ADHD 并非虚构——科学究竟说了什么

每个星期天，我们都会在《本周科技》中回顾本周的科技新闻。

Every Sunday, we cover the week's tech news on this week in tech.

大家好。

Hi.

我是TWIT播客网络的Leo Laporte，邀请你和Devindra Harnwar、Larry Maggett以及Alan Malefantano一起，向一位传奇人物告别。

This is Leo Laporte of the TWIT podcast network inviting you to join me, Devindra Harnwar, Larry Maggett, and Alan Malefantano as we say goodbye to a legend.

这位帮助我创办TWIT的人，我的导师和挚友，本周去世了，约翰·C。

The man that helped me start TWIT, my mentor and dear friend who passed away this week, John C.

德沃夏克。

Dvorak.

我们还会聊聊史上最奇怪的AI黑客事件。

We'll also talk about the weirdest AI hack ever.

这就是本周的TWIT节目。

That's this week on TWIT.

你可以在twit.tv以及所有播客平台上找到我们。

You'll find it at twit.tv and wherever you get your podcasts.

多动症似乎无处不在。

ADHD is seemingly everywhere.

确诊人数在上升。

Diagnoses are going up.

我们认识的很多记者朋友好像都有

It seems many people we know as journalists have

记者。

journalists.

对。

Yeah.

很多人都有这个病。

Loads of people have it.

而且孩子中的确诊率肯定在上升。

And kids is definitely going up in kids.

近年来，儿童多动症的确诊人数大幅增加。

Big rise in diagnosis in ADHD in children over recent years.

而正是这种增长，让一些人不禁好奇这到底是怎么回事。

And that increase, especially, is why some people are wondering what's going on here.

还有人声称ADHD是一种编造出来的病症，或者说是一种社会建构。

And there are claims that ADHD is a sort of made up condition or a social construct.

剧透一下。

Spoiler.

其实不是。

It's not.

但这就是我们本期《世界、宇宙和我们》节目要深入探讨的内容，来自《新科学家》。

But that's what we're diving into on this episode of The World, The Universe, and Us from New Scientist.

我是彭妮·萨切特博士。

I'm doctor Penny Sarchet.

我是罗文·胡珀博士。

And I'm doctor Rowan Hooper.

这里有很多要说的，尤其是关于女性的经历。对。

Now there's a lot to say here, not least with the experience of of women Yeah.

关于多动症。

With ADHD.

不出所料，这方面的研究一直被忽视，也缺乏深入探讨。

And not surprisingly, that aspect of it has been neglected and under investigated.

所以我们要深入聊聊这个话题。

So we're gonna get into that.

我们之所以想聊这个，是因为最近有个电视节目上出现了一些煽动性的言论，说多动症是个神话，是编造出来的，是一种社会构建，或者是一种新出现的疾病。

But we also wanted to address this whole subject because there's been some inflammatory suggestions on a TV show that ADHD is a myth, that it's made up, it's a social construct or and it's a new condition.

为了全面讨论这些问题，我们请来了卡蒂亚·鲁比亚。

And so to talk over all this stuff, we're joined by Katya Rubia.

她是伦敦国王学院的认知神经科学教授。

She's a professor of cognitive neuroscience at King's College London.

还有卡罗琳·威廉姆斯，一位作家兼科学记者，她自己就有多动症；以及亚历山德拉·汤普森，她是《新科学家》的医学编辑。

Caroline Williams, author and science writer who has ADHD and Alexandra Thompson, Medical's Editor here at New Scientist.

欢迎各位。

Welcome all.

嗨。

Hi.

你好。

Hello.

亚历克斯，先从你开始吧。

Alex, let's start with you.

你委托卡罗琳写了一篇文章，回应第四频道的纪录片《伟大的多动症迷思》。

You commissioned a piece from Caroline in response to the Channel four documentary, The Great ADHD Myth.

你当时是怎么想的？那个节目说了什么？

What were you thinking here and and what was it that the show said?

嗯，当这个标题出现在我的收件箱里，在节目播出之前，我就觉得这标题就是为了博眼球。

Well, when this landed in my inbox ahead of the show, I thought that feels like a headline that's designed to to shock.

而且感觉这个说法非常大胆。

And it's it felt like a very big sort of even suggestion.

不出所料，我知道他们会讨论为什么诊断数量会激增，我觉得这确实值得探讨，但说它是现代产物、没有证据支持，这完全不是事实。

And as expected, I knew that they'd go into why has there been this explosion in diagnosis and I do think that's something that's worth exploring but the suggestion that it's a modern construct, it's not backed up by evidence, that's just not the case.

所以很多其他地方都在讨论这个节目有多冒犯、多有争议，但我觉得我们真的有机会深入探讨其中的伪科学。

So lots of other places dug into how this was offensive and it's controversial, but I felt like we really had a place to go into the pseudoscience of this.

所以我就联系了卡罗琳，她写过很多关于多动症的文章，而且自己也公开承认有这个病，想让她好好剖析一下这个问题。

So then approach Caroline, who's done lots of writing about ADHD and is open about having the condition herself to really dig into this.

卡罗琳，我想说，当被告知你的诊断都是胡扯的时候，你肯定有点生气吧。

And Caroline, I guess it's fair to say you're a bit upset with being told that your diagnosis is all a piece of fluff.

是的，我是说，节目播出的时候，我客厅里全是喊叫声，纸上也写满了愤怒的笔记，部分是因为这否定了我整个人生的经历，而我最近才找到原因，但更主要的是因为我对科学的了解。

Yeah, I mean, there was a lot of shouting in my living room as it was going out, a lot of furious scribbling on the paper because, I Partly because it negates the experience that I've had my whole life and only recently discovered why, but mostly because of what I know about the science.

我知道他们说的并不是科学共识，也没有得到其他人的支持。

And I knew that what they were saying was not the scientific consensus, that it wasn't backed up by what other people were saying.

除了卡蒂亚，节目上所有人都完全认同“哦，这是个神话，原因如下”这种说法。

And with the exception of Katya, everybody on there was fully on board with the, oh, it's a myth and here's why narrative.

