The majority of individuals with ADHD have one or more comorbid disorders. Comorbidity is a technical (and admittedly, not very cheerful) word for ‘co-occuring’, meaning that multiple disorders or conditions are present at the same time. Anxiety and depression are the most prevalent conditions that co-occur with ADHD.
Researchers and clinicians want to better understand this comorbidity in ADHD. Does having ADHD increase your risk of developing other conditions? Is there a biolgical mechanism that underlies both ADHD and other conditions? Or are symptoms of ADHD actually broader than the attentional, hyperactivity and impulsivity problems defined by the DSM/ICD, and therefore also linked to other conditions? Or all of the above?
Going with the third option (which by no means excludes the alternatives), clinicians have noticed that many individuals with ADHD experience symptoms that are not specific to ADHD, but are also often seen in other psychiatric conditions. You could call these symptoms ‘mainstream’, or ‘common’ mental health problems. Some examples that are often experienced by those with ADHD are emotional instability, sleep problems, low self-esteem, distractibility and concentration problems, and mental restlesnesss or excessive mind wandering.
Understanding these comorbidities better is important, because often one condition can hide the ‘true’ underlying condition. For instance, a person with ADHD who experiences many symptoms that are also characteristic of anxiety (i.e. low self-esteem, excessive mind-wandering, sleep problems, avoiding difficult situations). In such a case, the person could receive treatment for anxiety problems, while he or she is actually needing treatment for ADHD.
To distinguish between these conditions better, we need to find out more about these common symptoms. Being distracted can have many different causes and can happen in many different situations. For instance: are you distracted due to pervasive negative thoughts, because the task you’re doing is boring, or because you’re thinking of many related things and drift off to new ideas?
To learn more about the nature of these symptoms, researchers have given mobile apps or smartwatches to participants with ADHD. Several times a day, the watch buzzes and the app prompts a question that the person has to give answer to immediately. Questions can for instance be: How are you feeling right now? Have good/bad things happend to you in the last hour? How much has this affectd you? Were you concentrating on a task or where you distracted? Where you tinking about something (un)pleasant? etc. This method called ‘experience sampling’ can give very valuable information about someone’s symptoms. When combining the information from a lot of individuals, this can also identify differences between different disorders, that were not really known before.
If you want to learn more about this topic, you can watch this webinar by professor Philip Asherson from King’s College London. He explains the common mental health symptoms of ADHD in more detail, and gives examples from his research, also using experience sampling.
This blog is based on the webinar by Philip Asherson “ADHD in the mainstream” that was created as part of the CoCA project. The CoCA project investigates comorbid conditons of ADHD: http://www.coca-project.eu.
Brisk/Risks: Go on – what’s the worst that can happen? (15-minute film with BSL) from kaisyngtan on Vimeo. Freeze frame shows participants Jaye Braithwaite with BSL interpreter Jacqui Beckford.
Attention deficit hyperactivity disorder (ADHD) is popularly associated with being easily distracted. Its other features, such as out of the box thinking, hyperfocus or risk-taking seem to be less discussed beyond specialist contexts. Brisk/Risks was a fun, accessible and engaging open mic event exploring risk-taking within and beyond the framework of ADHD and mind wandering. It featured King’s College London’s Professor of Psychiatry Philip Asherson, ADDISS Chief Executive Founder and President of ADHD Europe Andrea Bilbow OBE, and Wellcome Trust-funded medical humanities scholar Dr Sophie Jones, amongst others, and was curated by artist Dr Kai Syng Tan. Brisk/Risks took place on 4 December 2018 at Bush House, London, UK. The event was part of the ‘King’s Artists – New Thinking, New Making’ exhibition, featuring Tan’s exhibition of a large tapestry from #MagicCarpet, which was her project mentored by Asherson (since 2017). The film version of the event (15 minutes) is BSL-interpreted and edited by Studio Maba. The film premiered at Birkbeck Arts Week 2019, which included an exploration by Tan of the contested term of ‘neurodiversity’. In this blog post, Kai shares 2 transcripts from the evening, of presentations by Kai and one of the participants, Jaye Braithwaite, a ‘Creative, Tourettist and Teaching Assistant’. Read Kai’s own reflections on the open-mic and film here.
TRANSCRIPT: Opening provocation by Tan
Do you take risks? Why? Why not? What’s the riskiest thing you’ve ever done? Do you regret it?
Are you risk-adverse? What could be the opposite of risk-seeking? Pragmatism? Common sense? Does survival come into play? Does courage or naivety come into play? Does play and pleasure come into play?
