Misconceptions and stigma surrounding ADHD

Speaker: Prof. Stephen Faraone
Moderator: Barbara

[00:00:00] Barbara (moderator): So hello everyone, good morning, good afternoon, good evening, wherever you are. Very happy to see so many of you coming in for our second webinar on the topic of ADHD brought to you by the World Federation in cooperation with a number of additional networks in the field of ADHD: IMPACT ADHD Network across the Lifespan and EUNETHYDIS. It is my extreme pleasure to introduce our speaker today who is not only a colleague, but also a dear friend of mine. And I could fill an hour by just introducing him, giving him the right... How do you say acknowledging him in the way he would deserve. But I'll keep it short today because we only also want to hear of him and only say that he is one of the most highly cited authors in the field of psychiatry and psychology and the most influential researcher in the field of ADHD. His seminal work includes work on the continuity of ADHD from childhood to adulthood.

[00:01:19] And also he has been very, very important and essential in bringing together the field on the genetics and the biological underpinnings of ADHD. Before team science was a thing, he already did it. He took the initiative to bring all the researchers in the field of genetics together and also took the initiative for the first genome wide association study for genetics of ADHD. He is at the moment, in terms of his affiliation a Distinguished professor in the departments of Psychiatry and Neuroscience and Physiology at SUNY Upstate Medical University and a lecturer at Harvard Medical School. And just to say a little bit about the person, he's a very open minded and a collaborative researcher dedicated absolutely to science, but also with an eye to the individual behind the researcher. So with no further ado, oh, let me say a few more things. He will speak to us on misconceptions and stigma surrounding ADHD. And I have a few household things that I need to tell you before I give the word to Steve.

[00:02:38] So Steve will speak for about 40 minutes and after that we have some time for discussion and Q&A. For the discussion and questions, we would ask you to use the chat function because we cannot give you the microphone. So please during the talk, whenever you have a question, start typing in the chat and I will read the questions to Steve after the talk. OK. The session will be recorded and will be made available through the website of the World Federation. So, and now without saying any more, Steve, the floor is yours. Welcome.

[00:03:20] Prof. Stephen Faraone: Thank you, Barbara for that really kind introduction. I appreciate that. OK, today we're talking about misconceptions and stigma. This is a problem which has affected ADHD for quite a long time. For the three and a half decades I've been studying it and treating patients earlier in my career, we've always had stigma and misconceptions. I'm going to start first by giving you my financial disclosures. I do consult with a number of companies that make products for ADHD and have two patents, one of which is relevant to ADHD, but none of these companies had anything to do with this particular presentation. Well, let's talk about some of the common, most common, and perhaps dangerous myths about ADHD. The first is that it was a recent invention that was somehow exported to the world by the United States. Another is that it medicalizes normal behaviors. These are just normal behaviors that doctors have turned into a disorder. Another is that medications for ADHD are dangerous. And another is that the diagnosis of ADHD is subjective, meaning doctors talk to patients about it. There's no test because of that, it's meaningless. We should ignore it. Stigma is widespread.

[00:04:36] If you go to Amazon and search for ADHD books, you'll find this book, ADHD does not exist. You'll find this book The ADHD Fraud and you'll find many others as well. You'll also find myths about ADHD in academic journals. This is a journal called the Social History of Medicine. This author states that the concept of ADHD has spread from the USA where it emerged during the late 1950s to most corners of the globe. Talks about the insidious and relentless global propagation of ADHD, which again emerged in the USA not because children were suffering from a problem, but because of political, ideological, demographic, etcetera. All of this is just not true. In fact, if you look at the history of ADHD that we show in this slide from a paper I did with colleagues a few years ago, let's go back to 1775. The first description of ADHD was in a German textbook, followed fairly quickly by a description in a Scottish textbook. Now, of course, they didn't use the phrase attention deficit disorder or attention deficit hyperactivity disorder, but they did describe this syndrome in children that we recognize as ADHD today.

