ADHD and Me with Rory Bremner Horizon

Life isn't fair and I think politics has a duty to reflect that.

Rory Bremner is Britain's best-known political impressionist.

I wouldn't do that if I were you.

But there's a side to Rory that the public doesn't see.

For as long as I can remember, I've had a really active brain.

The trouble is... Sorry.

BLEEP! BLEEP!

-Back again, back again. Once more, let's go.

-BLEEP!

Come on.

For as long as I can remember, I've had a really active...

-BLEEP!

-Distracted all the time.

Constant distractions.

OK.

For as long as I can remember...

For as long as I can remember, I've had a really active brain,

but that's a good thing. The trouble is...

HE GROANS BLEEP!

Stop trying to get it right. Come on.

Come on!

-For as long as I can remember...

-BLEEP!

Rory has suspected for some time that he may have ADHD -

Attention Deficit Hyperactivity Disorder.

Because I get distracted, I think about too many things,

I get overwhelmed.

So, he's on a mission to find out more about ADHD.

What causes it?

Genes are not everything that there is -

there's also the environment.

And why does it exist at all?

People with ADHD would have been more the pathfinders.

BOY SCREAMS

ADHD can shatter lives and families...

..and push some into a world of crime.

After years of uncertainty,

Rory will find out whether or not he has the condition himself.

And he'll try a unique experiment for Horizon.

Wish me luck.

Ladies and gentlemen,

please put your hands together for Rory Bremner.

CHEERING AND APPLAUSE

Thank you.

Thank you very much indeed.

LIVELY TUNE ON CLARINET

For as long as I can remember, I've had a really active brain.

The problem is, when it gets too active,

it jumps around all over the place, gets distracted

by a million and one things, when I'm supposed to be concentrating.

I used to think that was just what it was like to be me,

but recently I've come to suspect

that it's what it's like to have ADHD.

So what does it feel like?

It's like having a brain like a pinball machine.

PINBALL MACHINE BELLS DING

See, a normal person might look that

and see a whole load of different breads, but I'm just drawn to the labels.

-They say "spelt loaf" and I think, why's it spelt like that?

-HE LAUGHS

It's like seeing a whole row of doors

and you want to go through each door

and each one leads to another door.

Knock knock. Who's there? Focaccia.

Focaccia who? Focaccia doing that again, you're in deep trouble.

In the meantime...

..another thought pops into your head.

This is a chorus line, isn't it?

-Just pulling your leg, sorry!

-HE GROANS

As a comedian, I kind of welcome that, because you want that freedom,

you want to be...

It's all the associations. It jumps, it's a leap of the imagination,

it's breaking the rules, if you like,

and breaking the rules is really good fun.

Until it's not.

ADHD is, of course, primarily a problem

for both Rory and his family.

ADHD can make you hate yourself.

I'm sure I'm very hard to live with...

..because I will drift off when I'm supposed to be...

..paying attention.

I'll forget things that I've been asked to do.

In the middle of a meeting,

I'll just go out and start swinging a golf club

or walking around the garden

when I'm supposed to be taking part in a...

..a meeting with a builder or a plumber or something because I'm just bored.

It's almost like there's a little devil inside you that goes,

"Ha-ha-ha, let's see how we can cock this up."

It's as an adult that Rory's come to suspect he has ADHD.

But typically, symptoms are strongest

and most visible in children.

Now can you see my face?

Jayden is five years old.

JAYDEN SCREAMS

He's an extreme case and was diagnosed with ADHD aged just three.

All day and every day, Jayden shows the core symptoms of ADHD.

Inattentiveness...

This is boring.

..impulsive behaviour...

Liar!

..and hyperactivity.

Not everyone with ADHD shows all these symptoms.

But Jayden does.

His mum, Emily, has tried all the parenting techniques...

-No.

-Let me go!

..including the naughty step.

All have failed.

So, she's had to take drastic measures.

So, we have to...

We have a door alarm on Jayden's door for his own safety

so that we know where he is at all times.

If we didn't have this, he gets up in the middle of the night or in the

early hours of the morning and will just do whatever he wants.

He has been known to leave the house.

ALARM BEEPS

So, that when he opens the door...

ALARM BEEPS

Straight away.

So that's quite fun.

So this is Jayden's bedroom.

We've lived here six months and he's already put a hole in the wall.

He did that about three weeks after we moved in.

He lost his temper.

He's scribbled all over the walls.

There's a hole in the floor.

We had to put a lock on the window the night that we moved in.

I woke up at three o'clock in the morning with this feeling,

came running in here to see what he was doing

and he'd tied his bedsheet

to the window arch and was trying to abseil down the side of the house

to get outside. He thinks that he can do anything.

He's invincible.

It's scary for us, really,

because he's constantly doing things like that,

the whole time.

This is my daughter Skylar's bedroom.

We had to put a combination lock on her bedroom door to stop Jayden

getting in.

It's like living in a prison.

It's normally much more tidy than this, but...

The damage on the wall. So whenever he can get in, if he gets a chance,

he will get in and break her things.

When he was about three or four, he would do things like urinate on her

clothes just to get back at her.

When he's angry, he doesn't care about other people.

And as his behaviour's become more extreme, she's become very quiet,

very reserved - depressed, I would say.

