understanding and attention and there's some stuff about like. So if you look at, you have like, a narrative event within ATV show. Yes. So there's like, a sequence of events. And then there's the end of a chapter and then a new chapter starts. Yeah. And.
For most children, they're more like to look away at the gap between chapters, yes. So they're understanding is driving when they look away or not. Whereas for kids with ADHD, they're not. They're equally united to look away in the middle. So it's that's idea like the the attention driven, my understanding. I think it's really, really. Yeah.
So that's really interesting and I don't have any research about that. But when I got, I don't know if you guys go to ever been to a bar in America where they have like at vs like every bar in America's Got like at vs showing different sports on the screen and I hate those bars because I can't sit, I can't sit and have a drink and chat to my friend with, like ATV bickering. You and not be paying attention. And I can only think they just get used to it. Yeah, exactly what you're saying. But I don't know if any research about that.
Yeah.
Yeah, yeah, yeah.
There is, yeah.
Yeah. No, it's interesting. I don't know. There's, I don't know anything about it. The thing that reminds me of this is another thing I've always wanted to do is study on which is the amount of noise you have in a home. So my niece was she was a baby, and my sister was living in this really small flat at the time. And she just had incredibly noisy first few years of her life, and she couldn't sleep through anything that.
And I've other clients you've had like really, really protective with their kids at coach.
And but we don't know what the difference is in the brain activity. So I really want to do that.
But yeah, it's similar. Similar idea. Anyway, this idea. So two things to show that two things are related doesn't mean that one causes the other. Yeah, there's a phrase for this. What is it? Well, I don't. Yeah. So it doesn't mean that listening to your or putting body pace and causes you to listen to things, is that something else, whatever it is being rebellious.
Things OK. With that being a direct link, OK.
So what could this be that causes high levels of TV watching and high levels of attention?
That's the difference.
Yeah. How much fine pans have got at home. Yeah, I'm engaged to parents, hold their kids. You know, how much how easy the child is to entertain. Yeah, that type of things. Yeah. Loads and loads of different things that that. OK, correlation is. I mentioned this earlier.
This one I don't know if really bugs me. It's true. People always in January and April and more like we left-handed, but I don't know why it really bugs me. I was trying to hit Google this and I haven't been able to come up with an explanation for why. OK, so how do we get around this? Let's get a bit of research methods. How do we get around this problem?
The two things are related doesn't mean that the two one course is the other, but we we we still need this type of study and this type of study is still not why, you know, obviously the same factors apply to studies looking at why smoking causes cancer. Yeah, people who smoke more and more, they have lung cancer, but we have the same things that are other things could be mediating it. How do we get around it?
Control kits using multiple.
Regressing. Yeah, well, it's at most, but regressing. Yeah. So you track the other very good track. Other variables as well, things like parenting. So it's gonna be status, diet, kids, personality form, a multiple aggression. And those show that it is still true that ADHD associates with things, but it's quite a small effect. Yeah, it could be stronger that might be stronger for boys and girls. OK, so that's kind of 1 bit of evidence which isn't perfect. You can never be sure with this that you've controlled everything. Yeah. But it's been done a lot because it's a really important point.
The second one I told you already, which is we can give them a little dose of tally and measure immediately afterwards.
And then yeah, the last thing was again this thing I wanna do. They they they they did like telly with mice. So they just had lots of flashing lights and lots of noises to mice.
And then they did the kind of performance on the test. So this is actually kind of slightly different to what you're saying about AJS. Do you not wanting to engage with it because this is much more like, does it does it like to the telly like cause changes in the chart?
Umm, yeah. OK, so that was a little bit of that. I think that's pretty much it. I'll just say what I've said. So there are lots of reasons why high level exposure should influence attention, but the currently evidence it does is inconclusive. OK, so there's lots of reasons why it's what plausible that watching TV causes ADHD. Yeah. And it's bottom up. Attention, it increases stress. Yeah.