[00:05:52] We're not going to go through this entire history, but there's a very long history of ADHD in Europe before ADHD emerged in the United States. So I like to say that ADHD, far from being an American export, is actually a European import to the United States, which of course we have done a good job, I think, in doing research and [unclear]. When we look at epidemiologic studies that have examined populations of children around the world for ADHD, eventually any place that someone has looked for ADHD, they have found it using epidemiologic tools.

[00:06:28] And that's in every continent of the world, except of course [Antarctica]. And what about the idea that ADHD somehow medicalizes normal behaviors? And this is because some people think, oh, children, all children run around a little bit and all children maybe talk too much. All children don't pay attention. Well, of course, many children do that to some degree. But we're concerned with ADHD, about children who do this to the extent that it actually causes problems in their lives. And of course, we're also concerned about adults that have problems in their lives. And again, here's a long list of problems. And at the very top, we see perhaps the worst, which is premature death. People with ADHD are more likely to die younger than people without ADHD. The risk is small, but it's real. They're more likely to be overweight, have obesity, hypertension, more likely to get involved in criminal acts, more likely to have learning disabilities, and so on. I'm not going to read this entire list, but there are many, many, many adverse outcomes of ADHD, especially when it's untreated that have been shown throughout the many decades that I've been studying this problem. So when someone tells you or a patient comes to you and says or parents worried that their child is just normal, if you will.

[00:07:45] And the phrase normal is kind of interesting because we don't like to think of children, or anyone, as abnormal, but we say that their behavior is so extreme that it's causing problems and it needs treatment. Since the 1960s and '70s the drugs used to treat ADHD have been attacked in the media and it's worse now with the Internet now with the TikTok and all of the ability to very quickly get out misinformation. We see articles like this even in newspapers like the Guardian, which is a well respected newspaper. I look at it every day. It's a really very good newspaper. But they have this article that ADHD drugs are as dangerous as crystal meth and Americans are getting hooked and that is just absolutely wrong. There's nothing true about that. And they say by all means let adults buy speed if they want it, for working, for partying or losing weight. But let's be honest with ourselves. The US is on track to becoming a nation of speed freaks, no matter how we choose to spell it. And that's just awful because it stigmatizes the medications used to treat a serious disorder. And in fact, we know that these medications have effects on real world outcomes. All of these real world outcomes have been shown to be reduced by use of medications for ADHD.

[00:09:05] Now these are not studies that are randomized controlled clinical trials. It's impossible to do long term studies like that. But these are studies that come from big population registries that they have in Sweden, Denmark, Taiwan, Hong Kong and elsewhere. Look at the outcomes of people with ADHD during periods when they've been treated and periods when they have not been treated. And again, all of these outcomes, accidental injuries and bone fractures, motor vehicle crashes, traumatic brain injury, burn injuries, emergency room admission, suicide, premature death, all of these even in the other ones on the right hand side, all affected. I shouldn't say just affected. The risk for them is reduced when for people with ADHD who are taking medication. So stigma related to ADHD reduces treatment adherence and efficacy. This was shown in an article by Mueller in 2012. Stigma has real world effects. It's not simply something that's out there that people feel upset about. It actually changes behavior and impedes evidence based care. One of the biggest effects of stigma, which bothers me is that the World Health Organization has excluded any ADHD medication from their list of essential medicines for children.

[00:10:30] The World Health... I'm sorry, the World Federation of ADHD, along with colleagues at the other local associations, have tried to convince the WHO to include it on the list, but they have not agreed to do that, even though all of these professional societies and advocacy groups around the world have supported the idea that we should put on the list.

[00:10:53] Now, why is this important?

[00:10:54] What's important? Because in many countries,, children cannot get medications for ADHD because the policies in that country require that the medication be on the list of essential medicines. We're not giving up. But it has proven difficult because it's really a very small committee that's been guided by faulty meta analysis and faulty advice in making this decision. I think in part due to the stigma of the medications. So we have this, what I call war on ADHD that comes from the media and the Internet. Despite the efficacy of medication, which is very high, adherence to medication is very low. As you can see from this graph here, within two to three months, the majority of patients with ADHD have stopped taking their medication consistently. And that's true for methylphenidate, amphetamines, atomoxetine. Patients renew their monthly prescriptions only about two to three times per year. So adherence is actually one of the biggest problems we have in treating ADHD.