She's depressed. I think it's really hard for her.

At school, Jayden is also kept under lock and key.

You're not allowed outside.

Because they're mean!

Mean teachers.

He isn't allowed out to play because they feared that he'd run off.

He's physically sort of locked into that room.

He has to have two people escort him to the toilet at all times.

Like, he cannot be left alone.

The impact on the whole family is profound.

I never get a break.

Me and my husband never, ever spend time together.

If we do, it's for very short periods of time.

Parents of children with ADHD

are three times more likely to divorce or separate.

Yes!

I feel trapped all the time.

There are days when I will just sit at the end of the day and cry...

and then you can go to sleep and it's a fresh start the next day.

I think I just live with the fact that it can't get much worse.

HE LAUGHS

The number of people living with ADHD is surprisingly high.

An estimated 5% of children and 3% of adults in the UK.

Before Rory finds out if he has ADHD,

he wants to know why people with ADHD behave the way they do.

So, he's come to King's College in South London

to see if looking at their brains can provide any answers.

-Hi there.

-Hi, Rory, very nice to meet you.

-Good to see you.

Professor Katya Rubia has spent much of her working life

studying the ADHD brain.

So, what I'm really keen to find out is, is an ADHD brain different?

-Yeah.

-How is it different?

-Yeah, it is, in fact, very different,

both in the structure of the brain and the function of the brain.

So...you could say the hardware of the brain

and the software of the brain,

both is underdeveloped.

OK. So, what are we looking at here?

These are slices through the brain.

Are we looking at the top down, as if the camera's here?

Yes, this would be the top and then you go down.

So this is around the eye level and this is the lower part.

-Oh, I see.

-They are horizontal cuts through the brain.

It's an MRI image.

-It's like brain carpaccio.

-This is based...

Yes, exactly.

What jumps out are the yellow areas.

What are we looking at there?

So the yellow areas are areas which are smaller in ADHD

compared to healthy controls.

And the areas we found are most consistently smaller

in structure are these frontal lobe regions,

which is in the frontal part of the brain, and the basal ganglia,

deep in the brain. The frontal lobe and the basal ganglia are connected.

OK, so what do those parts of the brain actually do?

These parts of the brain, they mediate many functions

which are very important for mature adult behaviour.

For example, the ability to self-restrain yourself,

to inhibit yourself.

And ADHD patients, they have problems with self-control.

-Impulsive.

-Impulsive, yeah, exactly.

They're impulsive. They also mediate attention,

they also have problems with timing behaviour.

For example, you know, if you are impulsive,

you do things prematurely, too early in time,

and you don't consider the consequences of your act

so you act on the spur of the moment and later you think.

It's like having a filter, really,

something that will stop you from doing something inappropriate

-or saying something out of turn or interrupting.

-Yes, exactly.

The degree of inattention and impulsivity

will vary from person to person.

Just as the changes in brain structure will vary, too.

So, I have an example of a test

which we use to measure self-control in ADHD.

And this task, the performance on this test

is typically impaired in children with ADHD.

So, it's called the stop task.

-Do you want to try it?

-Yeah, sure, absolutely.

OK, right.

If the arrow points left or right,

Rory must press the corresponding button.

But if the arrow points up,

he must hold back and resist the urge to press.

You see, I've cracked this.

Oh, no, I thought I'd just got that. Ugh!

It's a test of self-restraint.

Not something Rory finds easy.

-OK.

-Getting better.

I have to say, Katya, you have the perfect voice for this

in the background saying, "No, you're not concentrating.

"Please try a little bit harder."

-IN STRONG ACCENT:

-"That is ze point of ze exercise!"

-Exactly.

"We are testing."

I'm so sorry, that was really very...

It was incredibly rude of me.

I know! Do people get upset with you?

Yes.

-SHE LAUGHS

-But not for long.

-OK.

-I'm not surprised.

See, it's impulsive behaviour.

OK, the task is now finished.

Despite Rory's efforts, it's not a test he can win.

He's simply having a go at the task Katya uses during imaging studies.

So, the task which you've just done,

this is the typical task we do in an MRI scanner with children with

ADHD and normal children,

and then we compare the activity in the brain.

So I can show you how it looks like.

This is the results.

What you see here is the activity in the brain of the healthy adolescent.

So they activate, again, the frontal part of the brain

and the basal ganglia.

So, these connections are important for stopping your behaviour.

These areas are less activated.

They are activated in the healthy adolescents,

but they're not activated in ADHD.

So, you see, this is empty.

-So, the part of the brain that would inhibit...

-Yeah.

..you from doing something wrong is simply missing.

It's simply missing. Well, it's less activated, is less recruited.

And that's why they are not good in the task.

-MIMICS DONALD TRUMP:

-That's a big assumption, by the way.

But I do find you very attractive, so that's OK.

That was me in character.

-You're such a good Trump. Isn't he?

-Yeah.

-You should do a Trump one on TV.

-AS TRUMP:

-There's a line we have to draw.

I do it all the time, by the way. So... OK.

So, I think what really struck me there

was I was expecting to see in an ADHD brain,

I was expecting to see all sorts of activity -

you know, all the fun and all the Catherine wheels and all that,

and being able to say that, "Do you know what, actually,

"we're so much more clever and we have so much more fun,"

uh, and instead, there was kind of like a silence,

saying, "Well, where is it? Where's all that stuff we need?