Flip side: Failure? Up-side: Resilience?
Risks and opportunities. Truths or dare. Live fast die young. Crime and Misdemeanours. Health and safety? Sense and sensibility? Cock and bull. A well-known university states: ‘risk-taking produces innovation. That’s why our classrooms are safe spaces for our students to take risks’. Yeah right. We call students ‘clients’ and promise them nothing less than a 2:1. How’s that for innovation?
Seeking novelty, cheap thrills or doing extreme sport because your ADHD brain is under-aroused. Stealing flapjacks from a shop everyday for four years because it gives you a kick — and you didn’t even like flapjacks. Sorry UCL. Having your film banned, tapes confiscated by the government because you’re not allowed to talk politics there. Upheavals: walking out of your family, country, relationships permanent jobs — as the norm, to work on this project for example.
If you have ADHD, your child has 25% chance of also having ADHD – congratulations.
Research commissioned by Eclipse, a black-led theatre company in Sheffield, reveals how when black artists are told that their work is ‘high risk’, it’s ‘simply an excuse for racism’.
Is humanity under threat from the rise of AI? Is democracy dead? — Do we care? Forests are burning. The earth is dying, ice is melting — and we’re put on our bikinis, sunbathing, basking in the heatwave. Heroes like Aung Sun Suu Kyi have fallen. Left standing, on centre-stage, at the far right, are jesters, cowards. Movement, a human right under Article 13 of the Universal Declaration of Human Rights, is endangered. Walls physical and invisible are erected, borders hardened, our minds closed, as we fear the other, retreat to our tribes hide behind screens. We stop taking risks, as artists, scientists, researchers, makers, citizens, and only go for tried and tested options. Work with or fund something/someone unfamiliar? Don’t be silly. We feel impotent, so we punch down, not up. We’re so busy fighting amongst ourselves, that we’ve become what Stephen Fry calls ‘illiberal liberals’ and ‘irrelevant and outdated bystanders’. The masses have shown that they can’t be trusted. So is now the time for a new profound theory, as Slavoj Žižek argues?
What if human beings didn’t go to the moon? What if, 2 million years ago, our ancestors didn’t run long distances — 6 hours, 30 kilometres, after the antelope –to hunt them down? Would the Homo erectus have died of starvation? What if migrants who risk everything to give their kids better lives give up and ‘go home’, as people around them keep telling them for centuries? What if entrepreneurs with ADHD like Richard Branson didn’t risk everything and start their businesses?
What if no one comes to my first ever – and possibly last — open mic? What if people come but no one comes up to speak? Will this spell the end of my career as an artist-curator?
It’s OK. I have a plan B. It’s our secret — that’s why I’m whispering. I’m coming up with my own brands of perfume. It’s targeted at people who think ADHD doesn’t exist. So when they use it, it makes them ‘a little bit more ADHD’: more restless, more reckless.
One is called Impulse. The other? Risk.
Would you buy it?
TRANSCRIPT: Presentation by Jaye Braithwaite
I shouldn’t be hiding
There’s no denying
That I’ve got Tourettes
I tic I shout I move all about
Let’s do adhd next
I can’t keep still
I can’t concentrate
I can’t wait
My mind races
The competition is real
I get that urge to tic …The thought, the feel
Sometimes it’s good
Sometimes it’s bad
Other times I’m happy
Other times I’m sad
The creativity I get
The way it hits me
I feel so free
Writing at 3am
Paper and pen
Ticcing at dawn
Sleeping at noon
It all just happened
Won’t be ending too soon
I like to think
Think think think
Or am I just weird
I used to be angry
But I realised I was Just scared
Scared of people
And how they would react
It would cause me to act
Act normal or whatever that is
These weird things about me I hid
Hid them well
Until my head began to swell
I couldn’t take it anymore
It was time to pour
I’ve got adhd and Tourettes
And I’m allowed
Allowed to be myself
Now I can be
I can be finally free
*See film trailer version of the film Brisk/Risks here.
*See images and feedback of premiere of the film at Birkbeck, University of London, on 21 May 2019 here. The film premiere was part of Too Much/Not Enough: Neurodiversity and Cultural Production, of the Birkbeck Arts Festival, The evening featured 2 new provocations by Kai, alongside medical humanities scholar Dr Sophie A Jones and curator Alessandra Cianetti. Listen to podcast here and read the transcript of Kai’s response to the open mic/film, on risk-taking and leadership, here, and a provocation on the contested term ‘neurodiversity’ here.
