The future of ADHD
Pediatrician Yair Bannett studies and treats ADHD in preschool-age children.
His interests stem from watching too many families struggle to understand their child’s behavior. He now focuses on improving frontline care using artificial intelligence to analyze electronic health records. One recent study explored whether doctors are making appropriate non-drug interventions before choosing to medicate children. Through his research, he hopes to raise the standard of ADHD care for thousands – and perhaps millions – of children. Early diagnosis and better care can prevent later problems, Bannett tells host Russ Altman on this episode of Stanford Engineering’s The Future of Everything podcast.
Transcript
[00:00:00] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host Russ Altman. I thought it would be good to revisit the original intent of this show. In 2017 when we started, we wanted to create a forum to dive into and discuss the motivations and the research that my colleagues do across the campus in science, technology, engineering, medicine, and other topics. Stanford University and all universities, for the most part, have a long history of doing important work that impacts the world. And it's a joy to share with you how this work is motivated by humans who are working hard to create a better future for everybody. In that spirit, I hope you will walk away from every episode with a deeper understanding of the work that's in progress here, and that you'll share it with your friends, family, neighbors, coworkers as well.
[00:00:47] Yair Bannett: ADHD really is a serious condition, and it can be, uh, debilitating and it can get a lot of strain on an individual who has it. And there are very significant studies over the years, that are large prospective studies, that showed that ADHD is associated with higher, uh, bad outcomes, including mortality. And so, they're more likely to get into car accidents. They're more likely to be injured in general. They're more likely to have, um, drug abuse, uh, alcohol abuse, uh, problems, mental health issues, incarceration, uh, holding a job, right? Employment issues, educational of course I didn't mention, problems in not completing school or education. So, it is a very serious condition and it's a lifelong condition.
[00:01:39] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host, Russ Altman. You know, if you're enjoying the show, if you like to listen to it, we really would love it if you would rate and review it. Rating and reviewing, we like to get a 5.0 if we deserve it. Reviews tell people why you like it or why you don't like it. It's really useful and it helps grow the show. It also helps us get feedback from you, so thanks very much for doing it. Rate and review. Today, Yair Bannett from Stanford University will tell us that attention-deficit hyperactivity disorder can be diagnosed in young children, and it's super important to do so, so you can implement treatments to help them avoid the lifetime risks that come with that disease. It's the future of ADHD. Today we are continuing our new feature, the Future In a Minute. At the end of my interview with Yair, I'll ask him a few rapid questions. He'll give a few rapid answers, and that'll be it. Before we get started, another reminder, we love it when you rate and review. It helps us, it helps the show. It feeds the algorithm. Thanks for doing it.
[00:02:40] ADHD or attention-deficit hyperactivity disorder is a disease that we've seen diagnosed much more in the last couple of decades. Developmental behavior pediatricians are the specialists who study this disease and who understand how to diagnose it, how to treat it, and why it's so important to treat. It's difficult to diagnose, especially in small children, but it is possible and recognizing the disease early allows physicians to start treatments, both medical treatments, drugs, as well as non-pharmacological treatments that can really improve the life and the future of the patient. Who suffers from ADHD? Well, Yair Bannett is a developmental behavioral pediatrician at Stanford University and an expert at ADHD. He saw it as a primary pediatrician in the clinics, and then he made it his research passion. He'll tell us about ADHD, its symptoms, its treatments, and what the future is like.
[00:03:44] Yair, why did you decide to study ADHD, especially in children, uh, who are pretty young?
[00:03:51] Yair Bannett: Well, thank you for having me, Russ. Uh, it's great to be on, on the podcast and I'd like to say that initially, I started being interested in ADHD as a primary care pediatrician. Uh, when I first trained as a resident, I didn't have a lot of exposure to developmental and behavioral problems. But then as a pediatrician, as a PCP in the community, I noticed that parents often came to me with these concerns for ADHD and other developmental uh, concerns. And so, um, I started learning more and more about developmental behavioral pediatrics, and I, uh, decided I wanna specialize, uh, and know how to support children who have these, uh, challenges.
[00:04:32] Russ Altman: Okay, great. So, I think we, what we should do to start is establish some of the baseline basic facts about the disease. So, first of all, we called it ADHD, but it is attention-deficit hyperactivity disorder. Tell me if I'm wrong. And could you give a, a little picture about like, what are the symptoms, what's known about the causes? Where are we with this disease right now?