"Where are the networks?

"Where're all these things that typical people have?

"Where is it?"

These same questions about the fundamental origins of ADHD

have puzzled scientists for years.

So, Rory's come to Germany

because it was here that some of the earliest

efforts to understand ADHD were made.

The very first-known description of ADHD

appeared in a German textbook in 1775.

But shortly after, there came a more entertaining version.

In the 1840s,

a celebrated German physician called Heinrich Hoffmann wrote and

illustrated what became a very famous German children's book called

Shockheaded Peter, bursting with weird and wonderful characters

based on his patients.

Like Johnny Head-in-Air, Cruel Frederick, and this one,

Zappel-Philipp - Fidgety Philip.

I wonder if there's any merit in reading it like Alan Bennett?

It goes like this, "Let me see if Philip can be a little gentleman.

"Let me see if he is able to sit still for once at t'table.

"But Fidgety Phil, he won't sit still,

"he wriggles and giggles and then,

"I declare, swings backwards and forwards and tilts up his chair.

"Down upon the ground they fall,

"glasses, plates, knives, forks and all.

"How Mama did fret and frown when she saw them tumbling down

"and Papa made such a face. Philip is in sad disgrace."

Scientists have been chasing an explanation for what causes ADHD

for hundreds of years.

But with 21st-century technology, they are now catching up.

Rory has travelled to the Netherlands

to meet someone who is searching for the fundamental cause of ADHD -

by trying to identify the genes involved.

Good to meet you.

Nice to meet you.

To do that, Professor Barbara Franke has turned to an animal

that's rather easier to handle than humans.

My lab is trying to understand the pathways

that lead from genetics to ADHD

and we are using, among others, flies for that.

-Flies?!

-Yes.

-Seriously?

-Yeah.

Flies have ADHD?

Well, they can have aspects of ADHD, yes.

-Wow, this I must see.

-OK, I'm going to show you.

So, this is the fly lab,

so we have to put a lab coat on in here.

Ooh, I now become an expert.

Right, trust me, I'm a doctor.

So, here we are.

This is the lab where we do our experiments.

-Wow!

-These are the flies.

So... It looks like a spice rack.

-What have we got here?

-These are all Drosophila melanogaster.

-This is the fruit fly.

-So these are all flies?

-Yes.

-Are they alive flies?

They are all alive, yeah. If you have a look.

These are the little buggers you see in summer in your kitchen.

They have some food down here and they stay there...

-There's a very distinct smell in here.

-Yeah.

I was thinking it's not your perfume. What is it?

-It's yeast.

-It's yeast.

-That's what they feed on.

So, why flies?

Because they are excellent models for genetic studies.

So, the basic mechanisms of how the body works are very much overlapping

between flies and humans.

Do they...?

Do they have an attention deficit

or are you introducing it to them or are you taking a gene out?

What are you doing to make this analysis?

So, from the studies in humans,

we know several of the genes that contribute to ADHD.

What we're doing is to alter their expression in the fruit fly

so we can dial up the activity

or we can dial down the activity of this gene.

Is it a particular...always the same...?

Is it a particular genetic variation?

No, so there are probably several thousands of genes

that contribute to ADHD and we now know perhaps 20 to 30 of those.

OK. So then, knowing that,

you then manipulate that gene in a fly and analyse the behaviour?

Yep. Absolutely.

You're doing a really valuable job.

-RORY IN HIGH-PITCHED COMIC VOICE:

-Yeah, sure. Thanks very much.

Barbara and her colleagues are trying to identify

which of the known ADHD genes

is associated with precisely which aspect of ADHD behaviour.

Such as hyperactivity or inattention.

So, they take groups of flies, each with a single gene altered,

and see how that affects their behaviour.

So, this is an experiment

where we can measure distractibility in flies.

I'll just get my head around THAT concept!

So, flies can be... They have an attention span?

-Oh, yes.

-I know they've got a wingspan,

-but an attention span?

-Yes, they absolutely have.

Attention is a very basic behaviour and you need it to survive.

We're seeing if the gene that's been modified is actually responsible...

Yeah, causing...

So, what we see here is a maze in which flies have to decide

to go left or right.

We put the flies in here and then they are attracted by the light

over here, so light is a very strong stimulus attracting flies,

and they walk through the maze towards this attractor.

But because we have a monitor here with stripes moving to one side...

..some of them will get distracted, and the more they are distracted,

the more they will move to the side where the stripes go.

So, the impulse will always be to get toward the light.

Yeah.

As the flies move through the maze,

some exit more to the left

and some more to the right,

and a machine counts how many take each path.

-RORY IN COMIC VOICE:

-I like to look at the white light.

Oh, white light. Oh, green stripes.

Green stripes on the floor.

He does look very confused, this fly.

Green stripes are pretty, pretty. Follow the green stripes.

-RORY AS NORMAL:

-So, what's the difference?

How does a very distracted fly behave in this experiment?

A distracted fly would follow this stimulus that moves to the left more

than a non-distracted fly.

-Oh, because that's the direction that the stripe is going in?

-Yeah.

But I see the fly's point, in a sense,

it's like the floor beneath your feet is going off.

I find my eyesight is constantly just going...