The open mic and film are part of ‘We Sat On A Mat and Had a Chat and Made Maps! #MagicCarpet (from 2017), which is an art-science exploration which gathers diverse and divergent bodies (and bodies of knowledge) to explore difference and (neuro)diversity, with ADHD and how it relates to mind wandering as a starting point. #MagicCarpet was a 2017 Unlimited commission funded by Arts Council England, with additional support by King’s College London. Thus far, #MagicCarpet has reached more than 9000 people, including through Arts in Mind and Unlimited Festivals. Venues include Science Museum, Southbank Centre, South London Gallery, Art Workers’ Guild and the Peter Scott Gallery (Lancaster). Publications include an article that was read 2000 times within 2 days of publication in The Conversation (10.6 million readers) and a top 2018 editorial on neurodiversity and women in Disability Arts Online. 100% of the feedback for an event stated that the work has challenged their understanding of how the arts and science can collide and create new insights. AHRC reviewers have described a proposal of next phase of the work as ‘exciting and innovative’; ‘already leading the way’ and ‘with an impressive track record’. #MagicCarpet was awarded a prize for ‘Cultural Change’ by the National Coordinating Centre for Public Engagement (2018). Dr Kai Syng Tan FRSA SFHEA was the project’s lead and the first artist-in-residence at the Social, Genetic & Developmental Psychiatry Centre. An artist, consultant, curator and academic, Tan is best known for gathering diverse and divergent bodies and bodies of knowledge to engineer spaces of ‘productive antagonisms’ (Latham & Tan 2016) across disciplinary, geopolitical and cultural boundaries, in what she calls an interdisciplinary ‘ill-disciplined’ approach (Tan & Asherson 2018). Marked by an ‘eclectic style and cheeky attitude’ (Sydney Morning Herald 2006), ‘radical interdisciplinarity’ (Alan Latham 2016) and ‘positive atmosphere’ (Guardian 2014), she is recognised as ‘absolutely central’ for the emerging ‘Running Studies’, and was Visual & Communications Director for the £4m Opening and Closing Ceremonies of 8th ASEAN Para Games (2015).
Does your mind wander? What do you picture when you daydream? Where do you go? How far is too far? How often is too often? When does mental restlessness become impairment? What are the boundaries between pathology and normalcy, a healthy brain versus one that is ill, disordered and disorderly? What can a science-art collaborative exploration of mind wandering contribute to, challenge and extend our understanding of wellbeing?
Art invades science, science invades art: Phil and Kai at Monologue Dialogue IV exhibition inside Kai’s installation entitled ‘Crossed wor(l)ds (un-floored) (brain drawing) (2019 itinerary) (after Brexit, Chagall, Billingham, Wes, Savage, 2017)’, The Koppel Project, London.
Memory Lane, Institute of Psychiatry, Psychology and Neuroscience, King’s College London
Above: Left: Art invades science, science invades art: Phil and Kai at Monologue Dialogue IV exhibition inside Kai’s installation entitled ‘Crossed wor(l)ds (un-floored) (brain drawing) (2019 itinerary) (after Brexit, Chagall, Billingham, Wes, Savage, 2017)’, The Koppel Project, London (Photography by Richard Wright). Right: Memory Lane, Institute of Psychiatry, Psychology and Neuroscience, King’s College London.
A roving art installation
Drawing on emerging research on how mind wandering relates to Attention Deficit/Hyperactivity Disorder[i], channelling the exuberance of artist Grayson Perry’s legendary tapestries as well as an artist’s lived experience as a mind wandering extraordinaire, We sat on a mat and had a chat and made maps! #MagicCarpet is a new collaboration between artist Dr Kai Syng Tan and molecular psychiatrist Professor Philip Asherson that aims to generate a critical and creative space to explore the boundaries between normal and abnormal behaviour, social and medical models of disability, imagination and pathology, art practice and scientific research, clinician and patient. Under the mentorship of Professor Asherson at the MRC Social, Genetic & Developmental Psychiatry (MRC SGDP) at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), a key aspect of the practice-led research project is how Kai will gate-crash/invade/intrude/immerse herself within the environment of leading researchers in ADHD at King’s College London as a Visiting Researcher. Apart from observing/participating in seminars, Kai will also volunteer for scientific experiments and trials. She will then embed knowledge, questions and interpretations gained in the design of a tapestry. The tapestry will be weaved in Flanders Tapestries in Belgium, which has produced tapestry art by Perry and other contemporary artists. The work ‘takes off’ when people sit on the tapestry, and chat about their mind wandering. Because words may be inadequate or challenging, they also capture their discussions/disagreements/discoveries in the form of maps and drawings (and the point is not how well you draw) that they will co-create. Co-riders of this ‘magic carpet’ include clinicians and researchers from UK Adult ADHD Network (UKAAN), self-taught artists from Submit to Love Studios, of Headway East London, a charity for people affected by brain injury, and as well as students and staff at King’s and elsewhere. Selected maps, as well as commissioned text and developmental sketches, will be documented in a limited-edition publication. A one-day seminar, exhibition and book launch will take place at the iconic Art Workers Guild. Other possible exhibition venues may include the Southbank Centre and IoPPN. Those who cannot experience #MagicCarpet live may enjoy photographs and a short film published on social media.