[00:04:52] Yair Bannett: Absolutely. So, um, ADHD, uh, is a very common condition. And, uh, it, the, the prevalence varies. Uh, also I'll talk about the United States, but it even varies within the United States. Um, uh, and somewhere between 8 to 10% of children get diagnosed with ADHD, that is pretty high prevalence. And the symptoms we're talking about, uh, the core symptoms are hyperactivity and impulsivity, as well as inattention. Those are the core symptoms. And as anything in the DSM, the manual that defines this condition, there has to be a functional impairment. So, it's not enough to only have these symptoms, right? All of us sometimes, uh, are inattentive, uh, or have a lot of energy. But it has to be impairing. It has to prevent you as a child or as an adult from doing what you need to do. And another stipulation is that it has to occur in at least two settings. So, it can't just be at home that you're presenting with these symptoms. It has to be at least in two settings. And again, for children, typically the two settings would be home and school.
[00:05:57] Russ Altman: So that's really interesting. And, uh, in my lifetime, uh, my impression is that the, uh, the frequency of diagnosis has gone way up. And, and I'm sure we'll talk about that, but let me dive a little bit into those. You said hyperactivity, um, is, is one of the, and, and attention-deficit that's, it's in the title. Um, uh, where do we get our baselines from and, and, and how does a parent know if what they're seeing is, um, at a normal level? 'Cause you know, these can be kids and like kids are crazy. Um, but, um, and, and, and how, how can they figure out, and how does the clinician figure out if this level of activity is dysfunctional? Um, what are the, can you give a little bit more about the signs that they see? Maybe typical situations that a parent or a teacher might find themselves in?
[00:06:42] Yair Bannett: Yeah, and that's a great question. I would say, and it also ties to the, to your first question around why I chose to focus on young children, because I think that's where it becomes the hardest to distinguish, right? Because they're always bouncing around. Um, and so yes, I think that the answer, the short answer is it's very hard to distinguish. Um, and I think that's part of the controversy around ADHD that exists where people, some people will say, oh, it doesn't even exist. There's no sort of thing. It's just kids being kids. And I think as, you know, as experts in the field, we all agree that's not true.
[00:07:15] Um, and it's a spectrum like many other things. Um, and so for parents, for especially first-time parents, it is pretty much impossible to distinguish and know. And that's where they, they go to the pediatrician and say, hey, I, I'm not sure is this normal or not? Um, and, and that's exactly what happens often. That's what happened in my office as a PCP, where I said, okay, I want to get more training and understand how to distinguish, uh, when it is within the realm of normal, let's just watch and wait or, uh, gives minimal supports versus more.
[00:07:45] Um, and so, so again, there is the, it's a type of a condition that where the diagnosis relies on behavioral observations, on reporting, subjective reporting, from the parents, from teachers often. And all of these vary, right? So sometimes you might have, uh, one type of parent or one type of teacher that will report things and then another parent or another teacher will, will report very differently, right? So, you can imagine how inaccurate it might be. And so, we have to, again, as experts, we have to use our clinical judgment many times, use our own observations as well, uh, in the clinic to make a decision.
[00:08:21] Russ Altman: Now, um, what do we understand about the causes of the disease? You know, there's always nature versus nurture. There's a million other things of course. But do we think this is fundamentally an inborn, uh, an inborn feature of the, of the patient, of the child? Or is this something that is a response to environmental conditions? And I understand completely how this is a very sensitive issue is 'cause you don't want to tell a parent, you created an environment that created this, this disease, right? I mean, this is a very difficult, uh, I'm, I'm guessing assessment.
[00:08:51] Yair Bannett: That's right. That's right. So, we do know for sure over the past few decades, the, the data is gathering, you know, to clearly say there are, uh, inborn differences, uh, in children with ADHD. We know there are genetic components to it. We know that there are differences in the brain structure. Uh, of individuals with ADHD. And so, yes, the answer is, it is something that is inborn. At the same time, as with all of these conditions, um, including autism for example, which is another condition that we see frequently in our specialty, um, the answer is yes, the environment can also have an influence. Um, we don't know yet to what extent I would say.
