The Bad News About Untreated ADHD with Karin Varblow

ADHD is not just about attention. It is about self-control, self-esteem, and what happens when the brain goes offline.

Living with untreated ADHD is not just about missing assignments. It is about moving through the world without a reliable connection between what you know and what you do.

In this conversation, I talk with Dr. Karin Varblow, a behavioral pediatrician, former teacher and social worker, neurodivergent adult, and mom to neurodivergent kids. We look closely at what untreated ADHD really costs over a lifetime, from self-esteem and identity to health, safety, relationships, and even life expectancy.

Dr. Karin explains why ADHD is not simply a "school problem" and why kids who "know better" still cannot always do better in the moment. She shares her "know and go" model of the brain, which helps make sense of why lectures and bigger consequences do not lead to different behavior, and why kids so often feel confused and ashamed by their own actions.

We also talk about sleep, airway, co-occurring conditions, and how things like anxiety, trauma, allergies, and disordered sleep can overlap with ADHD or even mask it. Dr. Karin breaks down what good treatment actually looks like in real life, including medication, parent training, behavior supports, and making daily life more stimulating and relevant for the ADHD brain.

If you have ever wondered whether ADHD "really" needs treatment, or felt discouraged by mixed messages, this episode will help you see the bigger picture with more clarity and more compassion for you and your child.

Key Takeaways

• Untreated ADHD is not just about school performance. It affects self-esteem, identity, health, safety, relationships, income, and even life expectancy over time.
• Research shows that people with untreated ADHD have higher rates of emergency room visits, poverty, incarceration, and an average life expectancy that is years shorter than their non-ADHD peers. Treatment meaningfully improves these outcomes.
• ADHD is both overdiagnosed and underdiagnosed, and it often shows up alongside other conditions like anxiety, depression, learning differences, sleep disorders, allergies, GI issues, and trauma. Sorting out "what's what" takes time and thoughtful evaluation.
• Effective ADHD treatment is not one thing. The strongest evidence supports a combination of medication and behavior modification, with behavior modification defined as training and support for parents, not "fixing the child" in a weekly session.
• Behavior plans that focus only on lectures and bigger consequences usually miss the mark. Most kids already know the rules. The problem is not a lack of knowledge, it is a lack of access to that knowledge in the moment.
• Dr. Karin's "know and go" model helps explain this: the "know" part of the brain holds rules, values, and experience; the "go" part drives behavior. In ADHD, especially around non-preferred tasks, the "go" can take off before the "know" ever gets a say.
• That disconnect is why kids so often say "I don't know why I did that" and mean it. They are not being manipulative. They are genuinely confused and often ashamed, because their behavior does not match what they actually believe or want.
• ADHD brains do have strong executive function in areas of high interest. A child who cannot organize themselves around homework may show incredible focus, planning, and follow-through when building Legos or diving into a favorite topic.
• Sleep, breathing, immune function, and overall health matter. Airway issues, disordered sleep, allergies, and inflammation can all worsen attention, regulation, and behavior, and sometimes even mimic ADHD. Addressing these pieces is part of good care.
• Supporting a child with ADHD means changing the story from "try harder" to "let's change how we're asking, what we're asking, and how we're supporting you." When adults focus on relevance, relationship, and realistic support, kids get more access to their best selves.

About Karin Varblow

Dr. Karin Varblow is a behavioral pediatrician and neurodivergence specialist who has built a career around coordinated, whole-family ADHD care. She earned her BA from Duke University and her MD from The George Washington University School of Medicine as a National Health Service Corps Scholar, and completed her Pediatrics residency at INOVA Fairfax Hospital for Children.

Dr. Varblow's work is shaped by her unique path as a former educator and social worker, a former general pediatrician, a parent in a neurodiverse family, and an individual with ADHD herself. She supports families through medication management, parent support, behavior modification, care coordination, advocacy, and strategy development, with a focus on helping children thrive in real life, not just "meet expectations."

About Your Host, Gabriele Nicolet

Gabriele Nicolet, toddler whisperer, speech therapist, parenting life coach, and host of Complicated Kids. Each week, I share practical, relationship-based strategies for raising kids with big feelings, big needs, and beautifully different brains. My goal is to help families move from surviving to thriving by building connection, confidence, and clarity at home.

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