[MUSIC PLAYING] We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH Learn. [MUSIC PLAYING] Seeking autonomy and social connection, risk taking and identity making-- The. brain in adolescence is unique. It's primed to absorb and learn from the environment. And that means the teenage years are a chance to shift a young person's trajectory. This new series of Inside the Teen Brain explores how neuroscience can inform our understanding of young people's home, school, and life experience. In conversation with leading professionals, we answer three big questions-- what's the background? So what? And now what? I'm Dr. Jane Gilmour, and this episode is called ADHD-- Risk, Reward, and the Teenage Brain. Well, now, our first big question asks, what's the background? And I'm very interested in ADHD during adolescence because the core features of the condition share some characteristics with the teenage brain-- emotional volatility, a tendency towards risk taking, seeking novelty, and highly motivated by reward. A growing literature explores the nature of risk in young people with ADHD. ADHD and risk taking have shared genetic links, suggesting that risk taking is inherent to the condition and not secondary to it. Historically, risk taking in this population was explained in the literature as a tendency to diminish risk. But more recent data suggests that the mechanism is more an overestimation of reward. And so interventions must focus on the realism of expected rewards. Of course, risk simply means the outcome is uncertain. Not all risks are dangerous. Some are positive, like joining a new club. Some are prosocial, like standing up for someone who's being bullied. Risk taking, both positive and negative, likely occurs in the same individuals. And indeed, in her 2025 publication, Bram showed that the ADHD community are more likely to take positive and prosocial risks too. There's an oft-reported superpower associated with ADHD, which is clinically useful, but has lacked evidence to date. Well, this new data describing positive and prosocial risk taking sounds very much like the stuff of superheroes to me. The other great debate in ADHD is diagnosis and a topic that we discover in more depth in another episode of Inside the Teen Brain. A thorough diagnosis is key, particularly as it opens the door to drug treatments. A treatment, which, according to numerous reviews, addresses both core and psychosocial features effectively. Ford's national survey indicates population-- excuse me. 3, 2, 1. Ford's national survey indicates population rates of ADHD are steady despite the mainstream media narrative. But the wait for an assessment is growing for up to 40% of young people will wait over a year. Add to that, according to population data co-authored by our guest today, girls are identified on average four years later than boys. So here I stand at the intersection of the teenage brain and ADHD. I need some expert help. So let's move to our second big question and ask, so what? To help me answer this, I'm delighted to welcome Professor Susan Young, clinical, forensic, and neuropsychologist specialising in ADHD. She's held senior positions at Imperial College and King's College London, and has developed several clinical tools, including the ADHD Child Evaluation and the Diagnostic Autism Spectrum Interview. Her work focuses on understanding how neurodevelopmental differences shape behaviour, particularly in high-risk contexts. So she's an ideal candidate for our conversation today. Welcome, Susie. Hi, Jane. Thank you for inviting me. I'm very happy to be here. It's brilliant to have you. So we've got a lot of items on our agenda. So let's start with one big question. And it's one that's in the mainstream media, as I said. But I want you to imagine this as an essay question. ADHD is overdiagnosed. Discuss. [LAUGHS] "Discuss." Right. Well, first of all, if you did go to the literature, you'd find a lot of the opinion that it's overdiagnosed. You'd find a lot in the newspapers as well. You wouldn't find a lot of evidence that it's overdiagnosed. And in fact, Sam Cortese and colleagues and other colleagues-- and I'm part of this paper as well-- have recently published a paper giving the evidence for why it's not overdiagnosed. I think that this whole question reflects visibility, not evidence. So it's about what we're seeing with all these people who are clambering to get and desperately trying to get ADHD assessments. And the service is not being able to meet that demand. And I think that's happened for several reasons. One is that there is increased awareness. Our understanding and knowledge about ADHD has advanced with the science and the research that's underpinning it. So we have much more better understanding about this. And people are able to recognise themselves more, and they're coming forward. Secondly, we've got our fabulous celebrities from all walks of life, people who are coming out and saying, I've got ADHD. It no longer seems to have the stigma that was associated with ADHD. I do have to say one thing about celebrities though. I do believe that's a double-edged sword because there are people who've made it one way or the other. They've got some kind of status that, often through hard work. And I think it might set up expectations in young people that, hey, I could be like that. It's not a very representative sample, is it? Yeah. [LAUGHS] Not everyone can be will.I.am. So it sets up expectations. And most of them might