137 results for: "depresion"
En qué se parecen el TDAH y el TEPT
El TDAH y el trastorno por estrés postraumático o TEPT son diagnósticos diferentes. Pero algunos de sus síntomas son iguales. Ambas condiciones afectan un grupo de habilidades mentales llamadas función ejecutiva. Esto puede dificultar planificar, organizar, recordar información, manejar las emociones y más. Sin embargo, los síntomas se presentan por motivos diferentes.En el TDAH, los síntomas son causados por diferencias en la manera en que se desarrolla el cerebro. En el TEPT, los síntomas se producen debido a un trauma (un acontecimiento o una serie de acontecimientos muy estresantes). Pero no todas las personas que experimentan trauma desarrollarán TEPT. Es posible tener TDAH y TEPT. Pero el hecho de tener TDAH no aumenta la probabilidad de desarrollar TEPT después de un evento traumático.Estos son seis síntomas que tienen en común el TDAH y el TEPT:1. Problemas de concentraciónAunque por motivos diferentes, tanto el TDAH como el TEPT pueden causar problemas de atención y falta de concentración. Los desafíos con la función ejecutiva, incluida la dificultad para enfocarse, constituyen una parte importante del TDAH. Las personas con TDAH suelen tener dificultad para concentrarse, en especial en cosas que no les interesan. O puede que tengan dificultad para dejar de prestar atención a algo y pasar a otra cosa.El TEPT genera ansiedad y pensamientos intrusivos, los cuales pueden interferir con la concentración. Estos síntomas pueden ser desencadenados por cosas que le recuerdan el trauma a la persona: sonidos, olores, emociones fuertes, entre otras. Las personas con TEPT no siempre saben qué los produce ni por qué.2. Problemas para dormir Muchas personas con TDAH tienen problemas para conciliar el sueño, permanecer dormidas o despertarse. Les resulta difícil desconectarse de sus pensamientos y relajarse. La falta de sueño también puede empeorar los síntomas del TDAH. Las personas con TEPT a menudo tienen pesadillas, trastornos del sueño o insomnio. Al igual que con el TDAH, la falta de sueño puede empeorar los síntomas del TEPT.3. Autopercepción negativaTanto el TEPT como el TDAH pueden tener un gran impacto en la autoestima. Las desafíos causados por el TDAH pueden ser difíciles de manejar: problemas en la escuela o en el trabajo, la sensación de no “encajar” en ninguna parte. Tener dificultad todos los días con cosas que ellos saben que son fáciles para sus compañeros puede hacerlos sentir mal consigo mismos.El TEPT también puede afectar la autoestima. Muchas personas con TEPT tienen opiniones exageradamente negativas sobre ellas. Pueden pensar que han “causado” o que “se merecen” lo que les ha ocurrido. O que su trauma significa que están “dañados”. Estos pensamientos negativos también pueden ser una señal de depresión.4. Desregulación emocionalLas personas con TDAH pueden tener dificultad para lidiar con sus emociones. Puede que sientan las emociones con más intensidad o por más tiempo. Esto puede interferir en la vida cotidiana. Las personas con TEPT también suelen tener dificultad para manejar sus emociones. El TEPT puede causar episodios de ira, ansiedad y tristeza, e incluso ideas suicidas. Estos síntomas pueden causar problemas en el trabajo y en el hogar, lo que a su vez puede generar emociones aún más negativas.5. Problemas de memoria Los problemas con la memoria funcional significan que es posible que a las personas con TDAH les cueste retener información nueva en la mente el tiempo suficiente para poder utilizarla.El estrés provocado por el trauma que causa el TEPT también puede afectar la memoria funcional. Es posible que las personas con TEPT también tengan recuerdos intrusivos. Los recuerdos traumáticos que aparecen involuntariamente pueden afectar su sentido del tiempo debido al pánico que pueden causar.6. Impulsividad o imprudenciaLas personas con TDAH pueden tener dificultad para controlarse. Esto provoca impulsividad, que en algunas conduce a actuar de forma arriesgada y a conductas autodestructivas.El TEPT puede causar que una persona sea imprudente, lo cual se puede parecer a la impulsividad del TDAH. Alguien con TEPT se podría comportar de manera imprudente porque siente que no le queda mucho tiempo. O bien, algo lo desencadena y el pánico resultante dificulta más el control de sus impulsos. Próximos pasosEl TDAH y el TEPT tienen tratamientos diferentes. Es importante obtener el diagnóstico correcto y un plan de tratamiento consultando a un profesional de la salud mental. Conozca más sobre el TEPT en rainn.org.
Understood Explica el IEPEl IEP: Las 13 categorías de discapacidad
Es necesario que su hijo tenga discapacidad que corresponda a alguna de las categorías de discapacidad para poder calificar para un IEP. En este episodio, explicaremos de qué se trata. Existen 13 categorías de discapacidad enumeradas en una ley federal llamada Ley de Educación para Individuos con Discapacidades, comúnmente conocida como IDEA por sus siglas en inglés.Para obtener un Programa de Educación Individualizado o IEP, su hijo tiene que cumplir con el criterio de tener una discapacidad que se ajuste a alguna de esas 13 categorías.Los nombres de esas categorías pueden ser difíciles de entender, como “discapacidades específicas del aprendizaje” u “otros impedimentos de salud”.En este episodio de Understood Explica, su presentadora Juliana Urtubey hablará de lo que significan esas categorías y cómo se relacionan con el IEP. También explicará qué hacer si su hijo no califica en ninguna categoría de discapacidad o si califica en más de una.Marcas de tiempo:[0:48] ¿Por qué el IEP tiene categorías de discapacidad?[3:25] ¿Cuáles son las 13 categorías de discapacidad en IDEA?[9:46] ¿Las categorías de discapacidad son las mismas en todos los estados?[12:51] ¿El IEP de mi hijo puede incluir más de una discapacidad?[14:19] ¿Qué pasa si mi hijo no califica para ninguna categoría de discapacidad?[16:00] Puntos clavesRecursos relacionadosCentros de capacitación para padres: Un recurso gratuito en su estadoDescargar: Modelos de cartas para solicitar evaluaciones y reportesOpciones para resolver una disputa del IEPDescargar: Modelos de cartas para la resolución de disputas con la escuelaTranscripción del episodioJuliana: Para obtener un IEP, los niños tienen que cumplir con el criterio de tener al menos una categoría de discapacidad. Pero, ¿y si la capacidad de su hijo corresponde a más de una categoría? ¿Y si no corresponde a ninguna? Desde la red podcast de Understood, esto es "Understood Explica el IEP". En este episodio, revisaremos las categorías de discapacidad que utilizan las escuelas al decidir si un niño califica para recibir educación especial. Mi nombre es Juliana Urtubey, y soy la Maestra Nacional del año 2021. También soy experta en educación especial para estudiantes multilingües y soy la presentadora de esta temporada de "Understood Explica", que está disponible en español y en inglés. Bueno, comencemos. [0:48] ¿Por qué el IEP tiene categorías de discapacidad?¿Por qué el IEP tiene categorías de discapacidad?. Antes de revisar cada una de las categorías, quiero explicar por qué las escuelas las utilizan. La palabra clave es "elegibilidad". Su hijo no puede obtener un IEP, es decir, un Programa de Educación Individualizado, sino cumple con el criterio de al menos una categoría de discapacidad. Este requisito proviene de la ley de Educación para Individuos con Discapacidades o IDEA, por sus siglas en inglés. Esta ley tiene 13 categorías de discapacidad. Los padres escucharán hablar de esas categorías cuando asistan a la reunión de determinación de elegibilidad de su hijo. El equipo revisará las categorías y dirá si su hijo califica para alguna de ellas. Es posible que escuche el término "clasificación de discapacidad". Para muchas familias, ese es un momento muy emotivo de la reunión. Puede ser difícil escuchar que su hijo tiene una discapacidad, pero siempre pueden pedir hacer una pausa para calmarse y ordenar sus ideas. En un minuto revisaremos cada categoría, pero antes de eso hay algunas cosas generales que quiero que sepan sobre ellas. Primero, IDEA tiene trece categorías de discapacidad, pero eso no significa que solo cubra trece discapacidades. Estas categorías son tan amplias que incluso la condición más inusual podría encajar en alguna parte. Segundo, a veces las dificultades que tienen los niños no son causadas por una discapacidad. Por ejemplo, faltar mucho a la escuela o tener dificultad para aprender inglés como idioma adicional. En esos casos existen otras maneras de ayudar a esos estudiantes, pero para obtener un IEP los niños deben tener una discapacidad. Lo siguiente que quiero mencionar, es que algunas categorías de discapacidad puede que reciban más financiación que otras categorías, pero la categoría de discapacidad de su hijo no puede usarse para limitar los servicios de su hijo. Las categorías de discapacidad son puertas a la educación especial y su hijo solo necesita pasar por una de estas puertas para calificar, así tendrá acceso a cualquier tipo de instrucción especialmente diseñada o servicios que necesite. [3:25] ¿Cuáles son las 13 categorías de discapacidad en IDEA? Entonces, ¿cuáles son las 13 categorías de discapacidad en IDEA? Voy a empezar con las cuatro categorías más comunes, y para ayudarlos a comprender lo comunes que son, quiero que se imaginen un gráfico circular. Esto representa a los millones de niños que tienen un IEP. La porción más grande de este gráfico son los niños que tienen discapacidades específicas del aprendizaje, o SLD, por sus siglas en inglés. Aproximadamente, un tercio de los niños con IEP, califican para educación especial porque tienen una discapacidad del aprendizaje. Algunos ejemplos comunes incluyen la dislexia, que algunas escuelas llaman un trastorno de la lectura o una capacidad específica del aprendizaje de la lectura. La discalculia es una discapacidad matemática o un trastorno matemático. También existe la disgrafia y el trastorno de la expresión escrita, donde los niños pueden tener mucha dificultad para expresar sus ideas en un papel. Bien, entonces, los niños con discapacidades del aprendizaje representan aproximadamente un tercio del gráfico circular de la educación especial. La segunda porción más grande es para los impedimentos del habla o del lenguaje. Casi una quinta parte de los niños con IEP están en esta categoría. Este grupo incluye a muchos niños que necesitan terapia del habla, también incluye a los trastornos del lenguaje que pueden dificultar de aprender nuevas palabras o reglas gramaticales o comprender lo que dice la gente. Los trastornos del lenguaje también pueden entrar en la categoría de discapacidades del aprendizaje. Por lo tanto, si su hijo tiene un trastorno del lenguaje, puede que sea un poco complicado elegir la categoría. Bueno, entonces ya está lleno la mitad del circulo de educación especial que estamos diviviendo, y solamente con los niños que pertenecen a dos de las trece categorías, discapacidades específicas del aprendizaje e impedimentos del habla o del lenguaje. Ahora, la tercera porción más grande se llama Otros Impedimentos de Salud, OHI por sus siglas en inglés. Incluye alrededor de 1 de cada 6 niños con IEP. Esta es una categoría muy importante para las familias, porque incluye a muchos niños con TDAH, la ley IDEA enumera una serie de ejemplos que encajan en la categoría de "otros impedimentos de salud", incluyendo TDA y TDAH. También incluye asma, diabetes, epilepsia, intoxicación por plomo y anemia falciforme. Estos solo son algunos ejemplos que se mencionan en la ley, esta categoría es muy amplia. Bien, continuemos con la cuarta porción más grande del círculo, que es el autismo. El autismo incluye aproximadamente al 12% de los niños que tienen un IEP. Esto significa que alrededor de 1 de cada 8 o 9 niños con IEP califican para educación especial porque tienen autismo. Ahora, quiero hacer una pausa y señalar que estas cuatro categorías de discapacidad — las discapacidades del aprendizaje, los impedimentos del habla o del lenguaje, otros impedimentos de salud y el autismo — representan alrededor del 80% del círculo. Entonces, ¿qué pasa con el resto de las categorías? Bueno, están las discapacidades intelectuales que ocupan una porción bastante pequeña, el 6% del círculo, es decir 1 de cada 16 niños con IEP. Algunos ejemplos que podrían en esta categoría, son el síndrome de down, y el síndrome de alcoholismo fetal. Luego está el trastorno emocional, que representa una porción un poco más pequeña, el 5% del círculo — es decir 1 de cada 20 niños con IEP — y cubre cosas como la ansiedad y la depresión. Y luego hay otras 7 categorías que representan porciones muy pequeñas del círculo. El impedimento ortopédico. El impedimento visual, que incluye la ceguera. El impedimento auditivo, que incluye la sordera. La sordoceguera, que tiene su propia categoría y la lesión cerebral traumática. También hay discapacidades múltiples, esta categoría no se usa si el estudiante tiene TDAH y dislexia. Es más probable que discapacidades múltiples se utilicen para algo como discapacidad intelectual y la ceguera o cualquier otra combinación que probablemente requiere un enfoque altamente especializado. Y por último, están los retrasos en el desarrollo, que es la única categoría de discapacidad en IDEA que incluye un límite de edad. Hablaré más sobre eso en un minuto. Pero, por ahora les quiero recordar que no todas las personas con una discapacidad califican para un IEP. La discapacidad debe afectar su educación lo suficiente como para necesitar una enseñanza especialmente diseñada. Este es un ejemplo. Supongamos que su hijo tiene TDAH, ¿necesita enseñanza especialmente diseñada para poder organizarse y enfocarse en lo que está haciendo? O solo necesita algunas adaptaciones en el aula, como sentarse cerca del maestro y alejado de ventanas o pasillos que lo distraigan. Si no necesita enseñanza especializada, la escuela dirá que no califica para un IEP. Pero puede obtener un plan 504. Si desea obtener más información acerca de cómo los niños califican para un IEP, escuche el episodio cuatro. Y si quiere aprender más sobre las diferencias entre el IEP y el plan 504, escuche el episodio dos. [9:46] ¿Las categorías de discapacidad son las mismas en todos los estados?¿Las categorías de discapacidad son las mismas en todos los estados? La respuesta corta es no. La clasificación de la discapacidad puede ser un poco diferente dependiendo del estado. Algunas de estas diferencias son bastante pequeñas. Por ejemplo, algunos estados usan la frase "categoría de discapacidad" y otros usan el término "excepcionalidad". Y algunos estados tienen más de 13 categorías, porque hacen cosas como dividir el impedimento del habla o del lenguaje en dos categorías. Otra diferencia es como los estados utilizan la categoría de retrasos en el desarrollo. A los estados no se les permite utilizar esta categoría después de los nueve años, pero en algunos estados la edad límite es menor. Por ejemplo, yo vivía en Nevada, y ahí se podía clasificar a los niños con retraso en el desarrollo hasta los cinco años. Y cuando cumplían seis años, mi equipo tenía que determinar si otra categoría de discapacidad se ajustaba a sus necesidades. En la mayoría de los casos, esos estudiantes cambiaban a discapacidades específicas del aprendizaje. Pero en Arizona, que es donde vivo ahora, los niños pueden seguir recibiendo servicios bajo la categoría de retrasos en el desarrollo hasta que cumplan 10 años de edad. Hay otra gran diferencia que quiero mencionar, y tiene que ver con la forma en que los estados clasifican a los niños con discapacidades específicas del aprendizaje. Algunos estados todavía evalúan a los niños para las discapacidades del aprendizaje, utilizando lo que se conoce como modelo de discrepancia. Esto consiste en comparar el coeficiente intelectual o la capacidad intelectual de un niño con su rendimiento académico. Un ejemplo de discrepancia, sería un estudiante de quinto grado con un coeficiente intelectual promedio, pero que lea en segundo grado. Pero algunos estados no permiten que las escuelas utilicen un modelo de discrepancia. Esto se debe a que puede haber sesgos culturales y otros problemas con las pruebas del coeficiente intelectual, incluidas las pruebas que se realizan a los niños que hablan un idioma distinto del inglés en la casa. Así que estas son algunas de las formas en que los criterios de elegibilidad pueden diferir de un estado a otro. Si desea saber cuales son los requisitos de elegibilidad de su estado, pregúntele a la persona encargada en la escuela de conectar a los padres con el personal escolar o comuníquese con un centro de información y capacitación para padres. Estos centros, conocidos como PTI, por sus siglas en inglés, son recursos gratuitos para las familias. Cada estado tiene al menos uno. Voy a poner un enlace en las notas del programa, para ayudarlo a encontrar el centro más cercano. [12:51] ¿El IEP de mi hijo puede incluir más de una discapacidad?¿El IEP de mi hijo puede incluir más de una discapacidad? Sí. Si su hijo tiene más de una discapacidad es recomendable mencionarlas en el IEP. Esto puede facilitar que el IEP incluya todos los servicios y adaptaciones que su hijo necesita. Es posible que el equipo del IEP necesite clasificar las discapacidades según cual afecta más la educación de su hijo. Pero no se pueden usar etiquetas como "principal" y "secundaria" para limitar los servicios que recibe su hijo. Es principalmente una herramienta de recopilación de datos para que los estados puedan tener una idea más amplia de quien recibe servicios y para que. Y si usted no está seguro de cuál categoría de discapacidad debería incluirse como principal, piense que es lo más importante que los maestros deben tener en cuenta para apoyar a su hijo. Otra cosa que quiero mencionar, es que la categoría principal de discapacidad de su hijo puede cambiar a medida que crece. Un ejemplo es que los niños pequeños que tienen un impedimento del lenguaje podría cambiar a discapacidad específica del aprendizaje a medida que sus dificultades con la lectura o la ortografía se definan mejor con el tiempo. [14:19] ¿Qué pasa si mi hijo no califica para ninguna categoría de discapacidad?¿Qué pasa si mi hijo no califica para ninguna categoría de discapacidad? El equipo puede decidir esto después de la evaluación inicial de su hijo. O, si su hijo ya tiene un IEP, es necesario realizar una reevaluación, al menos cada tres años. Y parte del motivo es para ver si su hijo ya no necesita enseñanza especializada. Si la escuela dice que su hijo no cumple con los criterios para ninguna de las categorías de discapacidad, hay algunas cosas que puede hacer. Lo primero es que revise el informe de la evaluación. ¿La escuela examinó las áreas problemáticas correctas? Quizás el equipo necesite realizar más pruebas en otras áreas. También, puede solicitar una evaluación educativa independiente, conocida como en inglés por sus siglas IEE. Esta evaluación la realiza alguien que no trabaja para la escuela, lo más probable es que la tenga que pagar, pero en algunos casos la escuela debe cubrir el costo. Understood tiene un buen modelo para ayudarlo a redactar este tipo de solicitudes. Voy a incluir un enlace en las notas del programa. Estos modelos de carta están disponibles en español y en inglés. Otra cosa que puede hacer es conocer las opciones de resolución de disputas. Más adelante en esta temporada tendremos un episodio completo sobre esto, pero voy a incluir el enlace a un artículo para ayudarlo a comenzar. [16:00] Puntos clavesHemos cubierto muchos aspectos en este episodio. Por ello, antes de concluir, voy a hacer un resumen de lo que hemos aprendido. IDEA tiene trece categorías de discapacidad, pero eso no significa que solo cubra trece discapacidades. La categoría de discapacidad de su hijo es una puerta a la educación especial, no limita el tipo de servicios que puede recibir su hijo. El IEP de su hijo puede incluir más de una discapacidad y la categoría principal puede cambiar con el tiempo. Bien, esto es todo por este episodio de "Understood Explica". La próxima vez, vamos a hablar sobre términos importantes y derechos legales que todos los padres deben conocer si sus hijos califican para un IEP. Acaba de escuchar un episodio de "Understood Explica el IEP". Esta temporada fue desarrollada en colaboración con UnidosUS, que es la organización de defensa de derechos civiles hispanos más grande de todos los Estados Unidos. ¡Gracias, Unidos! Si desea más información sobre los temas que cubrimos hoy, consulte las notas del programa de este episodio. Ahí encontrará más recursos, así como enlaces a los temas mencionados hoy. Understood es una organización sin fines de lucro dedicada a ayudar a las personas que piensan y aprenden de manera diferente, a descubrir su potencial y progresar. Conozca más en understood.org/mission.CréditosUnderstood Explica el IEP fue producido por Julie Rawe y Cody Nelson, con el apoyo en la edición de Daniella Tello-Garzón. Daniella y Elena Andrés estuvieron a cargo de la producción en español.El video fue producido por Calvin Knie y Christoph Manuel, con el apoyo de Denver Milord.La música y mezcla musical estuvieron a cargo de Justin D. Wright.Nuestra directora de producción fue Ilana Millner. Margie DeSantis proporcionó apoyo editorial. Whitney Reynolds estuvo a cargo de la producción en línea.La directora editorial de la red de Podcast de Understood es Laura Key, el director creativo es Scott Cocchiere y el productor ejecutivo es Seth Melnick.Agradecemos especialmente la ayuda del equipo de expertos, cuyos consejos dieron forma a esta temporada de podcast: Shivohn García, Claudia Rinaldi y Julián Saavedra.
ADHD and depression
ADHD doesn’t cause depression, but the two conditions often occur together. Kids with ADHD are much more likely to be depressed than kids who don’t have ADHD. That’s especially true as they hit the teen years.Why do these conditions often co-occur? One reason is that ADHD can create a lot of challenges for kids, and those challenges can lead to depression. School and behavior problems can wear down their self-esteem. Trouble with social skills can make them feel isolated.Some people with ADHD may also be “pre-wired” for depression. ADHD involves differences in brain chemistry. And some of these differences may make people more likely to feel depressed. ADHD also often co-occurs with anxiety and substance abuse. Both of these can increase the risk of depression. Researchers are looking into other things that may make kids and teens with ADHD more likely to be depressed. These include gender, family history, and age of ADHD diagnosis.It’s important to take signs of depression or talk of hopelessness seriously. Young people who have both ADHD and depression also have a higher risk of suicide than young people who only have one of these conditions.
Understood Explica el IEPEl IEP: La diferencia entre el IEP y el plan 504
Al considerar la educación especial para su hijo, probablemente escuche los términos IEP y plan 504. La presentadora Juliana Urtubey explica las diferencias. Los términos IEP y plan 504 se usan cuando se busca más apoyo para su hijo en la escuela. Ambos sirven propósitos similares, pero uno incluye muchas más cosas y el otro es mucho más fácil de obtener.Es importante conocer las diferencias entre ambos para que su hijo reciba el apoyo que necesita.En este episodio, la presentadora Juliana Urtubey explica las diferencias entre el IEP y el plan 504, y cuál podría ser el más adecuado para su hijo.Marcas de tiempo: [01:02] ¿Qué es un plan 504? [02:48] ¿En qué se diferencia un IEP de un plan 504?[10:55] ¿Mi hijo puede tener un IEP y un plan 504 al mismo tiempo? [12:42] ¿Mi hijo se debería cambiar de un IEP a un plan 504? [14:15] ¿Qué necesitan saber los estudiantes multilingües sobre el IEP y el plan 504?[16:04] Puntos clavesRecursos relacionados¿Qué es una evaluación de educación especial?¿Qué hacer cuando la escuela reduce o niega servicios? Transcripción del episodioJuliana: Al buscar más apoyo para su hijo en la escuela, es probable que se encuentre con los términos IEP y 504 plan. Ambos sirven propósitos similares, pero uno incluye muchas más cosas y el otro es mucho más fácil de obtener. En este episodio de "Understood Explica", examinamos en qué se parecen estos planes y en qué difieren, y cuál podría ser más indicado para su hijo. Desde la red de podcasts de Understood, esto es "Understood Explica el IEP". Hoy vamos a aprender más sobre las diferencias entre el IEP y el 504 plan. Mi nombre es Juliana Urtubey y soy la presentadora de este podcast. Soy la Maestra Nacional del 2021 y soy experta en educación especial para estudiantes multilingües. A propósito de idiomas, me gustaría compartir que todos los episodios de esta temporada están disponibles en inglés y en español. Comencemos. [01:02] ¿Qué es un plan 504? Muy bien. Entonces, ¿qué es un 504 plan? Antes de hablar sobre las diferencias entre un IEP y un 504 plan, me gustaría explicar rápidamente qué es un 504 plan. Es un plan personalizado que elimina las barreras al aprendizaje de un estudiante con una discapacidad. Puede que usted escuche "cinco cero cuatro", 504 ó en inglés, "five o four". El objetivo es que el estudiante tenga acceso al aprendizaje en las mismas condiciones. Para lograrlo, el plan 504 suele incluir tecnología de asistencia, como por ejemplo lectores de pantalla, audífonos con cancelación de ruido o software de voz a texto. Muchos planes 504 también incluyen adaptaciones, que son cambios a la forma de hacer cosas. Un ejemplo común es tener más tiempo en los exámenes o poder salir del aula para tomar descansos breves. Y algo más que me gustaría decir, es que algunos planes 504 incluyen servicios como terapia del habla o clases de técnicas de estudio. Esto no sucede a menudo, pero estos servicios pueden ser incluidos en un plan 504. Entonces, en resumen, los componentes básicos de un plan 504 son: la tecnología de asistencia, las adaptaciones y los servicios. Es posible que en este momento esté pensando que el plan 504 se parece mucho al IEP. Y tiene razón. Ambos tienen mucho en común y pueden proporcionar muchos de los mismos apoyos. Pero hay algunas diferencias importantes y de esto trata el siguiente segmento. [02:48] ¿En qué se diferencia un IEP de un plan 504?Entonces, ¿en qué se diferencia un IEP de un plan 504? Me voy a enfocar en tres diferencias importantes. Primero, el IEP es un plan de educación individualizado que proporciona servicios de educación especial. Puede que los estudiantes que tienen un IEP pasen mucho tiempo en el aula de educación general. Pero la esencia de un IEP es que la enseñanza está especialmente diseñada para ayudar al estudiante a ponerse al día con sus compañeros. Por ejemplo, un estudiante con dislexia podría recibir instrucción de lectura especializada varias veces a la semana. En el IEP también se establecen metas anuales y se da seguimiento al progreso del estudiante hacia el logro de esas metas. Así que la clave aquí es que un IEP proporciona educación especial. En cambio, el plan 504 no proporciona educación especial. En un plan 504 no hay metas anuales ni seguimiento del progreso. Lo que hace un plan 504 es eliminar las barreras que impiden el acceso al plan de estudio de educación general. En este sentido, un plan 504 puede ser una buena opción para un estudiante con TDAH o con trastorno de la expresión escrita, que no necesita enseñanza especializada, pero sí adaptaciones, como sentarse en un lugar de salón donde haya menos distracciones o mostrar lo que sabe de otra forma. Por ejemplo, a través de una presentación oral, en lugar de tener que hacer un examen escrito. Para explicar esto más detalladamente, les voy a contar de uno de mis estudiantes llamado Brian. Él tenía un plan 504 para ayudarlo con su discapacidad visual. Para crear el plan, hablé con Brian sobre sus necesidades y trabajé con el Departamento de Tecnología de Asistencia de la escuela para encontrar herramientas que fueran útiles. Nos dimos cuenta de que a Brian se le facilitaba escribir y leer cuando usaba un tablero inclinado para elevar el papel. También Brian se beneficiaba de usar hojas de ejercicios aumentadas en lugar de tener un montón de problemas de matemáticas en una sola hoja, los problemas estaban escritos en un tamaño de letra más grande y en varias hojas para que él las pudiera ver mejor. Con estos apoyos, Brian podía hacer todas sus tareas por su cuenta y al momento de redactar el plan, un miembro del personal escolar incluyó mis sugerencias de adaptaciones y tecnología de asistencia. Lo único que nos faltaba para empezar era el consentimiento de sus padres. Y esto me lleva a la segunda gran diferencia entre el IEP y el plan 504. Son regulados por leyes diferentes y el IEP da más derechos y protecciones que el plan 504. Por ejemplo, el IEP se rige por la Ley Federal de Educación Especial, que se llama Ley de Educación para Individuos con Discapacidades o IDEA, por sus siglas en inglés. Esta ley está muy enfocada en la educación. Un detalle sumamente importante es que IDEA considera a los padres miembros igualitarios del equipo que desarrolla el IEP. Pero eso no ocurre en el plan 504. En el plan 504, se rige por una ley de derechos civiles muy importante, llamada Ley de Rehabilitación de 1973. Esta ley prohíbe la discriminación contra las personas con discapacidades en varias áreas importantes. Tiene una gran sección sobre el empleo y una gran sección sobre tecnología. Y también tiene una sección sobre educación. De ahí proviene el nombre "Sección 504". Así que el IEP y el plan 504 se rigen por leyes diferentes, y una diferencia entre estas leyes es en qué medida las escuelas tienen que involucrar a los padres. En un plan 504, los padres no tienen que ser miembros igualitarios del equipo. Las escuelas no están obligadas a involucrar a los padres en la creación de este tipo de plan. Solo necesitan el consentimiento de los padres para empezar a implementarlo. Pero aquí quiero mencionar que a pesar de que no están obligadas a hacerlo, muchas escuelas promueven la participación de los padres en la creación del plan 504. También existen reglas diferentes sobre lo que las escuelas deben hacer para realizar cambios en estos planes. En el caso del plan 504, las escuelas tienen la obligación de informar a los padres de cualquier cambio significativo en el plan. Pero la escuela no tiene que enviar una notificación por escrito. En el caso del IEP, las escuelas están obligadas a enviar una carta a los padres y que se reúnan con todo el equipo antes de hacer cualquier cambio al IEP. Si los padres tuvieran alguna objeción a los cambios, la escuela tiene que mantener el plan existente hasta que se resuelva la disputa. Con cualquiera de estos planes, las familias tienen derecho a solicitar cambios, pero tienen más derechos y protecciones con un IEP. Hablaremos más acerca de los derechos del IEP y la resolución de disputas más adelante en esta temporada. Ahora, veamos la tercera gran diferencia. Es más difícil obtener un IEP que un plan 504. El proceso para determinar quién califica para una IEP tarda más y tiene más pasos. Los estudiantes tienen que tener una discapacidad para ser elegibles para cualquiera de estos dos planes. Pero para obtener un IEP, los niños tienen que pasar por un proceso exhaustivo de evaluación en la escuela. Voy a colocar en las notas del programa un enlace a un artículo muy bueno de Understood que incluye todo lo que necesita saber sobre las evaluaciones de educación especial. Bueno, retomemos. Les decía que para obtener un IEP, los niños tienen que ser evaluados por la escuela. Pero en el caso del plan 504 no es necesaria una evaluación. Por eso el plan 504 es más fácil de obtener, pero es menos probable que incluya enseñanza especializada. Por ejemplo, consideremos a un estudiante que tiene TDAH. Lo principal que necesita para calificar para un plan 504 es un diagnóstico de su proveedor de atención médica. Pero para calificar para un IEP, ese mismo estudiante aún tendría que pasar por el proceso de evaluación completo en la escuela. Lo mismo si se trata de dislexia o depresión, o de una discapacidad auditiva o cualquier tipo de discapacidad. Con un plan 504 se obtiene bastante rápido las adaptaciones y la tecnología de asistencia. En cambio, con un IEP tarda más tiempo hasta que se determina si el niño califica. Más adelante en esta temporada vamos a seguir hablando de esto. Por ahora, solo quiero mencionar brevemente los dos requisitos de elegibilidad para un IEP. El equipo de evaluación tiene que determinar que el estudiante tiene una discapacidad. También que esa discapacidad afecta su educación lo suficiente como para necesitar enseñanza especialmente diseñada. Sé que es demasiada información, así que resumamos rápidamente antes de continuar. El propósito del plan 504 es eliminar barreras en los salones de educación general. El IEP proporciona educación especializada. Se tarda más en obtenerlo, pero proporciona más apoyos, incluyendo protecciones legales y metas anuales. [10:55] ¿Mi hijo puede tener un IEP y un plan 504 al mismo tiempo? ¿Mi hijo puede tener un IEP y un plan 504 al mismo tiempo? Sí, es técnicamente posible tener ambos, un IEP y un plan 504, pero es poco probable que su hijo necesite los dos, ya que el IEP puede incluir todo lo que tiene un plan 504 y más. Por ejemplo, si su hijo tiene un impedimento del habla y TDAH, el IEP podría incluir terapia del habla. También adaptaciones para el TDAH que lo ayuden a reducir distracciones en el aula o comenzar sus tareas. Sin embargo, existen algunas situaciones en las que podría tener sentido tener los dos tipos de planes. Por ejemplo, un niño que tiene un IEP se lesiona, digamos que se fractura la mano y necesita algunas adaptaciones para escribir hasta que se recupera. En lugar de pasar por la complicación de añadir y después eliminar esas adaptaciones de su IEP, la escuela podría optar por proporcionarlas a través de un plan 504. Otra situación en la que una escuela podría usar tanto un IEP como un plan 504, es si un estudiante tiene una condición médica que no afecta directamente su desempeño académico, como una alergia a las nueces. Así que hay algunos casos especiales en los que podría ser apropiado tener ambos planes al mismo tiempo. Pero en general, si su hijo tiene un IEP, mantenga solamente este plan. Es más fácil para usted y para los maestros manejar un plan en lugar de dos. [12:42] ¿Mi hijo se debería cambiar de un IEP a un plan 504?¿Mi hijo se debería cambiar de un IEP a un plan 504? Esto es bastante frecuente y no tiene que ser una desventaja. A lo mejor su hijo ha progresado mucho y ya no necesita la enseñanza especializada. Por ejemplo, supongamos que su hijo tiene dislexia y sus habilidades para leer han mejorado, así que ahora lo único que necesita son ciertas herramientas o adaptaciones, como más tiempo en los exámenes y libros de texto digitales que resalten el texto a medida de que se leen en voz alta. Estos dos apoyos se podrían cubrir con un plan 504, pero si usted piensa que su hijo sigue necesitando enseñanza especializada, usted puede abogar para que se mantenga el IEP. Vamos a tratar esto con más detalle en otro episodio de esta temporada. Por ahora, voy a incluir un enlace en las notas del programa a un artículo de Understood sobre qué hacer cuando la escuela quiere reducir o eliminar los servicios del IEP de su hijo. Otra cosa que quiero destacar es que también es posible cambiar de un plan 504 a un IEP, pero para esto es necesario que la escuela evalúe a su hijo, y ya como vimos, tarda más tiempo en obtener un IEP. Estamos preparando un episodio dedicado a cómo se decide quién califica para un IEP. [14:15] ¿Qué necesitan saber los estudiantes multilingües sobre el IEP y el plan 504?¿Qué necesitan saber los estudiantes multilingües sobre el IEP y el plan 504? Hay dos cosas sumamente importantes que las familias deben saber sobre el IEP y el plan 504 para estudiantes multilingües. En primer lugar, obtener un IEP o un plan 504 para su hijo no aumenta el riesgo de que se apliquen leyes migratorias ni a usted ni a su familia. Es totalmente entendible que las familias inmigrantes teman pedir apoyos específicos en la escuela. Sobre todo si tienen que proporcionar información personal al completar ciertas planillas. Es importante que sepan que todos los estudiantes en los Estados Unidos tienen derecho a recibir una educación pública que sea gratuita y apropiada, sin importar su estatus migratorio. Además, las escuelas son consideradas lugares sensibles. Esto significa que ahí no puede aplicar la ley de inmigración. Hablaré más acerca de este tema en un episodio posterior, dedicado íntegramente al IEP para estudiantes de inglés como segundo idioma. De momento, solo quiero mencionar que cualquier tipo de apoyo formal en una escuela, ya sea a través de un IEP o un plan 504, debe proporcionarse adicionalmente a la enseñanza de inglés como segunda lengua. No hay que elegir entre una cosa u otra. Usted no tiene que elegir entre recibir apoyo por discapacidad o enseñanza de inglés. Si su hijo necesita ambas cosas, puede y debe recibirlas. Bueno, hemos llegado al final de este episodio. Pero antes de terminar, quisiera resumir algunos puntos claves. [16:04] Puntos clavesEl plan 504 está cubierto por una ley de derechos civiles que prohíbe la discriminación contra las personas con discapacidades. El plan 504 elimina las barreras de acceso a la educación general. El IEP está cubierto por la Ley de Educación Especial y provee una enseñanza y servicios diseñados específicamente para niños con una discapacidad elegible. Ambos planes pueden proporcionar adaptaciones y tecnología de asistencia. Y por último, pero no menos importante, la enseñanza especializada es una característica esencial del IEP, pero no es muy común en el plan 504. Y con esto terminamos el episodio de hoy de "Understood Explica". No se pierdan el próximo episodio sobre los mitos asociados al IEP. Acaba de escuchar un episodio de "Understood Explica el IEP". Esta temporada fue desarrollada en colaboración con UnidosUS, la organización hispana de defensa y derechos civiles más grande del país. ¡Gracias Unidos! Si desea más información sobre los temas que cubrimos hoy, consulte las notas del programa de este episodio. Ahí encontrará más recursos, así como enlaces a los temas mencionados hoy. Understood es una organización sin fines de lucro dedicada a ayudar a las personas que piensan y aprenden de manera diferente a descubrir su potencial y progresar. Obtenga más información en understood.org/mission.CréditosUnderstood Explica el IEP fue producido por Julie Rawe y Cody Nelson, con el apoyo en la edición de Daniella Tello-Garzón. Daniella y Elena Andrés estuvieron a cargo de la producción en español.El video fue producido por Calvin Knie y Christoph Manuel, con el apoyo de Denver Milord.La música y mezcla musical estuvieron a cargo de Justin D. Wright.Nuestra directora de producción fue Ilana Millner. Margie DeSantis proporcionó apoyo editorial. Whitney Reynolds estuvo a cargo de la producción en línea.Laura Key es la directora editorial de la red de Podcast de Understood, el director creativo es Scott Cocchiere y el productor ejecutivo es Seth Melnick.Agradecemos especialmente la ayuda del equipo de expertos, cuyos consejos dieron forma a esta temporada de podcast: Shivohn García, Claudia Rinaldi y Julian Saavedra.