-I'm always, yes...

-Yep.

-Distractible me.

Barbara has already found one strain of flies

who are significantly more distractible.

Which means she's successfully confirmed at least one gene

that can contribute to ADHD.

-I could stand around here watching all day, but I must fly.

-BARBARA LAUGHS

-That was extraordinary.

-OK.

So, we've identified, or think we've identified

some of the genes responsible.

Does that mean that I could be

or anyone could be genetically tested for ADHD?

I wish that was the case, but...

-Oh. no.

-..we cannot, we cannot, unfortunately.

So, as I said, we have hundreds of thousands of genes

that contribute and we know only a few of them yet.

But there's another layer of complexity.

Oh, dear. My brain's starting to hurt.

Well, somebody once said that genes are not dictators,

they are committees. So, genes are not everything that there is.

There's also the environment,

because the genes do not work in isolation,

they will be influenced by the environment.

So, we have environmental risk factors.

For example, birth complications...

..environmental toxins, maltreatment even,

that increase your risk for ADHD and particularly do so if you also have

genetic risk factors for ADHD.

This is called gene-environment interaction.

With so much science and yet so little certainty,

Rory's feeling confused.

I'm really struggling to understand all this,

because every time I think I get it,

it gets even more complicated.

Even the scientists admit that, and they're the experts.

But what do experts know?

So, I've learned there are differences in the structure and the

development of an ADHD brain,

but these can be different in different people.

Two people can have different abnormalities

and yet both still have ADHD.

And the same's true of symptoms.

These vary from person to person.

Some people are hyperactive,

others might be impulsive and some inattentive.

And then there are the genes.

There are hundreds, possibly thousands of genes involved in ADHD.

And different people can have totally different genes,

but still all have ADHD.

And on top of all that,

there's no specific test, which is really frustrating.

Rory needs some help.

So, he's back in London to meet up

with psychiatrist Professor Peter Hill

for a science lesson with a twist.

So, Peter, this is all very confusing, or is it just me?

No, it's not you at all - it is complex.

It's a complicated interaction

between a number of issues and areas.

People used to think there was one cause of ADHD and we now know that

actually it's nothing like as simple as that.

There isn't a single gene that causes it.

There isn't a single neural network that isn't functioning.

It is indeed an interplay of multiplicities of all those things.

OK, so how can we simplify it?

I wonder if I could use a metaphor and do a bit of cooking just to show

you what might be going on.

HE CHUCKLES

Are you going to take ALL your clothes off?

Well, why not? That's your cue for the Naked Chef.

I'll do the jokes!

I'll go into my Antony Worrall Thompson mode.

Do you want some help tying that up?

What I want to do first is make a gingerbread cake

according to a standard recipe.

OK, so this is still to do with ADHD, is it?

-All will be revealed.

-OK.

I will start with a load of sugar.

A very specific...

This is a health-related programme, of course!

-All extremely healthy.

-You don't get Ainsley Harriott saying, "Just a load of sugar."

-It's like, how much?

-This is a lot.

OK, a load of sugar, a lump of butter.

And an awful lot

-of black treacle.

-Why are we doing this?

We're going to make a gingerbread cake,

which represents an ordinary person

who does not have ADHD.

OK. So this is all the right ingredients in the right order.

Absolutely. Just as the recipe says.

Lots of flour. You can't make a cake without flour.

Those will go in as well.

This, I can cope with.

And some eggs into the mix.

Having followed the recipe strictly for the first cake,

for the next, they change things slightly.

This time, although we're going to use the same ingredients,

we're going to cook it for less long.

So cake number three?

We're still going to make a gingerbread cake

but on this occasion we're not putting in any bicarb

and we're not putting in any eggs.

So there are things missing from the ingredients.

-Right, cake number four.

-OK, cake number four.

We are still making a ginger cake

but we're not putting in eggs and we're not putting in any spices.

I think there's a series in this.

-It's like... Can't Cook, Can't Cook Either.

-No!

THEY CHUCKLE

Going to make a little sabayon here.

Once they're all mixed, they each go into the oven.

This is like The Holy Grail.

HE CLIP-CLOPS AND NEIGHS LIKE A HORSE

Time to stop cooking.

Right, so time to get these out.

-Beautiful smell.

-Smells good.

Gorgeous, isn't it?

Right. That's number one.

Yours smells miles better than mine.

That's because yours hasn't got the spice in.

-That is still runny.

-Yep.

Now, this is real cookery.

Burnt fingers, the smell of singed flesh,

in association with a delicate aroma.

Now, these are all gingerbread men.

Nobody would see them as anything but gingerbread men.

This is the original, typical gingerbread man.

Well risen, with all the ingredients well cooked.

This is a less successful gingerbread man in terms of cooking.

It has not yet achieved the right texture.

OK. Cashier number three, please.

This one has fewer ingredients.

It's lacking key ingredients - in this case, eggs.

So its texture is really not great.

It's not so good.

The same is true for this rather flatter and paler gingerbread man

which lacks certain other ingredients.

In fact, in this case it lacks the ginger, it lacks the bicarb,

and it's just not as interesting.

So looking at those, give or take a few characteristics,

they are recognisable

but there are any number of factors that could be different.

So what has that to do with ADHD?