like to be. So there's a word of caution with that one. I think, though, another reason for overdiagnosis, actually, sadly, is poor quality of assessment that's being undertaken. It's not standardised. They're inconsistent. They're very different. People are using different methods. Some of the reports certainly that I see are really, really bad. The guidelines give you basic guidance about what the symptoms are. And NICE guidelines give a little bit of guidance on how to, but not nearly enough. So I will tell you that, actually, I have a book coming out-- two books coming out at the end of this year. Can you believe this, Jane? I couldn't believe it. There are no books on how to assess and diagnose ADHD in children or how to assess and diagnose ADHD in adults. I've written both of them with a psychiatrist, the wonderful Dr. Alexandra Lewis. And they're both coming out at the end of the year. And they'll be very comprehensive books that take everybody through every stage from the word "go" of preparing to do an assessment and sending out pre-assessment questionnaires right through to actually the post-diagnostic discussion and how to write the report, what should be in it. So we've developed that, and that's coming. And hopefully, people will find that helpful. And I've used the ACE, the ADHD Child Evaluation, and the ACE-Plus, the adult version, to illustrate it. And I think that's a really important point because as the help-seeking behaviour has increased, the resources, certainly in the NHS and those that are team-based, let's say, have not. And so there's inevitably a bigger gap between those seeking a diagnosis and those they are getting access to a high-quality assessment. I actually got a message through LinkedIn from somebody saying, Hello, Dr. Gilmour. Are you interested in this side hustle? It's easy money. You can earn so and so in a couple of hours to do ADHD and autism assessments. And I said a very, very firmly, firmly worded letter back. You cannot describe a four reasons of scientific integrity this activity as a side hustle. But secondly, the idea that a family might be coming forward to have an assessment, which could have huge repercussions, in terms of how the family addresses something, how the young person thinks about themselves. So it's really important. I think we should be linking your future, these publications, and sending them to a few choice centres because I think the private sector-- and there's very, very many excellent private sector services. But the private sector is also filling a gap in concerning way. So I'm not saying overdiagnosis or misdiagnosis doesn't happen. I think that it does, and I think that is a problem. But we have to balance the-- a true, genuine one is what I'm talking about. We have to balance these things about the poor quality of the assessment and the greater recognition. We have to balance everything together and think about, when we say overdiagnosis, really, how much-- I'm not saying it never happens. In some cases, there aren't some people who are overdiagnosing maybe. But that may not be a general thing that's happening throughout the country. It's just perhaps in one or two specific cases. Actually, I think the greater issue is under-recognition. Let's think developmentally now. So I touched on this in our introduction, the idea of ADHD being characterised by attributes that are also associated with the teenage brain. So what would we expect to see in the developmental trajectory of ADHD across adolescence and into young adulthood? I think ADHD is often missed and misdiagnosed because people say, no, they're just teenagers. They'll grow out of it. You've got the same things that are common in adolescence are novelty seeking, risk taking still, identity finding, reactivity. That's all very common in adolescence. But in young people with ADHD, this is stronger. It's more intense. It's more impairing, and it's more enduring. So it's more, more, more. It's plus. And it's more difficult as well for them to cope with and to manage. So we do know, of course, that symptoms change-- in particular, the hyperactivity symptom, the overactivity, the motoric overactivity. You're not going to see an adolescent in your consulting room rolling around on the floor, sticking their fingers in plug sockets. You're not going to see them do that. They are able, perhaps, to control and manage their feelings. They still have a sense of inner restlessness, but they are able to control it more. You may notice, though, that they're more fidgety because they're getting a bit fidgety after a while. But they can control it. And that's the key. So I think that the hyperactivity changes. The inattention seems not to change very much-- so the inattention symptoms. And the impulsivity seems to change less. But it's mainly the hyperactivity that seems to change. But it's not gone away. It's just more internalised. And of course, the structures change as a young person grows up. As they become teenagers, the structures around them at school-- there's more routine, there are teaching assistants, perhaps, in the class. The structures change around them and provide that support. And the young people with ADHD, if it's recognised, they will get that support. But if it's not recognised, and it's just all put down to this is a teenage thing that will all pass. Then they're going to miss out on a key academic time when they need to be choosing, thinking about their careers, choosing exams, making