Signs of depression at different ages
Depression isn’t uncommon for kids who learn and think differently. Depression often runs in families. But even for kids who don’t have a family history of depression, the ongoing challenges they face in school and life can take a toll.Depression is more than just feeling or seeming sad. It can affect kids in many different ways. Even at young ages, kids who are depressed might talk about wanting to harm themselves. It’s important that you take this behavior seriously and seek medical attention right away.This checklist includes signs of depression you may see at different ages. Every parent or caregiver will notice a few of these behaviors from time to time. But if your child starts showing many of them, don’t wait to talk to your health care provider.Signs of depression in preschoolSeems to have lost skills and gone backwards. Might use baby talk again or resume thumb-sucking.Has returned to having separation anxiety.Has become aggressive.No longer likes to play. Withdraws during playdates and puts up a fight about going on them.Goes off a regular sleep schedule. Might start napping at odd hours throughout the day.Is sluggish during the day.Is losing weight. Might have no interest in treats or in what’s being served at meals.Signs of depression in grade schoolFrequently complains about aches and pains, but nothing’s physically wrong.Has a negative outlook on life in general.Talks often about feeling sad or lonely, despite having friends.Talks about being bullied, even when there are no signs of it.Does much worse in school or in sports. No longer cares about doing well in anything.Loses interest in daily activities. Says things are “boring.”Spends most free time on the couch in front of the TV.Isn’t gaining weight at a time when kids are growing rapidly.Signs of depression in tweens and teensSeems distant. Has closed off emotionally to family and friends.Spends a lot of time behind closed doors.Seems uncharacteristically irritable and angry. Loses it over little things.Often lashes out in anger, including physically.Talks about feeling stupid, worthless, or hopeless.Thinks one bad outcome means everything else will be a disaster, too.Obsesses about shortcomings.Feels hopeless about the future.Is acting out with risky behavior.Has had dramatic changes in daily habits. Might start to binge on junk food or skip meals.If you’re noticing many signs of depression in your child, don’t hesitate to reach out to your health care provider. Read about why kids who learn and think differently might feel lonely. And if your child has ADHD, learn about the connection between ADHD and depression.
ADHD Aha!Depression, relationships, and the myth of the ADHD “superpower” (Max’s story)
Max Willey’s ADHD diagnosis has led him to a more stable life — and to seeing ADHD as a “glorious curse,” with downsides and upsides. Max Willey, an expat living in Norway, often found himself overwhelmed by complex tasks as a kid. There were too many moving parts, and his brain was always racing too fast. A teacher thought he might have ADHD. But it wasn’t until adulthood that Max was diagnosed “by accident.” He was feeling depressed and was struggling with some relationships. When he sought treatment, he was diagnosed with ADHD, anxiety, and depression all at once. Max felt relieved. And he’s come to see ADHD as a “glorious curse.” It has its downsides — but also allows him to feel and do wonderful things. Listen in as Laura and Max unpack this and more. Related resourcesADHD and creativityTrouble getting work done is real. Executive function challenges may be the culprit.ADHD and depressionEpisode transcriptJessamine: Hi, everybody. This is "ADHD Aha!" producer Jessamine. Before we get into the episode, I wanted to give you a heads-up that our guest, Max, shares his experience with depression. And there is a brief reference to suicidal ideation. Max's telling of his journey back from that dark period is important to his story, and we hope you will find it as insightful as we did.Max: Just recently, the realization that came to me was that I don't need to turn everything up to 11 in order for it to count. Sometimes it just needs to be showing up. These little things — they count. More than the gigantic, titanic, Herculean efforts. And with that, it's very liberating.Laura: From the Understood Podcast Network, this is "ADHD Aha!," a podcast where people share the moment when it finally clicked that they or someone they know has ADHD. My name is Laura Key. I'm the editorial director here at Understood. And as someone who's had my own ADHD "aha" moment, I'll be your host.I am here today with Max Willey. Max is a content and video producer and expat living in Oslo, Norway. Max is also a listener who wrote in. And one of the things that stuck out to me in the letter that he sent in to our "ADHD Aha!" email address was that he referred to ADHD as a glorious curse. Welcome, Max. Thanks for being here today.Max: Thank you for having me. It's a pleasure.Laura: Let's get started with when were you diagnosed with ADHD? What was going on?Max: The official diagnosis occurred when I was 31.Laura: So that was a few years ago.Max: A few years ago. Unofficially, my first-grade elementary school teacher picked up on some unattentiveness, inability to complete tasks. And that was brought forth to my parents, but nothing was really done.Laura: Tell me more about what led you to get diagnosed when you were 31.Max: Well, let's see. The childhood symptoms were, I mean, a touch of hyperactivity. The main thing I remembered from kindergarten was just that complex instructions were very difficult, and I lost interest very quickly.But at the same time, I felt that everyone around me was going so slowly. Like, if it was something that interested me, then I just soaked it up like a sponge. If it was animals or planets or facts about UFOs, I just ate that up.But if it was following through on complex things, then I was hopeless. I still remember the very first project I didn't complete. It was the, you know, those little hand printed — like you traced your hand for the turkeys for Thanksgiving?Laura: Yeah.Max: There were just too many moving parts for me to really wrap my head around. I was like four and a half, five years old at that time. And I just remember having this uncompleted turkey on my desk for a week. It just sat there and it was this constant reminder of my first failure.Laura: Wow. That's kind of amazing how vividly you remember that.Max: It just stuck out to me. Perhaps because, like, I've gone back in my mind so many times, I've ruminated so many times about these things and just been like, that was a sign and I should have seen it.I remember reading comprehension and math were also big issues because it just felt like everyone was running circles around me. I just completely did not get it. Until I was put in — this was in third grade — I was put in remedial reading and math. And they just took everything at a snail's pace. And I just remember, wow, this is fun. I can do this.Laura: I wonder if there was a struggle with reading and math, or if it was the effort that needed to go into learning — the kind of, the ADHD symptoms around that? Or maybe a combination of both. Have you struggled with forgetfulness?Max: Oh, yes. That was one of the things that drove my mom crazy in particular. It has been a specter over my life — forgetfulness. And like it just built up to such a state where, like, sometimes I would forget a piece of paper. I'd forget a piece of homework. I would forget to do this thing, or I would forget that. I mean, all throughout my childhood.And it drove my mother crazy. She would ask me, "Why did you do this?" or "What happened?" I would tell her "I forgot." And she would either mock me and say "I forgot! I forgot!" like that, or say, "Max, I'm going to get you a tombstone. And it's going to say 'Max Willey, I forgot' on it."The problem was, I thought it was normal for parents to do that to their kids. It's been a point of contention for not just me and her, but me and other people. Forgetfulness is a big issue that I've had to tackle.Laura: I think a lot of times when we talk about people with ADHD and we talk about forgetfulness, I think what we're really talking about is trouble with working memory, which is related to executive functioning issues. People with ADHD, their brain makes it harder for them to have strong working memory.So you've been carrying around this information that you had been identified as potentially having ADHD when you were a kid. You remember these struggles. So what led you to get evaluated for ADHD as an adult? What was the turning point there?Max: Well, it happened actually by accident. Because I was originally being treated for depression. There was a period between 2016 and 2019 where I had a serious personal decline. I was stretching myself thin with freelance work. I was working with someone who was very cynical and exploitative, working for them almost every day, on top of working nearly full time at a part-time job. And also starting a master's degree, which I didn't finish.It was a lot. And throw in multiple failed personal relationships into the mix. That pushed me over the edge. But it was a slow decline, I would say, from the early 2010s. And I just got to a point where I was showing all the classic signs of depression. Lack of interest in things, rumination, ideation of suicide, poor sleeping habits, poor eating habits, not exercising. It all just balled into one.And I was just like — I was in such a hole that I was just like, I can't keep going on like this. I need to get help. And so I went to the doctors. My general practitioner told them what was happening and they immediately fast-tracked me to a therapist's office. I was screened for different symptoms, and they identified ADHD. Plus generalized anxiety and depression.Laura: How did it feel? That's a lot of diagnoses to receive at one time. How did that feel?Max: I felt actually relieved. As crappy as I was still feeling, I was happy that I was getting help. I have this range of like mood from like 100 being like, you're living your most ideal, perfect life. It's heaven. Zero? Dead. You're gone. You don't exist. Like I went from 40% to at the end of the treatment, around 70%. So far, more stable. Still a long road ahead.I went through group therapy for ADHD. I actually met some people that I knew that I was surprised that they were there. I was like, What, you're here? You're one of the best people in your class. Like, that's a surprise. And they're like, Yeah, like, likewise. You know, I just. I didn't expect you to be here. It was fun to have that kind of camaraderie. And it was very nice to know that a lot of the symptoms that I was having were quite normal.Laura: Right. And to see them and people, it sounds like, who you admired or were in your eyes high achieving. Probably a good reminder that you can thrive with ADHD.So one thing I remember, Max, when we had our initial interview, you were like, my view of ADHD isn't all sunshine and roses, right? I remember you talked about the glorious curse, which I guess isn't totally a negative thing because you've got this word "glorious" there. I want to hear you articulate what you mean by ADHD as a glorious curse.Max: Absolutely. In my research of ADHD, I have heard more people than I can count call it a superpower. And the term just seems so saccharine sweet and just so like Oh, we're going to have fun. Whee! You know, just like — and I just was like, it's not a superpower. I mean, it's a curse.Because here's the thing. The glorious part is it opens up vistas of creativity and energy and dynamism that people just don't understand. Like when you are fired up, you get fired up. You just can do all the things. You feel like you have divine inspiration. The gods have just shone down a light upon you, and you are at the very center of what you were meant to be. It shows you that, off in the distance, off on the horizon. This glorious city in the clouds.But between you and that is a deep valley of sharp rocks and obstacles that you have to get through to get there. It's like the ADHD part oftentimes makes it impossible — or not impossible, but just very, very difficult and tedious to get there. So that's where the curse part comes in.It's glorious in that you can see the potential of who you can be, or even just things that just light your heart on fire. Brings out the best in you. But at the same time, it's like trying to sprint up a mountain with the ball and chain. So that's how I feel about that.Laura: Very — really beautiful imagery that you use to describe that, too. It really resonates with me. I feel like a good manifestation of this glorious curse is something that you described to me when we originally talked, which you actually had mentioned as being a big "aha" moment for you: writing your thesis.Max: Yes. I took my very first bachelor in humanities at the University of Oslo. And usually you have a year and a half to do your thesis. They clear your schedule and they just say, Just do that. And I took almost three years to get it done, because it was all of the things that hamper completing a task through — following it through.It was just the task was a bit complex. I was doing it by myself. And the longer I went without contacting my advisor, the more pressure I felt to deliver. And also fear of his wrath that was just building exponentially with every week, with every unanswered email. I just felt the pressure increase. And so I delayed. And I finished it and handed it in four minutes before the deadline. And that was my last chance.And one of the biggest symptoms, one of the biggest things that stood out to me was — aside from the things I mentioned, where the putting the pressure on myself and expectations from my advisor and just this pressure to deliver this perfectionism — was it again boiled down to my reading comprehension was too slow for my brain. And it — just like sitting there in a quiet environment, just like reading sentence after sentence. And then just my brain felt like I was holding my breath underwater. And you know that feeling when you just try practicing holding your breath for as long as you can, and it starts burning in your lungs? That's what it felt like in my brain.So it was frustrating. It was very, very difficult. It was a topic that I loved, too. And it was it was just so interesting. But the thing is that when you get into the nuts and bolts of it — doing the actual work — that's when the passion can evaporate. That's when you'd be like, I have to set up a schedule to actually do these things. I have to write two pages a night. It turns into work. It goes from being a passion and an interest to being an obligation.You know, a lot of people can say like, Oh, that's childish. Then you're not serious enough. Or you know, grow up, which I've heard before. But it's like that's the point for a lot of people where they fall off. And then it's like, I can't do this. I'm giving up.Laura: This race to the finish line. Handing in your thesis four minutes before it's due. I mean, that to me is exactly what you described with the glorious curse. You're sprinting up a mountain with a ball and chain. All of this was happening during what you called that decline time period that led up to your ADHD diagnosis, right?Max: Just before, I would say. Like it was this in-between phase where I graduated from my second bachelor, in media and communication studies. It started around there where one personal relationship ended very badly. And then I just had a string of bad relationships. And it really affected me because I had a lot of guilt.But the depression part — one of the main like points where I've ruminated on in that dark period was just like, You never follow through. You never complete tasks. You're never going to be anything. You are going to be surrounded by a graveyard of dreams. And that's essentially what I was feeling at the darkest points. It was like being awake at three in the morning. So tired but my brain is just on. And I was just thinking of all the points in my past where I could have changed things. Or thinking about how I'm never going to amount to anything because I never complete anything.Laura: Wow, that's really powerful. So you've got anxiety and depression kind of feeding off of and ruminating on what are essentially ADHD symptoms. So you're ruminating about your difficulty with these kind of every day.Max: Yes.Laura: Executive function skills, completing tasks.Max: And even up until that point, before my diagnosis, I just thought it was a personal failing. I just thought it was me. I had notes dating back to like 2011. Like "goals for my life" type thing. One of which was "Learn to be consistent. Follow through on tasks." Like on sticky notes I would have on my chalkboard.Laura: Oh my gosh, I did the exact same thing.Max: Yeah. God, why are we like this?Laura: Well, these like, giant ideas I've evolved from, you know, sticky notes to, like, emailing them to myself because that doesn't put any pressure on you to have an email to yourself that says, "Figure out next five years." Or like, "Get better at focusing" or whatever. It's like kind of this all-or-nothing approach, right? Where it's like we're not allowing ourselves — maybe because it's so difficult to break down tasks — we're not allowing ourselves to take these things in chunks. And instead it just looks like this big, giant gray cloud of things we will never get to.Max: The I think most destructive aspect of it, from what I've experienced, is like the older you get, the more that you rely on friends, on your financial stability, your health. And all of these things needs to be maintained. So I mean, that has always been a challenge for me.And like especially in the last few years when I was diagnosed with depression, you know, there are times where you just want to vent to a friend. You just want to meet up with someone that you feel safe with. And you just want to talk about everything that's on your mind, talk about what's in your heart.But for me, that was difficult because I realized that I have not maintained friendships, because I was under the presumption that if you get along with someone, you know, that connection will be there. Right? And I mean, at least in my twenties, I never really considered that maintaining friendships required effort. I always was under the presumption, very naive presumption, that like, oh, we've got chemistry. It'll come back like that. No.And that really was a bitter awakening in the last few years, just wanting to talk to someone who isn't your therapist, who isn't your significant other, who is not your parents, and just dump all of the stuff out on a table. And not just like talking about your problems, but also growing, you know, becoming an adult parallel with your friends. That's something that, you know, is very, very important, I think. And no one tells you that you have to maintain friendships. Growing up, at least no one told me. So that's — that was one of the things that really hit me in the teeth.If you find people of value in your life, you do need to touch base with them often. It's just I've never been good at consistency. So it's more of just the repetition of that effort has always been difficult, because then that falls into the routine. It's less novel and interesting, and it just kind of falls into the routine. Like the thought of maintaining something is just like, ugh, work. It's automatically in a work category and then it no longer becomes fun. I mean, this limiting mindset, that's kind of how I approached friendships for a while.One of the things that I realized just very recently, and this has been in due part to therapy, is that the reason why I was so averse to things like maintaining effort, maintaining fitness, or maintaining financial health or, you know, maintaining friendships, is that my presumption of what it takes to do that work has always been skewed. It has been contaminated by a perfectionist mindset, an all-or-nothing mindset, that any effort that you do has to be turned up to 111 in order for it to count.And with that corrupted mindset, every time I thought of doing work to maintain these things, I immediately was just like, I'm too tired. I cannot do this. Because I assumed that the effort it took was this monumental effort. But something that my therapist told me was that — it was more of a rhetorical question. She asked me, like, with those things, those assignments at work or the effort it requires to maintain certain habits or hobbies. Could you have done any better there and then with the knowledge that you had? And I was like, obviously not. I mean, I did the best I could. And she's like, There you go. You did the best you could with the knowledge you had.And that changed my mind is that maintaining things, half of the battle is showing up. And just recently, the realization that came to me was that I don't need to turn everything up to 11 in order for it to count. Sometimes it just needs to be showing up. Or sending a message to a friend. Sending them a funny meme or gif or saying, Hey, what's up? You know, just like what's new in your life? These little things, they count more than the gigantic, titanic, Herculean efforts. And with that, it's very liberating. And with that, it's more hopeful, I think.Laura: So, Max, you're here talking with me now, which means that you have a level of self-awareness. You're aware of your diagnoses. You're aware of what you're struggling with. I know that you've got coping strategies in place now. And am I right that you even can joke about some of this now?Max: Oh, yes. Oh, yes. I mean, that's the best part is just like my girlfriend. We've been together for five years, and she knows better than most the struggles, but also the humor. And we joke constantly about it. Early in our relationship I told her that, like, I envision my ADHD as a tiny baboon in a control center. He's watching stuff on his phone or got like 20 tabs open. And he's just like going from one thing to the next. He pushes a button here and there. Or he gets hyperfocused on one thing and just like lets the whole thing just melt down.It's easier sometimes to laugh at it — only if you are trying to fix it. Like if you're trying to actually deal with it, then yeah, sure, you can laugh. That's the thing. Like now I'm a grown-ass man, you know, it's on me to fix this.Laura: Do you need to fix it, or do you need to cope?Max: Well, I mean, yeah, maybe a little bit of both. You know, find strategies that work.Laura: I like that better, Max. You use the language that you want, but I like that better. I'm just telling you.Max: Yeah, OK. Healthier.Laura: Max, it's been really nice to talk with you today. I really appreciate your perspective. I love the imagery, the beautiful images that you use. And I appreciate your realism. I think it's necessary.Max: Thank you for this opportunity to talk with you. Just one parting point I think I'd like to make is just that life can be very beautiful with ADHD. I'm not trying to have this like, "oh, poor me" type mentality, you know. And it can be a very powerful tool if wielded correctly.My hope for other people is that they do have an opportunity to find a balance between the gloriousness of the curse so that they can actually get to those perfect vistas that they envision for themselves.Laura: You've been listening to "ADHD Aha!" from the Understood Podcast Network. If you want to share your own "aha" moment, email us at ADHDaha@understood.org. I'd love to hear from you.If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode.Understood is a nonprofit organization dedicated to helping people who learn and think differently discover their potential and thrive. We have no affiliation with pharmaceutical companies. Learn more at understood.org/mission."ADHD Aha!" is produced by Jessamine Molli. Say hi, Jessamine.Jessamine: Hi, everyone.Laura: Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. For the Understood Podcast Network, Scott Cocchiere is our creative director, Seth Melnick is our executive producer, and I'm your host, Laura Key. Thanks so much for listening.
Dyslexia and depression
Kids with dyslexia are more likely than other kids to have depression, especially as they reach their teen years. (Depression is also common in kids with ADHD.) Why do dyslexia and depression often co-occur in young people, as well as in adults? Researchers point to a few reasons:Stress: Dyslexia makes going to school stressful because nearly every class involves at least some reading. And chronic stress makes people more likely to develop depression. Low self-esteem: Trouble keeping up with schoolwork can wear down kids’ self-esteem. They may start to think they aren’t smart or that they need to hide who they are.Social isolation: Some struggling students would rather skip school or get sent to the principal than be embarrassed in front of their peers. This can lead to feeling isolated.Co-occurring conditions: Many people with dyslexia have co-occurring conditions, like anxiety or ADHD. These other conditions can raise the risk for depression. With the right support, young people with dyslexia and depression can manage these conditions and thrive. Keep reading to learn what depression looks like in kids — and find out how to help.