Well, I would see these two over here,

the ones that lack different sets of ingredients -

they are different sets of ingredients

although they are still gingerbread men -

as illustrating the impact of the genetic influences.

The genes that are missing

or present in stopping things developing.

So different sets of genes here, different ingredients.

Different sets of genes here, different ingredients.

But this is different because of the cooking.

It is as if it has not had enough growth experience.

So, for example, babies who are born very, very early indeed

are at greater risk.

Not all, but they are at greater risk of getting ADHD.

-Oh, right.

-So this is environment and this is genetic difference.

These two are still perfectly edible.

They just function in a slightly different way from these because

they have different characteristics.

That's in the make-up, the way they were cooked,

-and in the ingredients or genes that they have.

-Yes.

There are so many ingredients

that might be missing or that might be added,

and there are so many ways of cooking,

that this illustrates a little bit

of the complexity about gene and environment interactions

and contributions.

Genes and environment always interact.

So there we are, gingerbread men.

I think this is the only science programme

with both a helpline and a recipe sheet

available on the website.

Mary Berry, eat your heart out.

So just like the interplay of the ingredients and cooking

in gingerbread, genes and experience interact in each person,

creating slightly different versions of ADHD in each.

Now Rory has got to grips with the science of ADHD,

the big question is whether he has it himself.

So today, he's going for a diagnosis.

This is actually something I've wanted to do ever since I first suspected

I might have ADHD, but now it's coming to a diagnosis, I feel strangely

nervous and apprehensive.

My brain is running all over the place and I don't kind of really know

what's going to happen.

'Second floor.'

He's going to meet psychiatrist and ADHD specialist

Professor Phil Asherson.

-Phil.

-Oh, hi.

-Lovely to see you, Rory.

-Thank you for doing this.

Thank you so much for coming in today.

Not at all. I don't know what to expect.

Well, we're going to spend the day

doing a full diagnostic assessment of ADHD.

-OK.

-So it's quite a detailed assessment.

I'm just going to start by giving you these rating scales.

It will take you about 15 minutes.

I'll come back and we'll talk about it then.

It might take me a bit longer.

I think my mind is wandering already.

Let's see how we go.

-OK.

-Thank you. I'll see you shortly.

I'm never going to concentrate through all this!

So, this is a two-way mirror, so we can see Rory, but he can't see us.

"Excessive or inappropriate use of internet, video games or TV."

We know there are various deficits,

various things we can look at in the brain,

we can measure in the blood, linked to ADHD,

but they are still not at the point where we can use them as a clinical test.

In the absence of a biological test,

they have to take a more low-tech approach.

When making the diagnosis of ADHD,

we often use the ratings scales in the first step,

partly to screen for ADHD and to see what symptoms he feels he has,

and to get some idea of the severity of these things,

but the next step would be to review those questions and the answers

in a very detailed way

and get a very clear description of the kind of symptoms

and to make sure that it really is a problem

with attention regulation and attention deficit

that is underpinning and causing the problems that he's reporting.

Once Rory has completed the rating scales, Phil begins the interview.

One of the interesting things I notice from the rating scales

you've filled in was first of all that you scored

yourself as having many more symptoms as a child,

and then, with your ratings for how you are now,

where it does seem to be having a big impact on you is in the way

you kind of feel and think about yourself.

Your ability to function.

So for you, it may be the impact is not so much in work,

but actually outside of the work setting.

-And balancing it, I think.

-I don't know what you think about that idea.

Does that make sense to you?

I do recognise that, because work does give me a focus

and work gives me a routine.

Work, when you are doing something against a deadline,

is less of a problem. It's when I haven't got an outside focus,

when I haven't got a routine, that it can go to pieces.

What about simple things like reading a book?

When you're reading a book, can you read a book right through,

or is that difficult?

I find it difficult to read a book unless I'm totally concentrating.

As often as not, I'll start to read a book and then I have to

reread it and read again, and then it won't make sense.

After several hours of discussion,

Rory is about to find out whether he has ADHD.

-AS BIG BROTHER NARRATOR:

-ADHD diagnosis, day eight.

So, I think on the basis of the information you've given me so far,

I think it's highly likely that you have ADHD.

When I looked at your rating scales, you scored yourself as having

all of the symptoms - nine out of nine inattentive,

nine out of nine hyperactive, impulsive symptoms as a child.

And also, you scored yourself as being very impaired in

a wide range of different situations.

To me, you seem to describe significant problems

with focusing, keeping on track, being disorganised,

sustaining your attention.

When you are not under pressure,

when you are not doing something that you really want to do,

-is very difficult for you.

-Mm-hm.

It's an answer at last -

a confirmation of what Rory always suspected.

But the next day, Rory is feeling less comfortable about the diagnosis.

To some extent, that diagnosis was

an admission of failure in many aspects of my life.

It turns out that being confronted with the reality of it,

and a list of things which in many senses are failings,

and the kind of exposure of many things

that show that you can't really handle

or manage lots of aspects of your life,

is more, um, more overwhelming than I thought.

But for people who do have ADHD, there are ways of dealing with it,

and that can begin with the environment you live in.

It seems that the very worst environment for ADHD might be

our very own 21st-century world.

Modern life has gotten repetitive,

too dull or too repetitive, redundant,

and as a result, mundane or boring.