decisions in their approach to studying. So in a way, adolescence is a big masking thing for young people with ADHD because it's masking the actual ADHD, and it's under the radar. Does that make sense? Yes, it absolutely does. And I think it's a really important point to point out that the structure around that young person changes as well as their internal actions, if you like, and vulnerabilities because, of course, as you say, the transition between, let's say, school and college or university means that there is no structure, often, in a way that some young people have never experienced before. Even if there's not ADHD in the picture, you're asking a young person to be able to move into that different space and still address the cognitive challenges, the organisational challenges, the social challenges. So it's a huge demand. It's really, really important point. The demands increase, and they ramp up as they get older. They're having to do more and more on their own with less input. And they're expected to work more on their own. And it becomes very difficult. And that's when, I think, mid to late adolescence is when ADHD often becomes much more noticeable because they're less able to cope. Yeah. I'm going to come onto late onset or late diagnosis in a moment because I think that's a really interesting question. But I just wanted to, before moving onto that, think a little bit about the characteristically, at least, the ADHD teenage brain enjoys novelty, engages well with emotional learning, and less with a didactic approach. We also know that a lot of the psychological approaches, including cognitive behavioural framework, are effective for this particular group. But CBT has got a reputation, I think, for being a little bit dry. And I'm thinking about how to leverage the aspects of a therapeutic experience that might appeal to an ADHD young person. So how can we engage young people with evidence-based CBT techniques, I guess? That's what I'm asking. Well, CBT is dry because we make it dry. I mean, the thing is you have to adapt to the individual. I mean, it's really, really important. I love working with young people with ADHD and adults with ADHD. I love it because, actually, I find them challenging. They can be quite challenging. But also, with ADHD, they're rapid, and they're fast. You've got to keep up with them at times. You've got to be able to switch. You can't prepare. I have a nice, neatly written agenda and say, today, this is what we're going to do. They're oh, yeah, boring. They just switch off. And you've got to be able to keep up with them, and you've got to be able to think on your feet with them all the time to think about strategies, things that work. You've got to find out what they like doing, what they want to do. You've got to make the whole treatment meaningful for them. Less lecture, no didactic stuff. Use visual materials. One of the first things I do is I ask them to get a notebook. And I ask them to get a notebook. And as we go through strategies and we tried things, I ask them to write things down in their notebook. That notebook becomes their resource for later on, perhaps, when I'm not there or what have you. But it's not only that. It gives them something to do while you're in the treatment. So they write it down. And I always, always check what they've written down. I concept check that they've written down the right thing, they haven't missed something and written something down incorrectly. But it needs to be active. It needs to be engaging. I try to not just sit there the whole time. We might stand and do something, or I try to introduce something some kind of movement into it. It's so important that you have goals that are relevant to them, their goals. They might not be their parents' goals. Yes, right. It's got to be their goals. And they have to be immediate goals. So you're aiming towards that. Interesting. Sometimes I've found, often-- well, quite often that when I've got a teenager, I need to find out who wants them to be there. Absolutely right. So who's having forced this? Because so often, I've been faced with a 15-year-old or a 17-year-old. They don't want to be with me at 4 o'clock or 5 o'clock after school. They don't want to be with me. And they don't want to be there. And it's because they've been told their parents are the driving force. They want them to be there. They want them to learn and acquire skills and techniques. They really don't want to do that. Now, I know I have techniques that can help them. I know I can help them with strategies. But they've got to meet me halfway. They've got to have some kind of ownership, some onus in it as well. Otherwise, everyone's wasting their time and perhaps their money or someone else's money, because I don't think you can achieve something. That's not to say that you write it off first time. I think, what's a teenager's view of a therapist? Maybe someone who's older that comes along, and they have an idea of that. I can say, look, I haven't got horn-- with the little ones, there's no horns in here. I haven't got-- and it's about your approach. And I think you can see my approach, and this is what I'm like with them. But you've got an energy, Susie. And I think that-- which you can't manualize that. But I think that is very important. But you're talking about making it meaningful. And I think that's so important. And I do think quite a lot of us as clinicians forget about finding meaning in it for the young person and