[00:09:33] Um, but, uh, in ADHD specifically, you know, there's this whole question around, for example, screen time and how much of that's influencing. Uh, and so again, the, the answers are not there yet. But, uh, I would say for certainly we can, we always assure parents that, you know, it's nothing that you did wrong. Typically, unless it's a very extreme case, most likely it is the way the child is born and we can just try to adapt the household and maybe it, this household needs to be a little bit different. And so, the environment is not only a part of the problem potentially. It actually a lot of times is a part of the solution.
[00:10:08] Russ Altman: Great. So, a few more questions because this is really, really very helpful. Um, you made a very intriguing side comment that the, uh, prevalence may be different in different, not only in different parts of the world, but in different parts of the United States. Talk to me about what's known about that 'cause that sounds really interesting.
[00:10:24] Yair Bannett: Yeah, so the CDC, the Center for Disease Control, um, has a prevalence rate that it, uh, publishes and uh, the last time I looked, it looks like the West Coast, uh, specifically, and we are in California now, um, has lower prevalence compared to the East Coast. Those are kind of, I would say the two extremes in terms of the prevalence where it's the lowest, uh, around the West Coast and it's the highest, I would say, in the Northeast of the United States, um, and that has been true for a while. Um, and I don't know to say, again, I'm not an epidemiologist, uh, it's hard for me to say, you know, the reasons behind it.
[00:11:04] I'm not sure anyone does know. But, um, you know, there's this argument always about how much of it is true prevalence versus just, you know, higher, uh, detection in certain areas. There are cultural aspects to it as well. Uh, one of the things we know is that in Hispanic patients, the prevalence is lower, for example. Um, and one of the thoughts would be that, you know, in certain cultures, maybe there's just more tolerability for a wider, uh, you know, uh, presentation of, of behavior and development.
[00:11:37] Russ Altman: So, um, what about on the global scene? So, I know you, I think you mentioned that you practiced in Israel for, for many years as a primary care physician. Did you see a similar syndrome there? And what do you know about other cultures, uh, and other continents?
[00:11:50] Yair Bannett: Yeah, I would say that, uh, yes to your question about Israel, it is very similar prevalence to the United States. Um, and many other, I would say westernized countries, we find pretty similar prevalences. I think it becomes harder in other countries where maybe the monitoring also of these conditions is not as accurate or as robust, and it's just harder to know real prevalence. So again, it's really hard to tease out how much is just it, it's about the monitoring and being able to give a good number versus maybe, like we said earlier, differences in, in cultural perceptions.
[00:12:23] Russ Altman: Yes. Yes. Um, and then I also wanted to get a sense for the natural history. Um, you're, you're dealing with children and we're gonna talk about treatments, of course. That's, uh, I'm sure people are very interested in that. I am very interested in that. But before we get to treatments, if untreated, or if, if it's not a recognized, can you give us a sense for what, what is the natural history? What is the, the type of life and the type of challenges that a patient might have over time?
[00:12:48] Yair Bannett: So, so this is a great question. I think this is, again, one of the areas where there are large misconceptions about ADHD. So, I'm, I'm glad to have the opportunity to answer that. Uh, I would say first, one of the things we know is that ADHD is a lifelong condition. It was originally thought to be not too long ago, it was thought to just be a childhood disorder. Um, and what happens is children, uh, some age eventually stopped bouncing around. And so, you don't see adults, you know, uh, bouncing around typically, right? But many of these adults who had ADHD and were bouncing around, still have ADHD even though they're not bouncing around. Um, so that's one important thing to know. And the second part is that ADHD really is a serious condition and it can be quite, uh, debilitating and it can create a lot of strain on an individual who has it.
[00:13:36] And there are very significant studies over the years, that are large prospective studies, that showed that ADHD is associated with higher bad outcomes, including mortality. And so, they're more likely to get into car accidents. They're more likely to be injured in general. They're more likely to have, um, drug abuse, uh, alcohol abuse, uh, problems, mental health issues, incarceration, uh, holding a job, right? Employment issues of, uh, educational of course I didn't mention, problems in not completing school or education. So, it is a very serious condition and it's a lifelong condition. Um, and so that I would say the natural history before, and we, we'll talk about treatment like you said. But I'd say the natural history, um, can be quite grim. And again, it is a wide spectrum. So obviously there are many people who have ADHD and, and certainly thrive, but it can be quite debilitating.