[00:12:00] People stop taking their medications And why do people do that? Well, of course sometimes there's lack of efficacy and these are some examples that patients have given for why they stopped their medication. Sometimes it's adverse effects for sure and there are other reasons patients forget to take the medication, the parents decide they want to stop it. They stop taking it for the summer. There's lots of reasons that people have to stop taking their medications, but the stigma associated with these medications makes it easier for them to stop, but also easy for them not to try to find a solution. Because for all of these problems, there is usually a solution that a well-trained doctor can figure out, for example by for example, changing the dose or changing the medication or reducing the dose and adding a psychosocial treatment as a few examples. As another example of the potential impact that stigma has on adherence. This is a study I did with Joe Biederman back in 2019-2020 where we looked at treatment engagement and we found that by treatment engagement we meant did the patient or the parent fill the first prescription of medication on the left as children, on the right as adults.

[00:13:20] We found the same thing. If we just had treatment as usual, only 40% of patients filled their first prescription. I mean, that's remarkable that people were so afraid of this medication that even though they told the doctor they wanted it, they decided not to even take one dose. That improved with the text messaging intervention that Dr. Biederman developed. So there are ways to improve adherence that we and others are working on now. Medication stigma leads to an interesting kind of paradox that despite low effect sizes and a poor evidence base, parents and patients crave non-drug treatments. So and I understand that as a parent. I have a son with lifelong ADHD. He's now in his late 30s and he still has ADHD and I do wish that there was a non drug treatment that would help him but all parents really prefer non drug treatment options. So, for example, most studies that have surveyed parents find that most parents want to avoid particularly stimulant medications. They do rate benefits and risks, of course, which makes sense.

[00:14:35] But their treatment preferences are influenced by beliefs regarding the causes of ADHD about which there's misinformation, their knowledge about the treatments. Again, there's lots of misinformation there. Treatment goals and previous treatment experiences. These are ways in which misconceptions and myths about treatment can affect the actual treatment that the patient gets. This is kind of interesting. This is a slide that describes the beliefs of doctors on the left and parents on the right, but whether they want to use a video game treatment for ADHD. And as you can see in the blue, most doctors and most patients thought this was a good idea. Even though this video game...

[00:15:26] Moderator / host: She does decide to put on the 1.5. You need to turn your microphone off. We hear you in the background there, Steve. You're not now also muted.

[00:15:47] Prof. Stephen Faraone: OK, sorry everybody. We seem to have had a technical issue. But back on track. You can see in blue that most doctors, large majority of doctors and the large majority of parents like the idea of using this video game for treating their children. And yet video game in a clinical trial does not actually improve the symptoms of ADHD. And so that's my concern is that we will move to non effective treatments because of medication fears. Here's another. This is a very interesting non pharmacological treatment trigeminal nerve stimulation for ADHD, which everybody should know about because it's in the US, it's been a cleared by our Food and Drug Administration for use in children and they they show a significant effect in reducing ADHD symptoms. As you can see from this graph here, there were not many adverse effects, but there was some fatigue, headaches and changes in appetite and also significant increases in weight and pulse. And yet this particular device which became the first clear device is called Monarch, was tested in another study in Europe and not replicated in a 2026 study.

[00:17:07] So although these these devices are out there and available for parents, meaning the video game device [unclear] and also the trigeminal nerve device, they actually don't work very effectively. So in a sense, stigmatization of drug treatment has stimulated the search for non drug treatments and research is good. But it could lead to the use of less effective treatments. And that's a concern that I have and we should be also concerned about when we speak to patients about drug versus non drug treatment. Let's talk about the diagnosis. Diagnosis of ADHD for decades has been criticized as subjective and yet the evidence for validity is very high. So it doesn't if you, if patient comes to you and says Doc, you say I have ADHD, but you didn't give me a biological test, you didn't do a brain scan. How can you know this is real, this is valid and the answer is is a complex one. But the bottom line is easy because in some papers I did with colleagues, we did a complete review of the validity of ADHD following very strict criteria that are used to test the validity of psychiatric diagnosis.