A space to problematise, debate and make magic
As Flo Mowlem (April 11) and Dr Martine Hoogman (March 20) pointed out in previous blog posts, while mind wandering – in which attention switches from a current task to unrelated thoughts and feelings[ii] – is a universal human experience, excessive mind-wandering can be unproductive, and could be a key feature of ADHD; while ADHD can pose serious problems, there can be positives, and this is hitherto an under-explored area of research. Indeed, as one of the best example of a continuous trait found in both impaired and excelling individuals, ADHD is an ideal springboard to spark a discourse about the line(s) separating wellness and illness. BBC Horizon’s recent ADHD and me with Rory Bremner did a wonderful job in sparking mainstream interest in ADHD (not least in its controversial analogy of people with ADHD as half-baked gingerbread cakes and hapless victims of shark attacks). The ‘magic’ that #MagicCarpet as a project aims for is not to provide answers but to raise more questions. This is not just during the workshops, but publication, exhibition (if the tapestry and maps are portraitures of the makers’ neurodiversity, they present an interesting counterpoint to the hung portraits of able-bodied males that deck the Edwardian Hall of the Art Workers’ Guild), and beyond. While there are no shortage of melting clocks, cupboards that lead to other worlds and grand pronouncements about human beings’ primal desire for ‘journeys of the mind and body’, without which we ‘rot’ [iii] in the so-called ‘art world’, that mind wandering as a subject area, creative process or tool in the arts seems to be an unchallenged ‘given’ makes it an appealing area of research for Kai as a researcher and practitioner. Her own diagnosis of ADHD, dyslexia and dyspraxia in Autumn 2015 generated questions, not clarity. Where and when does the ADHD/art/personality begin, end or smash into each other? What are the problems and opportunities afforded by conceptualising and making ‘neurodiverse art’? Is this discussion a rehash of the tiresome myth of the ‘mad artist/genius’ (which artists themselves may corroborate, intentionally or inadvertently)? Is neuroscience society’s new tool to ‘other’ people who do not conform, or does it enlighten and clarify? What can art bring to this conversation? #MagicCarpet is Kai’s process of inquiry/discovery as a woman/artist/curator/researcher. It is also her way to interrogate existing representation of ADHD which she has found to depict as largely only affecting children or adult male criminals, and only as an aberration to be corrected, cured, ironed out, medicated.
#MagicCarpet may also present a template of how art and science can clash and/or create sparks. As an ‘experiment’ which ‘invites us into the epistemological space of the laboratory’ while pointing to ‘ethical and aesthetic territories of novelty, invention, and play’[iv], it contributes to discourses on interdisciplinarity. Research in and with the arts and sciences tends to be siloed, but grand (and not-so-grand) challenges often require crossovers and the pushing of boundaries. The work creates a platform for clinical communities to dialogue with the arts about ADHD. As a leading artist working in the art-science interface argues, ‘not only is medicine capable of providing new material for the gallery space’, art can bring ‘new knowledge into the consulting space’ [v]. Equally important is the opportunity for artists to engineer forays out of comfort zones, in order to learn unfamiliar tools, languages and processes. A mind that does not seek new frontiers is one that is closed and stuck. Kai is thrilled as she is terrified by the extent to which her trespass into the medical world disrupts her assumptions and habits as an artist. Which was why she approached Philip in March 2016. The ensuing cultural clashes, collisions and antagonisms would, hopefully, be jarring, surprising, productive [vi].