ADHD Aha!ADHD and depression (Josh’s story)
Josh Maxwell is a pediatrician with ADHD. An experience with a patient, and his own experience with depression, paved the way for his ADHD diagnosis. Pediatrician Josh Maxwell had two “aha” moments that led to his ADHD diagnosis. One came from talking with a teenage patient whose ADHD symptoms were different from what he’d seen in other patients. It wasn’t that the teen couldn’t pay attention, but rather that they were paying attention to everything all at once. Josh related to that feeling. Josh’s other ADHD “aha” came from his experience with depression. After starting antidepressants, he could more clearly see his own ADHD symptoms. Now, the coping strategies he’d put in place for himself, the masking, and even the childhood poem he wrote about fidgeting made perfect sense. Listen to this episode of ADHD Aha! to learn what Josh would rename ADHD, and why pediatrics is the only specialty for him.Related resourcesADHD and depressionHow attention worksShould I get tested for ADHD as an adult?Episode transcriptDr. Joshua Maxwell: My first big "aha" moment was with one of my patients when he came in for an evaluation of ADHD and did not meet the classic criteria, saying "It's not that I can't focus, it's that I focus on a million things at once," and realized that I do the exact same thing.Laura: From the Understood Podcast Network, this is "ADHD Aha!," a podcast where people share the moment when it finally clicked that they or someone they know has ADHD. My name is Laura Key. I'm the editorial director here at Understood, and as someone who's had my own ADHD "aha" moment. I'll be your host.I'm here today with Dr. Joshua Maxwell. Josh is a pediatrician based in Utah who's also a listener who wrote in. Welcome, Josh. Thanks for being here today.Josh: Thanks for having me.Laura: And for our listeners who obviously can't see us, I have to say that Josh is in his scrubs, this all feels very legit. Thank you so much. Thank you for listening. Thank you for writing in to tell us about your "aha" moments. And I think to get started, let our listeners know, when did you get diagnosed with ADHD?Josh: So, it's been very recently, actually just a couple of months ago, back in February of this year. So, I guess it came more of like a surprise diagnosis, but it all makes sense now.Laura: When you wrote in, you mentioned that you had two "aha" moments and I kind of want to take those one by one. So, would you mind starting with the first ADHD "aha" moment that you had?Josh: Yeah. So, I would say my first "aha" moment was more in a professional setting as a pediatrician. I diagnose patients all the time from, you know, young kids to teenagers. But for some reason, I felt like I could recognize ADHD pretty well. In our training, we're not well taught in ADHD, I guess. I mean, it comes up as like, "Here's the diagnosis, here's how you treat it," all of those things. But we're not taught how to, like, actually recognize it and then diagnose it.So, it's something that I felt very comfortable with that as I've seen more and more patients, it's just kind of come along. And so my "aha" moment came when I was talking with a patient and he wasn't meeting the classic criteria of ADHD. He wasn't the hyperactive kid bouncing off the walls. He was more of the kid that was just had a really hard time paying attention in school and said, "I don't know what's going on. Let's figure this out." So, we were going down that road.The biggest thing that stood out to me was when he said, "It's not that I can't pay attention. I'm paying attention to literally everything." And I was like, "Wait a minute, I do that to that. Doesn't everyone do that?" And so, when he was saying that, I'm like, "Oh, well, that's him. I guess I handle it fine myself. But since he can't pay attention, great. We'll start. We'll go down that line. And he did meet other criteria for ADHD. We started him on treatment and then it was like a night and day difference for him. He was like, "Wow, I can focus. I don't have to just be distracted by everything going on."So, yes, that was my first "aha" moment as a pediatrician, realizing that there's more to ADHD than just the classic DSM-5 criteria.Laura: So, would you say that in patients who you diagnosed prior to that, they were always showing up with these classic symptoms and you didn't recognize the symptoms in yourself?Josh: Yes, I think it was very easy to recognize the classic ADHD symptoms because that's just what we were taught. And I don't think I personally meet those classic symptoms myself either based on the official DSM-5 criteria.Laura: What are those classic criteria? Can you rattle them off?Josh: Based on my training, the classical criteria shows up as the hyperactive kid who can't sit still in class, who can't pay attention, who can't organize themselves, and is just seen as the kid who's always off daydreaming.And when you really get down into the weeds outside of the official DSM-5, you realize that a lot of those classic criteria come up because of the other things that are actually going on.It's not that you can't pay attention. You're paying attention to a million things at once. It's not that you are hyperactive per se. It's you're distracted by something that you just want to pursue. Those kinds of things, I feel like are just lost in the weeds or not like on the surface of the DSM-5 criteria.Laura: In particular, what that patient said to you, a teenager, you said that teenager said to you, why did it resonate so much with you? Can you give me an example of how you feel like you're paying attention to everything all at the same time?Josh: Yeah, I feel like it's the first time that anyone had ever described ADHD that way. Again, not the fact that you can't pay attention to anything. It's that you're trying to pay attention to a million things at once.So, for me, that's been my whole life. As soon as I walk into a restaurant, I can see everything that's going on. I can hear everybody's conversations, the lighting, whatever it might be. And then just because of that, I can't even have a conversation with the people right in front of me. I thought that was just a personality thing.Laura: Let's move on to your second "aha" moment. What? Because after you had this "aha" moment, you didn't get diagnosed, correct? You didn't go get evaluated or even self-evaluated. Sounds like something else happened.Josh: Right. I would say that's probably because I just checked that office. I don't meet all of the other criteria necessarily. That's just a personality thing, like I said before. But the second "aha" moment was a very personal one and it's still kind of ongoing and I want to just kind of approach the way I say this very carefully. I don't want to hurt anyone's feelings that I'm close to.It came with relationship struggles, which I know is common for people with ADHD. In my own relationship, I thought everything was fine. We were going good, like we were progressing in our careers, all of these things. But there's always been a piece where it's like, I'm not doing the right thing in the relationship. I'd sit down and have a conversation with my wife, and it would be like, "Well, here's the things I need from you." I'm like, "OK, got it, let's do it."And then I would go work super hard and try and do all those things, realizing that I wasn't actually doing what she wanted me to do. But I was really good at doing like the dishes or something, you know, or really good at keeping certain parts of the room clean when it was really something else that she wanted. So, I feel like I was always failing in that regard.But it got to the point where just our relationship struggles were too much and to call it what it is, I was depressed. Like I was diagnosed with depression. I had thoughts of ending my life and it all culminated in her saying that she wanted to separate. And it all kind of came crashing down at that moment when I approached my own doctor and said, "Hey, here's what's going on. I'm feeling very depressed. I don't feel like doing anything that I usually like doing." And usually, I'm a very active person and I had no interest in doing anything.She diagnosed me with depression. We started medication for depression. And then that, it's almost like that's when my like I was able to actually see myself for the first time. And that was like my real "aha" moment where, yes, like I was definitely depressed, like I had depression and treatment was appropriate in that setting, but it wasn't the depression that was the ultimate cause.So, then after I was able to actually see myself and what was going on, I could see what was actually happening with regards to ADHD, started going down that path and then it led me to my ADHD diagnosis.Laura: Thank you, first of all, for sharing all of that, for being so candid. Number one, I imagine that can't be easy to share. And number two, I think that it just speaks volumes about you, your openness about mental health. I imagine that that seeps out in your practice as a pediatrician. I said it's a great thing for your patients.Josh: Yeah. Thank you.Laura: So, what was it about receiving depression treatment and taking antidepressants? What were you able to start noticing more? What specifically in relation to ADHD?Josh: I mean, I hear a lot from people who get a late diagnosis of ADHD that I've heard on podcasts or read in books or whatever, that they were wrongly diagnosed with depression or anxiety or something else. I don't think that's always the case. I don't think it's the wrong diagnosis. I think it's just that ADHD was the underlying factor, and the treatment and approach in that setting was probably appropriate, like it was in my case, like treating my depression was totally appropriate.But then I had more self-esteem, more positive outlook on myself, which then allowed me to see that, you know, all these personality traits or what I call them, that it was OK to have them. It's almost like I could take my mask off. I think that's really what it comes down to, that it was OK that this was me, that I was doing those things, but the treatment allowed me to see that for the first time.Laura: Do you still have a depression diagnosis, or was it determined that you had been misdiagnosed and it's instead ADHD? Or is it both?Josh: It's definitely both. And there's a lot of crossover. But the initial treatment that I was on for my depression, we've brought that dose down significantly. And in my personal experience, like keeping that treatment for now is helpful just because of what's still actively going on with my relationship, that things do come up and it does trigger me, and it helps kind of keep my overall mood stable, so to speak.But the main driver in my case is the ADHD and treating that has been what's been most effective.Laura: It kind of reminds me of my own experience getting diagnosed with anxiety and then I reluctantly looking back, I wish I hadn't been so reluctant, but I reluctantly agreed to go on anti-anxiety medication that kind of cleared the air and it helped me discover my baseline.Josh: Yes.Laura: Once you were getting treated for depression, what were the ADHD symptoms that you were noticing the most?Josh: It's kind of funny because, I mean, I grew up kind of in a family where it was more just like, "Be happy. There's no reason to be sad, there's nothing wrong, everything's fine." And so, I put on that mask from a young age that like, "Oh yeah, I'm happy, I'm good." And so compensated and masked for almost my whole life. And I didn't realize that I was doing that until my depression diagnosis. So, it's really interesting.Like my baseline, I would say I make connections with things that seem pretty random. I like to move a lot. Again, like I said, I'm not the classic bouncing-off-the-wall person, but it might have been because of I've always been active, played sports, keep an active lifestyle, so that doesn't necessarily come out. I feel it's more my mask came off and I could see myself for who I truly was, and I could see that it was OK not to mask who I really am.Laura: You have coped with some fidgeting, so it might not be like classic hyperactivity of the roughhousing and bouncing off the walls, but maybe some restlessness and itchiness.Josh: Yeah, like a funny story that, I don't know why no one picked up on this, but in junior high we had to write a book about something or do a comic book. I don't even know why, but I wrote a book about clicking a pen.Laura: No way. Whoa, whoa, whoa.Josh: It was my poem. I think it was seventh or eighth grade. My teacher would always tell me to stop clicking my pen. And then because of that, I wrote a book. I think it's like "Tom clicks with his finger, Tom clicks with his thumb, whatever he clicks with, he always has fun." And I wrote a whole poem about fidgeting.Laura: Are you joking with me?Josh: No, no.Laura: I love when these little nuggets are unearthed of like, it was just sitting there all the time. I keep referencing my own story — I'm sorry for everyone who's heard this a million times; they must be so bored — but I remember going back to my journals from when I was a kid and seeing the word focus scribbled everywhere and I'm like, "My God, it's right there." You wrote a poem about fidgeting.Laura: I'm always interested to hear about how people who diagnose other people with ADHD, about how they get diagnosed with ADHD. So, I don't think we've talked about that yet. Can you tell me what you did and how it became official?Josh: As a physician, I have access to all the screener's questionnaires. I know where to go to find all of the answers. And it's something that we hear all the time as doctors from each other, like be careful not to diagnose yourself, like have your own physician. All these things just so that you can take the bias out of it. But I still started that process myself, of course.So, starting with depression, like, I recognized that those symptoms were happening. And so, I did the questionnaires that I would give my patients. I did the questionnaires that are available for adults. And I took that to my doctor and said, "Look, this is where I'm at. Do you agree with this?" Which I think was very helpful and it's the right thing to do. And she said, yes, absolutely. Like you meet all the criteria. She rescreened me with her own things and it all matched up. So, that was good.And then after that diagnosis, in the months between the depression diagnosis and following up with her, just to make sure that the medication was OK, in that process, I started to think about ADHD because things were popping up, you know, on my feeds, on social media and stuff. And I was like, "Wait a minute, hold up. Yeah, that makes sense. That makes sense." And took that to her, and I said, "Well, what do you think about ADHD?" And I had done some of my own screeners just to see and I checked the boxes and like, "Well, I don't really do that. No, I don't do that." But then I realized it's like, "I don't do that because I have a system. I don't do that, but I compensate really well in this way."And then when we took that away, she's like, "You meet all the criteria." But she didn't officially diagnose me. She wanted me to then go to a psychiatrist or someone like more trained than her in diagnosing mental health like ADHD. And so, I set up an appointment with a psychiatrist.And then between my primary care doctor appointment and the psychiatrist appointment, which was about a month, I totally went down the rabbit hole of ADHD. I found every single questionnaire out there. I hyperfocused on how to diagnose ADHD properly. I had every single questionnaire that I took to that appointment and said, "Look, this is ADHD. I totally have it. What do you think? Here you go." And then she's like, "Yeah, it's pretty obvious.".Laura: Wow. OK, first of all, shameless promotion. We just had the second season of Understood Explains podcast, which is all about ADHD diagnosis in adults. So, people check that out.Josh: I listened to it. It was good.Laura: Oh, you did?Josh: Yes. I agree with those recommendations.Laura: All right, we're done Josh. No, I'm just kidding. I'm so, so interested in this notion of symptoms getting missed because you have a system in place that must be so common for adults. And probably the reason a lot of adults don't get diagnosed is the systems in place. Is that what you meant by masking?Josh: I think it's both. It's both masking and compensating really well. So, I would say like, do you lose things like keys or your wallet? It's like, No, I don't lose those. Like, I put them in the same place every single time. When I get home, they're always there. So, that's my system. Like I don't ever lose my keys, but I also have a locator app. If I do lose them, I can find them. It's like I don't lose my keys. I have two or three systems in place, so I don't because when I can't find my keys, then the whole world collapses.Laura: And because you were losing them in the past?Josh: Yeah. And thinking back on my younger life in college, I left a laptop on top of my car and drove away.Laura: I'm sorry I'm laughing.Josh: So, yes, these things have happened. I just didn't realize that because I had created systems around it.Laura: You chose pediatrics because it better suited your ADHD. Is that true?Josh: Yes. It's different for everyone. Some doctors with ADHD work in like a high-intensity situation, like an emergency room. That wasn't for me. It's not only ADHD, I think in general, I'm a sensitive person, which is very common with ADHD as well. But that high-intensity setting, especially emergencies, ICU settings like I could not handle those, those were the most difficult times of my training was when I was working in those high-intensity emergency hospital-based situations where it was literally life or death and seeing plenty of death in my training.Like I was very sensitive to that but had to mask so hard the fact that like I was about to lose it, you know, but just had to go to the next patient, pretend like nothing happened, like I couldn't do that. But in a less intense setting, like hospitals, everyone talks about like hospital rounds, like you go around with the team to each patient. I might know everything about my patients that I was taking care of, but as soon as someone asked me a question about them like that, it was gone. My working memory was, it just left.So, that plus, like if you were working on a task or writing your notes, documenting about a patient and you get interrupted by a nurse or someone from the team about another task for another patient that needed to get done, it was that task transition, that task switch that I just couldn't do. I couldn't go bouncing back and forth from one thing to another to another and try and keep organized everything else that I needed to accomplish for the day for the patients I was taking care of.That setting was awful for me, and it was even worse in an ICU setting where there's alarms going off constantly. There's one patient in one room where something's happening and everyone has to go there or there's I mean, there's always something going on. And if you're trying to get work done, then it's really hard to focus and tune out those distractions to be able to do anything.And even in those intense moments where it's like, you need to be focused, you need to be able to pay attention to what's happening. It was very difficult because of how much was going on to focus on one thing at a time.Laura: Right, right. And like you said, it all depends on what your unique symptoms are and how they manifest, because I imagine for some people with ADHD, working in an intensive care emergency room and the constant urgency might be a great driver for them.Josh: Right. And the worst part about all of that wasn't the fact, — like I think I took very good care of my patients; I always tried to do that — it was the fact that the other members of my team, especially those in charge of me. Comparing me to others potentially. Like I got a lot of negative feedback about not being able to do a million things at once in the hospital setting.And I like that was really, really hard for me. I felt like a failure throughout my entire training, except in clinic setting where I could actually like organize myself. I could take time with my patients, I could look ahead to the schedule, and I thrived in that setting. And so, everyone knew that I hated hospital work, but I was known as like the clinic guy.Laura: How long have you been a pediatrician?Josh: I've been out of residency for about two and a half years now.Laura: Now that you've been diagnosed, do you ever look back to patients who you saw even earlier in your career like, "Hmm, now that I have more context, I wonder if that could be ADHD."Josh: Not as much like in my training, but even with my patients now, who I see for follow-up regularly where it's like we did diagnose them with something else and then realizing, "Wait a minute, let's take a step back. Are you feeling this way? Are you experiencing these symptoms?", and looking more down a potential ADHD route, seeing that they're presenting symptoms were, yes, depression, anxiety, whatever else.But again, the driver was actually ADHD. And now that we've with them, even now that we've kind of calmed the waters a bit, We can see that there's something else going on. Or as we're treating for one of those other things, it's this treatment isn't working. It's doing something, but it's not taking care of everything.And it's like revisiting that diagnosis and almost like re-diagnosing some of my patients, which has been very helpful. And we're all having "aha" moments together. Like this was actually what was going on the whole time.Laura: Do you ever share with your patients or their families that you have ADHD?Josh: Sometimes it's more just kind of feeling it out right now since this diagnosis is fairly recent for me.Laura: Now, that's true. It's been two months. Yeah. Let me give you a minute, Josh. Sorry.Josh: Yeah. So, with some families, like I'm thinking about one or two patients in particular where they've been looking for this kind of diagnosis, didn't know what it was. There were all sorts of other things going on that people were telling them were actually happening, and then we landed on ADHD together and then realizing that that was actually it. That patient and that parent both had a very emotional experience together and realizing the ADHD was actually what was happening then. It's like their world changed.Laura: Right.Josh: And so, in that particular setting I did share that I also have ADHD. It was more of just like, this is why we can all see it and understand it now, partly because I have this, and I can recognize what's actually going on and these are all the driving factors to this diagnosis rather than the surface presentation.Laura: I ask too, because I imagine that for a lot of parents, there's a fear that comes with any sort of diagnosis and a worry or even a shame. There's a lot of emotions that come with it. And just to know that here you are, you are a success story. I mean, and for them to hear that, "Oh yeah, my child's pediatrician has ADHD." It's something to be less worried about, needs to be treated, but less, you know, scared of.Josh: Yeah, I think those are the patient families that I do tend to share my diagnosis with. If they're not sure how this is going to impact their child moving forward or there is fear or even just a lack of understanding. And it's like, "Look, these are the steps that we need to take together to do this, then yeah, I feel comfortable sharing it with them.For others who are maybe more reluctant to accept that is actually the diagnosis, then I'm also a little bit more hesitant to be certainly open and vulnerable with them. But you know, like I think the more comfortable I get with my own diagnosis, I think it will come out more and more with my patients. And I don't know if this is the universe speaking to me or something, but since my diagnosis, I have had my schedule just like full of ADHD evaluations.Laura: Wow.Josh: Before it was just kind of hit-and-miss. But now it's every single day I'm having like two or three patients that I've never seen before coming in for ADHD evaluation. So, maybe this is word of mouth or whatever else, or just, you know, random chance, or maybe I'm just, you know, selection bias. I'm just seeing it now. But, it has been interesting.Laura: Just curious because, it is such a journey and you're so fresh on it. And frankly, I mean, you're already far more open than I was two months after I was diagnosed with ADHD. It took me ten years to even start saying it out loud. And I remember right after I started this podcast, I met a mom who was at a party and one of her kids has ADHD, and she mentioned that she's like, "Sorry, he has ADHD." And I remember I was like, "I have ADHD." It's the first time in a setting like that, but I just said it and I just saw the shame, like wash away from her face.Josh: That totally makes me think of just how in general mental health is so stigmatized and me seeing that directly, how it impacts my patients and trying to just bring more mental health awareness to everybody.As a society, emotional and mental health is not well recognized, which I think that's one of the frustrations I have as a doctor. Nothing emotional related is on the DSM-5 criteria for ADHD. Every single person that has ADHD has some degree of emotional dysregulation, and I wish that were a part of the criteria. It says, like many people, may experience other mental health or emotional issues, but it's not one of the checkbox criteria for it.So, it's like, "Can we just include that on there?" Like it's not something visible. If it's not visible, you can't diagnose it. And that frustrates me to no end. It's like if I were to rename ADHD, it's not attention deficit hyperactivity disorder, it's more of an attention and emotional dysregulation disorder.Laura: For banking on DSM-6. Is that the next one to come out?Josh: Yeah. If anyone has anyone on the DSM-6 panel, let me know. I'd be happy to share my thoughts.Laura: Josh, thank you so much for being here with me today. It's just been really lovely to talk with you and thanks for listening to the show.Josh: Yes, thank you.Laura:You've been listening to "ADHD Aha!" from the Understood Podcast Network. If you want to share your own "aha" moment, email us at ADHDAha@understood.org, I'd love to hear from you.If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode. Understood is a nonprofit organization dedicated to helping people who learn and think differently, discover their potential and thrive. We have no affiliation with pharmaceutical companies. Learn more at Understood.org/mission."ADHD Aha!" is produced by Jessamine Molli. Say hi, Jessamine!Jessamine: Hi, everyone.Laura: Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. For the Understood Podcast Network, Scott Cocchiere is our creative director, Seth Melnick is our executive producer, and I'm your host, Laura Key. Thanks so much for listening.
Typical Sadness or Depression? How to Tell the Difference in Your Child
All kids feel sad from time to time. But kids who learn and think differently are more likely to have these feelings often enough and intensely enough for them to be considered signs of depression. How can you tell if your child is just feeling down or if you might be seeing signs of depression?This chart can help you understand the difference between typical sadness and depression, and how to support your child in both situations.It’s important to take signs of depression seriously. Depression can make it harder for kids to function day to day. Left untreated, it can grow worse and possibly lead to destructive behavior like substance abuse and, in severe cases, suicide. If your child talks about harming themselves, seek help right away at an emergency room or call a hotline: 800-273-8255.Fortunately, there are safe, effective treatments for depression. The most important thing you can do is stay tuned into your child so you can get help promptly if you see cause for concern.Find out what steps to take if you think your child is depressed. If your child has ADHD, learn about the connection between ADHD and depression. A note about depression and anxiety: Does your child seem fearful or “on edge” a lot? You may want to learn about what anxiety looks like in young kids and in tweens and teens. Anxiety and depression can look similar to families, and many kids have both at the same time.
ADHD Aha!Impulsive extrovert or ADHD? (Sam’s story)
After treating her depression, Sam Salmons felt “fixed, but still broken.” Then her therapist saw her pattern of impulsivity and suggested an ADHD test.Before her ADHD diagnosis, accountant Sam Salmons felt “fixed, but still broken.” As a young adult, she spent years in therapy, treated her depression, and had a laundry list of coping skills. So, why couldn’t she stop her body from doing things — like interrupting — that her mind didn’t want to do? Sam saw herself as an “extroverted extrovert.” She was constantly talking and impulsively saying yes to everything. Then her therapist recommended an ADHD evaluation.Related resourcesADHD in girls: Overlooked?What causes trouble with self-control?How ADHD is diagnosed in adultsEpisode transcriptSamantha: My "aha" moment was at a work conference. I'm listening at lunch to this presenter who I really want to hear what he has to say, and I know nothing I will say will add value. And yet there's this intrinsic desire to say something, say something, say something. And then I go through this kind of internal dialog of shaming myself into not saying anything, and then my body just says it. Laura: From the Understood Podcast Network. This is "ADHD Aha!," a podcast where people share the moment when it finally clicked that they or someone they know has ADHD. My name is Laura Key. I'm the editorial director here at Understood. And as someone who's had my own ADHD "aha" moment, I'll be your host. I am so excited to be here today with Sam Salmon. Sam is a listener who wrote in. Thank you for listening, thank you for writing in Sam. She is also an accountant who is based in Virginia Beach. So thank you for being here. Samantha: I am so excited. And I mean, I kind of wrote in just to like, thank you for what you do because it really helped me. And then you were like, "Would you like to come on?" And I'm like "Stop." Laura: We like to sneak attack on people like that. Samantha: I know I'm over here just like, "Girl, let me give you a compliment!" Laura: Oh, thank you. I appreciate it. Let's start, Sam, with you at 23. What was that, about five years ago? Samantha: Yes. So, 23 was that special moment in between, I'm not depressed anymore, but I can't do the simple things I feel like everyone else my age around me is doing. It was this whole imposter syndrome of, you know, I have a job and I'm paying bills and I have a good friend group and I go out and do things and like, I can't take out the trash, I can't do the dishes. There's some huge mental block that happens when I go to like, do these simple things. And then I feel like, am I depressed because I can't get up and do this task? I'm sitting here on the couch yelling at myself internally, like "You have no excuses, why can't you do it?" So then I'm sitting there mad at myself and I'm like, am I depressed because I can't get up and do something? I've done the things I was told to do. I took my medications, I tried to take out alcohol. I mean, there was probably a period in the six months to one year before my diagnosis when I bought my home and it was on the tail end of Covid when everybody's returning to the office and I was working out, I had a life coach, I had a therapist, I had a psychiatrist, I did an elimination diet, I took vitamins, I went sober I think from alcohol for five months. I mean, I was doing all the things that in the little social media "Oh, holistically, you can fix things. You can fix your mental health if you just do these things." OK. I did all the things and still can't take out the trash. Laura: And so, this whole idea of "fixed" in quotes but "still broken." That was first of all, that was the subject line of the email that you wrote into that was certainly attention-grabbing. So, it sounds like you had been doing a lot of things to get your mental health on track, and yet something was still off. The next step I want to... the next beat, I guess for your story that I want to touch on is, I need you to tell us about the work conference. So this is when you're, how old? You're 20... Samantha: I am 26. Laura: Now you're 26, and you are at a work conference. You're an accountant. Samantha: I'm an accountant. I love accounting. I am a nerd at heart. So I'm at a fraud audit conference. Laura: Oh, that sounds like a blast. Yeah. Samantha: Oh, my God. It was so exciting. Laura: It's funny because other people would think that you were being sarcastic, but you're not. It was so exciting to you. Samantha: No, like, legit. And it was the first conference in-person post-COVID. So at this fraud accounting conference — back in the world, back to talking to people — I'm ecstatic, but I'm a professional. And so I'm trying to rein in my excitement. And it is day two, little tired, lunchtime. Me and some coworkers are sitting at a longer lunch table, and at the end was one of the presenters that went and his was so thrilling. Very exciting, no sarcasm. It was so engaging. I loved it. So, I wanted to hear more about what this guy had to say. So he's talking and I'm engaged, I'm excited, I want to hear what he has to say. And then I get this overwhelming urge to talk. And it's like, "Sam, don't say anything. Don't say anything. Don't say anything. Don't say anything. Like you have nothing of value to add. He's the expert. You want to hear what he has to say. Anything you say adds nothing."And I knew it. Then, all I could think about was not saying something. That took away from me listening because I was so — I don't want to say like, self-shaming — but I was kind of like, "Sam, if you say something you're going to take away from the moment, could be embarrassing, it's not the time and place. You’re a professional like, keep it together. Like let this man talk, he's the expert."And this went on for a few minutes, and all of a sudden, I say something. Don't know what I said, but I knew after I said it, it added nothing of value. And everybody kind of looked at me and said, "Uh huh." And then the guy went back to talking, just as I had imagined in my brain it would go. And then I sat there and I was like, "I don't get it. I literally didn't want to talk. I did everything to not talk. Why? Why do I feel like my body and my mouth run before my brain?"And It brought up moments where I had been talked to in my youth about thinking before you speak. I have no concept of that. Do you think before you talk out loud? like, that's how I process stuff. Like I never understood that. Or like, waiting your turn to talk. Politeness, professionalism, respect. A lot of those big words, especially in the business world, come up very often. Like there's a level of professionalism expected of you. And not only does your appearance, but your behavior has to match. And I just sat there and I was like, "I don't get it. I didn't want to do this. Why did I do it?" And then I thought of childhood. Think before you speak. No concept of that. Then it brought me back to this memory of freshman year of college. We're all sitting kind of in this dorm hallway in between classes. I hate silence. I can't stand silence. And I guess there was a break in the conversation, we're all kind of just chillin. And I said something. Once again, no idea what I said, just filling space. And this girl looked at me and she goes, "Sam, sometimes when you talk, I feel like you just, like, waste air for everyone else." Laura: Oh, dear. OK, so this is... that's intense. That's painful. Samantha: So here I am at this conference feeling like I did, at that dorm hallway freshman year, and I was just like, oh, my God, I literally for months after that comment from that girl, I really reined it in. I was like, "Oh my God," it just was this thing of shame for something I couldn't control. Laura: You've painted a really colorful picture of you at this conference. And I really, I'm imagining time really slowing down. I mean, talk about an "aha" moment, right? Like you've got the connection to your past. You've been here before, but now it's more acute. You're older. You know, you've processed a little bit more, maybe not all the way. That's big, right? And no matter what everybody else at that conference was thinking of you in that moment — which probably was not nearly as dire as what was going on in your own mind — that moment for you is such a light bulb. Like, that's. That's the show. We can cut it right here. That's "ADHD Aha!."Samantha: Literally. And that's not even the part where I realized I had ADHD. That was just me... Laura: Well, then I digress. Let's keep going. Samantha: Yeah, this story ain't over. I mean, that was the moment where I felt just the shame of my life of interrupting, lack of control over things that I didn't even want to do in the first place and I thought I was past it. That's what was hard. Was "Oh, I'm not in college anymore. I'm an adult. I own a home. I have a degree. I'm doing, like, a very professional job." Laura: Right. You're being treated for depression and anxiety. You're working on your mental health. Samantha: I'm not even really depressed anymore. Laura: Exactly!Samantha: I'm doing all the things. I'm having a healthy diet, you know, not depressed anymore. That was my thing, was... Laura: Yeah, you're like "Everything must be fixed," right? Samantha: I should be good to go! So a week after the conference, I had therapy and, oh, I love my therapist. She calls it as she sees it. But I had only recently started seeing her on recommendation from my psychiatrist. So I'm talking to her about the conference. And that was the big thing. At one, I was worried if I'd even have the energy because I exhaust quickly (which now makes sense), but also the inability to shut up. Why can't I shut up? And, you know, I'd been talking to her for a few months now, and she had asked me, she was like "Is this something, you know, that commonly happens?" And I told the story about the freshman dorm "you waste air for everyone else" comment and just kind of always feeling like my body did things that I would tell myself not to do. And yet, there I was doing it or saying it. Then she asked me a few other questions and I'm like, "Oh yeah, oh yeah, all the time." And she was like, "Have you ever been fully diagnosed? Have you done a full diagnostic workup?" And I was like "What are you talking about? I've been in therapy for six years. Like, I've done the little 14-question surveys on depression and anxiety." And she said "No, no, no. Like multiple tests. Like hundreds of questions, full workup, everything." And I was like, "No." And she was like, "I'm so sorry someone hasn't done that for you yet. But I'm pretty sure you might have either Bipolar Manic or ADHD. But definitely, something besides depression and anxiety is running your engine pretty much." Laura: How did that make you feel? I remember when we talked last, you mentioned I'm just an extrovert, right? I am an extroverted extrovert. That is what I told myself. And that's how I lived, when I had these outbursts, that was my excuse. That was my reasoning. And ironically, years of therapy and depression, anxiety, I thought I was like all hipped to the mental health, mental illness world. I thought I, yeah, I had depression wholeheartedly, 100%. But then I didn't know that you could have others. Like I thought "Oh, yeah, that's the thing. Let me fix it." But then I wasn't fixed. And so it went down this rabbit hole of her kind of highlighting some previous conversations I've had about things I've done since I've been working with her, stories I had and she is like "This seems to be a very common trend with you and impulsivity and inhibition to control." And she said, "The talking is just a piece." Laura: So you're talking with your therapist and this impulsivity theme comes up and you have this image of yourself as "I'm an extroverted extrovert, I'm talkative." Right? Which is, by the way, as a key reason why so many women go under the radar for so long because, like, "It's a female trait. She's just chatty" Right? "She's just chatty." But I want to talk more about impulsivity. Tell me what your body feels like. What does impulsivity feel like in your body? Samantha: So, I guess the best kind of example would be doing chores around my house. It's as if I'm on an autopilot to what's in front of me. It's, I'm cleaning upstairs, I got to take laundry downstairs, well, I have to pass by the dishes. Well, OK, "I should really get those dishes done. At least unload the dishwasher." Well, then I'm looking at putting this mug back on the shelf while I really want to wipe down that shelf. I go to grab a rag. OK. Well, I passed by the Swiffer. Oh, I've dog hair everywhere, "I should really swiffer that up." And then I'm looking at the uncompleted project that I'm also working on that I'm just walking past ignoring fully because I'm like, "Oh, well, you know, if I'm going to do that, I think I still got to go to the store and grab this, been meaning to do that for months." But it's a very autopilot...Laura: Right, just do, do, do. Samantha: And there was that thing before I was told possibly this is ADHD. there was a lot of anger at myself for not being able to control that. Also with going out and socializing. If, you know, I go out and meet people for dinner and they're like, "You know, I'm feeling like going out." I'm like, "Yeah, let's do that." And next thing you know, I'm doing tequila shots on a Monday night. Laura: So, not thinking, right? Samantha: It was yeah, like it just was I knew I had work the next day. I knew I had responsibilities. I mean, or if I'm not even drinking, I'm just out. Yeah. And then I'm spending money. Laura: Then you're saying, yes. You're spending money. You're saying yes to everything, right? You're saying yes to life and like, on autopilot. Is that accurate? Samantha: Yeah, it's literally this autopilot. But then there's so much shame in the after-effect. And that's where I think my therapist noticed, is these are things I'm not wanting to do, yet I'm doing them. I know I wanted to go home and go to bed, yet I found myself out and about. Laura: Yeah, that's really profound. That's a big moment. Samantha: So, I finally get officially diagnosed, which during the exam she said, "Do you realize when you get focused, you start humming?" And I go, "What?" No idea. And then, I forgot what the time frame of the questions were being asked halfway through the test. I'm like, writing all these things and this and that, and she's like, "I haven't even graded this, but I'm pretty sure I'm on the money." And sure enough, she was. And so I'm telling coworkers and friends and I'm saying, "Hey, I'm pursuing this path of my health, of getting diagnosed. There might be medication. I don't know how I'm going to react because my history with depression medication. You know, it's exhausting to adjust and regulate and it's physically wearing and it's mentally wearing. And so, I kind of wanted to give the heads up of "I'm going to be pursuing this path. I want to keep you up to date." I had great coworkers that were really supportive, but then some were like. "Well, yeah. You didn't already know you had ADHD?" Laura: Yeah, that's right. Samantha: I was in therapy for six years. Wouldn't I be the first to know? You know, that's the thing was it was this anger I had of, I was in therapy, I was doing everything I was supposed to do. How come no one caught this? How come I went this long without getting help? It was just mad, I think, at society for letting me go and believe that I couldn't have ADHD. So there's a Maya Angelou quote, "Do the best you can until you know better. Then, when you know better, do better." Laura: It's beautiful. Samantha: And that is how I feel like the whole source of anger washed away. I'm criticizing this path I was on. It went on unnoticed or undiagnosed for so long. But everyone around me, everyone on my path, even me, we didn't know. Laura: And now I think it's fair to say, like you do know better now, you've had so many realizations over the last few years. So like, what does that mean for you now, today? Samantha: Just that acceptance of, people can only work with what they know. And to advocate, to educate, to talk. Your podcast, amazing for talking about these moments where people are like, "I thought everything was fine and dandy, and then "aha," I could use and benefit from this help." Laura: That's beautiful. Extra points for using "aha" as well. Samantha: That's like the bingo word. Laura: Sam, your story is so gorgeous and so well shared. I have to commend you on the amount of detail that you bring. I've just been just basking in everything you've been saying and all of the moments that you painted. And this whole time I'm like "Am I talking too much?"Laura: You're the guest. It's your show today baby! Samantha: I know! But, thank you. Laura: You've been listening to "ADHD Aha!" from the Understood Podcast Network. If you want to share your own "aha" moment, email us at ADHDAha@understood.org. I'd love to hear from you. If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode. Understood is a nonprofit organization dedicated to helping people who learn and think differently discover their potential and thrive. We have no affiliation with pharmaceutical companies. Learn more at Understood.org/mission. "ADHD Aha!" is produced by Jessamine Molli. Say hi Jessamine!Jessamine: Hi everyone. Laura: Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. For the Understood Podcast Network, Scott Cocchiere is our creative director, Seth Melnick is our executive producer, and I'm your host, Laura Key. Thanks so much for listening.
Signs of anxiety and depression in different grades
When kids learn and think differently, it can impact their emotions. In some cases, there’s a greater chance they’ll experience anxiety or depression. Use this information to get to know the signs of anxiety and depression at different ages. Look for patterns and take notes on what you’re seeing. And be sure to reach out to your child’s doctor if you have concerns.