[00:14:28] Russ Altman: And, and what is our ability? So now, now I'm very interested. What is our ability for adult physicians to recognize ADHD and make that diagnosis later in life? I'm imagining that it's more difficult. You're kind of attuned to it. There are parents who are worried, there may be teacher reports, you're a pediatrician. Um, and I know you might not see 18-year-olds or 30-year-olds, or 50-year-olds. So how good are we in our, uh, primary care, um, of, for adults in recognizing this disorder?
[00:14:57] Yair Bannett: Yeah. So, I, I would say it's hard to recognize, especially now adults these days, typically what we hear in clinic, 'cause they bring their children who have ADHD, right? So, as I mentioned, there's a genetic component. So, I do get to see them in the office as parents, um, not as the adult, um, pediatrician, but, um, or the adult physician. But, um, to answer your question, what we mostly see is, is adults saying, oh, you know, I think I had ADHD, you know, uh, but I've never been diagnosed. And one of the, um, one of the criteria actually in the DSM for diagnosing ADHD, is that the symptoms have to appear before age 12. So, the idea again, is that, uh, to, to talk about ADHD, we're talking about something that emerges in childhood. Because if it's something else that emerges only in adulthood, likely it's something else.
[00:15:45] Russ Altman: I see. Oh, that's an important distinction then. So, they'll have to be going back and thinking about what life was like before they were 12. So, as an adult, they would have to talk to their parents, people who remember them, and kind of, there would be a little bit of archeology going on there to figure out if in retrospect, that could have been what was happening.
[00:16:04] Yair Bannett: That's right. And, and there is, uh, also, um, better recognition of adults with ADHD today. I do know that from also just from reading the literature and, and speaking with people, certainly more adults now going back and saying, yes, I wasn't recognized when I was a kid, but it is clear that I had ADHD and I still do. And I learned that I can, you know, take medications that can help me function better at, uh, at, at work, for example.
[00:16:27] Russ Altman: Great. Okay, good. So now let's get into treatments because of course people, of, of course people always think about pills, but I know that you've, uh, looked into not, uh, both, um, medications, but also non, uh, medication treatments. So where are we with treatments?
[00:16:42] Yair Bannett: So, um, yeah, there are two types of treatment for ADHD. There, there are the medications that most people know about, and there are also non-pharmacological interventions that are mostly for younger children, uh, that, that most of the research is done on younger children for that. Um, and so when we speak with families, especially of young children, we talk about these two arms of treatment. Uh, and ultimately for most children, we want them to receive both. So that is the gold standard, is to eventually, hopefully you'll be getting both medication treatment and also behavioral interventions. Um, so that's, I would say an overview of kind of the types of treatment we can go dive deeper into it.
[00:17:26] Russ Altman: This is The Future of Everything with Russ Altman. We'll have more with Yair Bannett next. Welcome back to The Future of Everything with Russ Altman. I'm speaking with Yair Bannett from Stanford University. In the first segment, we got a great tutorial on ADHD, attention-deficit hyperactivity disorder. Its symptoms, a little bit about its causes, and we're about to start understanding what are the treatments. Do they work and why are they important? Don't forget, at the end of the conversation, we're gonna have the Future In a Minute while I'll ask Yair some quick questions and get his off the cuff answers.
[00:18:16] Yair, you mentioned that there were both pharmacological and non-pharmacological treatments. Let's start out with the pharmacology. What, what are the drugs that we use and how do they work? What should we know about them?
[00:18:27] Yair Bannett: Great. So, we use, uh, generally two types of medications. Uh, the most longstanding medication that's been around for almost a hundred years now, uh, is in the category of stimulant medications. So, the name of the family are stimulants. The common names you may have heard of are Ritalin and Concerta and Adderall. Um, and so those medications are very safe to use in children. We know that they have a really significant benefit, short term for sure. Immediately, once you start using the medicine, you see reductions in hyperactivity, impulsivity, and increases in attention for most children.
[00:19:03] Russ Altman: I think there's a lot of confusion because they're called stimulants. So maybe you can address that. Uh, people thinking, why would you give some kid who is hyperactive, uh, a stimulant?