making it active. More than once, I've done some-- for example, I did a game of Fortnite with one young person. We do a little bit of Fortnite, and then we do a little bit of more challenging discussion. And we did that in order for that young person to stay in the room because it was just such a challenge. So I love that creativity. And I love the idea that the young person takes notes because that allows them to have ownership. They're writing their own manual. And I appreciate you're checking it conceptually, as well to make sure it's correct. But their phraseology might be slightly different. They may engage with it in a different way. And they've almost written themselves a post-discharge letter there with that content. So that's really important. I think that's great. But I love the idea of saying, what's in it for you? Why are you here? Because we have got to find that because it's tough work sometimes, doing CBT. It is difficult. You're getting at the very thing that is hard for that young person, as you say. And doing an hour of therapy, it means you're an hour not doing something else that potentially could be free time. So we've got to make ourselves as attractive activity as well as a useful one. I want to come onto diagnosis and late diagnosis here. So there's a debate, particularly relating to autism. But I wonder where this sits in the ADHD population-- the idea that a later diagnosis might indicate a different condition altogether. And we touched on this earlier. So what's your view on that in the context of ADHD? Well, I think that it's more about what's been missed earlier than it being a different condition. If you have ADHD, it's very likely you've had it for a very long time, and it's been missed for some reason earlier because it's been masked, it's been camouflaged because it hasn't really come about until things got really difficult at to school with all the challenges. So I think masking and camouflaging is interesting because that occurs a lot in autism. And I don't think we talk about that enough in ADHD, actually, not nearly enough. Any parent is masking and camouflaging all the time. A parent with ADHD, they're having to manage that. And I find they sometimes give their children some of their techniques that have worked for them. But I think people camouflage because of the things they do themselves, but it's also camouflage by things that other people do. So with themselves, it could be compensatory strategies that they've found, which, by the way, can be dysfunctional as well as functional. It's whatever they found to get their essays done on time. So for example, sometimes that could be that they leave it to the very, very, very last minute because that anxiety then gives them a driver to speed it through. But because they're so poor at time estimation, then it becomes too much and overwhelm kicks in. So the key to that, I think, is I get them to-- I say, OK, if that works for you, do that and leave that to the last minute. But don't make it the last minute. Make it a fake last minute before that. And then you give yourself the driver. And so you have a contingency plan. But it's also things that other people do-- so what the school are doing with the teaching assistants, with the extra time in exams, and computer use, and those kind of accommodations thing. So they're all masking, in a way, how bad the symptoms are because it's helping them. And it's masked at home by parents doing things for their kids, like doing a lot of help, sitting with them when it's homework time and sitting with them and making sure that they're getting it done. So I think the masking is causing a delay to this diagnosis for many young people. Late diagnosis means that if somebody presents a little bit later, that just means that they need even more careful, comprehensive assessment. That's down to the assessor, then, to really look and think, is this really something that's happened now? And it can be hard, especially with anxiety over exams and stuff like that, the differential diagnosis. But you have to go back and look and see what happened when they were much younger, and look for masking and compensatory factors. So it's really coming back to your important point about the context of that young person. So what's shifted in the context that the mask has dropped, if you like? Or what demand has moved into the environment, which means that the previous coping strategies break? So I think that's a really important point in terms of the subtlety and nuance in an important assessment. It's another reason to read the book, Susie. There we go. [LAUGHS] Right. Let's turn to think about risk taking-- so positive and negative risk taking. Now, in my clinical experience, teenagers experiment with a medication regime. So let's imagine they've got a diagnosis, and it's a valid one. They've been offered medication, but on the stroke of puberty, they're exploring their identity. So they may try out not taking their medication-- so experimenting with the role, if you like, of being neurotypical. Are there data to support that sort of pattern? I don't think there's data to support why they do it. But we do know that by the age of 21, most young people have stopped taking medication completely, I think. In adolescence, you're exploring your identity and who you are anyway. And I think they want to know, well, I've been taking this medication for x number of years. What's it like? They can't remember what it's like being