[00:18:23] We found that ADHD in adults first here was a valid disorder. We also did it for children, the same kind of research. And yet we still see papers like this by Martin Whiteley. He's a well known, you know, anti ADHD person who says ADHD diagnosis continues to fail the reliability and the validity test. And this was published in 2015. He says ADHD diagnosis are notoriously unreliable and yet presents no data in his paper about the reliability of ADHD, which has been shown to be very reliable in studies that actually assess its reliability. So these statements are made even in academic journals and they're just wrong. So we stigmatize ADHD when we make claims about the subjectivity of the diagnosis and then say that leads to over diagnosis or inappropriate diagnosis based on very weak data that do not address harm. We can talk later about over diagnosis under diagnosis. That's an issue of concern in the ADHD world, but it's not related to this issue of subjectivity.

[00:19:39] That's something we have to stop apologizing for the diagnosis being subjective and focus on the fact that it's very reliable and very valid and useful in clinical practice. And yet because there are concerns about subjective diagnosis that has driven the development of less valid, so-called objective diagnostic tools. And by objective I mean a biological test of some sort. In fact, here you go, these three objective tests. have now all been cleared by the US FDA for ADHD. In the US, we use the term clear to mean that the device has essentially been shown to be safe and have potentially some utility. It doesn't mean that the device is very useful. And in fact, when anybody has studied these devices, there's very little evidence to suggest that they're useful, necessary or sufficient for diagnosing ADHD in either children or adults. And if you're not sure about that, read this very nice article by Russell Barkley, one of the Deans of ADHD, if you will. And he was very famous when I was a graduate student studying ADHD.

[00:20:55] He wrote this article. Neuropsychological testing is not useful in diagnosing ADHD. Stop it. Prove it. This is a big mistake that many physicians still make that someone comes in for a diagnosis, they send the person to a psychologist to do testing to confirm the diagnosis, to rule in the diagnosis or to rule out the diagnosis. It is totally inappropriate to do that. It is totally appropriate to use neuropsychological testing for the purposes like to define the strengths and weaknesses of a patient to help them in their life, but it is not appropriate to use it as a diagnostic criteria. So we stigmatize the disorder. We stigmatize ADHD when inaccurately questioning the validity of the diagnosis as a means of justifying the search for an objective diagnosis. A good diagnosis is reproducible and gives meaningful predictions regardless of whether it is objective. That's the important thing about a diagnosis. It's useful in the clinical realm and it gives us meaningful predictions. Well, let's talk about the effects of stigma on patients and families. This study showed that people who were exposed to more stigmatizing communications had decreased self esteem, less acceptance by peers, social isolation, lower self perception competence.

[00:22:18] This was a survey of 1000 adults in Germany. Only about half identified the symptoms of ADHD as a mental illness. So that means half thought that it wasn't an illness, it wasn't a mental disorder. Which of course is wrong. One in five did not believe ADHD was a real disease. Most believe that ADHD in youth was caused by the family social context but the idea of biological causality was more common when thinking when answering questions about adult ADHD. But many of these adults thought that you know, ADHD was really caused by the family. This is the bad parenting that parents are incompetent and that leads to ADHD. Two thirds were against the use of stimulants for ADHD, even though we know they're highly effective and have low levels of adverse effects. Homeopathic remedies were four times more likely to be recommended. There's a very large gap between evidence based guidelines and public opinion about ADHD and its treatments, and that is in part due to stigma. When the same research group looked at the acceptance of adults with ADHD in hypothetical social situations, you can see these different social situations on the horizontal axis here and they were either rejected.

[00:23:37] The ADHD person would be either be rejected, accepted, or be neutral. If you just look at the rejection rate, this is the darker part of the bar. There's a fairly high rate of rejection of people with ADHD in certain situations. It's the highest for taking care of children. So many people almost 40% didn't trust people with ADHD to take care of their kids, wouldn't recommend them for a job. 25%, I mean, that's awful not to do that. I mean, having a son with ADHD who's an adult I would hate to see that affect his life. Fortunately it hasn't and he has a good position. And anyway, all of these other areas, there is a substantial fraction of people who would reject somebody or who would not accept them. If you look at this neutral category here, these are people who are not sure, the acceptance rate is fairly low for some of these categories. So stigma has real world effects on patients and therefore you can think of it as stigma as a hidden comorbidity. It's not a comorbidity like depression or anxiety, but it is a comorbidity. It's something that's affecting the patient because untreated ADHD plus stigma leads to increased perhaps exponential impairments exacerbate symptoms. It can halt treatment and it can drive morbidity because stigma can worsen anxiety, depression and substance use.