[00:19:12] Yair Bannett: Yeah. So, it is true and the effect varies depending on the person. So, a person without ADHD might become more stimulated. Uh, but what's interesting is, and again, this was a discovery that would just happen. It's not, you know, people just tried it out and saw it had an amazing effect. Uh, and so what we see is that the stimulants actually create more focus. Um, there isn't, I think the mechanism of action is not entirely, you know, understood I would say. But we do see that children who use stimulants typically have a large positive effect on the core symptoms of ADHD. I would say probably close to 80% of, of children have a positive effect.
[00:19:52] Russ Altman: That's great. Uh, and that's, so that's the first class is the stimulants.
[00:19:55] Yair Bannett: That's right. So, the stimulants, uh, again, I have a, a very strong positive effect on the symptoms. We also know from recent research, and this is very interesting, I think not many people know about this. But we do know that it also carries benefits, long-term benefits, and this is just emerging now because it's so hard to do these longitudinal studies. But there are really strong studies showing that people who are taking these medications, uh, long-term are less likely to have those bad outcomes I mentioned earlier, including incarceration, including drug abuse, alcohol abuse, um, and, and those, those kinds of bad outcomes, um, getting into car accidents. Um, so I think that's a really important thing to know about it because when people think about weighing the pros and cons of trying these medications, I think everyone agrees there are short-term benefits. But not everyone knows that there are actually long-term benefits as well.
[00:20:49] Russ Altman: And that implies just to, just to make a point of it, that some of these drugs you might be on either for life or for a very long time. Is that, is that right?
[00:20:57] Yair Bannett: That's right. And, and uh, and, uh, uh, these medications are very easy in, in the sense that you can stop and start whenever you want. There actually isn't even, uh, a ramp up period like many other, uh, um, medications, that are psychopharmacological medications. Um, so yeah, the, it's true a lot of, uh, and once the child grows older, uh, he or she becomes the person to decide also, right? Uh, for example, in college or later in life, do they wanna take it and when do they wanna take it? And they can choose to take it on certain days or just before specific, uh, events, like tests and things like that.
[00:21:30] Russ Altman: Oh, that's great. Oh, okay. And I think you said there were another class?
[00:21:34] Yair Bannett: That's right. The second class of medications are called non-stimulants. The most common ones for that, uh, are, um, alpha agonists, uh, as well as Atomoxetine. And the non-stimulant medications work a little bit differently on the brain, but they have also a smaller effect compared to the stimulants, and so they reduce the hyperactivity and the impulsivity, but they don't as much increase the attention.
[00:21:59] Russ Altman: Okay. And do you tend to use these together or is it one or the other?
[00:22:03] Yair Bannett: So, in some children we use them together. For most it's one or the other. Uh, I would say that we're looking into using non-stimulants for younger children more often because they have less of, uh, uh, different side effect profiles. So, one of the issues with stimulants is that a lot of times, uh, the main side effect is reduction of appetite, but it can also have other problems like maybe sleep problems or irritability, especially in young children. So that is why a lot of times for younger children we use non-stimulants.
[00:22:31] Russ Altman: Gotcha. Okay. So, let's move to the non-pharmacological. I know that you've done some, some work in these, and so what are the things other than the medications that can help in the in, in ADHD?
[00:22:43] Yair Bannett: Yeah, so there is really strong, uh, evidence to show that when parents or caregivers, uh, participate in what's called parent training and behavior management, and they, uh, apply some, uh, strategies to modify the environment, as I mentioned, and also learn how to manage specific behaviors, there is improvement, uh, both in the symptoms, but more in the environment of the home or the chaos in the home. Uh, homes are typically chaotic when there's a child or children with ADHD, and so that becomes better once, uh, those behavioral interventions are applied.
[00:23:18] Russ Altman: So just, just to dive in a little bit, 'cause I, I, I'm intrigued by this. You're a physician. What is the prescription for a chaotic home? Like, give me some examples of what you might, uh, ask a parent to consider.