off it. Or perhaps those who haven't been on it for very long, they are quite keen to come off it because you sometimes hear young people say, it affects who I am. I'm not really the same person. I'm not zany. I like being the class clown. I like to make people laugh. And people used to want me around. I used to get invited to parties, and I'm not anymore. So they miss that social networking that's associated with that. So I think they want to find out what it's like, who they are when they're not taking medication. And they want to know what it feels like, also, to live a "normal," quote/unquote, life. So I think that's what's behind it rather than just deciding to stop. The data is by age 21. I think it was most people. And then by age 25, they're pretty much all not taking their medication. And I think, hmm, I think when parents are involved and they're living at home, and parents are involved in supporting the medication and making sure they've got it, then things tick along. But then, as young people get older, they're more autonomous. They're taking more responsibility for themselves. Perhaps they leave home to go to college or to university, and then they've got responsibility for all that. And it's not their priority. They're more involved in other-- want to get involved in the social aspects and getting used to-- and often feeling actually overwhelmed by everything that means by living alone and being away from the scaffolding that they're used to. And I know a lot of young people who, for example, may forget to take their medication because they don't have mum/dad handing them their medication on in the morning. Or they may lose the kind of link to getting a prescription renewed. So that can be quite difficult, particularly if you're moving to a new city or a new country, even. And you have to find a GP and all those things. And the organisation around that is just too much. And so it falls out of the system. So it's interesting, that post-21 data. It's very striking. I'm just thinking about risk taking in terms of some dangerous risks-- for example, drink or drugs or even sexual behaviours that are risky. And these sorts of behaviours might put young people at greater risk of traumatic events. So I'm not suggesting that traumatic events are caused by impulsivity, but perhaps there's a factor there. We know that PTSD can often occur with conduct disorder. Can you talk a little bit about the potential links in ADHD? Yes. It's interesting because the data shows that if you have ADHD, you're three times more likely to develop PTSD. And if you have PTSD, you're twice more likely to have ADHD. So it's bidirectional. It's not causal. Nobody knows, but we just know that there is this basic relationship between the two. If you have PTSD, then we know it's diagnosable. There's a treatment protocol associated with it. So things will unfold in the course of that. I think the really interesting thing is what happens-- as you implied, Jane-- is what happens to those young people who feel they have trauma, but it's not diagnosable PTSD because they're the young people who are falling through the net. I mean, it's quite a contentious topic at the moment because I think we're all seeing young people with ADHD who think, well, I've got ADHD, so maybe I've been traumatised, or young people who think, I've had some trauma in my life. Does this mean I have ADHD? And that's taking it too far. We really need to get a handle on that. So actually, I have a consensus statement on this topic that I'm setting up to meet with experts in the field next week to try and get some guidance for health practitioners about what to do with this. But the focus, I think, is what to do because young people who feel traumatised-- and it's a subjective trauma. Trauma is subjective-- may not have a trigger that you expect with PTSD, but they may have been bullied at school multiple times. They may have had some bad experience, adverse experiences-- as you said, psychosexual or violence, being brought up in unstable homes. But actually, let me give you one example. It can actually be-- because it's so subjective, it doesn't need to be what we might typically expect. So I had a patient who was really very suicidal, very depressed, and had been for some time. And it all stemmed from when she was-- she was clear about this. It stemmed from when she was eight years old. The whole class were invited to a party. And she thinks that's the only reason she was invited, because the whole class were invited. And her mum was so thrilled that she was going to a school party and she'd been invited because she really didn't seem to fit and get on with other young people in her class at all. And her mum went out and bought her a pink, pretty frilly dress and said, you've got a party dress. You're going to be the princess of the party. And she didn't want to wear this because she knew everyone in school, they were all going in the latest trainers and tracksuits, and they were all in this sporty gear. And she really didn't want to wear it. But her mum insisted and said, no, you're going to be the princess. And that was it. After, she was bullied so much and teased. She was humiliated. She felt so embarrassed. And this was the pink dress. This, for her, was her trauma, and it had affected everything that she almost expected from her life beyond that. And this young woman-- she was 32 when I saw her. She was really very suicidal because the transaction of what she