This week we’re talking misinformation which is an interesting topic because it feels like it should be something where its easy to define and identify. We’ve all seen stuff online where we looked at it and felt, “how the heck does anyone fall for this kind of stuff?”
And that’s actually something that plays right into the hands of falling for misinformation. When we think we’re immune to something, we’re not on the lookout for it when it isn’t quite as straightforward. It’s the stuff that rhymes with the truth that is often the easiest for us to get trick by.
While it is easier than ever for us to get access to ADHD information it also means we’re exposed to more misinformation about ADHD than ever as well. But with a little bit of caution I think we can muddle through fairly well. And what I mean is that we just have some rules that we should apply when we’re evaluating the information that we’re presented with.
I think a perfect example of how easily misinformation can by pass our filters comes from earlier this year when there was an image of the pope in big puffy white coat being shared around social media. This picture was actually AI generated but most people didn’t clock the AI nature of the photo. And why would they, it was just a photo of the pope in a coat, I know when I saw it in my feeds I glanced at it and scrolled right on by and didn’t give it a second thought. In fact, had I not had it pointed out to me that the photo was AI I would have never known, although that’s also partially just because I would have never thought about it again.
But that’s the point here, I didn’t even think about the need to try and clock this image. And social media really is the place where most of us are most vulnerable here. Algorithms amplify sensational content and unverified information can easily spread from repost to repost. We get hit with some something that seems plausible enough to believe that we then don’t bother to do our due diligence, because “well I trust Steve, he wouldn't post something he didn’t verify.”
It’s also important to realize that often when we’re getting misinformation (at least in regards to ADHD) it’s usually not particularly malice. Often enough it’s someone who is fairly well meaning passing on information that they either heard wrong or misinterpreted.
For example, you may or may not have heard about how you shouldn’t take your ADHD medication with your morning orange juice or perhaps anything with citric acid or ascorbic in it. I actually got fairly curious about this because this felt like it was something that might be interesting to cover for the podcast, but as I dug deeper I wasn’t able to find reliable sources on this particular issue.
Since this is a complex issue, I asked one of my friends, who is a bio-mathematician working in pharmaceutical testing (we’ve all got friends like this right?). He was kind of surprised that this was a question at all because he told me just look in the documentation that is included with my prescription because that will have the best information about drug interactions. So I read through that entirely too dense document and… there was nothing in there about these interactions. Now, just to be clear here, I’m currently taking Adderall so that piece of data is only relevant to that medication. If you take another medication, you may have different interactions; every medication is going to have its own rules.
Even with that said, I was still finding information from fairly reputable sources saying that yeah, you should avoid citric acid for an hour before or after taking any ADHD medication. From what I can gather this is only due to an overabundance of caution. Apparently, there is a mechanism that has the potential to create an interaction specifically with stimulant-based medications, where gut ph (alkalinity/acidity) can reduce absorption. However, this interaction isn’t something that you’d typically see as clinically significant—that is, while it is possible, it isn’t likely to have an effect that you’d particularly notice. Typically, the recommendation to avoid these foods with citric and ascorbic acid is only there if you are noticing your medication isn’t working as expected.
Part of the confusion here also stems from the fact that these interactions don’t exist within a vacuum. It’s not like we’ve got someone pounding three glasses of OJ and then taking their meds and nothing else. There are going to be so many other factors that go into play here that probably have a much larger impact on your day to day functioning.
And I think this is a place that we can step back and realize that I just spent the last few minutes talking about how I went about verifying a fairly innocuous post about taking your meds with OJ. While it took me probably less than 30 seconds to see the initial post about this idea, it took me hours to be able to actually thoroughly answer the question. And the worst part is that the answer ended up being, “well kind of maybe sometimes.”
And that’s kind of the point that we were talking about in the beginning, it wasn’t that this information was straight up misinformation, but also wasn’t exactly accurate. But more importantly I think it is something that can often mislead people into focusing on the wrong things because one of the most important questions we can ask about this kind of information is, “Compared to what?” - as in when you are presented to something with an effective it’s important to understand the relevance of what else might also have an effect.
One example of this idea comes from Malcolm Gladwell’s book Outliers, which popularized an idea called the “relative age effect,” which takes research from Canadian psychologist Roger Barnsley where, in a study, he found that a significant number of elite players were born in the early months of the year. This was tied to the age cut-off dates for youth hockey leagues (January 1st in Canada), meaning players born earlier in the year were often more physically mature than their younger peers.
This effect has since been seen in a number of other sports, with some findings pointing to that in sports where the relative age effect is strong, athletes born in January to March may be 20-40% more likely to reach elite levels. This is due to a snowball effect where those who show early potential due to being more physically mature are more like to get more attention from coaches and more play time to develop their skills.
The idea being that those initial advantages keep giving those athletes a cumulative advantage because each year they are more like to continue to have the first opportunity to develop those advantages.
In an incredibly competitive field like professional athletics, that feels like a huge advantage. But it’s also something that tends to see diminishing returns. As athletes progress into older age groups and professional leagues, the impact of the relative age effect diminishes as individual talent, work ethic, and other factors become more important.
However, genetics, coaching, personal drive, and injury prevention will have a much more significant effect than birth month alone. In fact, one of the strongest indicators of whether someone will go pro in a particular sport is simply whether they had a parent who was a pro in that sport - so basically genetics. And this is also important to understand because the birth month will have basically no effect on individuals who don’t have any sort of other advantage. So while it is a factor and it can play a significant role in someone’s development on the road to professional sports, it might actually be one of the least important metrics to look at.