Salif Mahamane is studying

how our physical environment affects our attention.

We do the same things, day in and day out.

Often we'll go from a small house to a small office and we do

the same things day in and day out,

stopping maybe at the grocery store and then going home.

And those are the things

that just don't really do it for people who have ADHD.

Salif believes the problem is that an urban,

indoors environment is lacking spontaneity or surprises.

Anything that's going to happen in indoor environments

is going to be caused by you.

You have to make that thing happen, as opposed to interesting things

happening around you.

And Salif should know -

he has ADHD himself.

It was kind of weird,

it was very ironic that I actually study attention

and turned out to have ADHD myself.

When I'm inside, I feel like a caged animal.

I just want to get outside.

When I come outside, I feel much more alive.

I think in modern life, that is focused on being indoors,

we become really out of touch

with the environment that we are adapted for.

Salif believes that by changing his environment,

he can transform his mental focus.

It feels a lot better to be outside.

There are so many different things going on that I can hear.

Birds chirping,

I can hear a small rustling.

The wind and the raindrops.

It feels a lot more...

..I wanted to say natural.

It feels more natural for me as a person.

This is where I thrive.

According to Salif, there is a reason for that.

All of human evolution took place in a natural environment.

So, our attentional mechanisms,

just like the rest of our brains and our bodies,

are adapted for that environment.

Therefore, it is not surprising

that it is good for everybody's ability to

focus attention to be outside, and especially for people with ADHD.

Outdoor environments have been shown to reduce ADHD symptoms in a number

of studies, but more than that,

Salif believes that people with ADHD

are actually more in tune with these surroundings.

Some scientists think that people with ADHD were more

explorative, and pursuing their thirst for novelty and curiosities,

would have pushed further to find

resources and things like that

during a hunting and gathering lifestyle.

So, we would have been more the pathfinders.

And it turns out that while that might be a very useful role to play,

it's potentially also a very dangerous one.

Rory is going to meet someone who believes that rather than being

just pathfinders during human evolution...

-Jonathan, hello.

-Nice to meet you.

-And you.

What a wonderful room, it really is.

..people with ADHD might also have acted like minesweepers.

I did wonder, why hadn't these genes died out?

It didn't really make sense.

I think we need to have people like this around.

Somebody with ADHD is typically best

at making mistakes,

doing dangerous things,

and then all of society around him learns

from the cost of those errors.

So, can you give us examples of that risk-taking?

One of the best examples I can think of are sharks.

It's a few thousand years ago.

Suppose there was a little village here

and a boy decides to go swimming in the ocean. It's terribly hot.

And a shark comes along and eats him.

OK.

Major disaster.

Now, that's not just a tragedy for him,

it's not just a tragedy for his family,

this is major for his village.

News will travel like wildfire.

All the parents in that village will be keeping their kids from swimming

in the sea and the information will spread to neighbouring villages

up and down the coast. So this one boy's tragic death has led to major

improvements in safety

for potentially hundreds of people living along

this part of the coast.

So, it has alerted us to the risk?

Absolutely. Suppose there is another village over here, which is full of

people who are all very, very similar to each other -

highly predictable people who like doing things together.

Now, what happens is one day,

they decide to all swim in the sea together,

but unfortunately, they all get eaten by sharks.

-Mm-hm.

-OK? The entire village has disappeared

off the face of the Earth.

Now, if the entire village disappears,

the information can't spread,

there's this terrible waste of human life caused by the fact

that they were too homogenous.

What they needed instead was to be like these villages, where people

act as individuals when they are doing risky things.

That means there have to be small proportions of people in any society

-doing risky things.

-Mm-hm.

So if you look at a map nowadays on the internet,

you can find a worldwide map

of all the shark attacks in the last ten years.

None of it is information that has been collected

in an organised, pre-planned way.

It has been found out by individuals the hard way?

That's right, and a disproportionate number of them would have had ADHD.

I think evolution has created a subset,

an important subpopulation of human beings,

that try out risky things for the benefit of everybody else.

It's almost like an image of, I don't know,

First World War trenches,

and they need to know where the German positions are.

So the sergeant says,

"Perkins, would you mind standing up and walking over there?"

Boom!

And it's not great for Perkins,

but I suppose the rest of the company will know

where the German positions are.

Absolutely, but the typical person with ADHD

is not going to wait to be told,

but would be deciding to run off and have a little look,

-because he's bored.

-He'll just do it himself!

-Absolutely.

-"I'm so bored, I'm just going to walk into enemy gunfire."

"OK, well, I'm terribly sorry, Perkins.

"Look, there he is. Well, let that be a lesson to you.

"That's ADHD, chaps.

"Now, let's play football."

While ADHD might have been good for societies in the past,

in our modern world, it's arguably much less useful,

which can be a problem.

The desire to take risks can lead

people with ADHD into trouble and even crime.

Amy Sweet is a talented hockey player

who had hopes of playing for her country.

I used to play for Avon County when I was 16

and trained with the West of England squad.

But severe ADHD put a stop to Amy's dreams

when she started acting unpredictably.

2013, I decided I would go and graffiti a shopping centre.

I just went down

and just was walking around really bored and decided

I was going to put my name on the metal posts.

This is where I done the graffiti.