[00:24:58] It becomes, if you will, a trigger for these known comorbidities of ADHD which have a biological component to them, but also are affected by these external causes such as stigmatizing communications. You can think of these four types of stigma. So public stigma is what happens in the media. Media caricatures, cultural myths, societal stereotyping. There's structural stigma. It's the way that schools and workplaces are designed that make it difficult for people with ADHD to participate in those areas. There's affiliate stigma. That's, for example, blaming parents or partners or family units for ADHD. And then there's the internalized stigma. That's when the patient absorbs all these communications and begins to see themselves as having character flaws, personality flaws, or some kind of moral problems that other people don't have. And that of course makes them anxious, makes them depressed and worsens their outcome. You know, public stigma is really awful.

[00:26:06] Because the neurobiological differences, the deficits [unclear] are hidden, right? People don't see them. Their behavior is judged as intentional choices rather than symptoms. And of course, we need to educate patients about why this is happening so they can understand that the media caricatures sometimes, you know, reducing ADHD to hyperactive kids, invalidating inattentive presentations that are particularly common in adults and women makes it harder for these people to seek diagnosis. And then there's this kind moralization of executive functioning that, you know, society likes focus, punctuality, good organization, but some people confuse that with moral virtue or good character and that makes ADHD look like a moral failure as opposed to a disorder. Stigma also affects social policies. For example, in this study, they showed that stigma towards people with mental illness in general was associated with decreased support for coverage of mental and substance use disorder and insurance benefits. And stigma towards those with opioid use disorders was associated with decreased public support for increasing government spending to improve substance use treatment and with increased support for punitive policies.

[00:27:29] Now we need more studies like this that are about ADHD, but in fact, it's the same. We see the same problem that we're getting less funding for ADHD than we should because of stigma. And in fact, in the National Institutes of Health, ADHD gets less research funding than other psychiatric problems. Structural constraints increase failure. So, for example, standardized testing constraints, where tests have to get done in a very limited period of time. It's difficult for people with ADHD. Distracting open offices or open classroom designs are hard for people with ADHD. Or rigid scheduling can also be difficult for people with ADHD. Removing these constraints [unclear] can help people with ADHD live more productive lives. Affiliate stigma. That's when we blame the parent or partner or someone in the family unit leads to statements like, oh, you just need to discipline them. Or you're making excuses for their bad behavior. Or you're taking the easy way out with medication. The bad parenting myth is perhaps the worst because that myth can delay diagnosis and treatment because the parent does not want to go to the doctor and talk about something that may come back to them as suggest that they're doing something wrong in parenting their child.

[00:28:54] One way to think about stigma is that, you know, it's changing neurobiological differences into voluntary moral failures. That's something that's controlled. So in stigma with stigma, the stigma view is that the patient is lazy, unmotivated, careless, disruptive or drug seeking In the clinical lens, well, there's a dopamine deficit or there's a norepinephrine difficulty, the neurotransmitters aren't working well, there's executive dysfunction, working memory impairment, etcetera. So teaching patients about the what we know about the neurobiology of ADHD can be important because it can change their view. We can't change the public's view, but we can change the internalization of that view in the patient. And another problem is that stigma often creates this idea that these moral problems that I have are my identity. And I can't change that. And that means I'm going to have a terrible life, I call it the stigma trap: I am my symptoms. And that's actually not true. Patients are much more than their symptoms. They have values, they have their own level of intelligence.