所以这让我更生气了，因为我碰巧因为工作和兴趣一直在关注这方面的研究。

And so that angered me more because I happened to follow this research as part of my job and my interest.

所以我能看出这不是真的，但随便说点什么很容易，找人来同意你，然后让它听起来很有说服力。

So I could see that this wasn't, but it's very easy to say what you like, find people to agree with you and make it sound convincing.

所以我最生气的是，大家会以为这是真的。

So I was mostly angry that people would think that this was accurate.

那给我们讲讲其中的一些观点吧。

Take us through some of the points then.

首先，就是那个说它是新出现的疾病的说法。

First of all, the idea that it's a new condition.

对。

Yeah.

纪录片里有一句话，说十年前这种病还非常罕见。

So there was a line in the documentary that was saying, oh, well, you know, ten years ago, it was incredibly rare.

现在却到处都是。

And now it's now it's everywhere.

但实际上，这根本不是真的。

Well, that actually isn't true.

我们现在所说的ADHD，最早的相关描述可以追溯到18世纪。

Earliest descriptions of something that we would now call ADHD date back to the 1700s.

而且有一位苏格兰医生在1760年代说过一句很棒的话，他说，哦，就是那些人，他们无法在任何有用的时间长度内保持注意力。

And there was one great quote by a Scottish physician from seventeen sixty something saying, Oh, there are the people that they can't pay attention for any useful length of time.

他们形容自己坐立不安。

They describe themselves as having the fidgets.

这就像，如果这都不算多动症，那我就不知道什么算了。从那时起，它就一直以不同的名称被记录和记载。

It's like, Well, if that's not ADHD, I don't And know what it it's been sort of noted and documented under different names from then on.

所以这并不是一种新的疾病。

So it's not as if this is a new condition.

是的，最近确实有更多的诊断，但即便如此，尤其是在这部纪录片针对的英国，有证据表明，如果你看大规模的人口研究，对普通人群中的大量人进行ADHD特征的筛查，大约有5%的儿童和2%到3%的成年人符合ADHD诊断标准。

Yes, there are more diagnoses recently, but even then, especially in The UK, which is what this documentary was aimed at, there's evidence that if you look at large population studies, where you screen large numbers of people from the general population for ADHD traits, about five percent of children and two to three percent of adults would qualify for an ADHD diagnosis.

在英国，总体上有1%的人被诊断，即使在年轻男性和男孩中，这个数字也大约在3%左右。

In The UK, overall, one percent of people are diagnosed, and even in young boys and young men, those figures are sort of around three percent.

所以，证据表明我们仍然在诊断不足。

So, the evidence suggests that we are still under diagnosing.

所以，整个关于‘这是编造的、是新的、到处都是，而且只要要求就能得到诊断’的说法，在事实上是不准确的。

So, this whole set up of it's made up, it's new and it's everywhere and you can get a diagnosis just by asking for one, just isn't factually accurate.

对。

Yeah.

再跟我们多讲讲诊断方面的情况吧，因为近年来诊断标准放宽了，对吧？

And tell us a bit more about the diagnosis because they have broadened in recent years, haven't they?

是的。

Yes.

诊断标准随着《精神障碍诊断与统计手册》的每次更新都有所调整。

So the criteria have been changed with every sort of iteration of the DSM, the diagnostic manual.

而且这些变化是因为，直到大约2008年，成年人是不能确诊的。

And there were changes made because until about 2008, you couldn't get diagnosed as an adult.

那时候成年人根本不算一回事，后来才改的。

It just wasn't even a thing in And adulthood that's since changed.

作为那次调整的一部分，一些标准也变了。

And as part of that change, some of the criteria changed.

比如，以前你必须从七岁起就有症状和特征。

So for example, you used to have to have signs and symptoms and traits from the age of seven onwards.

现在已经改成12岁及以上了。

And that's been changed to 12 and upwards.

所以这有点不一样了。

So that's slightly different.

而且对于成年人，现在只需要满足五个核心症状，而不是六个。

And in adults, you only have to have five of the core symptoms rather than six now.

所以稍微有些变化。

So it's slightly changed.

所以你可以说，诊断标准确实放宽了。

And so you could argue that that diagnostic criteria has broadened.

我最近报道了一项研究，它表明这可能意味着我们诊断出更多的人。

And I reported recently on a study that suggested that may mean that we are diagnosing more people.

这是一项关于ADHD遗传学的研究，这个领域远非简单。

This was a study about the genetics of ADHD, which is far from straightforward.

但研究提示，随着诊断标准的放宽，我们现在诊断出的人，其遗传因素占比虽然较低，但仍然比对照组有显著的遗传易感性，如果你愿意这么说的话。

But the suggestion was that now with this broadening, we are diagnosing people with a lower genetic component to the disorder who still have a significant genetic vulnerability, if you like, more than the control group.

但它考虑到了所有其他因素，比如环境影响、生活方式、背景、教育等等。

But it takes into account all the other factors that are going into it, such as environmental impacts, lifestyle, background, education, all these other things.

所以，是的，我们确实诊断出更多的人了。

So, yeah, so we are diagnosing more people.

但我们仍然没有诊断出所有可能被诊断的人。

We're still not diagnosing everybody who could be diagnosed.

所以我觉得这两个问题很容易被混淆。

So I think those two issues can get conflated quite easily.

我能不能补充一点，女性现在更容易被识别出来，部分原因也是症状范围的扩大，就像你说的，比如注意力不集中，你只有注意力不集中这一项，也可以和其他症状一起被诊断为ADHD。

Can I add also that females are more recognised, part also, the broadening of the symptoms, which, you know, like you said, they increase, like inattention, for example, you can have inattention alone and still be diagnosed with others with ADHD?

所以现在成年女性ADHD患者更容易被识别了。

So adults, female adults with ADHD are more recognised now.

另一个变化是，以前如果你有自闭症，就不能被诊断为ADHD，这也导致了诊断范围的扩大。

The other change is of course that before, when you had autism, you couldn't be diagnosed with ADHD, so this has also led to a broadening of diagnosis.