I used a marker pen, it was just something I did in a moment.

Amy was arrested and taken to court, where she was issued with an ASBO,

or antisocial behaviour order.

It's not the first time Amy has been in trouble.

This is my folder of letters from the police.

This is about when I went to court for the antisocial behaviour order.

This is the community payback, when I had to do community service.

This letter is an acceptable behaviour contract -

me and a police officer agreed that I would not do certain behaviours

in a public place.

This one is to say that I had breached

the acceptable behaviour contract.

This one is from the police,

saying that I threw snowballs at a police community support officer.

This one is when I was charged when I bit my dad on the thumb,

when I was charged with common assault.

This one is for my criminal damage, when I smashed a window,

and arson, when I set fire to some bins.

And this one is the community order for one year.

Amy's misdemeanours are always of this same, impulsive type,

as her dad has noticed.

At the time, I don't think I do worry,

but now, maybe looking back, yeah.

You just used to live in the there and then, didn't you?

-Yeah.

-It was...

She'd do something - after, she'd be very sorry, always.

Never, like, "I don't care" -

she was always sorry after the event,

cos it would sink in, what she'd done.

The link between ADHD and offending is extremely complex.

Not everyone with ADHD is an offender,

but there is an association.

Whilst only 3% of adults have ADHD,

amongst prison inmates, that figure is closer to 30%.

And their offences do tend to be of a certain impulsive type,

such as shoplifting and speeding.

Sometimes I just wish, not I was normal,

but I wish I could make decisions before I do something.

But one thing has enabled Amy to get her behaviour under control.

I take this medication every morning, when I get up.

It helps me improve my concentration and stay focused.

It has made a big difference in my life.

I think sometimes, with the medication,

it's allowed me a lot more to think before I do something.

While Amy is not playing at the same level as before,

she's back on the pitch.

I can go and release my anger or stress, but also release all

my energy, and channel it into something good.

Medication has helped Amy get her life back on track.

But because everyone's biology is different,

it doesn't work for everyone.

One of the key problems faced by people with ADHD

is controlling their attention.

Multiple thoughts slide around in different directions,

all at the same time.

The challenge is to focus and keep thoughts along one single track.

So, Rory's gone back to Germany,

this time to the University of Tubingen,

where they're working on a promising new technique called neurofeedback.

-Friederike!

-Hi, good morning, nice to meet you.

Good to meet you. And you. So, what is it you do here?

The idea is to train the unruly ADHD brain

in the art of controlling attention.

Friederike Blume is one of the lead researchers on the project.

So, in really simple terms...

-Mm-hmm.

-..what are we doing here?

What does this do, in really simple terms?

In really simple terms,

you will be able to voluntarily control

-the activity of your brain.

-OK, right.

And that's your last patient?

No, that's not our last patient!

-So, I'm going to put this thing on?

-Yes.

Oh, right, so...

OK. This is like going to the hairdresser.

By measuring oxygen in the blood at the surface of Rory's brain,

the cap will detect which areas are most active...

You're not going to electrocute me, are you?

Oh, my God, silence - that means you are!

..and so, whether he's concentrating.

Feels like Cinderella.

It DOES fit!

To start the training, Rory enters a virtual world.

-Right, so... So, I'm now sitting in a classroom...

-Yes.

..in the second row of a classroom.

That's my... That's weird, because that's my desk.

Oh, god! I've got a pupil next to me!

Just extraordinary!

OK. Now, as soon as we start the training,

you will see an arrow on the blackboard either pointing upwards

or downwards. When it points upwards,

your job is to increase the lighting in the classroom.

And when the arrow's pointing downwards,

then you have to decrease lighting in the classroom.

So, how do I do that?

Many children and adults think about something nice,

or about something not so nice.

-And you're now allowed to explore and see what strategies work.

-Wow!

-OK?

-Right.

-Right, then, we start the training.

Thinking nice and not-nice thoughts

is just one example of how to control the light.

What's crucial is to learn

the feeling of purposefully switching on

and having control over his thoughts.

First, the arrow points up, so Rory conjures positive thoughts.

I'm thinking about the first tee at St Andrews on a beautiful day,

with the golf course in front of me,

and excited and with friends and looking forward to that -

holding that image in my head.

The cap detects which areas of Rory's brain are activated, and how much,

which in turn is related to how much he's concentrating.

This feeds back into the VR system to raise the lights in the classroom.

COMPUTER SPEAKS GERMAN AND RORY REPEATS

Ooh, that's exceptional!

An encouraging comment and smiley face provide extra feedback

when the lights are successfully raised.

So, what we'd probably tell a child

is not to move too much and sit calmly.

Next, Rory learns to control switching his thoughts,

deliberately changing focus from happy thoughts to sad.

So, now, the arrow points down.

Down one's lowering the light, so I'm thinking of a very cold,

miserable day, with the rain beating down, going down your neck,

or feeling sick.

Just the nasty, the dark and the bad thoughts.

COMPUTER SPEAKS GERMAN

OK, Rory, well done.

God, how weird that feels.

HE GROANS

It's a big, conscious effort of will, it really is.

-Yeah.

-Mm-hm.

-And I don't know, I mean, for other reasons...

Well, it's sort of like,

if you were to go to the gym for the first time in your life,

you're going to be really sore immediately following it,

and even the next day, and so on.