ADHD Aha!Hyperactive girl, labeled a troublemaker (Olivia’s story)
Olivia’s hyperactivity often got her in trouble at school. She was called “disruptive” and a “troublemaker.” Hear from Olivia, who also has depression, in this episode. As a kid, Olivia Chavez was disciplined a lot in school for her “disruptive” behavior. She would often seek out ways to move around and channel her hyperactivity. One incident led to an awkward conversation between the teacher and her mom. That conversation was the “aha” moment for Olivia's family, and put Olivia on the path to an ADHD diagnosis. Olivia also talks about ADHD and depression, and mentions a time when she felt “paralyzed” and had thoughts of suicide. This is discussed in a context of hope and strength.If you or someone you know is struggling with suicidal thoughts, help is available today at the National Suicide Prevention Lifeline.Related resourcesUnderstanding hyperactivityThe difference between ADHD and ADDADHD and depressionEpisode transcriptLaura: Hi, everybody. It's Laura. Before you listen, I want to let you know that my guest on this episode, Olivia, shares her experience with depression. And she briefly mentioned that at one point she considered suicide. Olivia's story is one of hope and strength. It resonated deeply with me. I hope it will for you too.Olivia: I was getting in trouble so often that I was starting to isolate these things like in tapping my legs or in tapping my pen or fidgeting my arms in some way. And then in order to get up, I realized that I had to ask my teacher to go to the bathroom. So, I was asking to go to the restroom so frequently, eventually my teacher had to sit down with my mom and said, "Is your child sick?"Basically wanting to know if there was something wrong with me, because I so frequently asked to go to the bathroom. And I told her, I'm like, "I just need to get up. I just can't sit in class that whole time." And she realized it might be beneficial if we got me tested for ADHD. And sure enough, that's what it was.Laura: From the Understood Podcast Network, this is "ADHD Aha," a podcast where people share the moment when it finally clicked that they or someone they know has ADHD. My name is Laura Key. I'm the editorial director here at Understood. And as someone who's had my own ADHD "aha" moment, I'll be your host.I'm here today with Olivia Chavez. Olivia is an actor and singer living in California. Olivia, so glad you're here with us today. Olivia: I am very excited to be here. Laura: Olivia, I would love to start off by hearing from you in your own words describing what you were like growing up. Olivia: If I can put it gently, I was a lot.Um, I've always been very hyper, very quirky, and goofy, which are some of my favorite qualities to this day. But I think that I just had a lot of energy and I didn't quite know what to do with it. Or the adults didn't quite know what to do with it, I should say. Laura: As a kid, can you remember what the hyperactivity felt like in your body, if you could describe it? Olivia: The hyperactivity really felt like I just had to get up and move. And it was very easy when I was playing outside with my sister and we had a group of kids in the neighborhood where my grandma lived where we would all run around. So there was no issue there. Really, where I noticed it was during school, once I had to be disciplined and listening, or in church as well. That was the most difficult because I felt like I had to get up and move and run around. Or sometimes they would even manifest itself in needing to talk, just any sort of movement in my body. And it was really hard to repress that. Laura: How did the adults around you react to that kind of behavior?Olivia: I think the way that my family reacted to it was very different than the way my teachers and authority figures reacted to it. At home, it was expected and fine, and I just had a lot of energy I needed to get out. But in school, I was very much seen as a troublesome student that was very early on labeled as the troublemaker of the class.Laura: It's interesting that you use the word troublemaker because it doesn't sound like you were actually doing anything that was causing trouble. Right? It was just how you were coping with your hyperactivity. Olivia: Yeah, it was hard to navigate because I didn't really think what I was doing was wrong. I just wanted to have friends and be chatty and play. And I always really looked forward to recess, but it was often taken away from me because I was a quote unquote "trouble child." Laura: That sounds really painful. I mean, that, that was a moment during your day when you could let out this energy and feel more like yourself. Is that fair to say? Olivia: A hundred percent yes. Laura: How did the kids your age react? Did you have friends growing up? Did you have a lot of friends? Did your behavior impact your relationships in any way? Olivia: I did not have a lot of friends growing up. I had two really good friends, and it's actually quite funny because my very best friend, who I'm still friends with today, she loves to tell this story. I had been put in time-out for who knows what, and this was in kindergarten. And we were in story time, and she turned back and looked at me, and I waved at her. And she knew that I was a bad kid because I was in time-out. So she turned around and stuck her tongue out at me. And a year later, we were best friends. Laura: I love that. That's really cute.Olivia: She's my absolute best friend. Laura: It sounds like she understood you from the get-go. Olivia: Yes. I think that when we did get to go out and play, her and I had very similar energy levels, and then there was another girl that she was friends with in her neighborhood and went to school with us. She was a grade ahead of me, but the three of us would always play at recess all the time. We had very out-there sense of humors, and the three of us were just inseparable. But as far as being very well liked or popular, I certainly was not. I was teased very, very much. Laura: Were there ever days that you just did not want to go to school growing up, or you just flat-out refused even to go to school?Olivia: Were there? Yes. One thousand percent, more often than you might think. I think every kid has those days, but I just, with the fact that I was being teased by everyone, the fact that school was just so hard for me. I wasn't retaining the information nor did any of the teachers wish to slow down to help me retain that information. And I just felt like it was a constant struggle. Like I was constantly running at a brick wall, and I didn't have help. Nobody wanted to help. Not at school. At home, I had all the help in the world, but nobody wanted to help at school. So why would I want to be there? I wanted to stay home with my mom and watch cartoons, and just not be there.So I would lie a lot to my mom and say there's no homework. And for a while it was easy to get away with, and then those pink slips and blue slips started piling up, and it all came out eventually. Laura: Oh, that is so interesting that you bring up lying. It comes up a lot, actually. You know, as I talk to people about ADHD, it's really common for kids with ADHD to lie, and it's not malicious lying. They are little lies to cover up things that are challenging. Can you give me some examples of like, pretend like you're telling a lie. What kinds of things would you say? Olivia: Oh, geez. It's been so long now. I'm just so perfect. Yeah, I mean, obviously the big one was, oh, there's no homework today. Oh, yeah, I read that book for the book report. Oh, yeah, I've been working on that book report. And then really it was down to the day before and I watched the movie and hoped that the themes would align enough for me to write a paper. I really hated when my mom was mad at me. That, still to this day, is my least favorite thing in the entire world. I can't stand when she's upset with me. So, I would make up lies to make sure that she didn't get mad at me. So, from little tiny lies to really big ones, I just didn't want her to be mad. Laura: You don't want to upset Mama. I get it. Olivia: "No, I didn't eat that slice of cheese, I swear!"Laura: When were you diagnosed with ADHD? Olivia: Between third and fifth grade. I can't really pinpoint it. I do remember at my school, they had these things called pink slips and blue slips and yellow slips, and a pink slip was just like a warning to your parents. And then if you got three pink slips, that turned into a blue slip, which was detention. Or sometimes if you did something really bad, you'd just automatically get a blue slip, and you'd have to get them signed by your parents.And I remember I was stacking up so many, and I didn't want to get in trouble, because my mom didn't really understand what this was either. So, all she knew was I was coming home with warnings and getting in trouble. So, what is a parent to do then to discipline their child and try to fix things at home?So, I was tired of getting in trouble, so I was stacking these up in my folder and just not having them signed. And then, you know, next thing you knew, they're like, "OK, this is a huge problem." So, they had to bring in somebody to come meet with me and everything. So, then, I started — this was in third grade — I started seeing a therapist once a week that would come in and she would basically play, like, board games with me and stuff and try to figure me out. So, I think that's when the therapy part started. And then in about fifth grade, I think they actually diagnosed me. Laura: And there was something that happened at school that, you had continuously been like running off to the bathroom, just as a way of coping with your hyperactivity to let some of that energy out. Tell me what happened. Olivia: Yeah, so, I started to realize that obviously, if you tell a teacher you have to go to the restroom, nine times out of 10, they're going to let you go. So, I found that the only way I was able to get up, because I couldn't just get up and randomly walk around in class. So, I started getting wise and said, "I'll just keep asking to go to the bathroom." And eventually my teacher had to sit down with my mom and said, "Is your child sick? Does your child have a bowel problem?" Or basically wanted to know if there was something wrong with me, because I so frequently asked to go to the bathroom, which obviously there was nothing wrong with me. I just wanted to get up. So, that ended up having to stop because that was no longer working. And then I just figured out how to isolate movements while I was sitting down. So, tapping my foot or shaking my pen in the air, just little things so that I could get my body moving. Laura: Wow. OK. So, a worry about a bowel issue. I know that, you know, we're learning more and more about ADHD as time goes on. It's just interesting to me, and nothing against your teachers or the school or anything like that — there's a lot of confusion out there about ADHD. But they went straight to bowel issue before considering maybe this young girl is dealing with hyperactivity and needs an outlet. Olivia: I don't really know, because I was young, but I think when I was growing up it wasn't as openly discussed. And I don't think that this Catholic school that I went to, I don't think they understood because they were just so used to these like really well-behaved children that came in. And I think I was sort of an anomaly at the time. Laura: So, would you say that that was really the "aha" moment for you and your family?Olivia: Yeah, I would say so, because I think that was around the time that I was tested. My mom thought the whole thing was funny. Like, she wasn't even remotely worried that it might be a bladder issue. She said, "OK, what are you doing?" So, she kind of sat down with me and said, "OK, well, what's going on?" And I told her, I'm like, "I just need to get up. I just can't sit in class that whole time."Laura: How did she react, your mom, when you got diagnosed with ADHD?Olivia: I don't think that she was surprised. My uncle actually had ADHD, so she was familiar with it and she had always told me and still tells me to this day that I'm, like, very similar to my uncle in a lot of ways — which I love. He was my favorite. But I think that she expected this on some level.It's probably really difficult to hear that. And I think that she wanted me to accept a lot of help for it. But I was teased so much already that I didn't want, for example, they'll give you extra time to take your tests or something like that. And I was like, "Absolutely not, I don't want that," because I was already getting made fun of so much.I knew that if I got extra time to take a test, the teasing would have just gone through the roof. And so, I just suffered, and I wasn't a terrible student. Even with the ADHD, I still muscled through. It was just harder. Laura: You got tested again in college, is that right? Olivia: Yes, I did. Laura: Why did you decide to have another evaluation?Olivia: As a lot of people are, in this world, I'm a little extra difficult on myself. And I felt like maybe I didn't really have it and I was just using it as a crutch to be a lazy student, or to say that, "Oh, my grades aren't as good because of this thing." So, I thought it was an excuse I was using. And I was also interested in exploring some medications, because when I was diagnosed as a kid, my mom didn't really want to medicate me.So, I wanted to explore medication. And so I said, "Well, let me get tested and see if I actually have it. And if I do, let me explore what medication options there are for me." Laura: That's such a common feeling among a lot of people, myself included. I got diagnosed twice because I didn't believe that I had ADHD. It was like, "OK, I'm just going to work harder. I'm not going to cut myself any slack. I'm going to be super hard on myself." It sounds like you were there as well. Do you still think that ADHD is a crutch? Olivia: No, I think Tik-Tok has been an amazing resource for me to learn that a lot of the things that I do every day are a result of my ADD, and I think that it's been beautiful for me to see that I'm not alone. It's also really validating to see, oh, that thing that I do constantly that maybe somebody in my life might've told me was annoying, or maybe that people harp on me a lot for like something simple, like being late. I had no idea that could be a factor because it was like, even when I was cognizant of it and I was like, I will not be late, I will not be late, I will not be late, it still happened even though I wanted it so badly not to. Just little things like that, learning that these are all factors in ADHD. It's been really nice to kind of have that validation and realize that I'm not crazy. I'm not crazy, I'm not lazy, I'm not useless.Like, little things that you tell yourself when you have ADHD. It's just nice to have a community of people who are knowledgeable and can help explain what's going on. I'm coming to find I need to be a little bit more kind to myself, because I'm very hard on myself and learning all of these things that, OK, this is a real disease. And these are symptoms that I have, and I can just learn from it and try to be a little bit kinder to myself. And then I can get through every day and not be sad. Laura: It is just so exciting these days to see more and more people come out of the woodwork and talk openly about ADHD and not sweep it under the rug.Do you ever get in a really low mood? Olivia: Yes. And that was one of the greatest things that I learned about ADHD through Tik-Tok. I tried to explain it to my mom a couple of times, and I said, "I have all this passion and all this drive to perform. Like, that's what I want to do. I want to perform for my job. And that's what I want to do for a living." I've always had such a strong passion for it, but then I look at this mountain that I have to climb to get there. And I said, oh, I've got to do this thing and this thing and this thing. And then the list of things that need to get done start piling up. And I just get really down, and I curl up into a ball on my bed, and I cry, and I don't do anything.I think it's called paralysis, ADHD paralysis, or something like that, where you just shut down completely. And it doesn't mean you don't want this thing. It doesn't mean that you're not trying to as hard as the next person. It just means that you are literally paralyzed by the idea of all of the things that need to get done.So, when I learned that, it actually answered a lot of things for me, because I've suffered with depression as well, which I now realize is all entangled in that beautiful ADHD web of mine. But I mean, I've definitely gotten a lot better. And knowing that's part of it has been really helpful, because I think just being aware of something can help you push past it.Laura: Yeah. I mean, we know that ADHD can create so many challenges, like the ones that you've been describing. And facing those challenges day after day, and sometimes not being able to tackle the challenges that you want to tackle, can lead to low self-esteem and feelings of depression.And you're right, it is tangled. There's kind of a chicken and egg thing with ADHD and depression. But one thing is sure that if you have ADHD, you're more likely to have depression than if you don't have ADHD. Some people think that kids with ADHD or people with ADHD are prewired for depression. Did you ever feel depressed or down like that, growing up, that you remember?Olivia: Yeah. A hundred percent. I'm about to get real deep with you right now. I was suicidal for quite a while. I just didn't really see a solve. I felt like there were so many things about me that I wanted to change. And if I could just chill out, if I could just be normal, and I felt like everything just kind of piled on top of each other.And I felt like a burden to my family — to my mom specifically. I just really felt like I wasn't somebody she could be proud of. And I felt like being gone would have been easier for everybody. Even talking about it now, it's really hard to talk about, because I'm so glad that I didn't. I'm so glad that I am where I am now and that I can sit here and talk to you about this and just be on the other side of it, because I'm so excited about where my life is now. And I think that there are probably so many other people in the position that I was who don't see a way out. And if you're listening, there is, it gets so much better.So, it was scary for a while. Just that feeling of helplessness. It's a hard thing to go through. Laura: Oh, I'm so sorry that you went through that, and I'm so grateful that you shared that. How do you think you did pull through? What was it that kept you going? Olivia: The people in my life who did understand — my mom and my sister and my dad, my immediate family, my aunts and uncles. I just had the greatest support system. And my mom maybe didn't understand everything. There may be still to this day things that she's like, "Olivia, I just don't get that. You can try to explain it to me, but I just don't get it." And even though she still has moments like that, she just supports me. And she's just like, I got you. I'm here for you.And when I was at my lowest, my sister told me she was pregnant, and I just had this whole new reason to live. And my niece is 7 now and she's my entire world. And I'm just so thankful for her, because every day I've got this beautiful, gorgeous being that makes me so happy every day.And I see so much of myself in her, like the quirkiness and the fun. I see that in her. And it's just so great, because those are — some of my favorite things about her are the parts of me that I see in her. Laura: You realize that you're creating that community right now for other people. Like the thing that pulled you through that dark period in your life, you're helping with that for other people right now who may be listening and may be dealing with the same thing that you coped with growing up, and as an adult, and that's a really brave thing to do. And I commend you.Olivia: Well thank you. I mean, in sharing this, I do hope that I help somebody else, because it's not an easy thing to talk about. And I think that being where I am now, and — I'm not perfect, I still have days where I just want to shut the door and cry for a little while. But I think that knowing where I've been helps with the moments where I feel like that, because I'm just such a different person now, and I can't say "it gets better" enough. It really, really does. And those darkest moments, I'm thankful for them at this point. Laura: What do you love about your ADHD brain? Olivia: Hm, what's great is that, I think it's almost part of my personality, that, like, quirky and fun and that "oh wait, did I finish that sentence?" thing about me is one of my favorite things. I think that, like, the energy that I have is beautiful, honestly, and I think that has a lot to do with my ADHD brain, because I'm constantly trying to catch up with myself. And it's fun. Laura: And I think that the media often, like, catches on to a lot of the fun or funnier aspects of ADHD, and that's not necessarily a bad thing. It's cool that people lean into that and it can be part of the conversation. What I worry about that sometimes, I don't want people to forget that ADHD is real, and it's hard, and it creates real challenges. And when ADHD is coupled up with something like depression or anxiety, it becomes, as you said, like, this tangled web. Olivia: Yeah. I agree with you, and I still struggle when it comes to creativity. Because I do love to write, but sometimes I'll sit down with a pen and paper and all my motivation has gone, or it just seems like too big a task. So, every day is something different, but I do think that my ADHD brain contributes to my creativity.Laura: You've been listening to "ADHD Aha," from the Understood Podcast Network. You can listen and subscribe to "ADHD Aha" on Apple, Spotify, or anywhere you get your podcasts. And if you like what you heard today, tell someone about the show. We rely on listeners like you to reach and support more people. And if you want to share your own "aha" moment, email us at ADHDAha@understood.org. I'd love to hear from you. You can go to u.org/ADHDAha to find details on each episode and related resources. That's the letter U, as in Understood, dot O R G, slash ADHD Aha. Understood is a nonprofit and social impact organization. We have no affiliation with pharmaceutical companies. Learn more at understood.org/mission. "ADHD Aha" is produced by Jessamine Molli. Say hi, Jessamine. Jessamine: Hi, everyone. Laura: Justin D. Wright created our music. Seth Melnick and Briana Berry are our production directors. Scott Cocchiere is our creative director. And I'm your host, Laura Key, editorial director at Understood. Thanks so much for listening.If you are struggling with suicidal thoughts, help is available today at the National Suicide Prevention Lifeline. You can reach them at 1-800-273-8255. Or visit their website, suicidepreventionlifeline.org.
ADHD Aha!ADHD frustration and anger, plus ADHD and tics (Adam’s story)
Adam Sosnik was diagnosed with ADHD after 15 years of therapy and wrong diagnoses. It clarified a lot about his life, but it didn’t solve everything. Lawyer Adam Sosnik was miserable in his job. Miserable when he couldn’t concentrate, which was often. Miserable because it was physically uncomfortable to focus on even a small thing, like writing a single sentence. The trouble was, he was being treated for anxiety and depression, but not ADHD. When he began working remotely during the COVID-19 pandemic, his wife noticed his frustration. And with her encouragement, he booked an appointment with a new psychiatrist. That led to an ADHD diagnosis, which validated the discomfort Adam felt. But it also marked the beginning of a new struggle.Also in this episode: Adam talks about ADHD and tics and his experience with Tourettic OCD (TOCD). And how he’s charted a new way of living that’s finally made him happy.Related resourcesADHD and ticsADHD and mood swingsA day in the life of an employee with ADHDEpisode transcriptAdam: The most "aha ha ha" was during the pandemic when I was continuing to work a job that made me miserable and my wife was recognizing that as it made me more miserable, my ability to continue to pursue it in the face of frustrations was decreasing. So, I finally said, "I can't take this anymore. I'm miserable. And I want to see another psychiatrist. You know, I do want to ask him about ADHD."Laura: From the Understood Podcast Network, this is "ADHD Aha!," a podcast where people share the moment when it finally clicked that they or someone they know has ADHD. My name is Laura Key, I'm the editorial director here at Understood. And as someone who's had my own ADHD "aha" moment, I'll be your host. I'm here today with Adam Sosnik. Adam is a listener who wrote in and shared his ADHD "aha" moment with us and we wanted to invite him on the show. He's also a lawyer who's based in Florida. Adam, thank you so much for being here today.Adam:Thanks a lot for having me. Really excited to talk to you.Laura: I'm excited to talk to you too. And I love already like the energy that you bring is just it's very, it keeps me up. I like that.Adam: I've been wired for a little bit. I've only walked through this conversation about a thousand times over the past three days, and I tried everything in my power to not do that thing.Laura: Oh, no, it's hard, you know, we're just going to keep it casual. We're just going to chat. And I guess we'll start with you telling me and the listeners when you were diagnosed with ADHD.Adam: Yeah. So, I'm 36 right now. I was diagnosed formally in February of 2021.Laura: Pandemic diagnosis.Adam: A pandemic diagnosis. So, once the pandemic started and I was working remotely, my wife was able to see me and how I worked and what made me miserable, and I'd been miserable for a long time in my job as an attorney. And she was able to see that when I was miserable, my concentration lacked, and I would be walking around the house not knowing why I was in rooms and looking for any kind of distraction or side project other than the work. She said, "Maybe you do have ADHD," because we had previously talked about it. I'd been in treatment since 2005 for what I was told was just anxiety or depression, and I was told maybe a little of ADHD, maybe a little bit of bipolar.Laura: It's that helpful to hear? Just maybe a smattering, right?Adam: A smattering, a touch. I can manage a touch of whatever this.Laura: Right.Adam: You know, I later learned that those things don't have a touch of it. It's just symptom severity. But I have it through and through, and I've been on every medication you could possibly think of for anxiety, depression, bipolar, some OCD-type medication. Nothing worked. Surprise, surprise. So, I finally said, "I can't take this anymore. I'm miserable. And I want to see another psychiatrist. You know, I do want to ask him about ADHD." We had one appointment and at the end of it, he said, "It really looks like this is ADHD." And I had your classic instantaneous reflection on every single second of your life, and I just saw everything differently. It was kind of like those like crime movies where at the end they realize who the killer is, and then the detective starts thinking back to all the different events that he participated in, or she participated in. All of a sudden, they see it from a different perspective. It was just incredible, and it felt awesome. It was just this surge of validation, which validation is probably what I have just been seeking my entire life.Laura: I want to stick with the conversation with your wife for a moment. That sounds like her telling you what she was seeing in you about concentration was really a tip off for you. I'm wondering if you could just speak a little bit more about your thought process when you were trying to concentrate and you couldn't. Like, what was it about that period of time that was obviously the coming together of the comment from your wife and whatever was happening with you, that was a tipping point?Adam: So, I was at the time practicing corporate law, you know. I liked law school. From the second I graduated and started working, I realized I had made a mistake. Absolute first second I walked into work. So, I was miserable, and I felt stuck. The salary was good. I didn't know what else to do.Laura: Why do you think that is?Adam: I have motivation issues. I have impulsivity issues to allow myself to be distracted by things that are more interesting. And so, she was seeing the increase in my inability to sit and do my work. And a lot of that was hard, but also a lot of it as a younger associate is a lot of mundane work, just drafting mundane, boring stuff. And she saw as I got more frustrated and miserable, I was able to do less and less of this to the point where it was starting to impact significantly my interactions with the world around me. You know, my temper was a lot shorter. Traffic was making me even more frustrated than it usually is, and I couldn't relax on the weekends, you know, any time I could be getting a phone call or an email saying, you know, this thing on Monday, we have to do and it's going to rain, it's going to ruin your life. And so just to have that unknown constantly hanging over my head, my happiness and my health and my sleeping ability decreased.Laura: You used the word miserable, which I think is a great adjective to use, but it wasn't like some people may hear the word miserable and they may think sadness or depression, right? And I know that you maybe had been, maybe had a smattering of that or a misdiagnosis of that, but it sounds like the "miserableness" it wasn't necessarily a depression so much as it was "I'm bored, I'm frustrated. I can't make decisions. I'm distracted. I'm constantly waiting for the next thing and that's leading to irritability and moodiness," which is all part of that ADHD cornucopia.Adam: You nailed all of it. And all that manifested almost into a physical discomfort where it's like, if I had a type of sentence, I just couldn't physically do it because it was so painful to focus all of my attention on writing a coherent sentence. And it was physically painful to do, and it would just take me so long to do things. And then I, you know, it was a catch-up and a mad dash, and that never works out. But you're right, it wasn't sadness. I didn't know what it was. I just knew I felt bad. And if you feel bad, it's probably anxiety or depression, because that's what the TV commercials tell you. But every single therapist I had... the balloonist in those depression commercials is not me.Laura: Yeah, and to your point, like your productivity at work wasn't suffering, even though maybe it felt like it was. But it sounded, based on what you said earlier, right, you managed to just push through it.Adam: Yeah. So, with and especially with law — I don't know anything about other careers — you're basically competing against every other person to first to make partner and then to attract clients. And eventually, it would get to the point where I would be of a certain age where you're either on track to, you know, making partner and becoming a bigger deal at work or you're kind of just going to fade into mediocrity. And I kept thinking that that breaking point was going to be coming. Every single day I'd wake up thinking that today's going to be the day where all the peers my age who've been practicing as long as me are going to be recognized as more talented or more reliable. So, that was the constant feeling that I wasn't meeting expectations. And to a certain extent, I really don't think I was, you know, my goal was to do as little work as possible, just get through the day and try and find the pleasure in it, which is really tough when you have to account for all of your hours, you know, billable hours. And it doesn't matter if you're working from 9 to 10:30 at night, if you've only billed for two and a half hours of work, that's all they see as your workday. Every single thing about that career was wrong environmental-wise. It just exasperated all the preexisting conditions that I knew I had, and I just didn't know that put together as a package it's ADHD.Laura: It was ADHD.Laura: I want to hear you talk about what I'll call your second "aha" moment. Your wife approached you about your concentration and that seems like an "aha" that led to your diagnosis. After you got diagnosed, then you had a childhood home "aha" moment that it's extremely resonant for me because I had the same thing. So, will you tell us about that?Adam: I would love to tell you about that, and I hope my parents never listen to this.Laura: I feel the same way.Adam: So, I found out I was diagnosed, and it actually came on that very same day, literally on the way home from a doctor's appointment. My wife was pregnant at the time, 20 weeks pregnant, and she had that 20-week ultrasound. And we found out our daughter was going to be born with what's called a congenital diaphragmatic hernia that spirals into a whole lot of other conditions, but ultimately, it's a lung issue. If you can't breathe, nothing else matters. So, that's when I kind of realized that everything we thought about ADHD was true. So, I was dealing with that literally the same hour that I was dealing with what we found out was going to be a significant life-altering medical condition for my daughter. And we ultimately decided that Florida would be the best place to move to. They had a hospital here in Saint Petersburg, Florida, where they had the best unit in the country to treat my daughter and my parents had moved to Florida. And just for fun, I went through some of the boxes of my old stuff that my parents had — my artwork, my report cards, not looking for anything in particular — and I found in it and I'm actually holding it in my hand right now...Laura: Oh wow!Adam: ...and so it's this 12-page report from when I was five years old in 1992. Apparently, my preschool teachers had suggested that I might not be ready for public school kindergarten, whatever those high standards are. So, I found this in my parents' house and I read through this, and at the end of reading it, I was like, "What the F! You guys didn't tell me about this? It is literally a play-by-play of what an ADHD diagnosis looks like." "Adam is an extremely active boy who is constantly moving or fidgeting throughout the session. For example, he was either shaking his foot or moving around his chair. In fact, his favorite activity was to spin around and around in the examiner's chair. Adam seemed to have a lot of energy, which he constantly needs to keep in check. The level of activity interferes with his ability to focus and to concentrate on work. He seems to manage to harness his energy well for approximately one hour after that amount of time, his attention begins to wander, etc., etc.."Laura: It's like out of a dictionary. Adam: It was like textbook, textbook. And I brought this to my parents, and I said, "Why didn't you tell me about this?" And they kind of thing, you know, they're boomers, we're Jewish. Their parents were first-generation Americans. Their grandparents were from the old country. Mental health wasn't something that was talked about. It was a shanda to say in Yiddish.Laura: What does that mean in Yiddish?Adam: It's just, it's a shame on the family.Laura: Oh wow.Adam: And, you know, it's a stigma. Not that this was openly talked about, but that's just kind of the impression you got just from growing up in my household. And they didn't really know what to say. My mom, I think, said "We just didn't know what this meant at the time, and so, we didn't know what to do." And that's when all of my excitement that I was diagnosed and now I could begin the process of recovery turned into anger without my ability to stop it. I was angry that this existed and that I could have known about this, and I could have brought this to other therapists. Throughout my process. I was angry that the psychologists doing the report didn't say that it was ADHD. The recommendations at the end were to go to a smaller kindergarten and then afterwards to public school, I guess, and go to occupational therapy and to have more structure at home. So, that timeout was created in my home where I sat and looked at a wall to calm down.Laura: That was the, that was the structure?Adam: Exactly. That was the structure. And for a long, long, long time after that, their lack of understanding maintained the anger inside of me. And it wasn't until recently where my acceptance of their lack of understanding kind of became my own understanding in and of itself, right? That open issue that I was angry about was now finally going to come to an end. Finally, that chapter was closed out because I came to that acceptance. And once you accept it, that's the understanding of the situation, and nothing to do but go forth from there. And so, a lot of that anger has gone away. But I got to say that the treatment itself didn't really begin and I didn't really begin to learn coping mechanisms until recently because that diagnosis happened right before we were going to move to Florida permanently for this hospital. And then my daughter was born, and she was in the hospital for five months, continuously hooked up to every machine imaginable. I'm walking around knowing that I have these issues, that I'm not going to be able to manage all this. And surprise, surprise, I didn't, and my mental health deteriorated even further. My relationship with my wife deteriorated even further. So, it wasn't this immediate. "Oh, I have ADHD. Aha!" Now it's time to start addressing it. It was "I have ADHD. I don't know what to do. No one has been able to help me before. I'm angry about it. And now the universe is throwing me a curve ball that no one ever wants."Laura: How is she doing now?Adam: She's doing great. She'll always have some management, but she is doing great. Cognitively, she's healthy. She's doing great.Laura: I want to pause and reflect for just a moment on everything that was happening. You had the pandemic. You have your daughter coming into the world with severe health issues. It's so much to go through and at the same time an ADHD diagnosis. And it sounds like that's a lot, a lot, a lot happening. And then, it sounds like maybe with about a year of processing because you got diagnosed in 2021 and everything that you went through, then you started towards treatment and then there was another diagnosis that came into play. Is that right?Adam: Correct. I also have a kind of an OCD and Tourette's combination called Tourettic OCD, is what the new term for it is. And I kind of figured that one out on my own. And then I did reach out to psychologists in the area, and it was just my process of elimination. I did always have tics, and I knew about that and the tics, I do you remember started when I moved before fourth grade, I moved from New Jersey to New York, and I loved where I lived in New Jersey. I had all these friends. Now I move somewhere where I have nothing, and I had no one. And all of a sudden, I developed tics.Laura: And I don't know much about tics. And I will not pretend to be any sort of expert on them, but I know that from content on Understood that's expert vetted, about half of all kids with chronic tics have ADHD, and about 20% of kids with ADHD have chronic tics. I know that the issues are highly co-morbid. Highly co-occurring.Adam: Yeah, I kind of call it the Holy Trinity, the ADHD, OCD, Tourette's Holy Trinity. And I will say this: the Tourette's and the OCD are child's play compared to what the ADHD does to you, especially as an adult.Laura: Wow, that's so interesting. Tell me more.Adam: So, as an adult, I've kind of learned to suppress the tics. There's always a bubbling energy underneath me that wants to tic. I've learned to kind of deal with the OCD, and it's a different type of OCD. I don't have any irrational fears. The compulsions are exclusively physical. A good example is I could walk through a door and close it and then say, "Uhm, let me just go back and close that door again so that it feels better so that it closes a little better and I can hear it click perfectly." An hour later, I can walk through that door and not even have that thought. So, it's a very odd physical driving urge. But the ADHD, I can't control my thoughts when my instant reaction to something is driven by ADHD wiring. And so that's the part — it's the emotional aspect of ADHD, which has by far scarred me the most, which does and continues to cause the most damage because managing emotions is really important in every single interaction. And you can't hide it, especially engaging with other people. You know, your reactions, you can kind of read them on your face. And so the ADHD, it just was so much more devastating and continues to be and it's so much less manageable and unpredictable than the Tourette's or the OCD. So, ADHD is the nastiest of those three.Laura: I imagine that for some listeners that will come as a surprise to hear that. And of course, everyone's story is different. For some folks, I'm sure that they're OCD or their Tourette's is much more difficult to manage than their ADHD. But I hear you. I mean, the managing emotions aspect of ADHD, which so many people don't even realize is a thing, but that is all tied up with executive functioning challenges. That's really hard. How in particular have you struggled with managing emotions?Adam: I realized my whole life I've been lost in thought. Everything I'm doing, I'm not thinking about that thing. I'm thinking about something else. And so, it took a lot of retraining my muscle memory to pay attention to what I am feeling. And I think that's a really high-level skill for everyone. And so, as a child, as an adolescent, as a young man, I just didn't have the skill. Something was blocking my ability to see the misery and then to connect it to in the moment when I’m miserable, "What am I really feeling?" And I don't know how to better explain it other than it's just a matter of paying attention. And I realize every single thing I do, I mean, I drop things all the time and I'll go to pick something up and I'll drop it immediately, and I believe it's because I'm not paying attention. I go, my fingers touch the thing that I'm going to pick up, and my mind immediately says, "Job done. You've gotten that thing, time to move on." But the fact of the matter is, all that happened was my hand went around it. There's also you have to pay attention to closing your hand and feeling the grip and then lifting it up and walking and recognizing there's something in your hand. And all those are specific tasks and things you have to pay attention to. And if you don't, you're liable to miss one of the steps and I miss steps all the time. Every single thing is multiple steps, and I realize I just don't pay attention to it. I really don't think that's exclusive to ADHD. I think a lot of us walk around diverse neurodiverse everything in between, everything outlying. I think we all walk around lost in thought for the most part, with very little attention paid to what's going on right now.Laura: I just want to reflect for a moment on, you've used the word "miserable" so many times in this interview, and I'm not saying that as judgment. It's just as something that I've noticed, that you quickly tend to follow it up with this moment of reframing what that is. And it seems like a big part of your journey is unpacking those little, tiny tidbits of like, "What do I mean by miserable and how can I turn that around?"Adam: 100% correct, especially because objectively, more comparatively, my life isn't miserable. It's great, but it's hard to see that, and it's hard to accept that when everything is frustrating. And if you can't manage all these frustrations, it's going to tear you apart. And there was no better word other than miserable. And misery builds on itself, and misery is addicting. And once you're addicted to misery, that's your comfort food. And so, to this day, it still feels weird to be happy about something or to start feeling miserable at something and then taking that beat and saying, "Why is going out with my in-laws to dinner making me miserable? Why is planning this project or this meeting, you know, making me miserable?"Laura: And some of those things have nothing to do with ADHD, but it sounds like...Adam: Nothing to do with it.Laura: ...this process has like kind of helped you with self-awareness, maybe on all aspects of your life.Adam: It helps me package the issues together and then attack it, seeing the whole picture.Laura: Well, Adam, I'm excited for you on this journey of finding coping skills and understanding yourself, and glad that your daughter is doing OK.Adam: And she's going to be a big sister, so...Laura: Congratulations!Adam: Thank you. Thank you.Laura: And I want to thank you for listening to the show, for writing in to the show, and for being on the show.Adam: I commend you guys. Your show is so refreshing. I haven't been able to talk to anybody about what coming out means with ADHD. And now I'm listening to all these stories and holy cow, this is a huge event in all of our lives. It's like being reborn, so it's just a super refreshing twist.Laura: Thank you. I really appreciate it. And now you're part of it.Adam: And now I'm part of it.Laura: You've been listening to "ADHD Aha!" from the Understood Podcast Network. If you want to share your own "aha" moment, email us at ADHDAha@understood.org. I'd love to hear from you. If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode. Understood is a nonprofit organization dedicated to helping people who learn and think differently, discover their potential and thrive. We have no affiliation with pharmaceutical companies. Learn more at Understood.org/mission. "ADHD Aha!" is produced by Jessamine Molli. Say hi, Jessamine!Jessamine: Hi everyone.Laura: Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. For the Understood Podcast Network, Scott Cocchiere is our creative director, Seth Melnick is our executive producer, and I'm your host, Laura Key. Thanks so much for listening.
5 steps to take If you think your child is depressed
Depression is common in kids who learn and think differently. Maybe you’ve been gradually noticing signs of depression in your child. Or maybe there’s been a sudden change in behavior that's causing you to worry. Either way, there are things you can do right now to help your child. Here are five steps to take if you think your child is depressed.1. Talk with your child.Try to find out what’s happening. Is your child upset over something specific that happened? Kids often have trouble expressing what’s going on or don’t know why they’re feeling sad or angry. Make sure your child knows you’re ready to help and that you’ll get through this together.Talk to your child about how common depression is and how it doesn’t mean someone is “weak.” People can lead a healthy life when their depression is properly treated.2. Call your child’s health care provider.Your pediatrician knows what depression looks like in kids. (The American Academy of Pediatrics says all kids 12 and older should be screened for depression.) Your child’s health care provider can also help you find a mental health professional who specializes in helping kids and teens, if needed.3. Reach out to your child’s school.Talk to your child’s teacher about emotional difficulties. The school nurse or guidance counselor may also be helpful. See if they’ve noticed any changes in your child’s behavior. Ask about school resources for struggling students.4. Learn about therapy options.Different kinds of therapies can help kids and teens with depression:Cognitive behavioral therapy (CBT) helps kids recognize and change their negative beliefs or behaviors. This short-term therapy tends to involve 5 to 20 sessions.Interpersonal therapy (IPT) focuses on relationships with other people. The goal is to help kids address problems so they can have healthier relationships.Family therapy can be a helpful starting point for kids who say things like, “I’m not depressed — I just hate my family.” This type of therapy can help family members improve communication and resolve conflicts.It’s very important to find a therapist your child likes and trusts. Also, keep in mind that some therapists use a combination of techniques such as a mix of CBT and IPT.5. Consider other treatments.Depending on your child’s symptoms, your doctor or mental health professional may suggest considering medication. Antidepressants are often used to help treat kids with moderate to severe depression. For kids with severe depression, a combination of psychotherapy and medication usually works better than either alone.And, lastly, a word about suicidal thoughts: Not all kids and adults with depression think about taking their own life. But if your child says anything about suicide, you need to take it seriously.Get your child help right away. Call a hotline (800-273-8255) or text HOME to 741741. Crisis counselors can be reached at both of these resources 24 hours a day.Understood is not affiliated with any pharmaceutical company.