但这只是意味着患病率，没有新的生物学病例。

But what it just means is the prevalence, there are no de novo biological cases.

自70年代以来，患病率的增长非常有限，大约增加了百分之四。

The prevalence has increased very minimal since the 70s, the increase is about four percent.

所以增长幅度很小。

So it's a very small increase.

增长的是，就像卡罗琳说的，识别ADHD病例的能力，以前在女性和女孩中，以及症状不那么明显的女性中，这些病例没有被识别出来。

What has increased is, like Caroline's side, the ability to pick up cases with ADHD, which before were unrecognised in females, in girls, and in females where it's less obvious.

而且在教室里，你知道，女孩们没那么好动。

And in the classroom, you know, girls are less hyperactive.

是的，所以ADHD现在被认可了，现在我们更多地在女孩和女性中研究它，女孩在教室里更可能是注意力不集中，而不是那种多动、上蹿下跳的男性刻板印象。

Yes, so ADHD is now sort of recognised, now that we study it more in girls and women, it's more likely to be inattentive in girls in the classroom rather than hyperactive and bouncing off the walls, which is that sort of male stereotype.

对，我觉得在男性中，你知道，这很明显，因为他们可能把椅子扔过教室。

Yeah, I think in males, you know, it's obvious because maybe they're throwing chairs across the classroom.

我跟我一个当老师的朋友解释说，相信我，我的脑子里也有好多椅子在飞。

And I explained it to one of my teacher friends like, trust me, there's a lot of chairs being thrown across my brain.

你只是看不见，但它确实存在。

You just can't see it, but it's still there.

所以我觉得现在大家对这个问题理解得多了。

So I think that's much better understood now.

对，而且女性更容易被误诊为抑郁症，因为症状不那么明显，可能更多是退缩、注意力不集中、学业困难，而男孩的症状更明显，多动、活动过度，当然还有破坏性行为。

Yeah, and females are more likely to be misdiagnosed as having depression, because it's less obvious, there might be more withdrawal, more have more inattention and struggle with school performance, and it's less obvious with boys it's more clearly, they're more hyperactive, the hyper motor activity you see better, and of course the disruptiveness.

卡佳，你是神经科学家。

And Katya, you're a neuroscientist.

你能给我们讲讲，我们对多动症患者大脑里发生了什么了解多少吗？

Could you tell us a bit about what we know about what happens in the brains of people who have ADHD?

有三十年的脑成像研究，多动症患者的大脑确实存在一致的差异。

There are three decades of brain imaging, and there are consistent differences in the brain of ADHD patients.

我们刚刚要发布世界ADHD联合会共识论文的修订版，有来自40多个国家的140位作者参与。

We have just now, we are about to publish the revision of the World Federation of ADHD consensus paper, includes 140 authors across more than 40 countries.

通过大量的汇总分析和元分析，我们达成共识：大脑的结构、功能和连接性都存在差异。

And the consensus across many, many mega analysis, meta analysis, there are differences in the structure of the brain, there are differences in the function of the brain, and there are differences in the connectivity of the brain.

我在节目里都说过这些，但他们只挑了连接性差异来说，而且那些差异其实很小。

And in the, I said all this on the programme, but they only sort of picked on the connectivity differences which are very small.

确实，这些差异很小，但结构上的差异或功能上的差异并没有那么小。

And they are tiny, is true, but the structural differences are not that small or the function differences.

很明显，确实存在差异，但个体差异很大。

And what is clear is there are differences, but there is a large heterogeneity.

这也是为什么这些差异看起来很小。

And that's also the reason why they are small.

不是因为每个孩子都有很小的差异。

They are not small because everybody has small differences.

而是因为有些患有多动症的孩子大脑差异很大，有些则差异很小。

They are small because some children with ADHD have large differences in their brain, some have small differences in their brain.

所以当你从群体层面来看时，差异可能没那么大，但这并不意味着每个患有多动症的孩子差异都很小，也不意味着每个孩子差异都很大。

Then when you look at the group level, they may not be that large, but that doesn't mean every child with ADHD has tiny differences, and it also doesn't mean every child with ADHD has large differences.

有些患有多动症的孩子，他们的大脑差异是正常的。

There are some children with ADHD who have normal differences.

但当然，群体统计的另一个问题是，不同的多动症孩子，他们大脑异常的区域也不一样。

But of course the other problem with group statistics is that different children with ADHD have different brain abnormalities in different regions.

所以那些有情绪调节问题的孩子，他们大脑中负责情绪调节的区域确实存在差异。

So the ones with emotional dysregulation have differences in areas of the brain which are important by emotional regulation.

有注意力问题的孩子，尤其是女孩，注意力方面的问题比较突出。

The ones who have attention problems have attention problems, especially females.

她们在某些额顶叶注意力网络方面存在问题，而男孩可能更多是混合型的，比如多动、注意力不集中加冲动，他们的差异就更复杂一些。

They have problems with certain frontoparietal attention networks, and then the males who may have more combined, you know, hyperactivity plus inattention plus impulsiveness, they have more complex differences.

所以每个孩子都不一样。

So every child is different.

要找到一个共同点就更难了，这也是为什么差异看起来小，因为异质性太大了。

It's more different to find a common denominator and that's why the differences are small because of the large heterogeneity.

我在节目里说过，确实不能靠脑部扫描来诊断多动症。

And what is true, what I said on the programme is you cannot diagnose ADHD based on a brain scan.

因为技术还不够先进，未来也许有可能，但现在还不行。

Because, but that's because technology isn't advanced enough, it may be possible in the future, but at the moment you can't.

我觉得这真的很让人生气，所有这些关于这种状况的证据都被忽视了。

I mean it's really anger inducing that all this evidence has been dismissed about the condition.

但说真的，这么做其实挺危险的。

But let's be clear, really, it's actually dangerous as well-to-do this.

我们能聊聊这个吗？

Can we talk about that?

卡罗琳，你先开始吧？

Caroline, do you want to start us off?

对，我是说，纪录片里有很多讨论。

Yeah, I mean this, there was a lot of talk, you know, in in the documentary.