But this has been enough of a tangent, so let’s bring it back to what we we’re talking about before, which was the effect of citric acid on stimulant medication. So, while that can have an effect, other factors are going to play a much stronger role. In the scheme of ADHD management, it’s important that we’re looking at things like diet, sleep, exercise, support systems as well as a host of other things. And of course, for many people, medication is going to play a vital role and so knowing if your medication is working as intended is going to be important. However, that’s only a small piece of what’s going on here. I honestly can’t find anything that speaks to the magnitude of effect that you might find from the stimulant and citric acid interaction beyond that it affects the absorption rate—meaning that you are still going to be seeing the effect, just at a reduced rate. The takeaway for me is that if you are experiencing inconsistent results from stimulant medication, it is possible that this could be a factor.
But again to bring it back to the earlier point, as compared to what? I know that one of the biggest factors on if I’m going to have a productive day or not has way more to do with the quality of my sleep. Peek medication effectiveness is going to mean nothing if I’m dead tired.
This is a question we often want to ask when we consider the information we’re getting online. Because often, while the information we’re getting isn’t misinformation, it’s still misleading us about what we should focus on. When we’re trying to get our ADHD management in order, it's more important to focus on the big wins instead of the things that, while moving the needle, don’t do so in a significant fashion.
And I think one of the biggest takeaways from this episode should be on how misinformation often isn’t just blatant lies about what ADHD is and isn’t.
In 2022, a study titled “TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality” found that about half of the analyzed videos were misleading. And I think their usage of words there is important because they weren’t saying that a majority of what they found was misinformation, just that the information could lead viewers to the wrong conclusions. The most common example of this was misattributing certain symptoms as being specific to ADHD. Of course, they did find things that were straight misinformation, such as videos stating object permanence is an issue with ADHD—and this probably comes from people mistaking the idea of out of sight, out of mind with object permanence, which is a developmental milestone for babies when they understand that the world exists beyond what they can see.
And despite some of my best efforts I wouldn’t be surprised if a number of my episodes wouldn’t be classified as misinformation. While I try to provide context and caveats for monologue-based episodes and try to minimize when guests are being too bullish with their statements, I can say with certainty that there are things I’ve missed. I mean, I’ve taken down more than a couple of episodes where I’ve had people write in to let me know about mistakes - and to be sure, I am always so very thankful people are doing that because I don’t want to be peddling bull crap.
Additionally, there are also aspects of ADHD that would scientifically be categorized as misinformation simply because of the difference between lived experience and what’s in the DSM-V. For example, I know one of my most popular episodes is on emotional regulation, which isn’t part of an ADHD diagnosis. In fact, an ADHD diagnosis doesn’t cover anything about emotions - they used to but were removed in a push to make the diagnostic process into a more quantifiable process, and unfortunately, emotions are notoriously hard to quantify. Nonetheless, emotional regulation is something that most people with ADHD have some struggles with. So, does talking about emotional regulation constitute misinformation about ADHD?
And yeah, this is where things get tricky. I mean, looking at what I’ve written, I can see a lot of language where I’m couching what I say—I use phrases like “many people with ADHD experience” because this isn’t a universal experience and helps build in the nuisance around the issue. Often, we see this kind of nuisance lost in short-form content like TikTok or memes.
For example, I just scrolled through some of my downloaded memes and found one that’s just a tweet that says, “I accidentally relaxed too much, and now I don’t have enough anxiety to get stuff done. #ADHD”
I could absolutely see how this could be classified as ADHD misinformation because that’s not how ADHD works in a clinical sense. However, in a lived experience sort of way, I absolutely get the message being shared. And because it’s just a tweet, it isn’t like it’s going to have a whole lot of context around it. And I wouldn’t expect it to. Sharing a meme of how my ADHD feels shouldn’t bare the same amount of scrutiny that book does. Same goes with a 60 second video on Tiktok. It’s not meant to be an all-encompassing look into what’s going on. More often than not it is simply a starting point.
Its important to remember that no singular thing is usually going to make all the difference in all the things. With that said, doing something like getting good sleep or really figuring out your medication can make the difference that makes everything else easier. Even then though, just doing that one thing probably is just the first step.
I often see misinformation as a symptom of people trying to make sense out of complex ideas - or sometimes going the other way and making things that are fairly simply more complex than they need to be. There have been plenty of times when I thought I understood a concept fairly well but once I tried to dive in and really talk about it found my understanding lacking. It’s easy to convince ourselves we know how something works when really we only have a basic understanding.
Misinformation can be deceptive in not only it’s simplicity but also in the fact that often it isn’t spread through malice intent. One of the unfortunately effects of how misinformation is often portrayed in media is that we often have this idea that whoever is spreading misinformation is doing so on purpose. Now, to be clear, sometimes that is absolutely the case, but more often that not there is nothing sinister going on.
But this is complicated by things like conspiracy theory, internet trolls and grifters. While I’d argue that more often than not people are spreading misinformation simply because they’re unaware of what’s really true, there are plenty of bad actors out there.
In the next installment of the series we’ll be getting more into the bad actors and talking about the conspiracy theories that help spread ADHD misinformation.
This Episode's Top Tips
Always verify the credibility of the information, especially when it relates to health - it’s easy for misinformation to spread, especially when it’s got some aspects of the truth to it.
Be aware that misinformation often stems from oversimplifications or well-meaning errors, not malice. This doesn’t mean it can’t still cause harm, but it does mean the need to be extra vigilant even when it comes to trusted sources. We all mistakes, I know I do.
Use the question, “compared to what?” to help you understand the full context and relevance of advice. Try and focus on implementing wins instead of focusing on the minutia.