expected and her interaction with the world was so strongly formed from that experience and the sense of shame and humiliation. I actually felt quite sorry for the mum because she did her best. She wanted her daughter-- but she just wasn't up on it. She wanted the best for her daughter, but she did the wrong thing. And so trauma-- the person needs to be heard. They need to feel that their experience is validated. You can't dismiss it and say, that was about a pink dress at a party when she was eight. Yeah. So it's a difficult thing to manage, I think. In some ways, it's exactly the challenge that ADHD has got. In other words, saying, oh, it's my ADHD, in a throwaway line that the general public may use maybe in an informed way, but often in a way that might negate somebody who has got ADHD through the appropriate mechanism and assessment, in the same way that trauma might be. Oh, that's traumatising. And actually, as you say, it doesn't matter whether it's a pink dress or something that, perhaps objectively, some other people would say, well, that's a more serious event. The point is that that young person experienced that in a really deep way. And the implications are significant. So I think ADHD and trauma, as you say, really needs to have some framework around it. So I think that's wonderful. It's a very good news to hear. I was just going to say quickly, if you have ADHD, then your response to that might be much more severe because there's no filter between think and do, and think and say. And so because of the impulsivity, because of the mood and the emotional dysregulation, there might be-- and this is the risk with this young woman was that you might be much more likely to act on suicidal ideations or thoughts of despair and hopelessness. Yeah, the vulnerability of the core features, if you like, may mean that the trauma is experienced in a potentially-- could be potentially more harmful way. I want to talk about-- because you are such a polymath, Susie. You have a forensic background as well. And I want to talk a little bit about young people who perhaps are on the fringes of the criminal justice system. And we know that a lot of young people who are in the criminal justice system probably have undiagnosed, and certainly some have a diagnosed neurodevelopmental condition. So when we're thinking about ADHD, the impulsive decisions that they may make increases the chances of committing a crime. Is there a way in which the ADHD model of care could inform policymakers or workers in a clinical context so that if we're working with young people who are on the fringes of the criminal justice system, they are prevented from joining that system, and perhaps we change our trajectory? Has ADHD got something to give us in terms of policymaking and care? Yeah. That's the golden question, isn't it? I think, by the time they're even on the fringe of this in the criminal justice system, it's almost too late. But certainly, by the time they're in it, it's probably too late, pretty much. I was part of a group a long time ago called The Better Futures Group, where we were pushing policy, and we had some input into the Children's Act some time ago. What we decided-- we were thinking, it's not just knowing we need to intervene earlier on, but it's with what? What do we do? And it was concluded-- it was a whole group of us that-- Peter Hill was part of the group. There were a lot of quite well-known names in that, and with a lot of experience. And we thought, the second fixed-term exclusion from school should trigger something to be looked at on more deeply. And then we were thinking, well, what? Well, even the strengths and difficulties questionnaire-- it's free-- maybe that could be done and scored. And then, depending on the scores, that would go to a health practitioner and if anything was showing that needs to be looked at. And why the second exclusion-- that was because we felt that with the first exclusion, most children will learn something from that, and they'll take steps to improve the behaviour or take steps to help and to gain, and there'll be better support around them as well from that. It will trigger some kind of action. But if they have two, then we thought the second one, that should trigger something that is done, and to look at that more closely than from that point onwards and perhaps try to prevent young people leaving from school earlier on without qualifications just so that it's recognised so that they have better opportunities that are given to them from a young age. And I like the idea of thinking about falling out of an institution and certainly, and particularly for talking about primary school-age children who are at risk of exclusion, there's a likelihood that there's something else going on developmentally. Even in secondary school, if exclusion happens, then falling out of that institution means they're disenfranchised from a variety of other social networks, and they're likely to be NEET, no education, no training, and so on. So that's very interesting idea of hoping. And how did that policy become implemented? Do you know what the outcome was? It's in the Children and Families bill, that second fixed-term exclusion. But it never went any further than that. And that's the sad thing about it. I see this cycle. I'm getting older now. I've been doing it for a long time. And you see this cycle go round, and round, and round again. And you think, when's it going to stop cycling, and people are actually