我们不知道我们给孩子做的事情的长期影响，等等等等。

We don't know about the long term effects of what we're doing to our children and blah, blah, blah.

这在一定程度上是事实。

And and that's to some extent true.

我们确实需要更多研究，长期研究，但出于很多原因，这很难做到。

We we do need more research, long term research, which is difficult for many reasons.

但我们确切知道的是，未经治疗的ADHD与心理健康问题（包括抑郁）的风险增加显著相关，还会导致身体健康问题，因为冲动会影响你的饮食、锻炼和生活方式，还会增加药物滥用的风险。

But what we do definitely know is that untreated ADHD is associated, increases the risk significantly of mental health issues, including depression, physical health issues as well, because impulsivity affects how you eat, whether you exercise, how you live your life, an increased risk of substance abuse.

所以那些关于药物的讨论听起来很吓人。

So all this talk about the drugs are terrifying.

但反过来看，如果不诊断、不治疗，滥用药物风险会增加，而且各种原因导致的死亡风险也会增加，包括自杀。

Well, the flip side is don't diagnose, don't treat increased risk of substance abuse, and also increased risk of death from all causes, including suicide.

所以我们知道，如果不治疗，对那个人、对社会、对他们的生活来说，后果都不好。

So we know that if you don't treat it, the consequences are not good for that person, for society, for their well-being.

而且我们也知道，当人们得到诊断后，不管他们是否接受药物治疗或其他任何治疗，这都有助于提升自尊和改善生活功能。

And we also know that when people get receive a diagnosis, whether or not they receive medication or any kind of treatment, that helps with self esteem and function in life.

就像突然明白了什么，生活变得轻松了一些。

It's almost like you suddenly understand and it makes life a little bit easier.

所以不诊断对谁都没好处，反而可能造成很大的伤害。

So not diagnosing isn't helping anyone and could do a lot of harm.

那么，可能有些观众，或者他们的父母会说，看那个小男孩，他们做了很多瑜伽，在大自然里散步，他开心多了。

So could people who maybe watch the program and their parents say, Oh, look, that little boy, they did loads of yoga and walking in nature and he was much happier.

我们让孩子停药吧。

Let's take our kid off the medication.

那可不太好。

That's not a good idea.

对，所以有很多原因说明这既可能危险，又让人反感。

So yeah, there's lots of reasons why this is potentially dangerous as well as offensive.

而且没有证据表明瑜伽对多动症有帮助。

And there's no evidence that yoga helps with ADHD.

也没有证据表明饮食或补充剂对多动症有帮助。

There's no evidence that diets or supplements help with ADHD.

运动确实有一点效果，但效果非常小。

There is a small there's evidence for small effects of exercise, but they are very tiny.

效果太小了，小到不能单独作为治疗方法。

They're very small, they're too small to be actually for exercise to be used as an alone treatment.

是的。

Yeah.

而且纪录片最后，父母还是让孩子重新吃上了药。

And in the documentary at the end, the parents did put the boy back on medication.

而且这被说成是一种失败。

And this was framed as like a failure.

哎呀，我们试过了，但还是不够，因为学校系统应付不来。

Oh dear, we tried, but it wasn't enough because the school system can't handle it.

但如果你仔细听他们说的话，那个男孩说他很难过，因为他在学校有些以前能懂的东西现在不懂了。

But actually when you listen to what they were saying, the boy was saying he was upset because he couldn't understand some stuff at school that he could before.

所以实际上，ADHD的一个问题就是，你努力努力再努力，却达不到自己的潜力。

And so actually one problem with ADHD is you try and try and try and you're not reaching your potential.

这对你的自尊心影响很不好。

And that has a real bad effect on your self esteem.

你总是——对我来说，开始接受治疗后的一个重大变化就是，我脑子里不再老是说‘天哪，卡罗琳，拜托’了。

You're constantly, one of the major changes for me when I started getting treatment was that I spend a lot less time going, Oh, for God's sake, Caroline, in my head.

而那种状态，你年复一年地这样，因为你需要，你想要，但你做不到，这真的很伤人。

And that, you do that for years and years and years because you need to and you want to and you can't, is damaging.

所以ADHD有很多事情你可能会做错，而忽视它、假装它不存在，可能是最糟糕的做法。

So there's a lot of things that you can do wrong with ADHD and ignore it and pretend it doesn't exist is probably the biggest thing you can do.

每周我们都会在《智能机器》节目中，聊聊人工智能、机器人以及我们身边的各种智能设备的最新动态。

Every week, we cover the latest in AI, robotics, and those smart things all around us on intelligent machines.

大家好。

Hi.

我是Triple Podcast Network的Leo Laporte，欢迎您本周加入我和Paris Martineau、Jeff Jarvis，一起对话Dan O'Dowd。

This is Leo Laporte of the Trip Podcast Network inviting you to join me, Paris Martineau, and Jeff Jarvis this week as we talk to Dan O'Dowd.

他为战斗机和大客机编写软件，他说他正在努力让计算机对人类更安全。

He writes the software for fighter jets and big commercial airplanes, and he says he's trying to make computers safe for humanity.

而这正是埃隆·马斯克没有在做的事情。

And that's exactly what Elon Musk is not doing.

《智能机器》，每周三更新，您可以在twit.tv/im或任何您收听播客的平台上找到我们。

Intelligent machines, this week and every Wednesday, you'll find it at twit.tv/im or wherever you get your podcasts.

Caroline，你在文章里提到的一点我觉得特别切中要害，就是“只是ADHD”。

Caroline, one point you made in your piece, that I thought was really pertinent is it's only ADHD.

只有在它被认定为一种障碍时，后面才会加上那个“D”。

It's only got the d at the end if it's a disorder.

是的。

Yes.

而且我觉得在神经多样性这个现代框架下思考ADHD是很有意思的。

And I think it's quite interesting to think about ADHD in the small modern framework of neurodiversity.

如果人们确实发现这给他们的日常生活带来了问题，他们会被诊断并接受药物治疗。

People are being diagnosed and they're being given drugs if they genuinely are finding that this has, is causing a problem in their day to day life.