ADHD Aha!ADHD and eating disorders
In this bonus episode, Dr. Roberto Olivardia talks about the link between ADHD and eating disorders, and where people can turn for support. Dr. Roberto Olivardia returns show talk ADHD eating disorders bonus episode. explains different types eating disorders — ADHD eating disorders, like binge-eating disorder (BED), often co-occur. Dr. Olivardia shares ADHD symptoms like impulsivity play role eating disorders. also talks treatment options someone know struggling eating disorder needs support.Related resourcesFind support National Eating Disorders Association.And learn about:ADHD eating disordersADHD depressionEpisode transcriptLaura: Understood Podcast Network, "ADHD Aha!," podcast people share moment finally clicked someone know ADHD. name Laura Key. I'm editorial director Understood, someone who's ADHD "aha" moment, I'll host.I'm today Dr. Roberto Olivardia. Dr. Olivardia clinical psychologist who's based Massachusetts. He's also Understood expert host Season 2 "Understood Explains" podcast, ADHD diagnosis adults. voice sounds familiar you, that's guest recent episode show, we're thrilled us today talk ADHD eating disorders. Welcome.Dr. Roberto: Thank again.Laura: pleasure. much fun talk personal story talk something probably difficult listeners hear also important share information about. talk ADHD eating disorders, want get started asking, someone struggling eating disorder someone know struggling eating disorder, recommend turn to? do?Dr. Roberto: So, definitely seek professional help eating disorders obviously, mean, it's psychiatric psychological illness, it's also medical condition affects body lot physical ways lot mental ways. it's type condition very, difficult somebody navigate without professional help.And sad statistics 10% women eating disorders get help get treatment them. men, it's even far less. So, vastly undertreated. So, recommend could starting talk primary care physician referral. National Eating Disorders Association phenomenal organization treatment providers database, referrals helpful, local experts community specialize eating disorders. condition need working someone experience expertise working eating disorders.Laura: Thank much. we'll talk treatment little bit go on. felt important start that. Don't cope alone. Get support need. basic definition eating disorder?Dr. Roberto: So, terms clinical diagnoses eating disorders, three four main ones. So, one anorexia nervosa, characterized severe restriction caloric intake, often results weight loss undernourishment, someone less nutrition body really needs, result whole host different adverse consequences body. It's often coupled distortion body image number people might see looking larger actually are.You bulimia nervosa, characterized binge eating episodes somebody consuming large amount calories one would typically consume short period time, sometimes point feeling sick sometimes even passing eating much. bulimia, it's coupled compensating behaviors like self-induced vomiting, laxative use, fasting, overexercise too, attempt neutralize calories, although doesn't actually that, talk that.And binge eating disorder, binge episodes, without compensating behaviors.And eating disorder conditions. One avoidant, restrictive food intake disorder ARFID, refers to, could similar characteristics symptoms anorexia, perhaps body image component.So, eating disorders don't always body image component people distortion dissatisfaction weight. could dysregulation food food intake. So, DSM would see disorders.But there's would call disordered eating. could come whole host different fashions dysregulated eating, poor relationship food, people might eat healthily per se, self-talk around eating negative damaging. So, somebody who, let's say, particularly underweight overweight, every time eat cookie, call pig. That's good psyche. So, although medically might issue, psychologically there's issue terms they're relating food bodies lot ways.So, see sort whole host. So, think it's really important one reasons actually people often likely get treatment think, "Oh, eating disorder somebody 80 pounds somebody 500 pounds somebody vomiting eat." come whole host different flavors.At end day, you're somebody dysregulated, negative relationship food, eating, body image, fit umbrella warrants treatment.Laura: people ADHD likely eating disorder? so, why?Dr. Roberto: always start by, it's important understand ADHD affects every life domain. So, think core ADHD terms executive functioning issues impulsivity, things actually every day kind things likely impacted ADHD.So, episode previously sleep ADHD. People ADHD often issues sleep. Eating another one. higher prevalence now, particularly binge eating disorder bulimia nervosa, ARFID, category sort dysregulated relationship, less anorexia. don't see strong correlation anorexia ADHD. often find co-morbidity anorexia likely people OCD, obsessive-compulsive disorder.Having said that, worked patients ADHD anorexia. primarily would call impulsive eating disorders like bulimia, binge eating disorder, ARFID category might rely people ADHD either drawn defensive certain tastes textures.So, people ADHD? Well, studies show know ADHD brain there's dopamine deficit, basically, dopamine neurochemical that's implicated reward. food stimulating, highly rewarding mechanism ADHD brain. mind you, people binge eat, people impulsively eat, they're kale carrots. time, foods people ADHD drawn, people eating disorders, general, drawn to, high sugar, high simple carb type foods. particularly rewarding ADHD brain. So, it's accessible, it's easy, it's legal.So, things people ADHD could use reward, soothe, self-medicate, distract negative emotions, also impulsivity alone. study done kids ADHD ages 10 14 food lab. group kids ADHD, kids without, screen beforehand level hunger, preferences food, basically let kind be. food available them. observed much ate, eat that.And afterwards, study showed that, even controlling bunch variables, kids ADHD ate kids without ADHD. interesting eating nothing level hunger, so, pre-level hunger nothing volume much kids ADHD ate. Kids without ADHD, level hunger correlated much ate. also kids ADHD even eat foods didn't even really like. asked said there. simply there.And sort joke, it's joke. mean, ADHD myself, could see-food diet see it, eat it. so, sometimes it's simple that. Sometimes, mean, patients work with, ADHD, don't hate bodies. might deep, dark things they're self-medicating. issue simply food there. It's available them.Laura: Right. remember interviewed personal story mentioned Chuck E. Cheese incident baffled how — friend relative? — able say, "I’m hungry anymore, I'm going piece pizza."Dr. Roberto: Absolutely. eat too, eat healthily, requires us tune what's called interoceptive awareness, know people eating disorders people ADHD low interoceptive awareness, tuning hunger cues, satiety
Treatment for mental health issues
Kids and adults who learn and think differently are more likely to have mental health issues than other people. Anxiety and depression are fairly common, in fact.In some cases, it’s due to stress. In others, there’s a more direct link. For example, many people with ADHD also have an anxiety disorder. The two conditions are known to co-occur.Treatments for mental health issues include therapy and medication. A common therapy is cognitive behavioral therapy (CBT). It’s a form of talk therapy. There are many medications for treating various mental health issues. People don’t all respond to medications in the same way. So, prescribers work to make sure the type and dosage is right for each person.Medication and therapy aren’t the only things that can help. Both kids and adult can learn strategies to cope with stress and tough emotions. And working on learning and behavior challenges can create a more positive outlook.
ADHD Aha!Masking ADHD symptoms to go above and beyond (René Brooks’ story)
ADHD advocate and content creator René Brooks shares her multiple ADHD diagnosis stories and unpacks the idea of ADHD as a superpower. René Brooks diagnosed ADHD three separate times — ages 7, 11, 25 — she’s plenty “aha” moments. When René child, mental health medication stigma kept family receiving vital education ADHD. diagnosed age 25, ready tell everyone ADHD diagnosis. René started Black Girl Lost Keys empower Black women ADHD. She’s advocate, content creator, host “Life Lost Keys” podcast. In week’s episode ADHD Aha!, René unpacks childhood ADHD diagnoses. shares she’d mask ADHD symptoms, led anxiety depression adulthood. Also episode: ADHD really superpower?Related resourcesRené Brooks’ podcast: Life Lost Keys ADHD medicationFrom Opportunity Gap podcast: ADHD race: Black families need knowEpisode transcriptRené: said, "The meds don't take away ADHD couple hours. still you're still things always did. It's you're able mask even better you've got one tool help move along, you're quite want be, you?" I'm like, "Oh."Laura: Understood Podcast Network, "ADHD Aha!," podcast people share moment finally clicked someone know ADHD. name Laura Key. I'm editorial director Understood. someone who's ADHD "aha" moment. I'll host. Laura: Oh, gosh. René Brooks Black Girl, Lost Keys, amazing René Brooks, content creator, advocates, Twitter, Instagram, podcasting. Hi, thank today. René: Thank me. real pleasure. Laura: first question you, René, ears ringing lately? René: Every get little bit ringy. trying say somebody talking here? Laura: I've folks show recently also colleagues office told "I going interviewing René Brooks," flipped out.René: Oh, sweet. Thank you.Laura: You're star. mean, really got much discussion around ADHD going community we're grateful you. René: grateful here. I'm grateful, it's really gratifying. It's long eight years work now, it's beautiful see direction conversation moving in. know, community's changed wildly past decade, so, completely different landscape we're dealing with. So, little like we've got growing pains, think we're headed positive direction. Laura: Right. mean, pioneer conversation woman ADHD particularly Black woman ADHD. first started speaking ADHD, think, know, third diagnosis — we'll get to — important messages get there? René: So, definitely wanted make sure Black people knew Black people ADHD. Like, course, know logically, don't see don't hear them, they're somewhere don't know are, that's really accessible you. So, wanted kind record least one person ADHD experienced living life Black person. really isolating conversations family friends, also difficult also person ADHD knew. show people isn't bad thing? it's frightening I'm wandering somewhere, can't reach anymore unless someone also see go, "Oh, OK, means." Laura: myths tried dispel first got started? René: Well, know, course, time bring ADHD, first thing anyone ever thinks of, it's frustrating us, meds. So, controversy stigma around medication, going me, going affect long term, dispel that. course, first, don't even know whether you're going try medication. That's tool. That's choice. So, shouldn't even first thing people think think ADHD. it's often is. So, stigma around meds. stigma around dealing kind mental health stuff Black person pull place danger know people committed will, who've experimented medical system, who've children taken away. So, open inquiry one's mental health also invite opinions professionals may culturally competent enough understand they're seeing find something sinister use penalize person. So, you're taking risk you're treating mental health. Laura: know mentioned earlier lot growth terms conversation community itself. around two particular myths stigma brought up? talked medicine, talked mental health, perception Black community. evolved, think, still, we? René: I've seen conversation meds shift much would like to, think that's everyone's burden bear. We're pulling along. think time there's something sensationalize topic, people going initially grab for. So, maybe always thing. hope it's not. hope one day someone make decision medication medicate without feeling like they're joining huge discourse maybe don't feel like identify with. far conversation around diagnosed ADHD different ways affects you're woman, you're person color, conversation could asked anything more. really feel like many new perspectives. There's much information. accuracy information always perfect, anyone perfect they're starting off? just, we're growing community I'm glad see directions we're shifting in. Laura: Yeah, completely agree those. would love see meds conversation evolve more. think particular medication shortages happening, vitriol around medication just, it's nasty. someone takes ADHD stimulant medication, battle every month getting prescription filled brutal. listeners don't know, diagnosed three times ADHD. René: was. Laura: age 7, age 11, 25. So, start 25, actually? want go backwards. sound? René: 25 favorite think says something finally able make decision myself, chose treatment. also, like, OK, we're going stay 25 saw jump past. Laura: know what? you, tell story want tell story. René: know what? It's jumbled story like ADHD stories are. like... Laura: Buckle up, everybody. Yeah.René: It's so, dark stormy night. So, 7 years old, brand-new teacher, fresh student teaching really fresh training knew look child might ADHD, correctly identified it. so, mother took pediatrician, pediatrician right edge retirement like, "Oh, new thing they're doing. They're trying medicate children." scare tactics used '90s. So, mom like, "Oh, well, OK. told give responsibility. I'll try create responsibility her." think worked? Laura: No, definitely not. kind responsibility? mom do? René: So, like basic chores, know, dishes and, like, dishes sensory nightmare me. hate day. So, like, know, go dishes, water's hot, it's cold, there's icky stuff on. just, war entire lives together. created lot misery didn't need to. known issue sensory one, like family, even though may understood neurodivergence, certainly understand giving someone tools need thing, kind point moving forward, kind tone took, push-pull civil war kind feeling household. René person who's given tools needs form responsibility, she's still not, we're getting performance her. So, I'm doctor said. child need, defiant child point? Defiant children get grounded, things taken away. you've got stress school you've got teachers fall anywhere spectrum agreeing ADHD thinking exists. so, you've got various levels frustration coming various different places want well child. Children want well. don't want displease adults around them. makes feel unsafe. So, wasn't lot safety there. Laura: feel like house? I'm thinking kids. can't help it. know, there's push-
Does ADHD raise the risk of mental health issues?
Children with ADHD are more likely than other kids to experience other mental health problems. Research shows they’re at greater risk for behavior issues, anxiety, depression, substance abuse, and self-injury. Adolescence is when kids with ADHD are most at risk of developing another issue.The most common problems in kids with ADHD are behavior issues. These include refusing (more often than other kids) to follow directions from parents or teachers and having emotional outbursts when asked to do things they find difficult or challenging.Kids with ADHD tend to get defiant in certain situations. For example, when they’re expected to do homework, go to bed, stop playing a game, or sit down and eat dinner. These situations are hard for them to tolerate because of the difficulties that are part of ADHD. These include:Paying attentionTolerating a boring situationReining in impulsesTransitioning from a fun activityControlling their activity levelWhen defiance becomes a disorderIs your child’s pattern of defiance severe enough to make life at school or at home very difficult on a daily basis? If so, and depending on your child’s age and symptoms, these are some of the diagnoses or labels that might be given after evaluation:Oppositional defiant disorder (ODD) is when a child has a pattern of behaving in uncooperative, defiant, hostile, and annoying ways with authority figures. Conduct disorder (CD) is when a child has a pattern of being aggressive, disruptive, or deceitful (frequent lying or stealing), and breaking rules. Disruptive mood dysregulation disorder (DMDD) is when a child has frequent, severe temper outbursts that seem completely out of proportion to the situation. The child is usually irritable in between outbursts. ADHD, depression, and anxietyADHD increases the chances that a child will develop depression, particularly in adolescence. What to look for:IrritabilityChange in sleep patternsChange in appetiteChange in academic performanceLoss of interest in friends and previously enjoyed activitiesFears that don’t seem reasonableWithdrawing from family membersIf your child shows symptoms of depression for more than a few weeks — and they’re interfering with life at school, with friends, or at home — it’s time to get an evaluation. Keep in mind that treatment for ADHD will not relieve symptoms of depression. Anxiety is also frequently present in children and adolescents with ADHD. Anxiety takes many forms:Generalized anxiety disorder is when someone is generally worried about everything and nothing specific all at the same time. A child might have fears and phobias about school, certain foods, germs, etc.Social anxiety is when someone is extremely fearful of being embarrassed or humiliated in social situations to the point where it gets in the way of daily life.Separation anxiety is when a child is unreasonably fearful about leaving a parent or is preoccupied with fears that parents or other family members might die.Obsessive-compulsive disorder is when someone is consumed with fears or unwanted thoughts (obsessions) and tries to control this with repetitive behaviors (compulsions).If your child seems preoccupied by fears and worries that are causing distress and interfering with life at home or at school, it’s important to have an evaluation for anxiety. ADHD and substance abuseTeenagers with ADHD are more likely to have substance abuse issues than kids without a history of ADHD. Kids with ADHD have a tendency toward low self-esteem. This may draw them to other kids who are more likely to be abusing drugs or alcohol. Although kids with ADHD are at higher risk for substance abuse, taking stimulant medication for ADHD does not increase that risk. If your child develops a substance abuse problem, it’s important to get separate treatment for that.ADHD and self-injuryTeenage girls with ADHD are more at risk than other girls for self-injury, like cutting. Look for:Talk about self-injurySuspicious-looking scarsWounds that don’t heal or that get worseCuts on the same placeIncreased isolationPossession of tools such as shards of glassLong-sleeved shirts in warm weatherAvoidance of social activitiesA lot of adhesive bandagesRefusal to go into the locker room or change clothes in schoolRespond immediately if you find that your child has been cutting. The longer a child is self-harming, the more difficult treatment can be. The doctor treating your child’s ADHD would be a good place to start.There’s no getting around the fact that kids with ADHD are more likely to have some other behavioral or mental health issue. The good news is that parents and caregivers who know what to look for and take action early can do a lot to prevent these issues from becoming serious. Explore more resources on ADHD and mental healthThe connection between ADHD and anxietyADHD and disruptive behavior disordersSigns of anxiety and depression in kids and teens
ADHD Aha!ADHD, working memory, and feeling like a “burden” (Pablo’s story)
Pablo’s wife noticed his ADHD-related struggles. And he shares a unique bond with his daughter, who has autism. Pablo Chavez forgetful easily distracted, trouble managing emotions. He’s also playful, fun dad. unique bond daughter, autism. Pablo’s wife Britney noticed trouble working memory, encouraged get evaluated ADHD. Pablo reflects ADHD-related challenges sometimes make feel like “burden” home. also positive attitude brings joy people around him.We learned Pablo’s story wrote us! love hearing listeners. email us ADHDAha@understood.org.Related resourcesWhat working memory?ADHD emotionsThe difference ADHD autismPodcast transcriptPablo: So, biggest "aha" moment wife pushing get diagnosis, know, several years big roller coaster really high highs really low lows, depression, anxiety dealing issues. like, no, that's it. know, something change.Laura: Understood Podcast Network, "ADHD Aha!" — podcast people share moment finally clicked someone know ADHD. name Laura Key. I'm editorial director Understood. someone who's ADHD "aha" moment, I'll host.I'm today Pablo Chavez. Pablo electrician, husband, father two lives California. Pablo got touch us via email. wrote us talk us show share story. compelled wanted invite on. thanks coming on, Pablo, thanks emailing us.Pablo: course. Thank you, Laura, me.Laura: anyone listening interested sharing story, email address ADHDAha@understood.org. read emails come in. don't always time respond right away, I'm thrilled hearing amazing people like you, listening show want share story.Pablo: It's honestly really great podcast. I've heard couple stories twice already.Laura: Thank you. means lot me. about, would love know, get diagnosed ADHD? Pablo: September/October 2021 officially got diagnosed. Laura: led seeking evaluation getting diagnosed ADHD?Pablo: That's kind like two-part series struggled change positions work, lot memorization, computer skills, scheduling, planning I'm strong in. boss would often get onto me. Like could forget? It's schedule? It's plan. Laura: again? Pablo: I'm union electrician, subcategorized low-voltage electrician. deal lot systems access control, data networks, CCTV, fire, alarm, DAS systems, fiber optics. I'm communications. I'm actually Airbnb, headquarters San Francisco. company contracted Airbnb manage access control systems globally. manage 16 sites, Beijing, Singapore, Sydney, Paris, Dublin, Portland, Montreal. Yeah, place. Laura: Wow. lot responsibility. sounds like lot manage.Pablo: Yeah, is. is. got yearly review, that's told me, like, performance isn't par. It's well. need step up. telling pushed start seeking help. That's wife told me, think aboutADHD? know, maybe symptoms coincide ADHD is. Laura: noticing? Pablo: Memory biggest part, honest. even going store, she'd send two three things. I'd forget least one, I'd call multiple times. again? again?One thing mention often usually parties, would often ditch her. purposely, right? go, oh, I'm going say hi guys really quick. I'd get caught jump another group go another group. end night, she'd fairly upset. know, barely hung me, know. And — understand someone would feel way. people would like upset significant didn't hang uncomfortable setting her. 'Cause she's introvert.I'm much extrovert. it's purposefully ignoring her, accidentally getting caught things. Laura: Give example. You're bouncing around, you're party you're talking someone. happens? move something else. Tell that. Pablo: Yeah. get — wife likes call giddy. get really giddy, really childlike playful energy. bounce around, conversate. Get excited. People seem eager talk usually seem interested giddiness. like learn. like hear stories. guess like interaction. It's soothing. It's fun.Laura: imagine one things really drew you. giddiness, playfulness. Pablo: Yeah, that's mentioned. soon started taking medicine, little concerned. thought wouldn't anymore, stories she's heard.Laura: case you, maintain giddiness? Pablo: Oh yeah, much. Laura: I'd like go back conversation wife first suggested, could maybe ADHD? remember said you? Pablo: brought lot symptoms. Like would extreme mood swings. I'd either really happy really mad upset. way express anger shutting down, shut down. don't talk. eye contact. I'm barely even there. Laura: maybe trouble managing emotions. accurate? Pablo: Yes, much so. much so.Laura: That's really common actually, Pablo. People ADHD, know, might tend feel anger frustration disappointment intensely others. That's related trouble executive functioning. Pablo: Yes. Oh, one. Executive function. would get stuck nowhere, knowing lot things do, able start. I'd hyperfocused things, one thing, maybe day complete clearness. Laura: describing earlier conversation, sounded like trouble working memory, absolutely sign ADHD. It's like sticky note brain you're storing short-term information. Pablo: Exactly. heard perfect analogy that, helped, kind help explain wife lot people ADHD is. imagine list tasks. sticky notes little cards. put desk shuffle them. That's memory. That's order go in. know, one — don't remember. kind look through, sort, every time. Laura: Pablo, used server restaurant — karaoke restaurant places. remember keep track people's orders. Like would furiously write down. — tell everybody, actually really great server. hyperaware struggled working memory just, never missed beat, right? always, wrote everything point would stayat table little bit long, never forgot anything. wrote down. Pablo: We're adaptive like that. think that's kind drives us little bit knowing fault. perfectionist. wife calls perfectionist, much so. "go big don't it" type attitude. giddiness always "go big." Don't shy away. it. Laura: last spoke, mentioned felt like burden. Pablo: Yes, much so. think rejection sensitivity, believe it's called. think affects quite bit. remember growing up, afraid lot things. lot things. illegal immigrant child. think pushed back further, kind heightened rejection sensitivity. Always felt like burden. felt quiet. Like would rely people say things me. growing up, pretty much same, except lot confident. learned mask lot symptoms, would portrayed quiet scary.Laura: felt like people perceived quiet scary? Pablo: Oh no, know. told me. Laura: told you. Pablo: Yeah. really fit high school. starting quarterback high school pitcher outfielder baseball. went all-league baseball. didn't good football, though, coming quarterback, right, freshman. told really scary, really scary, know, quiet, scary, serious. soon started practicing got know me, like, dude, funny. You're hilarious. You're cool. can't believe afraid you. Laura: That's big difference described terms giddy fun parents. hiding lot.Pablo: much masking lot symptoms high school. Laura: feeling like burden, Pablo, change got diagnosed? Pablo: No. No. don't think it'll ever change don't really control symptoms. feel like always rely people should. it's just, it's something don't want do. I'm learning accept it. I'm learning that, know, like wife wants help me. She's forgiving. She's tend
ADHD and seasonal affective disorder
Winter is an important time for kids and adults with ADHD to focus on their mental health. That’s because people with ADHD are more likely than people without ADHD to have seasonal affective disorder (SAD). This type of depression gets triggered by a change in the seasons. As the days get shorter, people are exposed to less sunlight. Many people start to feel tired and moody in the fall. These feelings tend to last through the winter. That’s why SAD is often called seasonal depression or winter depression. Shorter days can affect sleep cycles. Many people with ADHD have trouble with sleep year-round. But seasonal changes can make their sleep problems even worse. Sleep affects our brain chemistry. Trouble falling asleep or staying asleep makes it harder to focus the next day. When we don’t get enough sleep, we have less energy and feel more depressed. But the good news is that there are many ways to help. Keep reading to learn why ADHD and seasonal depression are linked — and how better sleep can help manage “the winter blues.”
ADHD Aha!ADHD and the myth of laziness (Rebecca’s story)
Rebecca is a high achiever who’s always pushed herself to work around and compensate for her ADHD challenges. And yet she still thought she was lazy. Rebecca Phillips Epstein has ADHD. But as with many high-achieving girls, her symptoms were missed early on. Then, during the pandemic, it finally clicked: She discovered a Twitter thread about people who beat themselves up for being lazy when clearly they’re not. Rebecca has always been aware of her challenges — procrastination, being late, and having a million great ideas that never get finished. As a screenplay writer and essayist, she’d overcompensate so no one would be the wiser. Hear how an ADHD diagnosis helped her rethink what she used to call “personality failures” or “laziness.” Also in this episode: How depression treatment before her ADHD diagnosis helped her tread water but never “surf.” Rebecca also talks about her decision to stop breastfeeding her second child in order to stay on her ADHD medication. Related resourcesADHD and the myth of lazinessADHD and the brain8 common myths about ADHDYou can also check out Rebecca's Washington Post article on ADHD medication and breastfeeding. Episode transcriptRebecca: I was scrolling through Twitter and came across a thread written by a woman who talks a lot about ADHD and writes a lot about ADHD. And she said that in her experience, the thing that causes her to pause and suggest to someone that they might want to talk to someone about this is when she hears people describe themselves as lazy when clearly they are not. She wrote, "If you're sitting around thinking that you're lazy, thinking that you're a failure, please allow me to suggest that maybe you're not." And it was like all those years of not understanding myself just suddenly made sense. All of the near-misses and the failures and the frustrations just clicked into place.Laura: From the Understood Podcast Network, this is "ADHD Aha!," a podcast where people share the moment when it finally clicked that they or someone they know has ADHD. My name is Laura Key. I'm the editorial director here at Understood. And as someone who's had my own ADHD "aha" moment, I'll be your host.I'm here today with Rebecca Phillips Epstein. Rebecca is a screenwriter and essayist who lives in Los Angeles. She's worked on a bunch of shows, including "Roseanne" and "Emily in Paris." She's also written for a variety of publications, like the Washington Post's On Parenting blog. Hi, Rebecca. I'm so glad you're here today.Rebecca: Hi. Thanks for having me.Laura: So let's dive right in, Rebecca. I would love for you to start by telling me when you were diagnosed with ADHD and what was going on in your life at that time.Rebecca: I was diagnosed with ADHD in June of 2020. And what was going on in my life at that time? The majority was what was going on in a lot of people's lives, which was the pandemic had totally changed every aspect of my life and career and family life. I had two young children. One was in his last year of preschool and the other was 6 months old. And in May of 2020, I was on Twitter and stumbled across a thread by a woman named Erynn Brook, who writes a lot about ADHD and neurodivergent brains. And it had been retweeted by a friend of mine. And because I care about this friend and I'm always interested in what they post, I clicked through.And it was a thread talking about speaking to people and helping them realize that they have ADHD. It happens a lot. And that she says when people are talking to her, the things she listens for that makes her say "you might want to talk to somebody about this" is when they tell stories about things they want to do, that they know how to do, that they care a lot about, that they just can't do. And they write themselves off as lazy or terrible people.And she wrote that the thing about lazy people is they don't actually care that they're lazy. They don't care that they're letting people down. They're fine with that pattern, truly lazy people. So if you're sitting around calling yourself lazy because you can't understand why you can't get things done and you're beating yourself up about it, perhaps you're not lazy. Perhaps it's something else. And it was like 30 years of tiny "aha" moments all of a sudden just exploded.I often compare it to at the end of "A Beautiful Mind," when Jennifer Connelly walks into the murder shed and he has all those pictures with the strings connecting everything, and the room starts to spin. That's what it felt like for me, because I had two very close near-misses to getting diagnosed throughout my life. But it hadn't happened. And in this one moment, just this one Twitter thread, I realized, like, it made everything make sense.I immediately emailed my therapist and said, "When I see you in two days, I need to talk about this." And we talked about it and she said, "I think this is undeniable." So I called my psychiatrist. I was incredibly lucky that I had known my psychiatrist for years, because she had treated me for postpartum depression when my oldest was a baby. So we had a long relationship. So when I went in there, I had a shorter diagnostic evaluation because she had years of notes on me and knowledge about my life. And she just said, "Yes. You meet the entire diagnostic checklist. You are a textbook example of how this gets missed in high-achieving girls."And similar to your story, Laura, I was a perfectionist. I fell back on my AP classes, my top 10 university degrees, being 15 minutes early for everything, because if I wasn't 15 minutes early, I was going to be extremely late. I knew what my shortcomings were, and I overcompensated for every single one that I could so that no one would know. Because I knew I wasn't good enough. But there was no good reason why. So I just had to hide it.Laura: Yeah, so you were overcompensating all this time and — but yet feeling like you were lazy. And that's — it's so interesting because one person says one thing in one particular way, and it just clicks. And you had that "Beautiful Mind" moment. So what were you feeling lazy about?Rebecca: Oh, God. Procrastinating everything. Being late on everything. A million terrific ideas that never got finished. You know? And as a writer, writing is hard even for neurotypical writers. It's like the Dorothy Parker quote, "I hate writing, but I love having written." And with ADHD, you never get to the point where you have written. You have the ideas, you know how you want them to be. But getting them out — getting started — is a nightmare. And I came up with some tricks and some tips and deadlines, of course, pressure.But for me throughout my life, I was just always that kid whose paper was a day late. And so all through high school it was, "Oh, my printer didn't work." "I emailed it to you. Didn't you get it?" And things that every teacher knows what that is. And because I was good and smart and accomplished, they let me get away with it. And I never learned that lesson when I was young enough to learn it. And so instead the lesson I learned was that I could get away with it. And it had that effect of me thinking that if I did put in an effort, then it meant that I wasn't good at something. So I had this, like this double bind of I'm naturally gifted, so I shouldn't have to work that hard. But even when I do work as hard as I can, sometimes I can't even produce anything.Laura: Yeah. Yeah.Rebecca: And in graduate school, it just got worse and worse because there was less oversight. I wasn't living with my parents to provide that structure, and so I would just stay up all night and wait. And I would have a paper that really I should have spent two weeks working on, and I would do it in 8 hours. And I would do almost as well as I could. And at the time, of course, I chalked it up to imposter syndrome and fear of failure. And "Oh well, if I work as hard as I can and I don't do well, what does that say about me? So that must be why."You know, there was always another explanation. "Oh, I'm depressed. That's why my house is a mess." And I was treated for depression a couple of times throughout my life. And I remember saying to the psychiatrists who were treating me, "I feel like I'm not drowning anymore, but I don't feel like I'm surfing." Like I'm never ahead of it.Now, looking back, I recognize that that's because I wasn't dealing with a serotonin deficiency. I wasn't dealing with standard depression. I was dealing with a dopamine deficiency, which is different. I was dealing with ADHD and the depressive behaviors that sometimes come with ADHD. So it looked like depression, right?Laura: Yeah. ADHD and depression can kind of mimic each other. Hats off to you for going into a writing career. I know exactly the feeling that you're talking about when — there's a reason that I'm an editor and I'm not a writer. I love when I have produced something — to go back to your Dorothy Parker quote — but getting there is just impossible. But I'm really fast when I can edit something.Rebecca: I didn't start out as a writer. I sort of tried to do everything, but — and when I look back, it's like, I don't know how I missed it because in college I did improv. I didn't do sketch in graduate school. I went to theater school, but not for playwriting, for dramaturgy. And the job of a dramaturg is to basically read drafts and give notes. To sit next to a director and just say thoughts to them. The job was immediate. It was very in the moment. A lot of the job was sitting and bouncing thoughts around and bringing my sort of academic background into a rehearsal room, which could be done live in the moment.And I noticed that I always thrived in environments where the only prep was being really smart or being really competent, and where the actual work was something I could do live — where it wasn't about homework, it wasn't about preparing, it was about showing up prepared. And that the bulk of the work was happening in the immediate sense. So there was no way to procrastinate. You know, I instinctively chose this path that leaned into my skills as a person with ADHD and where I could be creative but be in the moment.But when I moved to Los Angeles, I started working at a talent agency as an assistant. And a lot of the job was making phone calls, managing calendars, sending materials. And my boss has had upwards of 50 clients who all had submissions going out, who all had meetings to attend that I had to schedule. And everything gets rescheduled a million times. So there were hundreds and hundreds of emails every day and dozens of packets that had to go out. And so much to keep track of. And I recognized very quickly — this is pre-diagnosis — that I was going to forget everything unless I figured out a way to not allow myself to. So I created this enormous tracking spreadsheet where every single step had its own — put the email together, send the email, get response to email, check with my boss about response. Follow up with the same.Laura: Reminder to check the spreadsheet.Rebecca: But it was like every single step of like receive email, reply to email, was its own step, right? Everything so that I would know what step I was at and what I needed to do. And then I structure my day of, in the morning and the afternoon, there were 45 minutes where I would go down and see what can be followed up on. Where am I at? What have I left hanging? And this spreadsheet was so useful to me during the busy times of year that I — people started asking me for it. Other assistants in the department. And I am told that years later it's still a thing that assistants use in staffing season so that they don't lose track of things. Now, I had a pile of six months of contracts to be filed that I kept under my desk that nobody knew about. And then when I left the agency, the person who took over for me just had to do it as part of her training.Laura: Oh, my gosh. Rebecca, that is like some intense coping mechanisms there, but I'm really glad that it worked out for you and that now it's helping other folks at the company.Rebecca: Everybody knows what that's like to lose track of things, to forget things, to be overwhelmed. And it's not like these systems wouldn't help someone who's neurotypical, you know. And I think that's part of — they know that's part of — what's so tricky with ADHD is that all of the symptoms taken on their own are common. Everybody forgets things. Everybody loses things. Everybody interrupts people. Says things they shouldn't. But it's how much of it are you doing? Can you stop it? And how much of an impact is it having on your ability to live your life the way you want to?Laura: Right. That's something I talk about with a lot of guests is the ubiquity of the