Unlimited commission, unlimited possibilities
#MagicCarpet is one of 6 works commissioned by Unlimited in its Main Commissions strand for its 2017 round of awards. Unlimited is an arts commissioning programme that celebrates the work of disabled artists, with funding from Arts Council England, and is delivered by Shape Arts and Artsadmin. While the project is expected to run between Summer 2017 – Autumn 2018, there are possibilities to extend #MagicCarpet intellectually, artistically, pedagogically. An example is to tour the tapestry at various universities and working with the respective disability offices to help raise awareness of ADHD, mindfulness and neurodiversity in its staff and student populations. Another is to incorporate the tapestry as an object-based learning activity for students at MRC SGDP. Evidence relating ADHD with exercise as a preventative treatment is emerging[vii]. This is an area that could be developed into a research project, and relates to Kai’s existing body of work on running as a creative and critical toolkit. A related strand is to work with mobile EEG devices to enable the ADHD brain to create ‘brain drawings’ as the body runs through different places in various parts of the world, which could fit under the Science in Culture flagship of the Arts and Humanities Research Council.
Come ride the magic carpet with us. Share your thoughts, experiments, explorations, recommendations and counterarguments. Let’s see how far we can go (together).
Dr Kai Syng Tan FRSA SFHEA is an artist and curator. Through installation, performance, film, and text, she explores the body and mind in (com)motion. Sitting/slipping between/beyond discipline/form/conceptual frameworks/spaces/places/allegiances, her work is turbocharged by a day-glo palette, hyperactive layering and over-the-top vocabulary. They have appeared at Documenta, Royal Geographical Society, Biennale of Sydney, MOMA, BBC and the Guardian, and are collected by the Museum of London and Fukuoka Art Museum. Currently a Research Fellow at Leeds College of Art, Visiting Fellow at University College London’s Institute of Advanced Studies, Peer Review College Member of the Arts and Humanities Research Council and Director of RUN! RUN! RUN! International Body for Research, Kai completed her PhD at the Slade School of Fine Art, University College London. From Summer 2017 she will also be a Visiting Researcher at SGDP. @kaisyngtan
Professor Philip Asherson, MB,BS, MRCPsych, PhD is Professor of Molecular Psychiatry at the MRC Social, Genetic and Developmental Psychiatry (SGDP) centre at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London in the United Kingdom. Since 1996 when he moved to the IoPPN he has worked closely with Professor Jonna Kuntsi to develop a program of research on clinical, quantitative and molecular genetics of ADHD. In his own work, he has a particular focus on adults with ADHD. Current research projects include investigations of the neural basis of mind wandering in ADHD, clinical trials of prisoners with ADHD, and the impact of ADHD on learning in University students. He is the author and co-author of more than 300 articles and book chapters on ADHD and other neurodevelopmental disorders and traits. @ukaan_org
[i] See for instance Franklin, Michael S., Michael D. Mrazek, Craig L. Anderson, Charlotte Johnston, Jonathan Smallwood, Alan Kingstone, and Jonathan W. Schooler. “Tracking Distraction.” Journal of Attention Disorders 21 (6): 475–86. doi:10.1177/1087054714543494 (2014) and Mowlem, Florence D., Caroline Skirrow, Peter Reid, Stefanos Maltezos, Simrit K. Nijjar, Andrew Merwood, Edward Barker, Ruth Cooper, Jonna Kuntsi, and Philip Asherson. “Validation of the Mind Excessively Wandering Scale and the Relationship of Mind Wandering to Impairment in Adult ADHD.” Journal of Attention Disorders, June, 1087054716651927. doi:10.1177/1087054716651927. (2016).
[ii] Smallwood, Jonathan, and Jonathan W. Schooler. “The Science of Mind Wandering: Empirically Navigating the Stream of Consciousness.” Annual Review of Psychology 66 (January): 487–518. doi:10.1146/annurev-psych-010814-015331. (2015).
[iii] Chatwin, B. Anatomy of Restlessness: Selected Writings 1969-1989. Viking Pr. 100-106 (1996).
[iv] Callard, F, and Fitzgerald, D. “Medical Humanities.” Where Does It Hurt, 16–17 (2014).
[v] Padfield, D. MASK: MIRROR: MEMBRANE The photograph as a mediating space in clinical and creative pain encounters. University College London. 3 (2013).
[vi] Elsewhere Kai has talked about interdisciplinary collaborations. See Latham, Alan, and Kai Syng Tan. “Running into Each Other: Run! Run! Run! A Festival and a Collaboration.” Cultural Geographies, Cultural Geographies (Sage), doi:10.1177/1474474017702511 (2016).
[vii] Rommel, Anna-Sophie, Jeffrey M. Halperin, Jonathan Mill, Philip Asherson, and Jonna Kuntsi. “Protection from Genetic Diathesis in Attention-Deficit/hyperactivity Disorder: Possible Complementary Roles of Exercise.” Journal of the American Academy of Child and Adolescent Psychiatry 52 (9): 900–910. doi:10.1016/j.jaac.2013.05.018. (2013).