这并不会随便给那些只是想法有点不同的人开药。

It's not being handed out as it were to anyone who just thinks a

有点不同。

bit differently.

不，纪录片里确实说过，如果你主动要求，就能得到诊断。

No, and this was actually said in the documentary that you can get diagnosis if you ask for one.

但这并不反映ADHD应该被诊断的方式。

And that is not a reflection of how ADHD should be diagnosed.

我不是说没有人在诊断上做得不好，但作为成年人，要符合诊断标准，你必须具备这五个症状。

I'm not saying there aren't people out there doing it badly, but to qualify for a diagnosis, you have to have these five symptoms as an adult.

你还得有实际的功能性问题，就是在生活的两个领域里应对困难。

You also have to be suffering sort of functional problems, problems coping in two spheres of your life.

比如家庭和人际关系。

So that can be home and relationships.

或者处理日常事务方面。

It can be keeping up with life admin.

你可以说，这确实让我的生活变得比原本更困难了。

You can say, actually, this is actually making my life more difficult than it needs to be.

也可能是心理健康方面的影响，比如自尊心。

It could be a mental health side effect, self esteem.

但如果你没有那五个症状，或者它们没有给你带来困扰，你就不会被诊断。

But if you don't have those five symptoms and they're causing you problems, you don't get a diagnosis.

这就是让我生气的地方，大家都说，哎呀，我们都有点ADHD，所以没必要诊断。

This is the thing that makes me mad about everyone saying, Oh, we're all over ADHD and so what you don't need a diagnosis.

是的，我们确实都有一些这样的特质，或者很多人都有一些这样的特质。

Well, yes, we all have some of these traits or lots of people have some of these traits.

如果这些症状没有干扰你的生活，没有让你无法正常运作，那就不是多动症。

If they're not interfering with your life because they're stopping you from functioning, that's not ADHD.

所以，是的，这是一个谱系，当它达到某个程度时，就会变成问题。

So yes, it's on a spectrum and there's a point at which it becomes problematic.

这在医学上很多情况都是这样，比如血压，到了某个点，你会说，好，超过这个值，我们该担心了，低于这个值就不用。

And that's true of lots of things in medicine, with blood pressure, it gets to a point you say, okay, above this, we should worry, below this not.

多动症也是一样的道理。

It's the same with ADHD.

在纪录片里，他确实被拍到说，哦，我觉得我没有多动症，我没有这些问题。

And in the documentary, he actually was filmed saying, Oh, I don't think I've got ADHD, I don't have these problems.

然后画面切到他，说，哦，原来我是混合型多动症。

And then cuts to a scene where he says, Oh, so I've got ADHD combined type.

太好了。

Great.

然后我就被开了药。

And then I got prescribed drugs.

所以要么是严重程度被夸大了才得到诊断，要么是诊断者没有按照标准来，因为直播里展示的那些根本不是多动症。

So either the severity was sort of hammed up to get the diagnosis or the diagnoser wasn't doing it by the criteria because what was presented on stream is not ADHD.

还有一件事我们研究得还不够，你也一直在为我们写关于卡罗琳的文章，那就是女性和女孩患多动症的经历。

One thing that's still under investigated and you've also been writing for us about Caroline is the experience of women and girls with ADHD.

就像多年来女性和女孩在自闭症方面被忽视一样，我们现在发现多动症在男女中的患病率几乎相同，但表现可能不同。

And similar to how women and girls have been sort of neglected in autism for years, we're now discovering that ADHD is almost as or equally prevalent in both sexes but might manifest differently.

你刚为我们写了关于激素对许多患有多动症的女性确实有影响的文章。

You've just written for us about how hormones really have an impact for a lot of women with ADHD.

你能给我们讲讲其中的一些情况吗？

Could you tell us about some of that?

这很有意思。

It's fascinating.

是的，这实际上来自于接受多动症治疗的女性。

Yeah, so this is something that actually came from women being treated for ADHD.

她们开始对精神科医生兼研究员奎奇说，文中也引用了他的话，'这里和激素有关，你能研究我们吗？'

And so they started saying to their psychiatrist and researcher, Kuidge, who's quoted in the piece, There's something going on here with the hormones, can you study us?

女性ADHD和女性医学整体上都没有得到足够的资金支持和关注。

Women's ADHD and women's medicine in general is sort of not properly funded and covered.

所以她开始研究这个问题。

So she started looking into it.

从大约十年前开始，积累了不少研究，表明患有ADHD的女性患经前焦虑障碍（PMDD）的可能性显著更高，PMDD就像是加强版的经前综合征。

And so since that sort of time about, I don't know, ten years ago, there's been a decent amount of research stacking up to suggest that women with ADHD are significantly more likely to suffer from premenstrual dysphoric disorder, so PMDD, which is like PMS on steroids.

基本上就是每个月有两周抑郁，而不是普通的烦躁。

Basically depression for two weeks every month is not just normal irritability.

所以在这项研究中，大约有50%的ADHD女性符合PMDD的诊断标准，而普通人群中这个比例只有3%到8%。

So women with ADHD are sort of fifty of the women in this particular study qualify for diagnosis of PMDD compared with three to eight percent in the general population.

60%的ADHD女性在分娩后会出现产后抑郁，这个比例是普通人群的两倍。

Sixty percent of women with ADHD have post depression after giving birth, which is double the rate.

患有ADHD的人在使用激素类避孕药时，患抑郁症的风险会增加。

There's an increased risk with people with ADHD on hormonal contraception of depression.

然后研究开始关注那些没有使用避孕药的女性，以及她们的症状如何随着月经周期和激素水平的变化而变化。

And then studies started looking at women who are not on contraception and how their symptoms changed across the month along with hormones.

而且在周期的后半段，认知症状也会增加大约两倍。

And there's like a twofold increase in cognitive symptoms as well towards the bit of the second half of the cycle.

所以排卵后，注意力不集中、多动、冲动的问题会更严重，而且在月经前还会有一个小波动，之后又恢复正常。

So after ovulation, inattention, hyperactivity, impulsivity becomes more of a problem and also a little blip just before menstruation and then it goes back.

