Improve Focus with Behavioral Tools & Medication for ADHD | Dr. John Kruse

Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. John Kruse. Dr. John Kruse is an MD-PhD and practicing psychiatrist who specializes in the treatment of ADHD in both kids and in adults. As you'll see during today's episode, Dr. Kruse is among the world's top experts in understanding the various treatments for ADHD and tools for helping to overcome non-clinical issues with focus and attention. We, of course, discuss the drug treatments for ADHD, so those include Adderall, Ritalin, Vyvanse, Modafinil, Wellbutrin, basically all the drugs that are used to treat ADHD, and we cover their relative advantages and disadvantages. We also talk about the use of caffeine for focus and how caffeine can interact with those various drugs. Dr. Kruse also educates us on how specific behaviors, like our sleep timing, so not just the amount of sleep we get, but when we sleep, as well as our meals, our exercise, how all that can shape our levels of attention and focus. And that, of course, is relevant not just to people struggling with attention and focus or who have ADHD, but to everybody. Dr. Kruse isn't just a psychiatrist. He also has a background in circadian biology research, and he offers the intriguing idea that ADHD and other deficits in focus may, in many cases, be the consequence of a misregulated circadian rhythm. He tells us how to test that idea and potentially how to fix it. By the end of today's episode, you'll understand what stimulants do, the possible origins of ADHD in both kids and adults, and both the behavioral and drug treatments and non-prescription approaches to overcoming brain fog and focus challenges. So by the end of today's episode, you'll be armed with a ton of new knowledge and you'll have a lot of practical tools you can apply. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public. In keeping with that theme, this episode does include sponsors. And now for my discussion with Dr. John Kruse. Dr. John Kruse, welcome.

I'm glad to be here today.

Let's talk about ADHD, and probably best if we start off by just kind of laying out what it is. Is the H, is the hyperactivity component always in there? Uh, childhood ADHD, adult ADHD, maybe, if you would, just give us the- the top contour of this and then we can get into ways to combat ADHD depending on different circumstances, different needs, this sort of thing.

I'll just start out by saying that like most things in neuroscience and psychiatry, we- we have some definitions and we have lots of different thoughts and frameworks to approach things, so I'll start with our diagnostic category or how we- how we diagnose ADHD, and that is there are 18 different symptoms, nine of them are hyperactive-impulsive, nine of them are inattentive. So the inattentive ones are things like forgetting to follow through on things, losing items, um, being easily distracted. The impulsive and hyperactive ones are cutting people off in conversations, blurting things out, running around, um, fidgeting. But the definitions themselves were designed with a child population in mind because until roughly the mid-'90s, it was dogma that this was a disease, neurodevelopmental disease of childhood and that every child who had it outgrew it. That is dramatically wrong. Um, some kids do, most kids don't. The latest work suggests that most adults fluctuate in time with the severity of their ADHD symptoms. So jumping back to the definition, so we have these 18 different symptoms. As an adult, you need to have at least five of them, and when we say have them, all of these are things that normal people can display at any time. So any of us might interrupt someone, might have trouble sitting, might have trouble attending to a task, but to meet the criteria, these have to be displayed an excessive amount of time and an- or to an excessive degree to the extent that they're causing some dysfunction or distress and that they have to be displayed in multiple realms of life. So if it's only at work that you have trouble completing your task, you know, that might have something to do with your boss or an uncomfortable chair or something. So these have to be, um, traits that are displayed in multiple realms of life. Um, they have to cause, again, distress or dysfunction, they have to be to an extent that's beyond what a normal person does, and what's strange is often ADHD has a stigma it's not a real diagnosis partly because there isn't some, a fancy word is pathognomonic, you know, some classic symptom that's characteristic exactly of that. So with schizophrenia, we have hallucinations. Most people aren't having hallucinations. If you have those, you know, you might have schizophrenia or a drug effect, but- but that's unusual. Again, with ADHD, they're all usual behaviors, it's just to an unusual extent. So the diagnosis comes under s- uh, a lot of signum- stigma and questioning, you know, isn't this just normal behavior carried to an- a ridiculous extent?