[00:30:10] They can have empathy, creativity and can do wonderful things. But they have to understand how their brain regulates these areas of their life like task initiation, working memory and time perception. Teaching them that can help them escape this stigma trap, as this trap worsens ADHD outcomes. You know, you can think of this as a cycle here of failure. You get external invalidation from stigma that leads to internalized shame and self doubt that can spike comorbidity and anxiety and depression that can worsen the cognitive load and executive dysfunction. And that this task failure reinforces the sense of invalidation, which starts to become internalized. And this can increase the severity of ADHD unnecessarily. It just it's really sad that this has to happen to people. It also leads to sometimes masking of symptoms trying to not, trying very hard not to show ADHD symptoms because they are going to be stigmatized by the world. And so I like this cute diagram that you can think about. The neurotypical baseline is that we have most of us have lots of energy for executing tasks and regulating emotions, doing our daily planning.

[00:31:29] But if you're spending a lot of time masking your symptoms, your energy supply essentially is decreasing because you're suppressing your hyperactivity. You're kind of forcing yourself to focus using lots of energy that you then don't have for other things later in the day. And that can lead to anxiety and depression and misdiagnosis of ADHD. So as a summary of kind of the multiple impacts of stigma on diagnosis and treatment, we can see delays of assessment. We can see symptom masking that leads to, if you will, energy depletion and worsening of symptoms, rejecting the diagnosis and then abandoning treatment either by not seeking treatment at all or by not adhering to treatment once the treatment has occurred. Stigma is affecting, if you will, all these points in the diagnosis and treatment cycle.

[00:32:28] So what can clinicians do about stigma? This is perhaps the most important thing is we can't change public view. I mean, I try to do that as a researcher who lectures to the public, who has a website for the public.

[00:32:44] But what can we do about stigma? Doctor to patient or clinician to patient. Well, the first, of course, is psychoeducation. It's a process known as reframing. So for example, the patient is hearing the message, "You are lazy and just need to try harder." The message is reframed to "Your brain operates differently from others and needs medical help to improve your ability to regulate behavior, thoughts, and emotions." Because when patients and families understand that there's a neurobiological source of their problems, their shame and stigma, internalized stigma start to disappear. There are many examples of reframing. I can't go into all of them here, but you know, as some examples that some people have a fatalistic view of diagnosis. I have this diagnosis, this means I'm going to have a horrible life. And we say no diagnosis guides treatment. And that gives us a therapeutic objective of parental optimism and improved outcomes. We change the stigma of the stigmatizing view of the lazy, unmotivated child to explain reward deficiency. It's not that it's a moral deficit in the child. It's that their brain operates differently. And so the parent needs to learn methods to maximize the impact of rewards and so forth.

[00:34:04] Many of these reframing things like bad parenting causes ADHD. We say no, standard parenting just doesn't work with an ADHD child. Not that you're a bad parent. You have a child whose brain is not affected by standard parenting techniques. That neutralizes parental guilt and perhaps motivates them to better understand the parenting methods that could be useful for kids with ADHD. We help destigmatize medicines. I like this concept that we can say medical interventions create neurobiological equity, if you will. They change the ADHD brain to a brain that's more neurotypical and create equity.

[00:34:52] I love the example of wearing eyeglasses, right? Like me, I have myopia, but if I wear glasses, my vision is as good as somebody who doesn't have glasses. That creates optical equity. We have neurobiological equity when we treat a disorder like ADHD appropriately and we make their brain more neurotypical so they can engage with life in a way that's more productive, more enjoyable for them and helps them reach their goals. So it's not good to think of medications as simply performance enhancers. That phrase is sometimes used very negatively. The medications provide the neurobiological baseline that patient needs to achieve their goals in life. Getting them up to baseline, it's not making them kind of super focused or it's not giving them some kind of superpower or increased edge over other people. It's just getting to a neurobiological baseline. When you reframe, you can build a support network. So you teach the parents that ADHD is a genetic neurological trait. It's not caused by parenting style. You tell partners that the forgetfulness of their partner is a working memory glitch.

