Research Recap with Skye: Social Exclusion
Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig into the tools, tactics, and best practices to help you work with your ADHD brain. Today, I'm joined by Skye Waterson for our Research Recap series. In this series, we take a look at a single research paper and dive into what the paper says, how it was conducted, and try and find any practical takeaways.
In this episode, we're going to be discussing a paper called "Psychological Implications of Exclusion in Individuals with ADHD Symptomatology." That's a hard word there. This study asked a deceptively simple question: when people with ADHD symptoms are socially excluded, do their bodies respond differently than those without ADHD?
And so basically, what we're talking about today is RSD, or Rejection Sensitive Dysphoria, which is something that a lot of people have really started to resonate with, but there isn't a ton of research on yet. And I think this is a great place for us to kind of dive in on that research. So let's get into it.
If you'd life to follow along on the show notes page you can find that at HackingYourADHD.com/310
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William Curb: Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig into the tools, tactics, and best practices to help you work with your ADHD brain.
Today, I'm joined by Skye Waterson for our Research Recap series. In this series, we take a look at a single research paper and dive into what the paper says, how it was conducted, and try and find any practical takeaways.
In this episode, we're going to be discussing a paper called "Psychological Implications of Exclusion in Individuals with ADHD Symptomatology." That's a hard word there. This study asked a deceptively simple question: when people with ADHD symptoms are socially excluded, do their bodies respond differently than those without ADHD?
And so basically, what we're talking about today is RSD, or Rejection Sensitive Dysphoria, which is something that a lot of people have really started to resonate with, but there isn't a ton of research on yet. And I think this is a great place for us to kind of dive in on that research. So let me get into it.
Skye Waterson: Yeah, I'm excited to get into it. I will say upfront, this is not a meta-analysis. This is one individual paper with all of the pros and cons of one paper. But they did a few really interesting things. They have an experiment, which we can get into. They also asked some questions around rejection sensitivity dysphoria in general, as well as an actual assessment of ADHD symptoms using the stop-go/no-go task, which is really, really commonly used. So yeah.
William Curb: Yeah, and I guess another thing to mention about the paper, too, is it is from an undergraduate research journal, which doesn't lessen the impact of the research. It just kind of informs a lot of the reasons that they chose the way they did some of the things—'cause we're definitely going to have to get into their sampling and stuff, because that was a little bit... Even in their discussion, they talked about how they could have done a better job at recruiting people that weren't so demographically similar.
Skye Waterson: Yeah, and it's funny because, you know, I do like these papers because I feel like they give you a bit of an insight into the mind of the researcher. They're a little bit more open about like, "Oh, we could have improved this, and this is what we did, and this is what we would do better next time."
But yeah, so for the study, they recruited 60 participants. And yeah, they said, "We're looking for people who have ADHD" in the recruitment process. So they were very much self-selecting for people who were like, "Ooh, that's me. I want to be in this." And as a result, they ended up with more people who had ADHD in the sample than people who didn't. And also, they had 73% women and 26% men. So it was much higher than you would find in general, based on the stats that we have.
William Curb: Yeah. And since we're looking at the exclusion criteria, they then ran this... Their experiment was using this task called the Cyberball task, which sounds much fancier than it is. It's just a computer game where you are tossing a ball back and forth with three players. And to make the exclusion criteria, you have the two computer players originally throwing back and forth between all three, and then they just start throwing to each other, excluding the participant.
And I'm like, "That sounds horrible." But yeah, it is funny, too, thinking about this experiment, I was just like, "Man, that sounds like I would feel really uncomfortable." But I was thinking about that in terms of playing it with actual people. I don't know if I'd feel the same way in a computer setting.
Skye Waterson: Yeah, yeah. And that's the thing I was thinking about as well. Like, my feeling with actual people would be like, "Right, you know, I get it. I'm not the most coordinated of people, and I understand that you have now seen this as well," and I would feel all the rejection from high school and everything like that. But with a computer, I'd be like, "Is it broken?"
William Curb: Yeah. And so this is something that was really interesting with this study, because they were looking at not just how people felt, but the actual physiological change that they might see. And so they were measuring heart rate and blood pressure through a number of means, and they didn't get the result they were expecting. 'Cause they were expecting, "Oh, they're going to have this..."
To measure the feelings, they ran this Need Threat Scale—it's just like a 20-item questionnaire to see how they felt after doing the test, and it did show that the Cyberball task did make them feel excluded. But the physiological data didn't show that.
Skye Waterson: Yeah, and it was really interesting because it raised so many questions, and it was one of the reasons why I wanted to pull this paper—because now I'm curious.
The reason I was super excited about this paper was because heart rate is so interesting. With ADHD, there's like so many things going on. It's like rejection sensitivity for sure, but also dopamine and how we react to stimuli in general. It kind of opens up a world of questions about whether we have these big differences. And they were arguing that, yeah, our heart rate would increase.