signs and how that leads to so much like excuse-making. Sure, everybody struggles with it every once in a while, but like the severity and the frequency with which you struggle is huge. But because they're such common things, people tend to blame themselves. Again, going back to the laziness thing, I'm just being lazy. Or I should just — I just need to try harder. Or I didn't exercise today or whatever.Rebecca: And before I knew why, it was very difficult to make changes. Because if the only reason that I had for why I was doing these things was personality failures, then I couldn't solve it, right? Because if it's just, oh, this is just who I am and I am a failure. I'm lazy. I'm weird. I have a hard time making friends. I am obnoxious in group settings. You know, if it's just me, if I'm just terrible, then there's nothing to be done. And it was really not until after the diagnosis that I could give myself that grace of like, let's look at this a different way. Which I had not been able to do my whole life.And an example I talk about a lot is like vacuuming the floor. I, like many people, especially people with ADHD, housekeeping and cleaning is impossible. Because it's drudgery. It's not fun. There are so many steps, and I'd rather be doing other things. And for some reason, vacuuming was really the one that bothered me the most — that I could not make myself do. So I just would sit there after I put my kids to bed and watch the chunks of mac and cheese just drying on the carpet, going, "I have to vacuum. I have to do it. Just get up and do it." And I wouldn't. And I just wouldn't. And I would think, "Oh, I'm like, I'm a piece of shit. I'm a piece of shit. That's the only possible reason." And then after the diagnosis, it was OK. I have been spending years and years trying to force myself to vacuum because that was the only solution I could come up with to the problem of I don't vacuum. But the real problem is my floor is not clean, my carpets are not clean.So if I say like, let's just assume I'm never going to be a person who vacuums. Let's assume that my ADHD will never allow me to vacuum. Because what's really hard about it is the number of steps. The vacuum cleaner is like in a closet behind the garbage can in my small kitchen. So I have to move the garbage can, open the closet, take it out, unwind the cord, plug it in, move the table, move the chairs, push the thing around. It's like 15 steps and it's really annoying.So I said, "OK, so what if I'm never going to do this? Do I have to vacuum or do I have to have a clean floor?" And I bought a Dustbuster and it sits on a stand on the bookcase within arm's reach of my chair at the dining — I don't even have to get up. So now my floor is clean because I asked a different question. The fact that I couldn't even give myself permission to say "Maybe I should do this a different way" — that's one of the hardest parts of living with undiagnosed ADHD is, I think, the pressure you put on yourself to do things the same way everybody else does. Because you don't have, or I didn't have, a good enough reason to make those accommodations for myself.Laura: Exactly. The way that you described laziness was really important, because I don't like when people are critics of ADHD, say, OK, we're just making an excuse for laziness here. Because to your point earlier, it's not real laziness that we're talking about. We're not talking about we're not giving a damn about doing the things. Like there's a deep care — like you want your floor clean. You really genuinely care. You just could not get to it for whatever reason. I think that that's really interesting and important.Last time we chatted, you mentioned that when you were 7 you were almost diagnosed with ADHD. I would love to hear what was happening at that time.Rebecca: So I was in the second grade and I have no memory of this, so I'm kind of cobbling together what my parents told me. I have no memory of any of this, and I didn't find out about it till I was in my early 20s. But from what I understand, I was doing like a fine job in second grade grades-wise. And my teacher called my parents and said some version of "Rebecca is having more trouble in my class and she should given how smart she is. You might want to get her evaluated for ADHD." And so they took me to the pediatrician, who was like this old-school Manhattan pediatrician, who evaluated me and said unequivocally, "She does not have this. She is reading at a sixth-grade level. She can sit still and color for hours. Like that's not ADHD. Sounds like she's just bored and the teacher needs to work harder."Laura: Well, bored might have been true.Rebecca: For sure.Laura: Yeah, that's — again, ADHD is not related to intelligence.Rebecca: So I went back to school. And what I do remember is that I started meeting weekly with this teacher, and she created a chart for me. And every week there were check-ins of how I was doing on the different markers that would show up on the report card. From what I remember, it was more about just finishing everything, you know, and staying on task and not letting myself get distracted by other things. And so what she was doing was the kind of behavior modification that we know works now.And my grades improved. And it's funny, the reward. My parents said, if you get — I don't even remember what it was — you know, all satisfactory pluses, I was going to get a Game Boy. And I did it, and I got my Game Boy, and the game that was on it was Tetris. Which is kind of an amazing metaphor for what the 30 years that followed that were like. Because, you know, as you're playing Tetris, it starts out with the blocks are falling slowly, you have the whole screen to work with, and you turn them to make lines. And as the levels get higher and higher, they start to fall faster. And when you're not able to make straight lines, then you have less space to work with. Right?I was so smart at like the game of Tetris in life. But even though my pieces were falling so fast and I had so little space to work with, I was beating level after level. I did it! But I knew it was harder for me than other people. And if I'm supposed to be this smart, why is this hard for me? And what I didn't realize was that, like, my game was busted. Like other people had more space to work with. Their pieces were not falling as fast. And I was holding myself to the same standards that everybody else was. But I was working with a totally different system.Laura: Shout-out to that teacher, by the way. She sounds fantastic.Rebecca: Mrs. Bronsky, if you're listening, she really was my favorite. Mrs. Bronsky. She was just a sweet, gorgeous, funny. I loved her. But she saw it. She saw and she believed in me. And she built my confidence. She didn't punish me for these things. She found a way to reach me, which was really special, and it really made that year possible for me.Laura: So I really like this Tetris analogy. I love the way that your brain works. It's a very visual, creative image, and it's helping me understand, like, the pieces of your life, actually, as we listen to it. So at that point then, you're in your 20s, and they're like, "Well, it wasn't a thing." So you're like, "OK, bye. Bye, ADHD."But then you have your second child. It sounds like it just started storming Tetris pieces at that point. And not all of the "ADHD Aha!" listeners are going to maybe be as interested, but I would ask that they try to be interested in this aspect of it, because it's very interesting to me as a mom who breastfed. I believe you were breastfeeding your second child and you were at the same time like getting evaluated and diagnosed with ADHD — and potentially going on medication. So I would love for you to talk me through your thought process.Rebecca: You know, the recommendation that my obstetrician and my psychiatrist at the time made was to avoid it. Because the way that it is described is it should only be taken if the benefits to the parent outweigh the potential risks to the infant. And so for most people who are breastfeeding and have ADHD, it's like who would say that any potential risk to your baby is worth it? I mean, I went through that moment of like, well, I've suffered for 30 years without meds. Surely I can do six more months to get to a year.Laura: Get to a year of breastfeeding, you mean?Rebecca: Yeah, because with my oldest, I had done 14 months. It was not always easy, but it was easy-ish, you know? And it was because I had terrible postpartum depression with my oldest. Breastfeeding felt like a thing I could do. So I was like, I was going to do one thing well. And with my second, I did not have postpartum depression, like, at all. So for the first three months of his life, pre-pandemic, I was like, I love being a mom of two kids. Like, this is going well for me. I'm good at this. I am managing this in a way that I never could before. I had found a rhythm that works. I finally felt like I was getting the hang of it.And then the pandemic and everything shut down. And it was emotional overwhelm and a totally different schedule. And everybody was trapped in a thousand square foot apartment and all the things that have happened to so many people. So then when I got diagnosed and the question arose of what was I going to do? Sidebar: I would certainly recommend that any listeners speak to their doctors about the risks, about the benefits. And this conversation seems to be evolving. But at the time that I was diagnosed, it was presented to me as rather binary.And I will say that my psychiatrist was very flexible in that she said, you know, there might be a way to take short-acting medication and kind of pump and dump around it and minimize the risk as much as possible. But the amount of pumping I had to do before I took the 4 hours of medication, and then the pumping and dumping I had to do during to keep my supply up, and then after to get rid of any residual meds. And then I still had to feed him. Within a month of trying to do this, it became obvious that this was not going to work.First of all, I was miserable. And the whole time I was on the meds I was spending attached to a breast pump. And the difference for me, the first time I took the medication was so immediate and so obvious. You know, I compare it to like the first time you get on an airplane and put on noise-canceling headphones and all of a sudden you realize just how loud it was. You had no idea. And within 30 minutes of taking my very first dose of short-acting medication, I walked into the living room where my husband was sitting and I said, I'm going to have to quit breastfeeding. I am — there is no — I cannot not feel this way. I cannot — I feel normal. I feel quiet. I can't go back. This is — there's no way. I can't. No way.Laura: Clearly, you made a very informed decision. You did your research. You know, you did what was best for both you and for your baby. Like, if you're not in good shape, then how can you care for a child? And I'm curious about any feelings that came with that. Because we put so much pressure on moms to breastfeed. And then there's — you've got the shame feelings maybe around ADHD, and then the shame feelings around mom. I mean, did that just like concoct into like a cauldron of, like, crazy shame?Rebecca: At first, it was torturous getting him to take a bottle even of pumped milk at first. And there was this part of me that was going, "Why am I doing this to him? How can I be doing this to him just so that I can, like, have an easier time remembering where I put my keys down? That's not fair. It's not fair to him." But also because of what my constellation of symptoms are, my issues with emotional regulation and getting overwhelmed. I mean, all parents get overwhelmed, right? So when you already have an issue with getting overwhelmed and your go-to response is anger and freak-outs, which mine was, marriages suffer. Parent-child relationships suffer. And if it was me and a baby in a vacuum, that would be one thing. But it was me and a baby and a 5-year-old who had had everything taken from him. He was about to go to kindergarten. His fifth birthday was March 10th, 2020, and so his was the first birthday party that was canceled.So, OK, even if breastfeeding is what makes you a good mother, which it's not, but let's go with that for a second. Let's say breastfeeding makes you a good mother, OK? To a baby. But I had two kids. And I had to be a good mother to both of them. And on my meds, I am a better mother to both of them in the day-to-day activities of being a mother. Breastfeeding is a very passive, often, activity, which is wonderful when it works. But there is so much else that happens during the course of the day.And my oldest was old enough to remember. He knew what was going on and he needed me. And the bar for what I needed to do every day had gotten higher, because I needed to be able to shift between virtual schooling and infant care and dealing with our financial issues. Because my husband and I both work in TV and film and the whole industry was shut down. There was so much going on that required not just my active attention, but for me to be really at my best. And also I had already been breastfeeding for six months. That's a long time. I made it a long time.Laura: You did! Kudos to you.Rebecca: It just really wasn't a choice.Laura: I love when smart, strong women make thoughtful choices about what's best, not just for the people in their lives that they take care of, but also what's best for themselves. Because that ultimately makes us better mothers, better friends, better co-workers. So I think that it's really beautiful how you've navigated your diagnosis and motherhood. I mean, there's — you've got so much going on and you are, like, you're thriving. You're like a badass lady out there in L.A., let me say. So, I mean, cheesiest thing I've ever said.Rebecca: I mean, you know, I think so. And I think knowing that it's genetic and knowing that there is a high chance that one or both of my kids will have it, I've been able to lay that groundwork of — well, my youngest is young to understand. But my oldest, I told him about my diagnosis. I told him what it means. I told him how it shows up in my life.He knows I take medication. And I said, "It's kind of like how I wear glasses. I can't see as far as other people. I wear my glasses and I can. My brain can't organize itself the same way other people's can. I take my medication and it's easier." So that if and when the day comes, when that becomes his story, he will not see it as something being bad or wrong. He will see it as, oh, everybody has things about themselves that are harder for them than they are for other people. And maybe this is mine, and mine happens to have a name, but that doesn't mean it's worse or bad, it just is.And so it's been not just a gift to me in my parenting that I now know myself better and am more capable, you know, and mostly calmer. But it's been a gift to me that I get to consciously pass those things along to my children — however their brains are organized — and give them permission to do things in a way that works for them.Laura: That's beautiful. It really is. And I'm going to carry that with me when I go home and see my kids this afternoon. So. Rebecca, thank you so much for being here today. I really appreciate it.Rebecca: Thank you for having me. I loved talking to you. I mean, this type of conversation was life-changing for me in my own journey. So I'm so thrilled to be a part of it.Laura: You've been listening to "ADHD Aha!" from the Understood Podcast Network. If you want to share your own "aha" moment, email us at ADHDAha@understood.org. I'd love to hear from you.If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode.Understood is a nonprofit organization dedicated to helping people who learn and think differently discover their potential and thrive. Learn more at Understood.org/mission. "ADHD Aha!" is produced by Jessamine Molli. Say hi, Jessamine.Jessamine: Hi, everyone.Laura: Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. Margie DeSantis provides editorial support. For the Understood Podcast Network, Scott Cocchiere is our creative director and Seth Melnick is our executive producer. And I'm your host, Laura Key. Thanks so much for listening.
Cognitive behavioral therapy: What is CBT?
Many people who learn and think differently also have mental health issues. For some, just coping with daily challenges can cause a lot of stress or make them feel bad about themselves. But some have more serious problems with anxiety and depression. These conditions are common in people with ADHD, dyslexia, and other learning challenges. There are different treatments that can help kids, teens, and adults with mental health issues. Cognitive behavioral therapy (CBT) is one of them. Learn more about CBT.What is CBT?CBT is a form of talk therapy that can be used with kids, teens, and adults. Its goals are to:Get people to look at their thoughts, feelings, and behaviors.Show them how to replace negative thoughts with more realistic, positive ones.Help them change behaviors that cause problems in everyday life.Here’s an example. People with dyslexia often dread having to read out loud, whether it’s at school, at work, or in a social setting. They may fear being judged. Or they may feel “stupid” because they struggle when others don’t.Kids might say, “I’m stupid and I can’t learn. I’m not reading any more books for school.” Adults might say, “I’m not smart enough for this job, and I’m never going to succeed.”CBT can help people challenge that thought and replace it with, “I have a lot of strengths. My reading problems can make things harder, but I’m just as smart as other people. And there are tools I can use to make reading easier.”People work with the therapist to set goals, identify problems, and check progress. Kids may get assignments to do between sessions to build the skills they’re learning.CBT focuses on the present and the future. It helps people realize they have control over their behaviors.How CBT worksWith CBT, people meet with a therapist. That person may be a psychologist, a psychiatrist, or a social worker. They can meet individually, in a group, or with family members. With kids, the therapist first meets with the parents and their child to find out what they hope to achieve. That could be anything from stopping being bullied at school to feeling more confident.There are a number of techniques therapists use in CBT. One is called modeling. In this approach, the therapist demonstrates the desired behavior, like standing up to a bully.Another technique is called cognitive restructuring. This is an approach where people learn to recognize and replace negative thoughts. For instance, they might turn “I’m such a slob and everyone gets annoyed with me” into “I have a very hard time staying organized, but that doesn’t mean I don’t do other things well.”CBT is shorter term than some other kinds of therapy. The number of sessions people go to is usually between 10 and 20. But each person is different, and the number of recommended sessions can vary.There are certain steps involved in CBT. They include:Identifying things in your life that are upsetting to you.Becoming aware of your thoughts and feelings about them.Recognizing thinking that’s negative or not accurate.Reshaping that thinking into a more positive view.There are different forms of CBT. One is called mindfulness-based cognitive therapy. This approach teaches kids and adults how to manage their body and mind in response to stressors. Another is called dialectical behavior therapy (DBT). It’s a structured program for teens and adults who struggle with negative feelings and behaviors.Who CBT can helpCBT is used to treat people with a range of mental health conditions. These include:Anxiety disordersDepressionEating disordersBipolar disordersObsessive-compulsive disorder (OCD)People don’t need to have a disorder to benefit from CBT, however. This type of therapy can also help with chronic stress, fear, low self-esteem, and other emotional struggles. CBT teaches people how to manage their emotions and put things in perspective.For CBT to work, people need to understand their thought patterns. Kids under age 7 may not have that ability until they’re older.Where to find CBTDoctors and other medical providers are a good place to start. They may be able to refer you to specialists who do therapy. Many therapists do CBT. Some even specialize in working with people who learn and think differently. For kids, it’s a good idea to find a therapist who often works with children. Friends and family who have been in therapy another good source. They may have someone they recommend. Another option is to search online at the Association for Behavioral and Cognitive Therapies.Therapy can be expensive. But many therapists take insurance and some work on a sliding fee scale. You may also be able to find a mental health clinic in your area that offers free or low-cost services.If you’re a parent or caregiver, you may wonder whether your child needs support with emotional challenges. Find out when it’s time for kids to get help for mental health issues.
ADHD Aha!ADHD Aha! Listener letters roundup (YOUR stories)
Host Laura Key and the team share ADHD stories from listeners who have written in. Host Laura Key and the ADHD Aha! team have been blown away by all of the thoughtful and candid emails we get from our listeners about their own ADHD “aha” moments. So with their permission, we’re sharing a few of them on this episode. Find out which ADHD symptoms some of our listeners have struggled with — and what their path to ADHD diagnosis was like.Related resourcesADHD symptoms at different agesFind more ADHD personal stories in our Medium publication, for/by.Share your story, too! Email us at ADHDAha@understood.org.Episode transcriptLaura: From the Understood Podcast Network, this is "ADHD Aha!," a podcast where people share the moment when it finally clicked that they or someone they know has ADHD. My name is Laura Key. I'm the editorial director here at Understood. And as someone who's had my own ADHD "aha" moment, I'll be your host.Hi, everyone. We have a very special episode for you this week. In fact, I'm thrilled to say that it's an episode about you. Since we started "ADHD Aha!," we've gotten so much wonderful feedback from our listeners. Hearing how much you relate to or learn from the stories we're sharing is truly my favorite part of hosting this podcast. It reminds me why we created the show, and it motivates the team to keep going. So for this episode, I'd like to share excerpts from some of the letters. And by letters, I mean emails that we've received. You're going to hear some new voices. These are all Understood team members speaking, and they're going to be reading the excerpts with the author's permission.Our first letter is from Melissa. Melissa wrote to us saying she grew up a quote, goody two shoes who was unknowingly struggling with perfectionism and anxiety. Hey, that sounds like me. But like many of us, the pandemic heightened her mental health struggles to the point that she sought out therapy. And even though she felt like her anxiety and depression were improving, something else was bothering her."Melissa": One day, while scrolling through Instagram, I stumbled upon a post from a woman who had just gotten diagnosed with ADHD at the age of 26 and was sharing her experiences and struggles. My first thought was, "How come it took people so long to notice? How did she find out now at 26?" I myself am a 24-year-old and have been a preschool teacher for five years. It bothered me that nobody had raised any concerns. Little did I know I was on the same boat. Through further investigation, I realized I could relate to about 90% of the ADHD symptoms found in women. I was dumbfounded. I'm supposed to be one of the professionals who can recognize what this looks like in others and yet couldn't see it in myself. After being evaluated by my therapist and psychiatrist, it was confirmed: It was and still is a crazy "aha" moment. I am still trying to understand myself, and I'm not sure what to do half the time. But your stories inspired me and I hope mine can inspire others too.Laura: Melissa basically just summed up why we call the show "ADHD Aha!" It's so easy to overlook or brush aside ADHD symptoms, no matter how much knowledge you have about ADHD. It often takes hearing about someone else's story, someone you relate to, to spark your own "aha" moment, which is essentially what we're trying to do with this podcast. Thanks so much for writing in Melissa.Before we get to the next listener letter, I have a request. By the way, don't you just love it when podcast hosts chime in to ask you to do something? This episode is all about what we've been hearing from you. And the more that we hear, the better we can make the show. That's why we put together a survey that's really easy and quick to fill out. You'll find it at u.org/podcastsurvey. That's the letter U, dot org, slash podcast survey. Check it out if you can. And thanks again. Now back to the listener letters.This one comes from Terry, who got her ADHD diagnosis the summer before starting graduate studies to become a pediatric speech-language pathologist. Terry told us that she started and stopped college many times and finally managed to finish by, quote, white-knuckling my way through sheer force of will. Right on, Terry. But while waiting to hear if she'd gotten into her grad program, she decided it was time to get evaluated for ADHD."Terry": I remember thinking, so there is something wrong with me. That may sound completely politically incorrect, especially coming from someone who specializes in working with children with disabilities. So let me explain. I grew up in a home with a self-taught engineer dad and a fourth-grade teacher mother, who both told us we were all smart and could accomplish anything we set our minds to. And for the most part, we, I believed them. They were my parents, after all. But all the struggles I had with homework, math, writing, they felt extremely real too. I couldn't figure out how to reconcile these seemingly true but contradicting facts about myself. I felt like an unsolvable math equation. I was two plus four equals eight. My diagnosis justified that and said yes, two plus four never equals eight. But here's the other two parts. Now you equal eight. You're whole. Well, I was never really great with analogies, but hopefully you were able to follow me with that one. My diagnosis made both sides of the equation make sense, reconciling these two irreconcilable pieces of myself — that I was both smart and I struggle with things. In my home and in my head, I believed I could only be one or the other. It never occurred to me that I could be both.Laura: Terry's email reminds me of stories from a bunch of guests we've had on the show. I think about, for example, Dr. Kojo and how intensely he pushed himself to work harder and harder and harder until he got diagnosed. I think about writer and mom of four Jen Barton, who was coping with anxiety but still had a sense that her equation, as Terry calls it, was off until she was also diagnosed with ADHD. And I think about myself in both of these ways, never giving myself a break and telling myself to just try harder. And then getting my anxiety under control only to find that I still simply couldn't focus. Thanks for writing in Terry.Our next letter is from Taryn, who says they were recently diagnosed with ADHD at 33. They describe starting medication as, quote, the single most life-changing decision they have ever made, and they're grateful for it. But they say they're also grieving deeply for the years they feel they've lost."Taryn": I first asked my doctor for help with my mental health at the age of 12. She told me it was just teenage hormones. In high school, I spent so much time in the counselor's office. In college, I started therapy and medication. I've tried at least eight medications, and I've gone through so many diagnoses. I think about all the things that could have been different if I had gotten the right help sooner. I could have been a better friend, a better partner, a better child, a happier me. Part of me is really sad and really angry, and I feel super left out of the ADHD narrative. Everywhere I turn, there are people talking about how ADHD is positive for them in some ways. I feel that ADHD has been almost entirely destructive for me. But thank you for your podcast. I've listened to about half of the episodes so far, and it's been very helpful.Laura: Taryn's letter is so important. We try to show a diversity of experiences on this show. The positives, of course. But we don't want to gloss over the hard stuff and the difficult feelings that can come with an ADHD diagnosis. So thanks, Taryn, for your candor.This next letter comes from Daisy, who tells us she started the process of being evaluated for ADHD two years ago. She says that trouble managing emotions and other ADHD symptoms made it hard for her to grow up in a family that prided themselves on being unemotional and, quote, strong."Daisy": Rejection sensitivity was one emotion I constantly had that I could never explain to people. Whenever somebody said to me, "The worst they can say is 'no,'" I would immediately respond with, "Exactly. That's the absolute worst thing they can say to me." I could never understand why the word "no" was like a knife in my heart and caused me to immediately start crying. I felt silly and childish that I could not handle rejection, because that is a basic life skill. But something inside me could not connect the logic in my mind to what I physically felt in my heart when rejected. About two years ago, I randomly came across a blog talking about rejection sensitivity, a term I hadn't heard of at the time, and its relation to ADHD. As soon as I read this person's experience, I had my "aha" moment. Because I'm a young adult female, everything I had known about ADHD was based on the typical myths and stereotypes that dominate much of the public perception. I now had an explanation for why my entire life, I was afraid to ask for help, could never focus on a lecture for more than a few minutes at a time, or constantly forgot things people asked me to do. But it also explained why I have such intense passions for the things I love, why I experience a wide range of emotions, and why I feel uniquely me.Laura: We haven't talked a lot about rejection sensitivity on the show yet, but we have talked a lot about and we'll talk more about ADHD in girls and women and how symptoms so often get overlooked or swept under the rug. Trouble managing emotions as a lesser known symptom of ADHD. And if girls or women struggle with it. They're far too often labeled as just being too sensitive or too dramatic or too emotional. Thanks, Daisy, for your letter.Hearing from you all means so much to me. I love the community we've built around the show. But before we go, my amazing producer, Jessamine, who makes me sound way better than I sound in real life, is going to join us quickly for something fun. Hey, Jessamine.Jessamine: Hi, Laura. We have gotten so many awesome notes from listeners. I figured we could just share a few of the shorter one sort of rapid-fire style.Laura: Ooh, I love that. Let's do it.Jessamine: All right, so here's the first one. "I can't believe how much the people you're interviewing are describing my life. It's like they're reading a book about my past."Laura: Oh, that's nice to hear.Jessamine: I like that one. This one is, "I recently found your podcast when looking for resources for students, and it has felt like another absolute 'aha' moment for me."Laura: Yes, that's what we're here to do. I love it. Awesome.Jessamine: "This podcast is so helpful to feel heard and seen. It makes you feel like you aren't alone in coping, and that you have peers who truly understand the dynamics of ADHD and the moving parts that come with it."Laura: Oh, I love that. I feel that way every time I have an interview with someone. I get to experience that over and over again. So I'm with you.Jessamine: "It has brought me comfort and community that I didn't know I was seeking."Laura: Oh, same here.Jessamine: "Laura, I can't express how validating and healing it was for me to listen to your 'aha' moment. It came at a time when I needed it the most, and yet I didn't even know I needed it."Laura: That is so nice to hear because I was so anxious about sharing my own "aha" moment. You know this Jessamine. Remember that very first episode?Jessamine: Oh, yeah.Laura: Oh, I'm glad that it resonated.Jessamine: Tough place to start. Your first interview was, you know, yourself. But it was a good one.Laura: Yeah. Me crying about myself. Oh, my gosh. Thank you so much, Jessamine, for that. That's so motivational. And I hope it motivates you as well, because you are a huge part of the show and working with you is so much fun.Jessamine: Yeah, I really love working on the show and hearing how people connect with the interviews and feel less alone or more understood by the show is honestly my favorite part.Laura: Well, I think we're going to wrap it up there. Thank you to everyone who let us share their words on the podcast today and everyone else who has written in. And if you've listened this far, I'm assuming you're enjoying what you're hearing. I would love it if you would rate and review us on Apple Podcasts and other platforms. This helps more and more people find the show and have their own "aha" moments. Thank you also to my fabulous colleagues, Briana, Justin, Eleni, and you too, Jessamine, who were the voice actors you heard in this episode. And thank you all for listening. If you'd like to share your "aha" moment or anything else, please email us at ADHDAha@understood.org.You've been listening to "ADHD Aha!" from the Understood Podcast Network. If you want to share your own "aha" moment, email us at ADHDAha@understood.org. I'd love to hear from you. If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode.Understood is a nonprofit organization dedicated to helping people who learn and think differently discover their potential and thrive. Learn more at understood.org/mission. "ADHD Aha!" is produced by Jessamine Molli. Say hi, Jessamine.Jessamine: Hi everyone.Laura: Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. For the Understood Podcast Network, Scott Cocchiere is our creative director, Seth Melnick is our executive producer, and I'm your host, Laura Key. Thanks so much for listening.
Understood study reveals academic, emotional, and financial realities and implications of remote learning
Nearly 60% of Parents of Children with Learning and Thinking Differences Say Children Year Behind and May Never Catch Up vs. Just 16% of Typical Parents Parents Report Children with Learning and Thinking Differences Three Times Likely to Experience Depression Due to Remote Learning43% of All Parents Facing Financial Burden Because of Children’s Remote LearningNEW YORK (MAY 17, 2021) – Understood, a social impact organization and the only lifelong guide for those who learn and think differently, unveiled a study today with insights on how the shift to remote learning and the pandemic has affected children and families academically, emotionally and financially. Understood’s “Pandemic Learning Impact Study,” which surveyed 1,500 parents, found that those with children who have learning and thinking differences, like ADHD, or specific learning disabilities like dyslexia, are experiencing considerably more challenges than children without learning and thinking differences. “As we look to the next normal while still in the midst of the ongoing COVID-19 pandemic, we need to understand the full impact remote learning had on our nation’s children, especially those with learning and thinking differences,” said Fred Poses, CEO of Understood. “Our study findings validate that those with learning and thinking differences are especially vulnerable at this time and that our mission to help these kids thrive is more important than ever today and moving forward.” Academic Repercussions The study unveiled that in the remote learning environment, nearly three-quarters (72%) of parents have become aware of or noticed their children may have learning challenges or differences. And an astounding 59% of parents of those with learning and thinking differences say their children are a year behind because of the pandemic and may never catch up, while only 16% of typical parents — those whose children have not exhibited signs or have not been diagnosed with a learning difference — believe their children are behind in their studies.In addition, 44% of parents of children with learning and thinking differences say their child’s legal right to access an equitable education has been abandoned since the move to remote learning.Emotional Consequences Children with learning and thinking differences have been particularly impacted emotionally by the pandemic’s schooling changes, which has driven high levels of concern and anxiety at home. Almost half of all parents (48%) have noticed behavioral changes in their children since the start of the pandemic and an equal percentage (48%) of those with learning and thinking differences report suffering high to extreme levels of school-based anxiety since the pandemic, more than double the rate among typical children. The study also found: Children with learning and thinking differences are also about three times as likely to have experienced depression related to schooling changes.The stress related to distance learning has been much higher for those with learning and thinking differences versus those without (65% vs. 44%), resulting in emotional distress (61% vs. 36%), physical symptoms (57% vs. 30%), avoidance of attending classes (47% vs. 23%) and more. Financial Implications Additionally, 43% of all parents say they are facing a financial burden because of their children’s remote learning. However, when comparing the two parental groups, almost twice as many (56% vs. 30%) parents of children with learning and thinking differences say providing their child with the academic supports they need has put a major financial burden on their family. 77% of parents are investing a significant amount of both time and money to support their children with learning and thinking differences to keep pace academically amid the COVID-19 pandemic. Buying supplemental software and apps, hiring personal tutors, and cutting back hours at work are the most common steps that parents have taken to support their children during the pandemic.Twice as many (49% vs. 25%) parents of children with learning and thinking differences are concerned about the “summer slide,” the loss of academic skills and knowledge during summer vacation, compared to those of typical children.The majority (86%) of parents of children with learning and thinking differences are planning on summer academic supports compared to just half of parents of typical children. Conducted in April 2021, Understood’s “Pandemic Learning Impact Study” leveraged quantitative data from a total of 1,500 parents of both neurotypical children and those with learning and thinking differences across the U.S. to understand how the COVID-19 pandemic has impacted children academically and emotionally. The survey polled parents of children between the ages of 5-18, with 62% identifying as White/Caucasian, 25% as Black/African American, 5% as Asian and 1% as Native-American. Twenty-five percent of the parents identified as Hispanic/Latino. Full study results are available upon request.About Understood1 in 5 Americans have learning and thinking differences, such as ADHD and dyslexia. They are often misunderstood, undiagnosed, and dismissed, and these differences are viewed as a weakness. This leaves many on a journey that is stacked against them and costs society more than $500 billion. Understood is the only lifelong guide for those who learn and think differently. Today, we help more than 20 million people each year discover their potential, how to take control, find community, and stay on a positive path along each stage of life’s journey. When others join this journey, and people are broadly embraced, everyone thrives. Understood is a 501(c)(3) charitable organization based in New York. For more information, or to become a partner, visit u.org/media.
Understood Explains Season 2Who can diagnose ADHD in adults?