But it's very hard to be sure that it is is the take away message, yeah.
So yeah.
Yeah. And any more thoughts on that or I mean it's it's more complicated in a lot of ways. You know we've got on to thinking about, you know things like how you, how are you understand the content and the different ways in which the different pathways through which understanding drives attention compared to just that low level pay attention to the movement. Yeah, that's where I think it's a really interesting area to be looking at. But yeah, right.
What do you mean by hyper fixation?
How was he?
Yeah, I didn't know. There's a lot to say about that, but no, I think about that a lot too. I was watching a kid on a plane the other day, and it was exactly the same. I'll just go from being all over the shot. Yeah. And then a minute screen comes out like that and and in a lot of ways, it's like it's one system. So I need to have a certain amount of stimulation. Yeah. And if I'm not, if I'm getting my stimulation from outdoors, then I don't need to make my own stimulation. Yeah. Whereas if I'm not getting my stimulation, then I need to be generating my own stimulation. So you can view, like, that. It's a whole system, you know, like, the child's compensating for it. They're not getting from the screens.
So that's one way thinking about it, there's not very much research on that.
Yeah, yeah.
Yeah.
Yes, so so we, so I was talking about this, if it is concentration, but I'm working on with Gem who's just finishing a PhD with me, who is a teacher for a long time. And we were talking about this. I was saying like for kids who are very salience driven, very attention capture driven when you're teaching a class like you really want to be. They look at me, kids like, I definitely do this when I'm doing a tool and I want people to look at me for non period of time. If I'm just moving like this, it's easier for people to see their eyes and yeah. And if I'm moving my hands, it's easy to keep your eyes.
But like, is that a good practise as a teacher if you're teaching in a class to put us here to a very ADHD?
Or for general, we say from home experience, exactly the opposite. But in fact the teachers are very calmly, they'll find it harder to start then if they find it easy to engage in that long term because they find it relaxing around. So that's another really tricky. Do I try and be like SpongeBob? Yeah, because the kids are used to paying attention to SpongeBob. Or do I try and go for this longer term route or I try and do car me. So I do me answer that you've been trying for so.
It's a it's better. So one day it just doesn't access to it, so.
I wonder if it's because my brain's like so familiar with it that I get. Yeah, yeah. Yeah. So that so that's another thing that I think is really important about. And I'm again, I'm thinking, look back at this a lot at the moment with predictions. So predictability.
So so I so my 2 year old so she won't. So I was making rice salads. Yeah. So just like raisins and nuts and rice and other stuff. And I was making it with them. And they were eating like, the dried apricots. They were eating every single individual ingredient they went in.
They're eating it and I think how they're gonna really like this was to make and then they wouldn't touch it when it's made. And that's that. Why is that? And then and then I I and this really works now that if they know what it's going to taste like before it goes in their mouth, then they'll eat it. Yeah. But the problem with rice salad is every mouth will taste a little bit different. Yeah. And so I think that that casserole is and everything like that. They just won't touch. But individual things where every man will say is identical. So. So I think it's that that that you learn.
From being able to predict what is what, it's gonna taste like. So it's like literally your frontal cortex is making a predictions, like Bayesian dynamics. I predict what's going to happen and then and then that's either correct or not. And I find it rewarding if I get the correct prediction. Yeah. And it's a sweet spot. So if it's like, if I can most of the time predict, then I like it if it's too predictable or not so, so. So basically. Now I'm just really focusing on, like, predictable proves of my kids and like my daughter, who's really, really fussy. Like, if she's pad, carrots, like, every day.
Then she will taste the carrot.
It's the same as repetitions or where they seek out repetition, so watching the same movie again and again like you know there on pros for the like the 50th time and it's the same thing like Frozen's a lot of their brains. Yeah, but that's why the more they do it, the more they can predict what's going to happen. So they'll find it rewarded to do it. It's really important. I was having this argument with you. I was presenting. Sorry. Just one second. I was presented to this Scottish Book Trust. So all these like people they do like books with kids. And I was saying the same thing that.