William Curb: Yeah, and instead they found a drop in blood pressure, which was unexpected, which then came back up after the test. They measured at five points so they could try to see if they could pinpoint when the rejection happened. But that's not what they found. And I mean, one of their ideas in the discussion was that maybe it just wasn't an intense enough experience to get that physiological response.
Skye Waterson: Yeah, I wondered if maybe it was just a bit boring. Like if you're watching two characters in a game, and you're like, "Oh, this game is broken. They're just tossing to each other. Is this normal? Is this what's supposed to happen?" And you're not feeling anything except probably boredom.
William Curb: Mm-hmm. Yeah, I was really interested in one of the other studies that they cited that talked about this Island Getaway task, and I was like, "Oh, that sounds terrible, too." It's basically like a Survivor thing where you get voted off the island, so it's just like a social rejection. And I was like, "Oh, that would also be terrible." Like, even in a computer game where you're just like, "Oh yeah, there's 10 other people," and they say, "Yeah, you're not the person that's going to come with us."
Skye Waterson: Yeah. I wondered—and we're going a little bit sidetracked here—but I wondered what would happen if they told people that it was actually live. So, "This is a game, but similar to games on the internet, these two people are actually real people and you're a real person, and they're deciding who to pass the ball to." Like that kind of thing.
William Curb: Yeah, and I think that would definitely up the level of like, "Oh, why aren't they passing it to me?" I was also thinking like maybe if there were more participants, so instead of just three back and forth, have like five and see if that has any effect, too, because then you can get more of the like in-group, out-group feel.
Skye Waterson: Yeah, 100%. 100%. Yeah, it was really interesting. And then what was also interesting was that they did do that assessment of whether people said that they experienced rejection sensitivity, and people said yes. So the people who said that they were experiencing rejection sensitivity and the people who were according to their test were not the same people.
William Curb: Yeah, which—I mean, this is not to say that rejection sensitivity is all in your head. I mean, technically... and I do want to say though, it is because that's where all our experience happens. So it is, but that's okay.
Skye Waterson: The like big question for like, does this prove that RSD is real or not real?
William Curb: And the answer is like, it just shows that people have a perceived rejection, but it does not show any physiological response.
Skye Waterson: Yeah, yeah, exactly. It was also really interesting—they just randomly put this in, and this is the kind of thing that I love about these papers. They had a little piece where they just mentioned as well that they also checked level of mistakes. Did you catch that piece?
William Curb: Oh, on the go/no-go?
Skye Waterson: Yeah, yeah. They mentioned that somewhere in this paper they said people who said that they struggled more were the ones who made the most mistakes in the go/no-go task versus the people who actually had higher rates of ADHD according to the symptoms. So it was like an interesting piece there.
William Curb: Yeah. Well, yeah, it was really interesting 'cause the go/no-go actually failed to validate the ASRS screening. So it didn't match up in the way that you would expect. The ADHD group actually had more measurable attention and impulsivity differences than was expected—or it didn't show that, is what I mean. It was the other way, whereas the go/no-go was not as meaningful for validating ADHD as it should've been for this kind of test.
Skye Waterson: Yeah, I thought that was interesting 'cause essentially what they were saying was that because they particularly went after a group of people who identified as having ADHD, and then they gave them assessments... They gave them the ADHD assessment and the rejection sensitivity assessment, and you know, people scored highly on that.
But then what they were scoring on those assessments versus what they were seeing in the tests—the go/no-go task and their computer game—were different. And I thought that was a very interesting conversation about kind of how these tests are run. Because I'm guessing—I don't know about how you feel about this—that we will do another assessment, probably a meta-analysis, of rejection sensitivity. But this is a very interesting peek into how this is done.
William Curb: Yeah. And well, it's also really interesting to look at the order of testing they ran things in, which felt... 'cause they did not look for ADHD first. They ran these tests first and then were looking for ADHD, which I mean, I guess could be trying to be like, "Hey, we're not trying to prime you."
Skye Waterson: Yeah. "We just... but we did tell you when we were trying to recruit you."
William Curb: Yeah. And they were, you know, because they also with that had pre-screenings to be like, "Okay, if you already have blood pressure issues or anything like that, we're going to exclude you," 'cause that could possibly manipulate the data in funny ways. But yeah, it did make for some interesting limitations that came from this study.
Skye Waterson: Yeah, yeah. And I think this is a good paper to show you, you know, sometimes people will go... You'll read a newspaper article: "RSD Not Real," da-da-da, "Not Related to X, Y, Z." And this is sometimes those kinds of papers. And so when you look at them, you're like, "Oh no, there's some very, very real limitations. This is only going to be really known by doing a meta-analysis." And now we have to go and read all the other papers, and well, you know we're going to do it, guys.
William Curb: Yeah. And it's important to... even though this study has some weaknesses in certain places, it does show, like all research, it's stepping stone to stepping stone. You can't just get to the big paper. You first need to be like, "Okay, well, what's not working for looking for what we want to try and find?"
I am saying that wrong, 'cause like, not trying to find... It's like, you know, we're not out to prove something. We're trying to uncover the truth of what's going on with research, but trying to figure out what the study is actually looking at versus what you're actually finding.