Find out which types of health care providers can diagnose ADHD in adults — if it’s worth the wait to see a certain kind of specialist. What type of doctor should you see for ADHD diagnosis — primary care provider? Psychologist? Psychiatrist? Is it worth waiting longer to see a specialist? How much does it cost? Get answers to common questions from Understood Explains host Dr. Roberto Olivardia: Can my primary care doctor diagnose ADHD? [00:50]Do I need a psychiatrist or psychologist to diagnose my ADHD? [03:19]What other kinds of specialists can diagnose ADHD? [05:13]How much does it cost to get an ADHD diagnosis? [07:01]Is it worth waiting longer for a specialist? [08:15]Key takeaway, next episode, and credits [09:05]Related resourcesHow ADHD is diagnosed in adults Can psychologists prescribe medication?Neuropsychological testing in ADHD: A special reportAbout psychiatric mental health nursingEpisode transcriptWho can diagnose ADHD in adults?You’re listening to Season 2 of Understood Explains: ADHD Diagnosis in Adults.Today’s episode answers the question “Who can diagnose ADHD in adults?” My name is Dr. Roberto Olivardia, and I’m a clinical psychologist with more than 20 years of experience evaluating people for things like ADHD. I’m also one of the millions of people who have been diagnosed with ADHD as an adult. I’ll be your host.My goal here is to answer the most common questions about ADHD diagnosis. Along the way, you’ll learn a lot about ADHD in general. We’re going to do this quickly — in the next 10 or so minutes. So, let’s get to it.Can my primary care doctor diagnose ADHD? [00:50]The short answer is yes. General practitioners or primary care providers can diagnose ADHD. But they may recommend you go to a specialist instead. Let’s go over some pros and cons for getting diagnosed by your primary doctor…First, on the positive side:You already know your doctor. You don’t have to hunt around to find one.You can probably get an appointment pretty easily. And your doctor can help identify or rule out medical conditions that can have ADHD-like symptoms.So those are all good things. But there are some potential downsides in getting diagnosed by a general practitioner.First, primary care doctors may not have a lot of training in diagnosing ADHD in adults.It’s hard to believe something that is so common isn’t fully understood even by many doctors, including mental health providers. Without the right training, ADHD can be misdiagnosed. More often, however, studies have found that ADHD is vastly underdiagnosed. This is often because people with ADHD can also have issues with anxiety, sleep, and depression. And all symptoms can get swept into those categories, and the ADHD gets overlooked. Which may be why some of you listening today have made your way to this podcast. Also, the other point I want to make is that general practitioners may not have much training in how to treat ADHD.Diagnosis is only the first step. And all of your next steps will be to learn about ADHD and how to manage it. For example, if someone decides to take medication, it can take some time to find the right medication, the right dose, and manage any side effects. Sometimes it can take trying several different medications or doses before finding what works the best for you.It’s not as simple as “here is a prescription” and you’re on your way. Also, although medication can be very helpful as a part of the treatment regimen, it’s not enough. Remember: Pills don’t teach skills. Therapy or counseling can be really important ways to help you understand how ADHD affects you and develop strategies to change those behaviors. And you’ll likely need to get that kind of advice from someone other than a general practitioner.Bottom line: Find out how much training and experience your primary care doctor has in diagnosing ADHD. Ask them if they feel confident they can tease apart what’s causing your symptoms so they can correctly diagnose and treat your ADHD.If they say, “Yes, I’m confident I can do this,” great! If they say no, then they can always refer you to a specialist. Do I need a psychiatrist or psychologist to diagnose my ADHD? [03:19]In short, both are qualified to diagnose ADHD. But not all psychologists and psychiatrists have training and experience working with ADHD patients. So it’s important to ask first. So I’m a psychologist and I do a lot of diagnostic work. I also have many patients who were diagnosed by a psychiatrist and come to me for ADHD treatment. So without knowing more about you, I can’t tell you which is a better fit for you. But I can tell you how psychologists and psychiatrists are similar and how they’re different. Psychologists and psychiatrists who have ADHD expertise are similar in that they know how to suss out whether you might be experiencing another mental health issue that can look like ADHD or that might be happening in addition to ADHD. The big difference between these two kinds of specialists is what happens after they make a diagnosis. With psychiatrists, the big upside is they are medical doctors who can prescribe medication. On the downside, psychiatrists may not have the time or training to help patients work on daily life skills that can be so helpful for people with ADHD.Psychologists are often the reverse of this. Most psychologists can’t prescribe medication, unless they live in a handful of states that require extensive training and make exceptions due to severe shortages of medical providers. Meanwhile, many psychologists do have a lot of training in cognitive behavioral therapy. This type of therapy is useful in helping people with ADHD identify problematic patterns in their daily lives and find ways to replace those behaviors.It’s common for people with ADHD to get counseling from a psychologist and medication from a psychiatrist.But if you’re trying to decide which one of these specialists to go to for diagnosis, it may come down to cost and availability. How soon can you get an appointment with one or the other?What other kinds of specialists can diagnose ADHD? [05:13] There are three other specialists I want to discuss in this episode: neurologists, neuropsychologists, and nurse practitioners. First, neurologists… and I’m only mentioning them here because a lot of people ask about them. Neurologists typically aren’t the kind of specialist you’d start out with to get an ADHD diagnosis. But they might diagnose you with ADHD if you go see them to rule out something else, like a seizure disorder or some other medical condition. Next, neuropsychologists. They’re really good at figuring out if you have, say, a learning difference like dyslexia. For example, they can tell if you’re a slow reader because you’re having trouble processing the words or because you’re having trouble paying attention or some other reasonNeuropsychologists can also diagnose ADHD. But because they can test a wide variety of skills including intelligence, memory, and other specialized skills, it can often take longer to get an appointment with them. And they might not include as much information about different aspects of your life, like trouble at work or managing your relationships. There’s also some research that suggests neuropsych testing might not pick up on ADHD in some people, because the tests are often done in distraction-free environments that aren’t anything like normal, day-to-day settings.And last but not least, nurse practitioners. If you’re going to see a nurse practitioner for help with ADHD, look for one with advanced training in psychiatry. They’re often called psychiatric mental health nurse practitioners or PMHNP for short — whew, that’s a mouthful! They’re also called advanced psychiatric nurse practitioners. And they can diagnose ADHD, prescribe medication, and provide counseling. This can be a great choice if this kind of nurse practitioner lives in your area.How much does it cost to get an ADHD diagnosis? [07:01]The answer depends a lot on where you live, who you’re going to see, and how long you can wait. If you have insurance, then your only cost may be the co-pay to see a doctor who’s “in network.”Some specialists may be “out of network” or might not take insurance, so you may have to shoulder a hefty out-of-pocket cost that can be hundreds of dollars. Or in the case of a full range of neuropsychological testing, it may even cost thousands of dollars. One possible way to lower the cost of ADHD testing is to call up a college or university near you. It’s very common for schools that have graduate programs in clinical psychology to also have free or low-cost clinics where students do their training. You’d be evaluated by a grad student, but that person would be closely supervised by an expert. And in many cases, your evaluation will be reviewed by more than one highly trained professional.The same is true for medical universities that are training future psychiatrists and other kinds of specialists. Hospital clinics are likely to accept a large number of insurance plans. Some hospital-based clinics also offer free evaluations or use a sliding scale that charges lower fees to people with lower income levels.Is it worth waiting longer for a specialist? [08:15] There are a lot more primary care doctors than there are specialists, so the wait times are going to be longer. Is it worth the wait? This is a really tough question, and the answer depends on several important factors: First, how are you doing? Are you in crisis? Is there a medical problem or addictive behavior you’re struggling with? If so, the sooner you get an appointment with a provider the better. Also, think about how quickly you may need a diagnosis so you can start getting formal accommodations at work or school, or if there’s something urgent going on at home and you need to start taking steps to help heal your relationships. One option is to start working with your primary doctor now and get on a list to be evaluated and treated by a specialist in a few months.Key takeaway, next episode, and credits [09:05]OK, that’s it for Episode 2. The key takeaway I’m hoping sticks with you is the importance of getting a diagnosis from a professional who has training and expertise in ADHD.Remember that not all medical doctors or psychologists have this kind of experience. It may take some work to figure out who you can see and balance that with your finances. Even with long wait times, don’t let that discourage you from getting a diagnosis that could set you on a path to a better life. Thanks for listening to this episode of Understood Explains. And I hope you’ll join me for Episode 3, where we’re going to cover in-depth what kinds of questions to expect in an ADHD evaluation.You've been listening to Season 2 of Understood Explains from the Understood Podcast Network. If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources, as well as links to anything we've mentioned in the episode. One important note: I don’t prescribe ADHD medication and I don’t have any affiliation with pharmaceutical companies — and neither does Understood. This podcast is intended solely for informational purposes and is not a substitute for a professional diagnosis or for medical advice or treatment. Talk with your health care provider before making any medical decisions.Understood Explains is produced by Julie Rawe and Cody Nelson, who also edited the show. Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show.For the Understood Podcast Network, Laura Key is our editorial director, Scott Cocchiere is our creative director, and Seth Melnick is our executive producer. Understood is a nonprofit organization dedicated to helping people who learn and think differently discover their potential and thrive. Learn more at understood.org/mission.
Lorraine Bracco, star of “The Sopranos,” on how she used humor to cope with dyslexia
Actress Lorraine Bracco is best known for her role as Dr. Melfi on the iconic television show The Sopranos, in which she helped mobster Tony Soprano exorcise his inner demons. In some ways, it was a part she was well prepared for. Bracco had been in private therapy for years for depression. And she’d also had her own demons from the difficulties she had as a child with dyslexia.She shared some of those struggles with Dr. Harold Koplewicz, of the Child Mind Institute at the 12th Annual Katz Memorial Lecture.“I hated school because I felt really dumb,” she told Koplewicz. “It was a huge struggle.”Bracco says that her difficulties became quickly apparent when she had to learn to read. “Whenever I was called upon to read aloud, I was anxiety-ridden.” Writing and math weren’t any better. “I was a disaster. There was paper and pencil and nothing made sense.”Bracco’s parents tried their best. But her father, a fishmonger, had started working at 14 or 15. Her mother was a stay-at-home mom and “definitely dyslexic,” according to Bracco. There wasn’t much information available about dyslexia when she grew up. She went through school with few noticing. “Social promotion — that was me. I think they invented that for me!”To deflect attention away from her struggles, Bracco turned to humor and storytelling. “I was always kind of a jokester in class,” she reminisced. She explained she was forced to find a “creative way” to express herself. Once when a boy she had a crush on asked her to read something, she pretended to be a human typewriter to make light of the situation.Bracco’s creative side got a jolt from a middle school teacher who believed in her. He encouraged her to follow her dream of becoming a model and spoke to her parents on her behalf. They agreed. She went to Wilhelmina Models and they took her on the spot.Her career as a model took her to France, where she lived for a decade. She learned spoken French surprisingly easily, which she credited to her ability to learn scripts quickly by reading them aloud. In France, she modeled, acted in French films and produced a popular television show, Les Enfants du Rock (The Kids of Rock and Roll).After her first marriage ended in France, she fell in love with the actor Harvey Keitel and returned to the United States. She starred in the movie Goodfellas and was nominated for an Oscar for Best Actress in a Supporting Role for her portrayal of Karen Hill, a mob wife.After splitting from Keitel, she went through a difficult and costly custody battle over their daughter. She declared bankruptcy. Depression followed, but she didn’t recognize it right away. “I had a sh---- decade and a really bad year, before I admitted to myself that this was a problem,” she reflected. “Depression is a vortex. You don’t have it. It has you.”Things started to look up after she landed the role of Dr. Melfi in The Sopranos. With therapy and medication, Bracco recovered from depression. Now, she’s an advocate for treating mental health issues. “You have a toothache, you got to dentist. A broken leg — you go to emergency room. But if you show any signs of mental illness, people say: Just stop that. Don’t do that. Just grow out it.”She’s also speaking up about learning and thinking differences. Looking back, Bracco wishes that she had gotten help for her dyslexia in school. “I think I would have been challenged in a way that would have made me intellectually stimulated,” she said. “Instead of using humor to hide.”But today, she’s thankful that there’s much more awareness. She even joked about how her daughter went to a Montessori school where they offered “creative” spelling. “I could have used that!”Lorraine Bracco’s story highlights the emotional side of learning differences. You may want read up on how negative feelings about learning can turn into depression. And learn more about founding partner the Child Mind Institute.
ADHD Aha!ADHD, sleep apnea, and symptoms beyond the DSM (Roberto’s story)
Dr. Roberto Olivardia is a clinical psychologist with ADHD. While he was learning about ADHD for his career, the symptoms felt a little too familiar. Dr. Roberto Olivardia clinical psychologist ADHD expert diagnosed ADHD adult. learned ADHD career, signs felt familiar: impulsivity, trouble focus, more. procrastinated constantly college mischievous kid. even kicked Sunday school. Once got sleep apnea control, ADHD difficulties became even clearer — wasn’t you’d typically find DSM. (That’s handbook health care professionals use diagnosing things like ADHD.) Roberto host Season 2 Understood Explains, unpacks ins outs adult ADHD diagnosis. also two kids ADHD. Listen episode ADHD Aha! learn ADHD trouble sleeping, plus ADHD time zones (the “now” “not now”).Related resourcesDriven Distraction, Edward M. Hallowell, MD, John J. Ratey, MDHow ADHD affects sleep — helpIs ADHD sleep disorder?Understood Explains Season 2: ADHD diagnosis adultsEpisode transcriptRoberto: So, "aha" moment realizing, "Oh, beyond attention. beyond school." eat food spend money sleep plan activities things made much sense. "aha" moment recognizing ADHD really connected many things.Laura: Understood Podcast Network, "ADHD Aha!," podcast people share moment finally clicked someone know ADHD. name Laura Key. I'm editorial director Understood. someone who's ADHD "aha" moment, I'll host.Laura: I'm today Dr. Roberto Olivardia. clinical psychologist Massachusetts. He's also Understood expert host Season 2 "Understood Explains" podcast, covers everything need know ADHD diagnosis adults. Super relevant show. show ADHD "aha" moments, know, Roberto, lot folks listening show may wondering, "Should get diagnosed ADHD?" So, we'll talk Season 2 "Understood Explains" get interview. welcome. Thanks here.Roberto: Oh, it's pleasure, Laura. Always pleasure talking things ADHD.Laura: Well, let's get started. diagnosed ADHD adult, right? makes apt host Season 2 "Understood Explains." So, don't start telling listeners diagnosed ADHD?Roberto: So, officially diagnosed 35. However, realized that, "Oh, it, like ADHD," probably 30, 31, know, tell people keep mind, I'm 50. so, young, kids diagnosed ADHD kids pretty serious conduct disorders, probably lot undiagnosed learning disabilities, kids might poor social skills, hyperactive, impulsive.And even though hyperactive, wasn't hyperactive antisocial way oppositional way. mischievous, don't get wrong, within sort boundary, well school, even though hated school. So, wasn't identified back then.So, nothing throughout life ever see affiliation knew time ADHD. Even graduate school late 20s, learned it, frankly wasn't lot, that's indictment particular program. ask lot colleagues this: "How much learn ADHD clinical psychology PhD program?" people say "very, little."So, wasn't patients started private practice, treating issues like eating disorders OCD bipolar disorder, also happened ADHD. suddenly I'm like, "Oh, let learn ADHD," would read it. one things I'm reading it, like slowly, like, "Oh, understand that. Oh, makes sense me. relate that." wasn't much like fireworks epiphany like people, certainly lot patients diagnosed ADHD. familiar sense of, "Oh, me. Oh, yeah, makes sense." actually something validating, felt good about.Laura: signs stories relating most, like angle ADHD? flavor?Roberto: Yeah, think first specifically remember patient sleep apnea. struggling depression. eating disorder also sleep apnea ADHD. reading sleep apnea, thought, "Oh, like lifetime sleep issues." mean, sleepwalker, sleep talker, sleep paralysis. severe sleep apnea, night terrors, name it. So, would read sleep apnea would read connection ADHD sleep, thought, "Oh gosh, makes much sense." So, remember like first angle perspective.And reading executive function issues around procrastination, lot times think past, would think, "Oh, people..." honestly think culturally people still solely see ADHD, person procrastinates doesn't get done. certainly, affect lot people ADHD. part, least school, one always got done. would night. would literally, mean, college running across campus get paper professor's mailbox 5 p.m., mean, that, would get done.And so, started reading that, like, "Oh, wait minute, people ADHD, procrastinate pull off," me. started sort reading broad sense impulsivity, it's like, OK, well, maybe haven't issue this, this, that, always identified knew intuitively addictive personality — anything like like much quickly. And, level, friends growing people issues related it.I didn't see different individuals — even individuals might conduct disorders issues. hung lot kids. mischievous side younger, kind liked little bad. little dangerous.Laura: I'm going ask that, don't worry.Roberto: So, read that, thought, Oh, honestly, much. don't think lot written ADHD '80s, mid '90s. mean, think Ned Hallowell's book, "Driven Distraction" written in, think '94, '95, that's adult ADHD even talked about, kind nuts. like "Where people think went? Like 18 vanished?"Laura: Right. Suddenly executive functioning issues, won't problem college.Roberto: life, right?Laura: Yeah, exactly. So, OK, that's, taking notes. So, number one, ADHD sleep, folks may recognize Roberto's voice actually published bonus episode "In It" talking ADHD sleep "ADHD Aha!" feed, great. want ask little bit that. next thing mentioned procrastination, still getting done. So, like latching onto urgency, sounds like. mind go back little bit ADHD sleep?Roberto: Sure. Absolutely.Laura: quick explanation connection ADHD sleep. encourage folks go back feed listen full explanation, I'm curious interact, also played life.Roberto: Yeah, lot research done ADHD sleep, think honestly, know tip iceberg. know centers brain are, particularly frontal lobe, activated implicated sleep. One best quotes ever heard, don't, wish could credit don't know said it, actually first ADHD conference went 2008, speak every year. said, "For someone ADHD, going sleep lying dark room waiting nothing happen." was, totally made sense thought it's unstimulating it's kind boring. Like you're waiting to, "OK, happening? Like, going to...?"And course, mind thinking it, know, much. it's easy there's stimulation ADHD person generate stimulation we're so, need that. Like brain, dopamine deficit. So, we're always seeking stimulation. sleep, you're kind of, job de-stimulate, really hard.And psychological components well. mean, nighttime also less distractions, one's expecting anything nighttime. college grad school, nothing distract me, better zone work. sometimes nighttime level procrastination would get day. OK it's do-or-die situation kind thing.So, there's something that. it's even work. Sometimes could be, "I don't want let go day I've fun downtime." I'm very, productive throughout day, years ago could literally nothing day. kind wasting day procrastinating yet
5 questions with Ann Douglas about “parenting through the storm”
Ann Douglas is an award-winning parenting author. Her latest book is Parenting Through the Storm: How to Handle the Highs, the Lows, and Everything in Between. It’s a guide for parents and caregivers who are raising kids with mental health and behavioral challenges.The book hits close to home for Ann, whose four children all have multiple issues. Her daughter struggled with depression and an eating disorder as a teen and was recently diagnosed with ADHD. Her three sons have learning and thinking differences, including ADHD and learning disabilities. One also has autism.In this interview, Ann shares her advice.1. What do you mean by “parenting through the storm”?There are periods of struggle when families may encounter a child having a difficult time. If your child has a learning or thinking difference, you’re probably going to face these storms.The good news is you can weather this struggle together with your child and emerge stronger and more connected than ever. It’s more than possible.I have two favorite quotes about finding strength in the middle of struggle. This theme comes up time and time again when I talk to parents.“The oak fought the wind and was broken, the willow bent when it must and survived.” —Robert Jordan, The Fires of Heaven“And once the storm is over, you won’t remember how you made it through, how you managed to survive. You won’t even be sure, in fact, whether the storm is really over. But one thing is certain. When you come out of the storm, you won’t be the same person who walked in. That’s what this storm’s all about.” —Haruki Murakami, Kafka on the ShoreThe second quote in particular really speaks to me. The first time I read it, I felt a shiver run down my spine because it captured the experience of my family and other families so perfectly. We’ve been forever changed, but also immeasurably strengthened, as a result of the storm.2. What’s a big storm you hit as a parent, and what did you learn?When my daughter was 15, she slipped out of the house and went missing in the middle of the night. I was panicked and worried to death. Thankfully, a police officer helped us track her down. Afterward, he and I had a heart-to-heart conversation about my daughter’s risky behavior.“You can’t wait for someone else to step in to save your daughter,” he told me. “You have to save your daughter yourself.”His words were both terrifying and liberating. I suddenly had a sense of our power as parents. Instead of waiting for someone else to step in and solve the problem for us, we needed to start trying to make things better ourselves. No one knew our daughter as well as we did — and no one loved her even a fraction as much.Up to that night, we’d been holding out hope for some miracle to solve things for us. But we realized we needed to commit to doing the hard work of advocating for our daughter. And we did. It was a long journey, but one that had a happy ending. Our daughter is currently thriving as a young adult.3. How much should a child’s diagnosis affect parenting decisions?You don’t want to overlook the value and importance of obtaining an accurate diagnosis. A diagnosis is a valuable piece of information that allows your child to tap into supports that might not otherwise be available. It can also help your child gain insight into their own strengths and struggles.But, at the same time, it’s important to remind yourself (and your child!) that a diagnosis simply can’t capture all the things that are unique and wonderful about them. It’s just a starting point.Instead of becoming fixated on the diagnoses, I suggest focusing your attention on the nature of your child’s struggles and what you can do to help with those struggles. You may find it useful to ask yourself this simple question: “What does my child need from me right now?”There are all kinds of practical things you can do today to begin to make things better for your child and your family. For instance, you can zero in on parenting strategies that bring out the best in your child. You can teach your child stress management techniques. You can help your child build a support network.4. How can parents manage feelings of guilt over the challenges their kids face?First, remind yourself that you did the best that you could with the knowledge and skills you had at the time. You wouldn’t ask any more of a friend, so don’t hold the bar unreasonably high for yourself. Practice self-compassion, in other words.Steer clear of the temptation to play the blame game when it comes to genetics. You wouldn’t blame yourself for the fact that your child inherited a genetic vulnerability to a medical condition like diabetes. So why should you beat yourself up for potentially passing along any other type of gene?Here’s something else to consider. Let’s say learning and thinking differences do happen to run in your family. Instead of beating yourself up, take comfort in the fact that you have firsthand experience and understand what it takes to thrive with these issues. Instead of seeing this as a liability, recognize what a gift it can be to your child.5. Where can stressed-out parents find peace of mind?Vincent van Gogh once said: “There is peace even in the storm.” As parents, we can find peace by savoring the moments of calm, however fleeting they may be.Give yourself permission to feel joy in your life right now. You don’t have to postpone your happiness until some mythical future day when everything in your life is perfect and your child is no longer struggling. You deserve to feel joy in your life right now.Make self-care a priority. Don’t feel guilty for allowing yourself to take a break from the hard work and worry. No one deserves a happy and healthy parent more than a child who is struggling. Understand that taking the best possible care of yourself is actually an act of kindness toward your child.Finally, don’t be afraid to reach out for support from others who truly understand. There are many other parents who’ve weathered (or who are weathering) similar storms. Peer support is magical. Tap into some of that magic. You don’t have to do this alone.
In ItUnpacking the teen mental health crisis: How we got here and what to do about it
The teen mental health crisis. How is it showing up in kids with learning and thinking differences? And what can we do about it? We’ve been hearing a lot about a mental health crisis that’s affecting kids — especially teens — really hard. What’s behind this crisis? How is it playing out for kids with learning and thinking differences? And what can we do about it?To help answer these questions, hosts Rachel Bozek and Gretchen Vierstra turn to Dr. Matthew Cruger. He’s the clinical director and a senior neuropsychologist at the Child Mind Institute. Learn how the crisis is showing up in his practice, especially with kids who learn and think differently. Hear Matt’s thoughts on when the crisis started — and why. Plus, get Matt’s advice on how families can help support their kids’ mental health. Related resources Treatment for mental health issues How to talk with your child about social and emotional issuesListen to this episode of The Opportunity Gap for more tips on supporting kids’ mental health Episode transcriptGretchen: From the Understood Podcast Network, this is "In It," a podcast about the ins and outs...Rachel: ...the ups and downs...Gretchen: ...of supporting kids who learn and think differently. I'm Gretchen Vierstra, a former classroom teacher and an editor here at Understood.Rachel: And I'm Rachel Bozek, a writer and editor raising two kids with ADHD. Today, we're talking about our children's mental health.Gretchen: We've been hearing a lot in recent months about a mental health crisis that's hitting kids, especially teens, really hard. It was there before the pandemic, but we know the isolation and anxiety brought on by COVID-19 didn't help.Rachel: And honestly, even if we weren't hearing about this crisis in the news, I think it would still be on our radar. Because speaking for myself, at least, I see evidence of it all around me.Gretchen: I do, too. I mean, I see it in my own home. And I've been hearing from lots of parents in the community that kids just seem to be saying a lot of "What's the point? Why should I do it?" And they're just lacking some of that motivation that I think kids used to have.Rachel: Yeah. Yeah. So I guess the question I have is: What's behind this crisis? How is it playing out in particular for kids with learning and thinking differences? And what can we do about it?Gretchen: So to answer those questions, we're speaking today with Dr. Matthew Cruger.Rachel: Dr. Cruger is the clinical director and a senior neuropsychologist in the Learning and Development Center at the Child Mind Institute.Gretchen: In that role, he does clinical work, neuropsych exams, cognitive assessments, and other evaluations for gifted children, as well as kids with learning difficulties, autism spectrum disorders, and ADHD.Rachel: We are delighted to have him here with us on the podcast. Matt, welcome to "In It."Dr. Cruger: Thank you.Rachel: We've been hearing for some time now about a mental health crisis for teens and even pre-teens. And we want to get into how this is showing up for our kids who have learning and thinking differences in particular. But first, we thought it might be useful to look at the problem more broadly. Even before the pandemic, we were seeing a marked increase in depression, anxiety, and suicide among teens. Is that right?Dr. Cruger: Yeah, I think that prior to the pandemic, we certainly recognized there's a couple of things that I think are factors. One is that we don't have enough clinicians to provide treatment for all the patients that need treatment. So families adjust to many of the struggles that their kids have, hoping that they'll get better, when some clinical intervention could be helpful in turning things around.Gretchen: What about what we've heard about the impact of technology and social media? Has that had a negative impact on kids?Dr. Cruger: I think so. Certainly, I think kids are spending a lot more time on technological devices. The impact of that is that they're not necessarily out interacting with other kids. Certainly, we want parents to monitor the kind of content that they're accessing as well, because there can be communications in that context that are problematic for kids and present a way of living in the world that's not as helpful. So the amount of engagement and the access to certain types of content on the on the internet I think is problematic and exacerbates things.Rachel: Yeah, I definitely saw this with both of my kids that when the pandemic hit, the device usage just like went through the roof for so many reasons that we all know and understand. But can you talk a little bit about how that contributed to this crisis?Dr. Cruger: Yes, I think that it was obvious because most of us were home and everything switched to remote platforms. Kids had to be on the computers every day for much of their schooling. And obviously many families couldn't also stop the work that they were doing. And so I think by necessity, some of the technology became — it served as a babysitter, right? For some of the time when kids had downtime. And it is less of an interactive experience, I think, even under the best circumstances.So I think with those increased time screen usage going up, we have pretty good evidence that that can have negative effects on their mental health experience. And I think it's persisted. So even with the return to school, the situation has sort of led kids to have a decrease in their experience, right?Gretchen: I think about engagement with the kids during this time period, right? Whether that was school or family. But like, really school, like I saw at home, at least for me, like engagement go down.Dr. Cruger: Yes, I do feel like — and I'm reflecting on my own kids in particular, who were in third grade and kindergarten at the time. So there are special, unique challenges at those developmental time frames. Right? Kindergartners need to learn to read. That is such a great process to do in person with a teacher who is helping you sound out words, who has books and content right there for you.And third grade when you're really starting to like apply yourself for deeper thinking. That's something where a mentor, a sort of coach, someone who's there as your champion to support you like a teacher could and give you direct feedback. That kind of engagement is really essential to the learning process that we are all used to. So there's no doubt that that was much harder to do. So I think that that clearly had an effect.Gretchen: Yeah, I mean, in my house I had a fifth grader going into sixth grade. So in middle school. That's such a social time for kids. And to be isolated from your peers during all of that, it was really hard.Dr. Cruger: Yeah. I think that during that time frame, the group of kids I was most worried about were kids that were in middle school heading to high school or in the early phases of high school. It's a time of really serious reflection on the material that you're working with in school. And really it's where a lot of those social advancements happen. Really learning where you stand in relationship to others and more complex social encounters and interactions were so important to develop in that time frame. And a lot of those kids I do think suffered. They were sad.Gretchen: So what does all of this look like and sound like in your practice? What have you been hearing from the kids who come into your office these days?Dr. Cruger: Yeah, I think maybe the first piece of things is like a low-level sort of sadness or anxiety about some experience that's sort of persisted. I do feel like kids benefit from the sense that they are going through some of these experiences for a purpose. And I think it's been very hard for us to know how to explain to them why things are organized the way they are. What's the higher purpose, what are they striving to achieve?So that reflects a little bit of the engagement piece, like to be fully engaged in the content of material. But also to feel like school happens in a certain way and we're headed for a certain destination. That seems to me to have been lost.Gretchen: Yeah, like I would say, like in my house, I've heard a lot of "What's the point?"Dr. Cruger: I think that's true. I think there's an apathetic sort of response. It's sort of like it doesn't really matter so much what I do. And I've heard it for a long time, you know, where in focusing on academic work with kids, you know, kids might have for a long time have said to me, like learning math doesn't really matter because I won't use it in my future.But it's maybe like a broader response to the time, like, I guess a feeling of like, I don't really know what the point is or what the goal is of what I'm being asked to do. That's a little bit of a helplessness towards the task and activity.Gretchen: Rachel, I want to step back for a second here and just pick up on something that Matt just said. He's talking about how kids responded to the time. What's that time? All the time Is the pandemic, right? When things really shifted. And I think it's worth unpacking a little bit about what that time was and what it did.Rachel: Yeah, right. Definitely. It's easy to forget from a little distance how just upside down our world was when the pandemic first hit. All of a sudden, a lot of kids discovered that their parents, their teachers, and maybe other people that they always would look to for answers really didn't have much to offer or know what to do.Gretchen: Yeah, I mean, it must have been — I know it was hard for kids to see rules changing all the time, adults complying, not complying. To see, you know, your parents who used to like get up and go out the door to work are now sitting at home in their pajamas on the screen all day. And what's happening there?Rachel: And and the rules about screen time kind of went out the window and, you know, some other rules, too, just because we were all just trying to get through the day. That's a lot.Gretchen: Yup. So it seems like all of a sudden kids are like: All these structures that you have in place are arbitrary and made up. And I'm not going to go along with this anymore.Rachel: Yeah, we got called out. So let's get back to our conversation with Matt.Rachel: We know that you work with a lot of children who have learning and thinking differences. Can you talk about how all of the stressors that we're talking about here may be affecting them in different ways?Dr. Cruger: Yeah. I mean, I think that if you — I guess I reflect on the learning differences that I see. The kids who are struggling with academics, in particular, the inputting of new ideas, new processes for solving problem. They need real guidance on how to manage that material. And that can sometimes come from family involvement, but often comes from direct instruction. They really need teachers who are able to guide them in that process of learning.Kids are struggling to find a source of motivation that they can direct their efforts to. And sometimes they feel like it's hard to know: Will their efforts pay off? And that can sometimes lead to sort of decreased motivation.Rachel: You know, we've been talking a lot about the impact of the pandemic on mental health. But I know there are a lot of other sources of anxiety and depression for kids these days. Things like school shootings and climate change. Do you hear about those kinds of things from the kids that you see?Dr. Cruger: Well, I think you bring up, Rachel, like a set of things that are on my mind. There's a bunch of global issues that kids confront. So it's very common for me to hear kids talk about sort of what we think of as like climate anxiety. You know, that worry that the world is on a crash course towards not being able to exist in the way that we know it. And that is a like a low-level worry and source of preoccupation for kids, even though they're highly motivated many times to do something about that.I think violence and safety is another thing that kids spend their time thinking about. And I certainly also think a lot of teenagers are focused on their own identity development. That's a developmental goal for that age range. And there's so much information about choosing your identity. What are acceptable identities? What are identities that others will not accept? That makes that process, I think, even more complicated for them. So those preoccupations, I think, sort of derail them from knowing how to invest time in the things that they need to do.Gretchen: Right they're figuring out all those questions around sexuality and gender identity. Not to mention, for older kids, they're thinking about what they want to do with their life. Is that something kids come to you for guidance on?Dr. Cruger: Yeah, I mean, I think that a lot of teenagers think there might be only like four or five jobs that a person can have in life, or that college is the only choice.Rachel: Yeah, totally. Although they all seem to have gotten the memo that professional video game player is a thing.Dr. Cruger: There is no doubt.Gretchen: Or YouTuber.Dr. Cruger: Yes. YouTuber Influencer Professional Video Player. Yeah. Yes. I think I did say to my son at one point, not that many people get paid to play video games.Gretchen: Right.Dr. Cruger: He did not believe me. So.Gretchen: You know, not to bring us back to doom and gloom, but for one more moment, I do want to ask about something else has been in the news. Is this whole idea of loneliness — that we have a loneliness problem in the U.S. Are you seeing that come up in your work with kids?Dr. Cruger: I do think that it's worth sort of questioning what are the ways that kids have contact with others outside of school? When do they get to play with each other? I sound like, you know, I have a lot of gray hairs in my beard, which I do. But like, I remember being outside on the street playing football. And we just don't see kids out and engage with each other in unstructured play activities quite as much.And, you know, I do also think like going to your friend's house to play video games when I was younger was sort of boring. You could only play Atari 2600 for so long. But now they're much more engaging and activating processes that the kids immerse themselves in. And so I think it leads to some challenges in how to have contact.Rachel: So how can we best help our young people, you know, as parents, as caregivers, as teachers, whoever's listening. What makes a difference for them? You know, in all of these things, loneliness and the other things we've been talking about.Dr. Cruger: Yeah. I mean, I think most parents decided that they were going to have kids sort of set their kids up for the best future and the best life. So I think just reminding ourselves again of the importance of the parental involvement with kids, I think is the first piece of things. Right?It's been hard to, I think, over this past period of time, to keep our values front and center in our mind because we've had to adjust to what's required in the moment. And so to return again to the idea of, like, what are the most important things for me and my family? I do think there's value in families sort of trying to think of is there a motto that they could have for their family that sort of captures that moment, like "We Crugers stick together" or something like that? It sort of captures the family spirit, but also like a positive element of we're all in this together and we have values that we're trying to achieve.I do think spending more time together is a clearly like an antidote. As annoying as it was for my kids to learn to play pinochle, that was the thing that we focused on learning. Because it gave us time to get away from the screens, to sit down together, to challenge each other. And I think those kind of activities where you're really engaged with each other and having a good time are very important.There's no doubt family meals are also something that we should invest in. It's not always possible and it's not always easy when you're catching things on the fly. But that time where you're sitting down together as a family I think is really worthwhile.I won't say family meetings because everybody calls family meetings and the only people that show up are the parents. But I mean, but that idea that there's time to work together to align your interests. And then I think helping support your kids to find, you know, the one or two or three good friends, and making traditions and routines that they can sort of establish with their peers that are reliable. Like if they, you know, the friends all come over on Friday for pizza or something like that, that might be something that's like low investment but really worthwhile.Rachel: Yeah. I feel like our family meetings always, there's an expectation that there's some, like, amazing surprise. It's like, hey, we're going to have a meeting and it's like, oh, we're going to Disneyworld. Like, No, we actually need to talk about something that's going on in school.Dr. Cruger: That's right.Rachel: They backfired.Dr. Cruger: Taking out the garbage. Yeah.Gretchen: Right. The chore list.Dr. Cruger: Yeah, exactly.Gretchen: So if you think your own child may be anxious or depressed, but they aren't talking with you about it, what can you do as a parent? How do you figure out if they're at risk in some way or if they're just going through a fairly typical high and low of life as a teenager, for example?Dr. Cruger: Yeah, I mean, I think parents need to trust their instincts. I do think that when we have concerns about our children, it's not often just because we're worrying needlessly. It means that we're noticing something that our intuition is sort of telling us we better check in with them about.I think that a safe space for talking for kids is one that sort of models what we know good friendships are about. Right? It's sort of a model of a place where you can share information without someone making designs on how you should improve. Right?Some of the things that might make it easier if you're, you know, the teenagers turning away from you, if there's two parents involved, maybe it's time for the other parent to try to take over. And getting away from the house, going out to eat for breakfast, carefully bringing up a topic that you have concerns about. I think all of those things. You know, a nice soft start works well for all of us. Don't start with a heavy hand when we're raising a concern with someone that we love. And I do think that kids who are going through some struggles do desire solace for those struggles. So if they know that you're available for that, that's helpful.Anxiety is maybe a tricky one because anxious people try to get out of the situations that provoke anxiety. So even talking about the thing that makes you anxious, you really sort of are mobilized to seek to avoid it. The problem is, is that if you avoid it, it just sort of gets worse. And so I think that's one thing that parents should sort of keep in mind, that when your child is feeling anxious, it might make them sort of naturally more reticent to share with you the details of that.And, you know, some mind reading is very problematic. Like, if you say, I know you're thinking something negatively about it, the person you say that to is bound to get irritated with you. But if you say, I've been noticing that you look sort of sad and I want to help with that, you know, can you tell me more about what's going on for you? That kind of mind reading might convey interest and sincere desire to understand. That kind of mind reading is affectionate and maybe positive and might yield a good result.Gretchen: You know, getting back to making a safe space to talk to kids about what's going on. I've really been trying to do that. And I know I've mentioned before that I do a lot of this in the car, which doesn't work for everybody. But the other thing I've been trying hard to do, which is very difficult for me, is not be the advice giver, is to kind of just sit and listen and let them vent. And then when I don't give advice, every once in a while, my daughter will give me this look like, Well, where's your advice? I'm looking for it now. And then I give it.Rachel: Right. But you have to wait for that cue for sure.Gretchen: Yeah.Rachel: Yeah, I think that's great. And I try to do that, too. I definitely have some work to do there because I often jump in with like, well, it sounds like.... And I just offer my read on what happened, which isn't necessarily why the conversations happening.Gretchen: Yeah.Rachel: I do like that approach. and I think they do get to that point where they still want to know what we think.Dr. Cruger: Yeah.Rachel: So what do you wish people better understood about this crisis and how we get out of it?Dr. Cruger: I think my biggest wish would be really thinking about how they can, you know, parents can develop or teachers can develop like a deeper, more personalized understanding of the people that they're interacting with. So time is always tight, but a way to really show sincere interest and engagement, I think is important. Otherwise, it's sort of like almost like commuting culture. We're just sort of passing each other by, sort of missing those moments and opportunities to make deeper contact. So that's why I think what I would wish for it, you know, time and opportunity to take a moment to find out what's going on, I think that would be a real boon for people.Gretchen: That sounds like a good plan.Rachel: Thank you so much for this. It was such a great conversation.Gretchen: Yeah. Thank you so much.Dr. Cruger: Well, thank you. I appreciate being able to talk to you both. I enjoyed the conversation and I appreciate what you're doing.Gretchen: You've been listening to "In It" from the Understood Podcast Network.Rachel: This show is for you. So we want to make sure you're getting what you need. Email us at init@understood.org to share your thoughts. We love hearing from you.Gretchen: If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode.Rachel: Understood.org is a resource dedicated to helping people who learn and think differently discover their potential and thrive. Learn more at Understood.org/mission.Gretchen: "In It" is produced by Julie Subrin. Briana Berry is our production director. Justin D. Wright mixes the show. Mike Errico wrote our theme music.Rachel: For the Understood Podcast Network, Laura Key is our editorial director, Scott Cocchiere is our creative director, and Seth Melnick is our executive producer. Thanks for listening.Gretchen: And thanks for always being in it with us.