going to stop talking about what to do, and they're going to actually do something? And I have to admit, I get a bit irritated about this. I mean, we know the data, and they know the data. They know that 26% of people in prison have got ADHD. They know that 30% in youth offending institutions have got ADHD. They know that 30% to 40% of young people in pupil referral units have got ADHD. The data is there. And my only conclusion is that there's not enough care about individuals who are anti-social. It's not the support that they feel is required. And we're preaching to the converted. This is truly an echo chamber. But we can't afford not to treat these young people because the social costs and the societal costs are enormous. So not only is it a lack of social care, it's a foolish judgement in terms of the outcome because those young people will inevitably become disenfranchised and may have contact with an expensive criminal justice system, with an expensive social service system and so on. And so for a variety of reasons, it's nonsensical, I think. I totally agree. There's data to support that, Jane. There's a Swedish study on-- a registry study that showed that they looked at hard data comparing people with ADHD compared to the offending records. And when the people have got a diagnosis and when they've been on medical treatment, the crime rate drops by 30%. The thing is the argument then has to be, well, OK, if you don't care about the people in the prison, what about ADHD? So there's all these cost savings that could be made because they're recidivist offenders once they're in that system. So some people get out, thank goodness. But for many, sadly, it carries on. So what do you care about? OK, breast cancer or the diabetes. OK. Well, with what you save with this, you could invest more money into what you do care about. So there we are, Susie. You need to be prime minister. There we are. You get on to that. Before I turn to my last question, I want to talk a little bit more about risk taking. So risks are often learning experience. So can you tell me, what's your favourite mistake? And what did you learn from it? Something that perhaps didn't go to plan. And perhaps, at the time, you thought, oh, this is not how I thought it would turn out. But in retrospect, you learned something. You turned a different corner. You went into a different area of work. Well, OK, it's a personal one. I have a daughter with ADHD. And when she was little, she was struggling. In fact, she's quite textbook female with ADHD throughout her life. But she was having difficulties. She wanted to fit in, and she was having difficulties with her peer relationships. And there was lots of peer pressure to do stuff. And she'd come home sometimes and be quite upset. And she'd sing because that was her thing that would make her feel better. But she'd be very distressed because things weren't working out at school. And a colleague of mine was round. And he said to her, oh, how school is. And it all came out about this person said this, and they said that. It all gets very spiteful. And he said, no, you've got to learn to say no. You've got to learn to be assertive. And so she said, OK. And said, now, what you do is you just got to say no. And what you have to do is you have to say no, and you have to say why you're saying no. All right? So she said, oh, OK. He said, well, let's practise this. So he did a little practise with her. And he taught her to say, no, I'm not going to do this because I don't want to do it. And he practised and practised. And she went off and did that. And I'm not doing it. I don't want to do it. And he said, do you think you could try that next time? And she said, yeah, I think I can. So I was really quite happy about that. And I still don't think it was a mistake teaching her that. But the only thing is, the next time, the couple of evenings later, she was sitting, watching TV. And I was saying, it's bedtime. Come on. Off you go to bed. And she stood up, and she said, no, I'm not going to do it because I don't want to do it. [LAUGHS] And so every time I was telling her something, she'd turn it back on me. So I guess it's a favourite. I don't think it was a mistake teaching her that, but it did turn the tables on me a bit. There we are. As always, often the way with young people, hoisted by our own petard. How brilliant though. I love the sound of your daughter's style. What a smart cookie. She was generalising and using a tip. You can't argue with that. OK, let's turn and answer our final question, now what? So here, I want a single practical tip that our listeners could embed into their practise or their activity in academia that would improve our offer to young people. I've got really one thing to say, and that's bear in mind that the person has a problem. The person is not the problem. And an intervention needs to fit the person. You can't try to squeeze the person into the intervention. It has to work for them. Just as you would do with medication-- I'm talking about psychological intervention. Just as you would do with medications, you titrate, you work it out. And it's all about the individual and what works for them. And that's what we have to try and do. And I don't think we do it enough. Oh, that's a pearl of wisdom. Well, wonderful. Thank you, Susie. Well, it just remains for me to thank you for your expertise. It was wonderful to have you join our Inside the Teen Brain today. Thank you so much. [MUSIC PLAYING]