这真的很有意思，因为现在这方面的研究越来越多了。

So this is kind of fascinating because this research has started to stack up now.

对我来说，这以前从来没想过，但回想自己的经历，确实是这样，比如，我会有正常人的状态。

And to me, it's something that never occurred to me, but yeah, it kind of you think back to my own experiences like, okay, so I have normal human being weak.

我会有开心的状态。

I have happy human being weak.

我会有生气的状态，还有那种状态。

I have angry and I have that weak.

而且它会一直循环，循环，循环。

And it kind of cycles, cycles, cycles.

实际上，这就是激素和ADHD之间的相互作用。

And actually it's the interaction between the hormones and ADHD.

现在有大量研究开始涌现，试图解释这背后的原因以及我们该如何应对。

And there's a huge amount of research that's starting to come out to try and explain what's going on and how we might deal with it.

嗯，我正想说，这会影响你根据周期不同阶段来调整治疗方法。

Well, I was going to say that will have to impact how you treat it according to what period in the cycle you're in.

对。

Yeah.

所以目前只有一项研究，涉及九名女性，而且是由同一位研究者进行的。

And so there is there has only been one study with nine women and by the same research

确实报道不足，对吧？

really is under underreported, isn't it?

对。

Yeah.

她一直在争取研究经费，但多次被拒绝，对方说这不重要，不值得做大规模试验。

Well, she's been trying to get funding and has been knocked back several times from funding saying, no, this is not important to do a big trial.

但她想做一项正规的随机对照试验。

But she wants to do a proper randomized controlled trial.

但是有一小群女性，在精神科医生的指导下，在这段时间把兴奋剂药物的剂量增加百分之三十到五十。

But with a small group of women who sort of working with their psychiatrists, increase their dose of stimulant medication during these periods by just thirty percent, thirty to fifty percent.

这似乎能平复她们症状的加重。

And that seemed to level out the increase in symptoms that they got.

因为在一些基于问卷的研究中，有些女性报告说，她们感觉完全被自己的激素控制了。

Because some of these women in some of the questionnaire based studies, people are reporting just feeling controlled by their hormones.

就像一直处于混乱之中。

Like it's constant chaos.

我不知道自己会变成什么样。

I don't know where I'm gonna be.

我不知道该怎么办。

I don't know what to do about it.

我完全受激素摆布。

I'm at the mercy of my hormones.

所以，是的，我们确实需要找到办法帮助人们度过这个阶段。

And so, yeah, so we do need to find some way of helping people through this.

你关于这个的专题报道里有一句话让我印象特别深刻。

And there's a line in your feature on this that really, really stood out for me.

精神病学不止于脖子以上。

Psychiatry doesn't end at the neck.

我觉得这个说法真的太妙了。

I thought thought that just such a great way of putting it.

对。

Yeah.

我的意思是，这确实是我非常关注的方向，就是身体和大脑的连接，还有内感受，以及身体里发生的事情，大脑其实非常在意，因为大脑存在的目的就是维持整个身体和大脑的存活。

I mean, and, know, this is this is very much my my thing, of body brain connections and sort of interoception and what what thing that's going on in your body, the brain cares about a lot because you know, the brain exists to try and keep your whole body brain, the whole thing alive.

所以激素波动是大脑需要了解的信息。

And so hormonal fluctuations are information that your brain needs to know about.

而且雌激素除了是生殖激素之外，在大脑里还有很多重要的功能。

But also oestrogen as well as being a reproductive hormone has a huge number of jobs in the brain.

它调节多种神经递质，包括与ADHD高度相关的多巴胺。

It regulates various neurotransmitters, including dopamine, which is highly implicated in ADHD.

它影响连接性。

It affects connectivity.

连接的形成、断开和维护都需要它。

It's needed for the making and breaking and maintenance of connections.

它影响大脑的新陈代谢，也就是大脑能量的供应。

It affects metabolism in the brain, the availability of energy in the brain.

所以当雌激素水平急剧下降时，无论是产后、更年期还是月经周期中，都会对大脑产生影响，这其实一点也不奇怪。

So it's hardly surprising really that when oestrogen drops off a cliff, whether that's after pregnancy or menopause or throughout the month, that that has an impact on the brain.

我们从动物研究和现在的人类研究中已经知道二十多年了，雌激素在大脑中扮演着这些重要的角色。

We've known for twenty years plus from animal studies and now human studies that oestrogen has all these important roles in the brain.

Caroline，我想问你一个问题，我听到一些传闻，也在社交媒体上看到很多讨论，说围绝经期女性的诊断数量似乎在激增，这让我想到，围绝经期的一些症状，比如脑雾之类的，会不会被误认为是ADHD？

Caroline, one thing I wanted to ask you about, I've heard anecdotally and seen on social media lots of chat about an apparent boom in diagnosis amongst perimenopausal women and that had made me wonder, you know, some of the symptoms of perimenopause like brain fog and that kind of thing, Are they being confused for ADHD?

但你的文章似乎表明情况并非如此。

But your piece suggests that's not what's happening.

不，我确实问过一位在这个领域工作的研究人员，因为有一种很片面的说法，比如“哦，这只是脑雾，只是年纪大了”之类的。

No, I actually asked that of one of the researchers who's working in this area because there's this whole toxic side thing of like, oh, well, it's brain fog, it's just your age sort of thing.

但并不是这样。在研究中，很多成年后被诊断的女性是在四十多岁接近更年期的时候被诊断出来的。

But no, so in the studies, a lot of women who are diagnosed in adulthood are diagnosed in their late 40s around this perimenopausal period.

但区别在于，如果之前一直顺风顺水，一切都很好，然后更年期来了，出现脑雾，这并不符合多动症的诊断标准，因为至少从12岁起就必须有症状。

But the difference is when being diagnosed, if it's been plain sailing going through life, everything is fine and then menopause hits and brain fog is happening, that doesn't qualify for ADHD because you have to have had symptoms from the age of 12, at least.