[00:23:30] Yair Bannett: So, so that's a great question and this is something that again, we're hoping that pediatricians can also, uh, consult parents on, not only developmental pediatricians. And the simple things we talk about are, first of all, making sure that you have a strong connection, building a strong connection with the child. That's the foundation really. Uh, and you wanna have a positive, strong connection with the child. And then on top of that, then you layer some structure, some, uh, reward system. Uh, one of the, uh, principles are called positive discipline. Uh, we don't wanna punish them and say, oh, you know, you were bad and you get punished but rather catch them when they're good.
[00:24:10] You wanna identify when they're behaving well, when they're not, uh, you know, getting up from the table every second. Or not yelling or not interrupting, oh, that, you did a great job there and, and build a system of rewards. Um, those are just a few of the principles. There are also things related to structuring the routines also. So, things are anticipated and, and there's some visual aids. Also, for example, morning time is, is usually difficult getting organized in the morning. So, there are different techniques like that that can help.
[00:24:38] Russ Altman: And, and, and have they been studied? Like are they working?
[00:24:41] Yair Bannett: Yes. So, there are studies that show again that there are when you take that type of intervention, you can see improvements in the behavior as well as in the environment of the home, the quality of life of the family.
[00:24:55] Russ Altman: Great. So, the last few minutes I wanted to ask, 'cause I know that you're, you're using, uh, a, a variety of methods to, uh, assess the quality of care. Because of course the, the pediatricians who are specializing in this disease are of, as you said, they're using medications. They might be making prescriptions about a less chaotic home. How do you know if it's all working?
[00:25:15] Yair Bannett: Yeah, so, so what I've focused on, and again, I came to this, uh, area of developmental pediatrics after, uh, several years of being a PCP, of being a primary care pediatrician, and my passion grew when I realized that we're not doing a great job in offering the right treatments always, or even knowing what the right treatments are. And one thing I didn't mention is that most children with ADHD are managed by their primary care pediatrician. And so that's why once I came to Stanford and, and specialize in developmental behavioral pediatrics, I decided to focus my research and my career on helping to support PCPs to know how to give, you know, provide better care for children.
[00:25:55] Russ Altman: 'Cause they're on the front lines and there are probably not enough specialists like you to go around for all the amount of kids with, with the, with the disorder.
[00:26:02] Yair Bannett: Yeah. So that's why I chose ADHD because it's so prevalent and it's clear to everyone that PCP should be managing it. And indeed, they are. They're managing most kids. And so, the way I've done it is, um, my team has been looking at electronic health records. And we've been using, I started looking at natural language processing, uh, back in 2017 when, when my mentor offered it. And I said, oh, that sounds interesting. And then this big AI boom came about. And so now we're using large language models and having really a great success in identifying what treatments are being offered.
[00:26:33] And so we're able to look, for example, and see for young kids, for those preschool aged kids with ADHD, are the pediatricians recommending non-formal theological interventions? Or maybe they're jumping to medications, maybe they're not aware of the interventions. Are they giving the right counseling that we talked about to the parents, even if they don't know where to refer to? So, all of those things we can glean from the electronic health record, and I think that's very exciting because beforehand we were not able to analyze that data. And this is, especially for developmental pediatrics or any mental health, uh, related, uh, field, most of the data lie in the free text. That's where everything is described. That's where,
[00:27:11] Russ Altman: Where, where the physician writes their notes.
[00:27:13] Yair Bannett: Exactly. Exactly.
[00:27:15] Russ Altman: So, and, and then I'm imagining that with, with an ability to do this, you could do like sensitive, um, uh, uh, sensitive feedback to the individual physician that, you know, you're doing a good job, but we have seen that you haven't made use of this modality. You might want to consider it, and of course, if it's delivered appropriately, they would probably be very glad to get this feedback, is my guess.
[00:27:37] Yair Bannett: That's exactly right. And I think that's where it helps that I was a PCP myself, so whenever I interact with them, I say, I know where, I know how hard it is. I know you don't have time. Uh, but here, yeah, let's help you. It's really not punitive in any way. It's not judgmental like, oh, you're not doing what you should be doing, but rather, uh, listen, uh, we can build a tool and we can help you, uh, you know, with, uh, also with the help of, again, providing you feedback, this is how you're doing compared to others. That's a really well-known motivator for, for clinicians to do a better job and, and to know what to offer to children.