So, let's turn the lights back on.

Ooh!

So, next time I try to read a book,

should I be sort of physically summoning up that feeling,

that state of mind...

-Mm-hmm.

-..of happy, warm...?

-Yeah.

-What's that?!

-That's what we give the children.

-I see!

-So, you might just take that,

and as a reminder of what you thought

and how you felt like in the training situation,

when you tried to increase the lighting.

-Well, thank you.

-You're welcome.

-That was really, really fascinating.

-That was great.

-It was our pleasure.

For Rory, treatment is optional.

His ADHD is mild, and he's channelled it

into a successful comedy career.

But he wants to try one last experiment.

Would medication improve his performance, or kill it?

Over the last few weeks, Rory's perspective on his ADHD has altered.

Funnily enough, that formal diagnosis changed things,

because whereas it previously had been an elephant in the room

that I kind of quite enjoyed,

and I sort of would just occasionally point out to people,

I think the formal diagnosis woke up the elephant,

and for the last few weeks, I've been sharing

an increasingly smaller room with an increasingly larger elephant.

So, today marks a different stage,

where I'm going to see how this elephant responds to medication.

And that's a big step.

OK.

I think it's very, very important

that any stand-up comedian should have with them

in the dressing room at all times a consultant psychiatrist.

Isn't that right, Phil?

Oh, absolutely.

-So, what have we got here?

-Well, it's methylphenidate,

but it's got a name that's called Tranquilyn.

-Tranquilyn!

-But it's the same as what they used to call Ritalin.

Why...? I should just be darted!

Right, now, I've...

You know, I've... I've wondered what it would be like

-for a long, long time.

-Mmm.

-And this is scary.

I really don't know what it's going to do.

-Mmm.

-Whether it's going to speed me up,

-or slow me down.

-Mmm.

Erm... Oh, my God - my hands!

-OK, all right.

-We're not expecting it to...

How long have you been a drug dealer?

-We're not expecting it to speed you up.

-OK, here we go.

It's the kind of paradoxical effect -

it should slow you down,

just give you more control, you should feel more in control.

It's interesting that the first time I'm taking these

is half an hour before I go onstage.

But it should be a pretty good test of...

..of the effect they have. So, erm, let's see how it goes.

Wish me luck.

Phil thinks Rory needn't worry.

Many people use methylphenidate.

There were over one million prescriptions last year

in England alone.

Methylphenidate is the same as Ritalin - that was the original

drug that was used, it was called Ritalin.

Erm, it's quite hard to understand why it's got such a bad reputation.

I think it may be because anything around giving drugs to children,

in particular, is something

one naturally wants to be rather sort of cautious about.

I mean, it is also related to stimulants.

And so, things like cocaine, for example, or speed - and, of course,

they're also controlled drugs.

But surprisingly, you know, when you take this medication in the normal,

therapeutic way, you know, it's not addictive.

It's not known exactly how stimulants slow down the ADHD brain.

It seems paradoxical.

But it's thought they increase activity in those parts of the brain

that are less developed.

This medication sort of gives the brain a boost,

so that's kind of why they're stimulants,

and so they can actually sort of help you to focus.

Methylphenidate, of course, has some side effects,

all drugs have side effects.

Some people feel a little bit more nervous

or a little bit more restless.

And that would really indicate

it's not going to be the right sort of medication for you.

Ladies and gentlemen, welcome to Soho Theatre.

Please put your hands together for Rory Bremner!

CHEERING AND APPLAUSE

Thank you!

Thank you for... Thank you very much indeed.

Thank you, it's great to see so many of you here.

-AS DONALD TRUMP:

-We got a lot of people...

So many folks here tonight, folks. We got...

We must have 50,000 here tonight.

We got 50,000 people...

They say that there is only 150 - they're bad people.

They're such bad...

Got so many bad people, folks - judges, attorney-generals,

Republican senators - bad people, folks, bad...

'I feel quite clear-headed.'

It's a bit like somebody's switched my brain

from techno and Radio 1 to...Classic FM.

-AS JEREMY CLARKSON:

-We've got a Prime Minister called May,

a Chancellor called Hammond...

What could possibly go wrong?

The music in my brain is not

pounding and...rapid and...switching.

It's sort of calmer,

and more...more serene.

-AS BORIS JOHNSON:

-I... I stand before you now, the, er...

the unlikely lovechild of Angela Merkel and Donald Trump,

ladies and gentlemen. I, er...

'The question is whether I want'

that high excitement and panic,

or whether I want a kind of more controlled chaos.

And I think in a sense,

for a comedian, a controlled chaos is not a bad state.

-Thank you.

-APPLAUSE

'It's something that I need to experiment with.'

Over the last few weeks,

Rory has found out what causes ADHD and why it exists.

But also, that he definitely has it himself.

I think what's really struck me in the making of this film was,

I always knew that people with ADHD, that we were different.

But now, I realise it's not just because we behave differently,

it's because our brains ARE different.

I hadn't really thought of people with ADHD

as being essentially shark bait before.

But if you think about it, if we are the ones who take the risks,

if we're the ones who blaze a trail,

if we're the ones who go that much further, and in going further,

we show people where the boundaries are

and where the possibilities are, then that's great.

We'll have that.