所以，做这项研究的研究员米歇尔·马特尔告诉我，当她询问那些在更年期被诊断的女性时，她们从八岁左右就有症状了。

So what Michelle Martell, who the researcher who's doing this work said to me is that when she questioned these women who were diagnosed in perimenopausal years, they had symptoms from the age of eight or something.

这些症状一直存在。

It's always been there.

但问题可能是，她们一生中一直在掩盖、应对或绕开这些问题。

But maybe what the problem is, is throughout life, they've been able to mask or cope or work around some of these issues.

但当雌激素突然大幅下降，比经前综合症那周下降得还要厉害时，就像公交车轮子掉了，油箱里没油了。

But when oestrogen leaves the building and completely plummets, like it's never plummeted before, even in PMT week, it's like the wheels come off the bus, that there's nothing left in the tank.

你无法弥补失去的东西。

You can't make up for what's been lost.

所以这可能就是这些症状显现出来的原因，因为所有的应对策略和后备系统都失效了。

And so that's probably why these symptoms are coming through, because all the coping strategies and all the sort of backup systems have all gone down.

接着卡罗琳刚才说的，我想补充一点，我们更新世界ADHD联合会共识时的一个关键发现是，ADHD不仅跟精神疾病有关，还跟身体疾病有关，所以它不只是影响大脑。

On the context of what Caroline just said, I wanted to say that one of the key findings of our update of the World Federation of ADHD consensus on ADHD is actually that ADHD is associated with not just mental disorders but also physical disorders, so it doesn't stop at the neck exactly.

ADHD和肥胖、免疫系统问题都有关系。

And ADHD is associated with obesity, with immunological problems.

而且它的遗传率高达百分之七十五到八十，这完全反驳了ADHD不是真实疾病这种说法。

Also, there is a seventy five to eighty percent genetic heritability, yeah, which speaks totally against ADHD not being a real disorder.

所以它确实和很多问题相关。

So, is associated with a lot of problems.

它是遗传性最强的疾病之一，几乎和身高一样高，和精分、自闭症这些遗传性很强的疾病差不多。

It's one of the most heritable disorders, almost as heritable as height and as heritable as schizophrenia and other, you know, quite genetic disorders or autism.

所以它是个真实的问题，既伴随精神上的共病，也伴随身体上的问题，很多身体上的问题。

So it is a real problem, is associated with mental comorbidities, is associated with physical problems, a host of physical problems.

从更容易感染，到更容易得免疫系统疾病，比如关节炎，或者晚年各种自身免疫性疾病。

It goes from more likely to get an infection to actually having more likely immunological problems like arthritis, for example, later life or all sorts of other autoimmune diseases.

有大量流行病学研究，大规模的那种，都表明兴奋剂治疗能减少精神共病，减少住院，减少事故，包括交通事故和自杀。

There are so many epidemiological studies, large scale epidemiological studies, who have shown that stimulant treatment is associated with a reduction in mental comorbidities, with a reduction of hospitalization, reduction of accidents, traffic accidents, suicide.

好处太多了。

There's so many benefits.

所以我觉得，如果说它不是真正的疾病，没有任何影响，只是调皮捣蛋的孩子或者父母教育不好，这种说法是很危险的。

So I think it's very dangerous to sort of claim it's not a real disorder, it hasn't got any implications and it's just naughty children behaving poorly or suffering from bad parenting.

但我觉得ADHD的问题在于，注意力不集中和冲动这些症状在人群中的分布是呈正态分布的。

But I think the problem with ADHD is that the symptoms, inattention and impulsiveness, are normally distributed in the population.

所以它只是这个连续谱的极端端。

So it's the extreme end of a continuum.

但人们不理解这一点。

And people don't understand it.

大家都觉得，哦，我也有点注意力不集中，也有点冲动。

Everyone thinks, oh yeah, I have a bit of inattention, have a bit of impulsiveness.

但如果你看到一个真正的ADHD孩子，你就会明白这是一种真实的疾病。

But if you see a real ADHD child, you understand it's a real condition.

那这背后的动机是什么呢？

What about the motivation behind this?

因为这让我想起那些仍然否认气候变化或否认需要实现净零排放的人。

Because it reminds me a bit of people who still deny climate change or the need to go to net zero.

你可以理解，也可以不同意，但你能理解他们背后的动机。

And you can understand and you can not agree, but you can understand the motivation behind that.

但在这里，我无法理解否认你们两位一直在告诉我们的这些大量证据的动机。

But here, I can't understand the motivation behind denying this vast body of evidence that you two have both been telling us about.

我觉得一个主要的担忧总是我们不知道药物对患有多动症的大脑有什么影响。

I think one of the the the key fears is always that we don't know what the drugs do to to to brains with ADHD.

而且其中一个关键问题，我觉得一个主要障碍总是药物治疗。

And one of the key problems, I think one of the key barriers is always medication.

确实，药物有一些副作用，比如升高血压，但这些副作用比精神科其他任何药物都小得多。

And fair enough, there are some side effects, it increases blood pressure, but the side effects are much smaller than any of the other drugs in psychiatry.

另一个问题是，在三十年的影像学研究中，我们还没有发现药物效应，我一直担心药物效应。

And the other issue is we have not found in thirty years of imaging I was always worried about drug effects.

我研究过药物对多动症儿童大脑的影响。

I've studied the effects of drugs on the brain of ADHD children.

正因为如此，我之前担心它会有不良影响。

For that reason I was worried it would have a detrimental effect.

但我从来没发现过这种情况。

But I never found it.

所以三十年的研究，我们都没有发现它对大脑发育、大脑结构或功能有负面影响。

So thirty years of research, we have not found a negative effect on brain development, on the structure of the brain or the function.

如果有的话，反而是相反的。

If anything, the opposite.

它似乎对某些大脑区域有保护作用，这些区域特别受多巴胺支配，因为这些孩子多巴胺较少。

It seems to have a protective effect on some of the brain areas, which are particularly innervated by dopamine because these children have less dopamine.

所以我们只是在把异常的情况正常化。

So we are just normalising what is abnormal.

我们并不是在给他们用药，让他们变得异常。

We are not sort of drugging them and making them abnormal.

恰恰相反。

It's the opposite.