Like reading the same book again and again and again early development.
There's a really good neuroscience argument why it would help children. Yeah, they need to practise seeing thinking again, again, again. And these librarians were also inbuilt about we've got to be pushing different books. You know, we've got to be encouraging variety. So I was really having an argument with them about just saying, like, repetition. Like, the more you repeat earlier on, the better you can cope later on. But so it's complex. It's interesting. Yeah.
Yeah.
Yeah, yeah, yeah.
Yeah, it's like it's safe for. Yeah, but yeah.
Yeah, I I I read exactly that with someone with autism on Tiktok was saying exactly the same thing with the with fruit. Exactly the same that the problem with fruit is I never know exactly what it's going to taste like, whereas Doritos, every single bag of Doritos, it tastes exactly.
OK. Yeah, yeah.
OK, whatever's happening, 'cause, some of them are small. Oh, really? Yeah. That's interesting. Yeah. So that's. But I find that so interesting. 'cause for me, that's exactly what I like about fruit. Like, you never know what's going to taste like. No to or you just say it's the same, but that difference you either, like similarity or you like difference. It's like I'm a real like, I'm really like, but yeah.
Set. Yeah, yeah, yeah, that's a different. Yeah. Yeah. Yeah, yeah, that's true. Yeah.
Good. OK. Yeah, yeah.
Oh, Gemma. Yeah. Yeah. Did she do a talk talk for you? No. Oh, OK.
Yeah. So funny enough. So we started doing, like, early years teacher training and we just did a session last week for the some groups of headteachers talking about first offers about screen time and the second-half is about outdoors. And it works really well together. So. So there's good evidence. So yeah, I see she might come into a talk for you. I don't know if she's she's going to do a talk, but, but basically. Yeah. So she found. So even moving the same classroom from an indoor setting to an outdoor setting, even in a.
Learning like urban school setting just in an urban playground. Just then she found that the stress levels were lower in the kids outside and it was relating to the noise and stuff.
Yeah. So it was the ones that.
But you did was struggling. Most who showed the biggest bet gains. I think that was still, yeah.
Yeah. Yeah, yeah. Yeah, yeah, yeah. And it's stressful. It's really stressful sitting still. Yeah. And you have to concentrate really hard and not standing up. Yeah. And that's just exhaust your concentration.
Yeah.
I'm really big on that because like, I can't. I can't say so much about it. When I've got something to fiddle with.
Anyway, so really nice chat and we've had really interesting conversations, really good questions. OK, let's just finish just with a quick recap of everything and then.
And then you get break and then someone's going to get 12, OK.
So the charge rate isn't just an image or version of an adult's brain. Different parts of the brain develop a different speed. Speeds. We've been talking about how some parts are early developing, so the subcortical areas, occipital a bit at the back that does vision prior to the bit, the top that does motor late developing, particularly temporal cortex, frontal cortex and executive functions for all children are the slowest developing aspects of behaviour. So ADHD, you know, in a lot of ways it's something that applies to every child.
How you describe how a child is different to an adult and just as you know, is talking about how some children differ from other children. Let me talk about the genetics. ADHD is highly heritable, but there's no one single gene that causes ADHD. It's combination of lots of genes that attracts in complex ways. So we can't yet do a gene scan to tell whether someone's getting ADHD or not, even though it's heavily genetic. But there is evidence that environments can cause it independent of genetics. OK, we talked about epidemiology. ADHD is more common in children than adults.
Very varying rates of diagnosis across the world and more common in boys and girls, and have virtually everybody who's got what? It's heavily comorbid with lots and lots of other conditions.
Then we've talked about behavioural deficits, people, they just are worse at impulse control, but it's not the same as saying that ADH is caused by difficulties in impulse control. They've got problems other than impulse control and not everybody with ADHD has impulse control problems, etcetera. OK.
We haven't talked about behavioural strengths because there isn't research in it, but there definitely are there.