[00:36:08] It's not a measure of their love for you or their concern about you. And to the larger team of teachers and so forth, we kind of shift the concept of managing bad behavior to supporting a unique nervous system, a unique neurobiology. So put simply, psychoeducation translates misinformation into reality. We change the idea that ADHD is an invention of modern society and screen time to the truth about the history of ADHD, that it's been around for quite a long time. And this idea, for example, that screen time causes ADHD is wrong. It's the same as when they used to think that television caused ADHD back when television was introduced. So there are many myths about ADHD. The ones that you hear from your patients will vary and the more you know about the disorder when you hear a myth, such as people with ADHD can't focus on anything you can explain to them. No, ADHD is a problem of attention regulation and in fact, sometimes people with ADHD can have intense periods of hyper focus where they're doing something very rewarding and they can focus on. Now we could go on for quite a long time talking about misconceptions.

[00:37:24] I'm not going to do that because there's just not enough time in the webinar and there's really too many of them. But as you can see from this slide, I've just catalogued a few more of the misconceptions. I think one of them that is coming to the fore today is this idea that ADHD is, sorry, I'm going to go back. ADHD is over diagnosed. Well, the truth is that for ADHD and also for any medical disorder, both over diagnosis and under diagnosis occur. And that's because healthcare professionals are not perfect and they do sometimes make mistakes, but those mistakes can actually be corrected fairly quickly. It shouldn't be a concern for the parent or the patient. Another myth about ADHD medication is that the stimulants cause substance addiction for people with ADHD when used therapeutically, that's actually wrong. When the stimulant medications are used therapeutically, they actually lower substance abuse risk. It's not to say that they're not potentially addictive, They are if they are misused, then they can become addictive, but when used therapeutically, they actually lower the risk for substance abuse.

[00:38:48] Well, I'm going to go on now and just give you a few resources that you can go to to find out more about ADHD: the World Federation of ADHD where we had posted the international consensus statement on ADHD In the US, we have CHADD, which is the family support and advocacy group for ADHD. There's lots of toolkits for health professionals, there's comprehensive stigma resources there. And of course, there's NCBI, the National Center for Biotechnology where you can see and read peer-reviewed publications about ADHD, stigma about all sorts of topics. And I always encourage people to go to the website pubmed.gov, where you can learn about ADHD. Before we end, I'll just give a short advertisement for our 11th World Congress of ADHD, which will be in June of 2027 in Cape Town, South Africa. Hope you can join us. More information is at the World Congress website. And I do have some free resources for ADHD at adhdevidence.org, including many slides that can be used for educating other people about ADHD.

[00:40:10] So with that, I think we're ready to have some questions and I do love to have questions, so please put them in the chat. I see we have 10 in the chat already. Hopefully they're questions and not concerns of some sort that I have to worry about. Barbara.

[00:40:26] 

Barbara (moderator): 

No, definitely questions and very good ones.

Stephen V. Faraone is a Distinguished Professor in the Departments of Psychiatry and Neuroscience & Physiology at SUNY Upstate Medical University and Director of Research for the Department of Psychiatry. He is also Senior Scientific Advisor to the Research Program Pediatric Psychopharmacology at the Massachusetts General Hospital and a lecturer at Harvard Medical School. Prof. Faraone studies the nature and causes of mental disorders in childhood and has made contributions to research in psychiatric genetics, psychopharmacology, diagnostic issues and methodology. 

An author on over 1000 journal articles, editorials, chapters and books, he was the eighth highest producer of High Impact Papers in Psychiatry from 1990 to 1999.  In 2002, Prof. Faraone was inducted into the CHADD Hall of Fame in recognition of outstanding achievement in medicine and education research on attention disorders. In 2008, he received the SUNY Upstate President’s Award for Excellence and Leadership in Research. In 2009 he was awarded Alumni Fellow status at the University of Iowa in recognition of his outstanding contributions to society and his profession. In 2010 he received the Chancellor's Award for Excellence in Scholarship and Creative Activities from the State University of New York. In 2013, he was awarded the title of Distinguished Professor by the State University of New York, which is conferred upon faculty having achieved national or international prominence and a distinguished reputation within the individual’s chosen field through significant contributions to the research and scholarship, or through artistic performance or achievement in the fine and performing arts. In 2018 he received the Lifetime Achievement Award from the International Society of Psychiatric Genetics and in 2019 he received the Paul Hoch Award from the American Psychopathological Association.