我们是在把不正常的状态恢复正常。

We are normalising what's abnormal.

我理解人们可能会选择抗抑郁药或抗精神病药。

And I understand people could decide anti depressant medication, anti psychotic medication.

那些药的副作用要严重得多，影响也大得多。

The side effects are much more severe, much more impairing.

而ADHD药物的副作用相对较小，但需要监测。

The side effects and ADHD are relatively minor and they need to be monitored.

当然，你需要监测血压或心血管问题。

Of course you need to monitor the blood pressure or cardiovascular problems.

但很难理解这种担忧从何而来。

But it's difficult to understand where this is coming from.

是的，我想关于药物，有一点很重要，就是大家总觉得这基本上就是可卡因，好像我们在让孩子嗨起来一样。

Yes, mean, one of things that I guess I think is important to add about the medication is that there's this whole idea about, you know, it's basically cocaine and you know, as if we're getting children high.

从我自己的用药体验来看，你从低剂量开始，慢慢增加，直到有效果，然后到某个点就过量了。

From my experience of being titrated on the drugs, you start on a low dose, you get sort of slowly eat up until you get the benefit and that gets to a point where it's too much.

当你到了那个剂量，药效过强的时候，你并不会到处狂欢、玩得很开心，反而会觉得很难受。

And when you get to that point, there's too much, you're not running around partying, having a great time, you feel dreadful.

感觉就像喝了十杯咖啡一样。

You feel like you've had 10 cups of coffee.

你会忍不住地盯着手头该做的事，停不下来，而且你也不想停下来。

You can't stop manically staring at what you're supposed to do and you don't wanna stop.

那种感觉一点都不好受。

It's not a nice feeling.

没有人会因为吃了过量的ADHD药物而觉得开心。

Nobody's having a good time taking too much ADHD medication.

所以我觉得这就是为什么会有这种反对的声音。

So I think that is partly why there's this kickback.

就像是在说，哦，都是药物的错，都是大药厂的错。

It's like, Oh, it's the drugs, it's big pharma.

还有一种观点认为，这是社会的问题，我们试图把每个人都塞进同一个模子里。

There's also this idea that it's society and we're trying to force everyone's square pegs into round holes.

确实有一些研究指出，既然这是一种遗传性的状况或一组特质，那在人类进化史的某个阶段，它肯定是有优势的。

And there is some research into, okay, well, being that this is a genetically inherited condition or set of traits, that must have had advantage at some point in our evolutionary history.

所以有一种观点认为，在狩猎采集时代，可以这样推断：在以前我们打猎采集的好日子里，我们都需要有人能四处游荡，帮你找到新的觅食地。

So there's this idea that in a hunter gatherer, this can be extrapolated to say, in the good old days when we were hunting and gathering, we could all wonder, you needed someone who would wander off and find you a new foraging ground.

你需要一个容易感到无聊、然后会去发明新东西的人。

You needed someone who got bored easily and would invent something.

对，这听起来不错。

Okay, so that's great.

但人们常常用这个来论证，说我们得回到那种状态，让每个人都自由发展。

But that's often used to say, well, we need to go back to that and just let everyone be free.

我的观点是，即使在狩猎采集的好日子里，群体里那个有多动症的人也是一把双刃剑，过去如此，将来也如此。

My point, my feeling on this is even in the good old days of hunting and gathering, the person who was ADHD in the group was very much a double edged sword, always has been, always will be.

他们是那个出去探索、发明新东西的人。

They were the person who went off exploring and invented stuff.

但他们也是那个忘了看火、让火熄灭的人。

They were also the person that forgot about the fire and let it go out.

他们也是那种会走丢或者把东西乱放，结果熊闯进来把资源都吃掉的人。

They're also the person that wandered off or left stuff out and the bear came in it, all resources.

所以就有这种浪漫化的想法，觉得我们只要去森林里摘摘浆果，一切都会好起来，不用强迫人们适应现代生活。

So there's this kind of romanticisation of like, oh, we should just all go and wander around in the woods picking berries and everything will be fine and not force people to live in the modern world.

但我觉得这有点误导人。

But I think that's a bit of a red herring.

这种认为障碍是进化优势、所以它们才一直存在的想法，在我看来，根本就是错的，因为我们生活在社会里，我们会保护他们，治疗他们。

This idea that disorders are an evolutionary advantage, that's why they're still here, in my opinion, this is just simply wrong because we live in a society, we protect them, we treat them.

如果我们不治疗多动症的孩子，他们更可能死掉，他们因为各种并发症而更早离世。

If we wouldn't treat ADHD children, they're more likely to die, they're dying earlier from all sorts of comorbidities.

所以如果不治疗，他们反而更可能消失。

So they would actually disappear more likely if they were untreated.

至于说用药物把孩子变得像僵尸一样，这又是误解了。

And on this idea of zombifying children with the drugs, this is again a misunderstanding.

人们不明白，临床剂量的兴奋剂，只是那些滥用兴奋剂的人所服用剂量的一小部分。

People don't understand that the stimulant dose, which is the clinical dose, is a fraction of what is taken by people who abuse stimulants.

当然，滥用兴奋剂确实和大脑变化、大脑异常有关，也和心理健康问题等有关。

Of course, stimulant abuse has been associated with brain changes, brain abnormalities, has been associated with mental health issues and so on.

他们之所以会兴奋，是因为他们服用的剂量比我们给他们的要高得多。

The high they get is because they take a much higher dose than the one we just give them.

我们给的剂量只是很小的一部分。

It's a fraction.

比如埃琳娜·辛格的研究，他们直接询问了孩子们，结果发现患有多动症的孩子，根本不会因为药物而感到特别兴奋。

And studies by Elena Singh, for example, who have asked the children themselves, what they find is that children with ADHD, they don't feel so amplified by the drug at all.

所以，这是对那个节目的误解。

So this was a misrepresentation of the programme.

他们并不会感到特别兴奋。

They don't feel so amplified.

他们反而觉得能更好地控制自己的情绪。

They feel better in control of their own emotions.

他们的自控力也更强了。

They have better self control.