New imaging, lots of different brain systems are atypical. Is not just a simple there's one area that's atypical, that some people with ADHD show slower brain development, but most patients with ADHD don't show complete catch up. And then we talked about treatment. It ought to be the case based on our original theories, that inhibition training stops ADHD, but it's not the case. Methylphenidate is effective for most children, but we don't know why it's complete lucky fluke. Other treatments are also partly effective, but again.
You know, we're quite far off at being able to design a study that something that helps in ADHD and it's not a thing. It's a messy group of multiple different problems. They get lumped together into one category and it's probably consequence of disruptive development rather than the cause of it. And then screen time in ADHD, we talked about lots of reasons why TV watching might cause ADHD and then certainly the available evidence suggests that it's bad for concentration. But there's problems with both types of studies.
OK, anyone's got any questions? Give me a shout and obviously just feel free to. Yeah, yeah.
No, and this is another one of the many problems. So they they go up and down a lot. Yeah. So this is back to, I think you were saying about kids at home like my kids. So at the moment, though, he's pretty, my son's really good in school. And then sometimes he'll come home and just be like.
And then just like that and it's really, you know, you test a kid at different times, different days, summer shy, some are not and when they're shy, they look like they've got autism. You know, it's really hard. It's a real challenge because you don't have the time you really need to observe the child continuously for several days together.
Yeah, it's pretty tricky.
Presents his ADHD. Oh, I don't know something about that. What?
Yeah. I mean, it's a bit of complicated with so arc straight after trauma, everyone gets flashbacks and there was some people they go and some people they don't go. So like you technically you can only get a PTSD diagnosis, a certain amount of time after you've experienced a trauma just because basically everyone has symptoms. And it's only if you don't get them. So that's one thing looking at the time, course, how long did I do?
I'd like to start.
Yeah. Yeah, so, so in this next lecture on multiple diagnosis and multiple diagnostic routes, we talk a lot about. I'm going to talk about a lot about that like why do we have mental health categories? Yeah. So if what I've been saying about how everything is just a messy thing as a typical development and everyone moves between diagnostic categories and is very hard to be consistent, you know, we were talking about this in the break, you know, if the depositions of ADHD has problems paying attention, how on Earth do you get a tool consistent amounts to that between kids? Yeah.
So like things like this, where 11% of kids in America have it nought .5% of kids in France have it. Yeah, it's obviously, you know, something cultural going on there in terms of, like, how likely we are to do it. So why is it useful? What what? What's the point of having mental health categories? But we can talk about that when we get to that because I think it's a really good question. And it's a really complex answer. Yeah. You know, I've got a lot of friends who are kids in different stages of getting diagnosis. Some are desperate for their kids to get diagnosis. Some are desperate for their kids not to get a diagnosis.
And it's like really complex to school wide.
Thank.
And so if you act in that, then you might.
Oh, I have to do that makes a difference. That's like, very smart. We used. Yeah, that sort of people I know who are desperate for those kids to get a diagnosis. That's why it's not him. It's his ADHD.
Yeah. OK.
Yeah, yeah, yeah.
And then the new members board a lot of that's for domestic violence and you can see those children aren't open, at least piece of season.
There is a 40% saying that there needs to be nothing.
For those children children, it's not. Have they got news Institute or have they gone for a process that schools in this time of symptoms?
It's. Yeah. Yeah, yeah, yeah, that that's the paper that they're. They're more like to get everything. But that's the thing about, you know, that's something weird about stress.
Anyway, well, that was nice chat. Well, you got 15 minutes break and then someone, I think it's one of my PhDs is coming to talk about something they're doing, but I'm afraid I don't know who.
Say again?
Oh, you got mcqs at 12:00 o'clock Mark Mcqs at 12:00 o'clock or you get this. Guys, can you tell me that's something.
OK.
So is she actually coming here?
She's coming, OK?
Great.
Looks.

Sam Wass stopped transcription