[00:28:10] Russ Altman: So then now we can see a future where, uh, as you, as the basic findings in the field come from specialists like you, you have a way to then spread that to the primary care physicians to improve, basically, float all the boats a little bit better, um, for, for the, for the treatment and recognition of this disease. The last thing I wanted to ask, and I should have asked it before, is, um, in many situations that I'm aware of, it always helps to get the diagnosis early. Uh, and I'm wondering if that's the case here. I'm, I'm kind of assuming that if you can make a reliable diagnosis in a, in a very young child, it gives you more ways to, um, intervene and, and get better outcomes. Is that true for ADHD or is it still a question about whether I know it's true for autism. Uh, is it, is there a question about ADHD that you do better when you get an earlier diagnosis?
[00:28:59] Yair Bannett: Yeah, I would say, uh, the evidence is not as strong, perhaps, as we know it is for autism. But for ADHD, uh, my belief is that yes, it is very important to identify it early. We know, and the reason is because we know that in preschool age, if you have ADHD, you are more likely to not succeed in school, including elementary school. You'll have problems. And so, that's where really preparing and knowing in advance and coming into the school and coming into kindergarten prepared is a, is a huge benefit.
[00:29:29] Russ Altman: Great. Well, that's fantastic. And if it's okay, I'd like to switch tracks now and go to our new feature called the Future In a Minute, where I ask you some, uh, I think simple questions and, and you give me some simple answers. Does that sound okay?
[00:29:42] Yair Bannett: Sounds great.
[00:29:43] Russ Altman: What is one thing that gives you the most hope about the future?
[00:29:46] Yair Bannett: Well, I think the most hope, uh, the thing I'm most excited about also is really in applying the AI technologies, the large language models, to identify rich information in the electronic health record and get a better sense of how well are we treating children, this is with ADHD, or any other condition, and then also applying that to then improve their outcomes. And I think there's a lot of excitement about AI, for example, also in drug discovery and things like that. But I think the same level of excitement I feel about mining the rich information, electronic health record, especially for mental health.
[00:30:25] Russ Altman: What's one thing you want people to walk away from this episode remembering?
[00:30:29] Yair Bannett: I want them to remember, uh, developmental behavioral pediatricians are really important, uh, in supporting children with ADHD. I think more people in the field of medicine should be aware of this field, especially pediatricians, and so we need more developmental behavioral pediatricians.
[00:30:43] Russ Altman: Aside from money, what is the one thing you need to succeed in your research?
[00:30:48] Yair Bannett: I certainly need to have collaborators who, uh, have, uh, expertise that I don't have, again, especially since I'm, I focus my research on, uh, applying AI to clinical, uh, care. Uh, I need data scientists. I need machine learning experts, and that team science approach is critical for me to succeed.
[00:31:07] Russ Altman: If all goes well, what does the future look like?
[00:31:11] Yair Bannett: Well, I think the future can look like the experts and primary care pediatricians are still the ones managing children with ADHD. But they have this incredible technology that allows them to have more personalized care, to understand better the treatments that we're offering and how those treatments can improve long-term outcomes for these children and their families.
[00:31:33] Russ Altman: If you were starting all over again and you needed to get your certification or your degree in a different discipline, what would it be?
[00:31:39] Yair Bannett: Well, that's an interesting question. Um, you know, in medical school, I, I took improv theater, uh, and I really enjoyed it. So, I think if, if medicine and research wouldn't work out, I think I might, you know, find myself on the stage doing some improvisation theater.
[00:31:55] Russ Altman: Thanks to Yair Bannett. That was the future of ADHD. Thank you for listening to this episode of The Future of Everything. We've now passed 300 episodes, so we have a ton of issues in the back catalog of The Future of Everything. Please go listen, especially on a rainy day if you need some good conversations to listen to. I wanna remind you that if you're enjoying the show, yes, the algorithm might put it in front of you, but the best way to spread news of the show is just to tell your friends, your family, your colleagues. Tell 'em, future of everything, this guy Russ Altman, not so bad. And that'll help us grow the show and make sure that we're responsive to the interests of the entire listenership. You can connect with me on many social media platforms, including LinkedIn, Threads, Bluesky, Mastodon, where I am @RussBAltman, or @RBAltman. You can follow the Stanford School of Engineering @StanfordSchoolOfEngineering, or more simply @StanfordENG.