Understanding invisible disabilities in the workplace
If you see someone at work using a wheelchair, wearing a hearing aid, or using an assistive device, you likely are aware the person has a disability. But not all disabilities are obvious to the eye. These are known as invisible disabilities. An invisible disability is a physical, mental, or neurological condition that can’t be seen from the outside. But it can impact someone’s movements, senses, or activities, according to the Invisible Disabilities Association. Some examples of invisible disabilities include autism spectrum disorder, depression, diabetes, and learning and thinking differences such as ADHD and dyslexia. Invisible disabilities can also include symptoms such as chronic pain, fatigue, and dizziness. “It is important to understand invisible disabilities in the workplace,” says Jess Stainbrook, executive director of the Invisible Disabilities Association, “because based on statistics, a significant portion of your employees are likely to have one.” The statistics on invisible disabilitiesAccording to a 2017 study by the Center for Talent Innovation, among white-collar, college-educated employees, 30 percent have a disability. But only 3.2 percent self-identify as having a disability to their employers. And of all employees with a disability, 62 percent have an invisible disability. In the survey, those employees responded: “Unless I tell them, people do not know that I have a disability.” That means many people go through their day-to-day work lives without revealing what disability they may be experiencing or how it impacts them physically, emotionally, and mentally. Why people are often silent about invisible disabilitiesFear is a major reason why people with disabilities — invisible or otherwise — don’t disclose them. “Those who are already employed may be afraid of opening themselves up to discrimination,” says Claire Odom, senior program manager at Understood. “On the other hand, some people don’t want to be seen for their disability, which they may consider to be a minor part of their life, so they don’t disclose.” Another reason for silence: People with invisible disabilities may think that co-workers won’t believe they have a disability. “There’s no easy way to convince people you have something that no one can see,” says Stainbrook. And job seekers may be reluctant when asked on an application if they have a disability. “Many fear that answering yes will reduce their chance of getting the job,” Stainbrook adds. How you can help employees with invisible disabilitiesYou may be surprised by the high percentage of employees in the workforce who have invisible disabilities. So, what can you do to help? Here are concrete steps you can take. 1. Make employees feel comfortable disclosing their disability. Employees with invisible disabilities will feel more comfortable presenting their authentic selves if they know they work in an inclusive environment. This starts with communicating disability inclusion efforts across the whole company. And those who disclose their disabilities are more than twice as likely to feel regularly happy or content at work than those who have not disclosed to anyone, the 2017 study by the Center for Talent Innovation found. 2. Review the type of accommodations your company offers for people with disabilities. Under the Americans with Disabilities Act (ADA), people with disabilities are entitled to reasonable accommodations. “People with disabilities, invisible or not, can perform their job at or above expectations if given a way to do it that meets their needs,” says Odom. Providing accommodations for employees with disabilities is not usually expensive or difficult. According to a survey by the Job Accommodation Network (JAN), 58 percent of accommodations cost nothing. And nearly all of the rest involved a one-time cost that averaged only $500. Here are some examples of low-cost accommodations: An employee who struggles with working memory due to a learning disability could receive written instructions for job duties instead of relying on verbal discussion. A person with a chronic condition may need a flexible start time or break time to take medication. 3. Offer services and support for people with disabilities. Creating or promoting an employee resource group (ERG) that focuses on disability is an empowering forum for employees with disabilities and their colleagues who are allies to network and raise issues. Your company can offer support for employees with invisible disabilities in other ways. This can include: Making sure mental health coverage is included in your company insurance plan. Seeing out-of-network providers can be costly. Promoting free services that are part of the employee benefit package. An example of this is health coaching to reduce stress. The benefits of supporting employees with disabilities — both visible and invisible — go beyond improving the work lives of individual employees. A 2018 study by Accenture discovered that companies that adopt best practices for hiring and supporting people with disabilities achieved — on average — 28 percent higher revenue, double the net income, and 30 percent higher economic profit margins than their peers. An inclusive workplace that supports people with disabilities of all kinds leads to more than just bottom-line benefits. It fosters a culture of openness and creates an environment where all employees can succeed.
ADHD Aha!The problem with attention “deficit” (Ernie’s story)
Executive coach, actor, and former criminal defense attorney Ernest Anemone shares his ADHD story — and why he questions the term “attention deficit.”Back when he was a criminal defense lawyer, Ernest Anemone related to one of his clients: An impulsive, irritable teenage boy who burned down the penalty box of a hockey rink. But what Ernie related to wasn’t just the ADHD behaviors. It was the teen’s feeling of having no control over his own life. Now, Ernie is an actor, filmmaker, and executive coach for Fortune 500 companies. Growing up, Ernie felt like he had no agency. He knew he didn’t have the type of focus society favored. But he was (and continues to be) good in a crisis. Ernie can focus — one could argue — when it really matters.Also in this episode, the embarrassment and shame that comes with executive dysfunction. And is ADHD really an attention “deficit”? Related resourcesADHD and hyperfocusHyperactivity in teens with ADHD: What it can look likeHow attention worksEpisode transcriptErnest: He was struggling in school. He was struggling at home. He was just struggling in general to have a sense of identity and a sense of place in the world. Feel like he was a subject in the world rather than an object. I remember a lot of that from my childhood too. Laura: From the Understood Podcast Network, this is "ADHD Aha!," a podcast where people share the moment when it finally clicked that they or someone they know has ADHD. My name is Laura Key. I'm the editorial director here at Understood, and as someone who's had my own ADHD "aha" moment, I'll be your host. I am here today with Ernest Anemone. Ernie is a former criminal defense attorney and a current actor, filmmaker, and executive coach for Fortune 500 companies. Ernie, you're such a Renaissance man. Let's start with what you do as an executive coach for Fortune 500 companies. Ernest: Sure. And thank you for having me. My work is primarily centered around helping people have better conversations. So, I work with executives at all levels of leadership in many different industries, and the main goal is to help them create a culture of psychological safety, where there's conversational turn-taking, people feel vulnerable enough and comfortable enough to fail if need be. Laura: And a former criminal defense attorney. Is there a connection there or just completely disparate experiences? Ernest: I think that during the time that I was practicing criminal defense, which was nearly a decade, I learned a lot about human behavior and communication. And, I do take a lot of that with me into the room. Laura: And, correct me if I'm wrong, but in your time as a lawyer, there were some experiences working with education law that sparked your thoughts that you may have ADHD. Ernest: Yes, but that actually came later. The first thing that gave me an inkling that something might be going on with my mind was probably my first criminal client. It was a 14-year-old boy who had burned down a hockey rink. Well, not the entire rink. I'm giving him too much credit. The penalty box of a public hockey rink. And, I remember sitting down with him and explaining the charges against him, and then we just started talking about life in general. And a lot of the things that he was describing to me about his impulsive nature, his inability to focus, his irritability, it all started to pull things into focus for me around my own life and growing up and those feelings that I had thinking that it was just depression. And there's an old saying that all advice is autobiographical. So, what I did for him was I told him a little bit about my story and how I could relate to some of the things that he was saying. And I remember getting a call from his mother the very next day saying that "For the first time, my son has sat down with his sister and helped her with her homework. He has helped clean up around the house, and he just generally seems a little bit happier. I don't know what you said to him, but I'm happy that you said it." And that was probably the moment where I was hooked on doing that as much as possible. Laura: What was it to this kid's experience that you felt resonated with your own? Ernest: Primarily, it was the lack of control he felt like he had over his own life. He felt like he lacked agency, although he didn't exactly phrase it that way. He was struggling in school. He was struggling at home. He was just struggling in general to have a sense of identity and a sense of place in the world. Feel like he was a subject in the world rather than an object. I remember a lot of that from my childhood too. But more so, you know, it was the impulsivity. He felt as if he had to keep moving. He couldn't stop. To stop was to die, you know, but to keep moving was you know, just roll forth into chaos for him. Laura: Tell me more about the lack of agency and the lack of control, and how specifically you felt similarly in your life. Ernest: I think that to a large extent, all children and young adults grow up feeling somewhat disrespected, somewhat less than. It's just the nature of the way our system of education is set up. It's the way our society is set up in many ways. And we're on the verge of being told that we have to have more responsibilities and be the caretakers of this world, but also then not be trusted to say or do anything. And I feel like there's very little thought put into that in-between time to allow young adults the space to reflect about how they like to work, how they like to be in this world. And I think that when you don't have that space for reflection, it can lead to dark places sometimes. And I know it did for me as an adolescent. Laura: And how would you have preferred to work or preferred to be as an adolescent? Ernest: I would have preferred to have heard early on that there are different ways of thinking and learning. Just that alone probably would have went a long way for me. When you're young, you have no frame of reference for how your mind works. It just is what it is. You probably don't think about it any more than a fish thinks about the water that it's swimming in. And then it's only through comparison that you begin to understand that you are a bit different. You're not sure whether it's a good thing or a bad thing, but generally speaking, standing out and being different in this world opens you up to all sorts of attacks. Laura: Give me an example of tween or teen Ernie in the classroom at school, for instance. And where looking back, you can see now that, oh, your ADHD was really creating some challenges for you and you were misunderstood. Ernest: For me personally, I would have a hard time letting go of certain issues or certain points. I'm certainly very opinionated and I could not keep those opinions to myself. It was very hard for me to listen to something that I knew what the ending of it was. If I knew the end of the sentence, I knew what the end of this thought. I wanted to move on to the next thing, which I didn't know. And it was like nails on a chalkboard for me to have to sit there and listen to something that was very predictable for me. Laura: Did it come across as impatience? Ernest: Yes, I came across — I know for sure — as irritable, arrogant, and I certainly wasn't trying to be either of those things. Laura: I've experienced that myself. Just this "All right, all right, move on. I know, I know, I know, I know, I know." "But I have never told you this before." I'm like, "I already thought it through. I know what you're going to say, I know you. I've been studying your every word, I get it, can we move on to the next thing" and then... Ernest: And you know, I'm acting as if this is past tense. But, you know, it's still something that I struggle with. Even in my relationships now, even with my partner. It's hard sometimes when we're trying to make a decision — maybe about something critical or we're trying to work something out — and I just need to skip to the next subject, which I know is the heart of the matter. I know that that's deep down is what we need to be thinking about and what we need to be acting on. I have to even remember that other people have their own ways of thinking through things, and it's important when you're working with another person to translate what you need and translate what they need into something that both of you can collaborate on. Laura: You have this experience as a defense attorney. What happened next? Ernest: Yeah. So, I started my legal career doing eviction defense with legal services, defending terminations of public benefits, defending evictions. And I really did love that work. But at some point, I decided to hang my own shingle because, again, I became very frustrated with the way that things were run, and I needed to prove that I could do it better in some way. So, I hung my own shingle, and then I started taking criminal work from the public defender's office on contract. I also helped defend IEPs. I helped defend disciplinary actions. Laura: And for those of you listening who don't know what an IEP stands for, it stands for Individualized Education Program. IEPs lay out the special education supports and services students need, and that can include kids with ADHD. Ernest: These, I would say, are where the early days, or at least earlier days, of ADHD becoming something that mainstream society was more aware of. I was still at the time very much unaware of it. I feel like I got my education in the field. Hearing people's stories, seeing what they went through, seeing the benefits of a well-crafted IEP, and how it really did change lives. Laura: You were drawn to do this type of work that involved IEPs, and at this point, you were not diagnosed with ADHD? Ernest: No, no. Nor did I have a desire to be, even then. Laura: But you felt drawn to it? Ernest: I did. I felt drawn to the stories, and at first, I didn't know why, but I slowly began to get a sense that I was finding out more and more about myself with each of these stories. I was taught that, you know, you need to succeed in spite of all of the challenges of the world, and that the world is a tough place. Education is hard, and you have to fight for it, and you need to succeed in spite of all of these things. I started to learn a different way of seeing things, which is, you know, instead of succeeding in spite of all of these things. What if we could succeed because of our circumstances rather than in spite of them? And, I think that forced me to take a kinder view of myself. Laura: Did that include seeking out an evaluation? Ernest: Yes, ultimately it did, but very late in the game. Because, even despite all of that, there were, I think, other biases at play around medication. Because I was also raised in a family and in a generation where men especially, do not talk about any mental health challenges that they're having and they don't get prescribed any medication for that. I was literally told at points that, you know, you don't want any of that to go on your permanent record because you'll never get accepted anywhere. You'll never get hired anywhere. So, I did keep that prejudice for a long time, that bias for a long time. And then, when I finally broke down one day and I saw what medication had to offer, it was really a game changer for me in terms of working through things differently. Laura: So, you got evaluated. You were diagnosed with ADHD, and it sounds like you had the option of taking ADHD medication, but you resisted for a while. Do I have that right chronologically? Ernest: Yes. Out of some twisted sense of pride, maybe. Laura: What happened when you "broke down" and then... or do you just mean that, like you finally gave in and decided you would... Ernest: Well, you know, it came down to feeling depressed, and whether or not depression was at play, I think is an open question. There was never any definitive answer on that. But I think that depression primarily stemmed from having a lack of focus and a lack of interest in the things that used to interest me. And I was somebody who wanted to get a lot of things done. And I had a sense of what those things were. I just couldn't bring myself to do them. It was physically painful to try to sit down and do some of the things that I wanted to do, right? Some of the things that I wanted to write, you know, form some of the projects that I wanted to form. I didn't realize until very late in my life that, when it feels like a physical impossibility, that might be time to seek out an evaluation. Laura: How did it feel, getting evaluated for ADHD? Ernest: Liberating in a lot of ways, I guess less scary than I thought. I mean, I think I'm fortunate because I have heard stories and I've seen certainly horror stories where people are essentially gaslit into thinking that it's everything but ADHD. Laura: That does happen. Yeah. It's unfortunate. Ernest: There are certainly socioeconomic disparities, racial disparities in how people are evaluated and treated. So, I will say that I'm grateful that I was lucky to have a thoughtful and caring provider. And the way that it felt for me was, each question was a great opportunity to reflect, just in general, and recalibrate. Laura: And talk to me about attention deficits. You have thoughts about this term "attention deficit." Ernest: So, my partial perspective on the matter is that attention deficit is a bit of a misnomer. It's more of an attention difference, because when it came to giving certain things attention, I could give it attention all day long. I had a different type of attention, is what I've come to understand. And I think that would resonate with a lot of other people. And the reason that I think we have called it attention deficit is because there is one type of attention that our society overwhelmingly favors.Laura: Which is? Ernest: Which is rote memorization, which is obtaining technical skills. Having a technical approach. We often don't favor curiosity and imagination and novel ideas. And funny enough, that in my work as an executive coach, a lot of what I do — I find, day in and day out — is helping people unlearn some of that conditioning. Laura: So, as a society, we value attention to detail and not necessarily in the creative sense. It's attention to being able to manage all of the mundane things of life. When we first chatted, Ernie, you mentioned that the mundane causes anxiety for you. It's not the big stuff. That you're really great in a crisis, you're really great at digging into things that you're really passionate about. But like this whole being attentive to the everyday stuff that we have to, or "have to be attentive to" is painful. Ernest: Absolutely. I mean, this was, I think, one of the things that scared me most about practicing law. And I didn't realize again until later that I didn't fear the things that most people feared. I feared the things that most people had a relatively easy time with. Simply, you know, keeping track of cases. You know, I was also raised in the generation that was on the cusp of using case management systems and, you know, automated software and such. So, every attorney has to have some type of tickler system where, you know — to keep up on certain things — because sometimes I had upwards of 50 cases going on at once. And that always frightened me. It always kept me up at night. The idea that, even with a calendar, I couldn't keep track of some of the details that I needed to keep track of. Laura: Were you worried about showing up late and dealing with paperwork? That kind of thing. Ernest: I mean, not only was I worried about it, it happened on more than a few occasions. And it was incredibly embarrassing to have the court call you up and say, "Where are you? You were supposed to be here at 9 a.m." Laura: Yeah. And I think I don't want to skip past that word "embarrassing" too quickly, because a lot of these things people often brush off, like, it's just becomes kind of like a meme whether or not you have ADHD. "That was so ADHD I was so late." When you do have ADHD and you know that you're struggling with these kinds of things — In my experience, I won't speak for you, it goes beyond embarrassing — It leads to shame. Ernest: It does. We have embarrassing moments, you know, every day, everybody gets embarrassed at some point. But shame, I think, does hit the nail on the head because it makes you second-guess everything about yourself. It took me a long time to learn to love the way that I think. It's part of just loving myself. I see the advantages to it now, and I also know my shortcomings, and I'm not so proud now that I won't seek out help where I need to. Laura: I'm still thinking about attention deficit and that word "deficit." Yeah, I think the way that you phrase that is really interesting. Like we have a deficit in the things that society wants us to be attentive to, but that doesn't mean that's the most important thing to be attentive to. Ernest: Let's face it. I mean, we have a profit-driven culture. But, you know, there is value to slowing down sometimes. Laura: Where do you feel like your attention thrives? You talked about crises. Can you give some examples or where else, like where does Ernie show up? And he's like "I am super attentive. I'm not going to miss a beat. And I am right here and I'm on it." Ernest: I think I found the integration that I needed in my life through coaching. I recognize now that the happiest times of my practice working as an attorney was not sitting in writing briefs, but it was working with people. It was sitting across the table from other people, and I started to find value in my way of thinking about things, because other people weren't thinking that way, and they would tell me, "Oh, that's the first time that I thought about it that way." I would often have a perspective for them that would help them take a step back and look at things differently. And I saw that that was something that I could provide, and I was hell-bent on public service. And you've got to go where your skills meet the world's needs. And that's why I enjoy what I'm doing now. Laura: Do you find that a lot of your clients are neurodivergent? I imagine you work with a lot of folks in the C-suite just top of your head. You feel like you're more often trying to help senior-level folks, senior leaders understand other people's neurodivergent ways of thinking? Or is it that they themselves are neurodivergent and you're trying to help them relate more with other folks? Ernest: Honestly, it's a good mix of both. What I think you find when you start working with more senior leaders is there are a lot of — what probably would have been described as — dilettantes. You know, that was a word that I was afraid of being labeled my whole life. But some of the most successful people in the world were themselves dilettantes in other people's eyes. They had many different interests. Laura: And describe what you mean by that, when you say dilettante. Ernest: You know, it's that idea that somebody is just steeped enough in a bunch of different things to know enough to get themselves in trouble, but never really understands anything deeply. Laura: Know just enough to be dangerous? Yes. Ernest: No, just enough to be dangerous. Whereas the word polymath is admirable. But, you know, the distinction between a polymath and a dilettante is certainly debatable. Laura: Define polymath for the listeners as well. And maybe for me, I'm just saying. Ernest: A polymath would be somebody, I guess, who is a master of all trades. Maybe not all, but multiple professions, many. Can speak maybe different languages. Skilled in mathematics, but also chemistry, and also the humanities. I think some of the people that we tend to admire are polymaths, but they may have been accused at some point in their lives of being dilettantes, which carries a negative connotation. I mean, I was told, you know, at a few points in my life that "I need to get serious." "You need to get serious and stick with something." You know, "Leaving the law is a mistake because, you know, you've already had so many years of experience and built up credibility. Why would you leave all of that?" And, my answer is because life is for living. You know, there is no — as Alan Watts would say — serious destination that we're trying to get to. It's a musical thing. You know, the point is to enjoy yourself and dance and sing along to the music. And as soon as something doesn't please me anymore, why would I stick with it just out of some rote sense of obligation? Laura: What did you say earlier, when you were talking about your experience with the young person who set fire to the penalty box? All advice is biographical? Ernest: Yeah, all advice is autobiographical. Laura: That coming up a lot in your work as a coach?Ernest: Well, I mean, that is my one and only caveat for any advice that I give, before I give or attempt to give any type of advice to somebody. Because I don't trade in advice. I don't believe that wisdom is something that can be communicated. Wisdom is something that we experience individually. So, whatever wisdom I've gained from living my life, that doesn't transfer to another person. So, whenever I give any type of advice, I give it with the caveat that all advice is autobiographical, meaning that, this is how I experienced it. This was how I saw it through my eyes. And to the extent that that helps you, great. And if it doesn't, ignore it and move on. Laura: So, what's the most common piece of advice that you give to help corporate leaders understand the importance of neurodiversity, or just to understand neurodiversity in general? Ernest: I have a bit of an odd answer, I guess. Or at least this is what the first thing that comes to mind is getting over their own shame and guilt. I find that the number one problem in most organizations, corporations, government organizations, non-profits, just community groups is people have a difficult time talking to each other in any genuine sense. We have discussions and we know how to discuss things, but we often don't know how to have a dialogue. And the difference between those two things is a discussion. You know, it has its root in percussion, the same root as percussion. It's like I beat my drum. You beat yours. I say my thing, you say yours. That's a discussion. But a dialog is where we bring two different reflections or ideas about the world, about ourselves to the table. And both of us walk away with a new third thing. You know, it's transformative. It's not just about me saying my thing and you saying yours. Laura: Ernie, I don't know if you can hear me taking notes occasionally on my laptop. I'm not even doing it for the sake of the interview. It's totally selfish. I'm writing down these gems that you're providing as if you were my own coach right now. Ernest: Well, I appreciate that. And again, to the extent that anything I say helps you, good. But if not, just ignore it and move on. Laura: The ultimate caveat. So, are you a dilettante or are you a polymath? Ernest: I am what you say I am, right? So, I would say that I aspire to be a polymath, and I probably am always questioning myself as to whether or not I'm just being a dilettante, to keep myself honest. Laura: So, when you went in to get evaluated and you came out the other side and you had been diagnosed with ADHD, what was the overall outcome for your well-being? Ernest: It gave me, once again, a language for telling a different story. And I think, I mean, I don't want to wax poetic here, but then again, it is one of my favorite things to do. Laura: I mean, this is your time, Ernie, go for it. Ernest: I hope this all gets edited into something flattering, rather...Laura: Justin is incredible. And leave that in, Justin. Don't cut out the fact that I said you're incredible. Thank you. Ernest: So, you know, our brains are giant metaphor machines. I hesitate using the machine metaphor to describe our brain, but for the sake of argument. Our brains run on metaphor. The only reason that I can distinguish the table that I'm sitting at from anything around it is because I could see things around that are not a table. So, it's this constant "this and that." I understand this because I understand that. And that's the transformative power of stories. They help us step outside of our own mind and see things from a different perspective. We often get so caught up in the story that we're telling ourselves that we can't see things any differently. Going back to the fish, not thinking about the water that it's swimming in. You know, if you ask a fish "How's the water," he may be like, "What's water?" I think that's what happens with our own self-narratives. Every morning we get up and we tell ourselves the story that we're the same person who went to bed the night before. So, I told you I was going to wax poetic, but I'll end it there. Laura: I love it. Ernest: So, you know, that story is very powerful. For better and for worse, as we all know. So, a lot of the shame and the guilt that comes from having ADHD or trying to seek a diagnosis or an evaluation comes from this story of whether that's a good thing or it's a bad thing to have ADHD. And really, I mean, it's neither. Oscar Wilde famously said that "There's no such thing as a good story or a bad story. There's well-written stories and poorly written stories."So, you asked, like, what did getting a diagnosis do for me? It helped me realize that I was thinking in terms of good or bad. But really, I just needed to start writing my own story better. And that story is going to include the same challenges that it did before the diagnosis. But now I get to tell it in a different way. I get to say how that story ends. Laura: Ernie, thank you for chatting with me today. I can't think of a better place to end than right there. That was beautiful. Ernest: Thank you. Laura: I really appreciate your time. Ernest: It was a pleasure being here. You learn something new about yourself every time somebody gives you an opportunity to say something about yourself. Which is why my future efforts are being focused on my nonprofit, "Project My Voice."Laura: Do it. Ernest: We are just getting started, but a lot of the work that I have done in Fortune 500 companies, I think is better suited for the community. So, I want to work with students. I want to work with teachers. I want to work with parents. I want to work with community members, and I want to give them that space to reflect on their own lives and tell better stories to each other and also about themselves. And I want to do that through film, which is another love of mine. Because talking about stories and the transformative power of stories, film gives us this wonderful shared experience, and we often waste it when we all get up and walk out of the theater, just strangers. So, the idea behind Project My Voice is, let's watch a movie together, and instead of walking out of the theater, strangers, let's walk out of the theater knowing each other a little bit better, and having learned something more about each other and something about ourselves. Laura: So, cool. That sounds great. Congratulations. I'm excited to see all the wonderful things that you do. Ernest: Well, thank you very much. Laura: Nothing mundane ever. Ernest: Can't. It's a physical impossibility. Laura: You've been listening to "ADHD Aha!" from the Understood Podcast Network. If you want to share your own "aha" moment, email us at ADHDAha@understood.org. I'd love to hear from you. If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode. Understood is a nonprofit organization dedicated to helping people who learn and think differently, discover their potential and thrive. We have no affiliation with pharmaceutical companies. Learn more at understood.org/mission. "ADHD Aha!" is produced by Jessamine Molli. Say hi, Jessamine! Jessamine: Hi, everyone. Laura: Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. For the Understood Podcast Network, Scott Cocchiere is our creative director, Seth Melnick is our executive producer, and I'm your host, Laura Key. Thanks so much for listening.
Workplace mental health: 5 ways to support employee wellness
Each year, one in five adults in the U.S. will experience mental illness. Yet only one in three who need help will get it. As a result, many people will either miss work or will get less done on the job. The latter is known as presenteeism, when people go to work while struggling with physical or mental health issues. This is why focusing on workplace mental health is so important for your bottom line. The World Health Organization (WHO) estimates that depression and anxiety cost the global economy $1 trillion per year in lost productivity. But WHO also found that for every $1 spent on treating common mental health concerns, there is a return of $4 in improved health and productivity. According to the Society for Human Resources Management, many employers are enhancing emotional and mental health benefits. Types of support can range from managing stress, to treating invisible disabilities such as anxiety and depression. The potential benefits of supporting employee mental health include:Increased productivity: Research shows that nearly 86 percent of employees treated for depression report improved work performance. And in some studies, treatment of depression has been shown to reduce absenteeism and presenteeism by 40 to 60 percent.Increased retention: In a 2019 survey of more than 1,500 employees nationwide, more than a third of the respondents said they had left a job due at least in part to mental health. Of these, 59 percent said mental health was the primary reason.Decreased health care and disability costs: According to the National Alliance on Mental Illness, rates of cardiovascular and metabolic diseases are twice as high in adults with serious mental illness.The connection between physical health and mental health prompted the American Heart Association’s CEO Roundtable to release a report called “Mental Health: A Workforce Crisis.” It urges employers to provide comprehensive programs for the prevention and treatment of mental illness. “The cost of doing nothing is higher than investing in evidence-based prevention and treatment,” the report found.Ways your company can support employee mental healthA nationwide employee survey found that what people want the most in the workplace are trainings and more easily accessible information about where to go or who to ask for mental health support. A more open culture about mental health at work is also important to employees, according to the survey. With those findings in mind, here are five ways your company can support employee mental health:1. Understand how mental health impacts your employees.“It’s important for managers to be trained to recognize the signs of emotional distress so they can react in a supportive rather than a punitive way,” says Jerome Schultz, PhD, a clinical neuropsychologist and a lecturer at Harvard Medical School. “Some employees need people around them to say, ‘Hey, I see you might be feeling stressed. Maybe now is a good time to try some breathing exercises or go take a walk.’” Here are some proactive steps you can take to understand and assess your employees’ mental health:Make mental health training mandatory for your company’s leaders to help them be more aware of and invested in this aspect of their employees’ well-being.Train managers on what to do if they see signs of emotional distress or substance abuse.Use mental health calculators to estimate the prevalence and associated costs of untreated depression and alcohol and substance abuse at your workplace.Consider using surveys such as the Work Limitations Questionnaire and the Brief Job Stress Questionnaire to measure how your employees’ health and stress levels affect their productivity.2. Include mental health coverage as part of your health care plan.Learn about the Mental Health Parity and Addiction Equity Act. It requires insurance coverage for mental health conditions (including substance use disorders) to be no more restrictive than insurance coverage for other medical conditions.Avoid plans that offer “phantom” mental health coverage. And find out how many psychologists and psychiatrists are in-network.Provide a health savings account (HSA) to help offset out-of-pocket costs.3. Establish an employee assistance program (EAP).Many companies use an employee assistance program (EAP) to support workplace mental health. Some employees may be reluctant to use this resource due to fear of stigma, shame, and lack of understanding about how these confidential programs work. But there are things your company can do to increase EAP usage. For instance, New York’s YMCA of Greater Rochester changed their communication strategy about their EAP. Instead of just posting notices in break rooms, they now send out a monthly mental health newsletter.“The newsletter reminds employees these benefits are available to you. It’s paid for you. It’s there for you. Use it as much as you want,” says Fernán Cepero, YMCA of Greater Rochester’s senior human resources business partner. “Employees know ‘I can call to work out a plan. I can get assistance I need now rather than waiting for a crisis. I can get help before I even have to use my insurance.’” To encourage employees to use an EAP, your company can:Provide direct access to mental health professionals via phone and/or in-person.Offer this resource to employees as well as to their immediate family members.Make it easy for employees to know who to talk to or where to go to access mental health resources.Emphasize that your EAP can be accessed confidentially and free of charge.4. Use communication to reduce stigma and increase access to mental health resources.Don’t wait until open enrollment to mention mental health benefits and community resources. Promote them frequently, such as in monthly newsletters.Ensure that your executives mention emotional well-being every time they talk about recruiting talent and building an inclusive culture that helps employees bring their best selves to work.Offer workshops so employees can learn more about mental health and resilience.5. Promote well-being.Build as much flexibility as possible into all employees’ schedules.Offer access to apps that can help with sleep and stress reduction.Consider offering a meditation room, mindfulness training, and/or yoga classes at work.Encourage employees to use their vacation time. Some companies do this by limiting the amount of vacation employees can roll over into the next year. Provide accommodations and develop a return-to-work process so that employees who need to take a leave of absence because of a mental health issue feel supported when they come back.And finally, create opportunities for employees to build connections with each other, such as through social events, affinity groups, and electronic message boards. “Employees are more vulnerable to the negative impact of stress inside and outside of the workplace if they have not built strong positive relationships at work,” says Schultz. “Help make work interesting, social, and fun, so stressed-out employees aren’t working in isolation. Workplace relationships that are positive provide a source of support — that’s hard for anything else to replace.”
Understood Explains Season 1Private vs. school-based evaluations for special education
Why do some families pay for private evaluations when the ones at school are free? Find out in this episode of the Understood Explains podcast. families pay private evaluations ones school free? neuropsychologist? person things school psychologist can’t? Listen episode Understood Explains learn answer, involves making diagnoses.Host Dr. Andy Kahn psychologist spent nearly 20 years evaluating kids public private schools. first guest episode Dr. Ellen Braaten. teaches psychology Harvard Medical School. also runs Learning Emotional Assessment Program Massachusetts General Hospital. Andy Ellen explain:How private evaluations compare school-based evaluationsWhy families may want seek one other — bothWhat look private evaluator Ways help cover cost, like asking school pay independent educational evaluationAndy’s second guest parenting expert Amanda Morin. They’ll share tips tricky topic: say child getting private testing evaluated school.Related resourcesPrivate evaluations: need knowPros cons private vs. school evaluationsNeuropsychological evaluations: need knowIndependent educational evaluations (IEEs): need knowWhy different evaluations may different resultsHow-to resources13 questions ask hiring private evaluatorHow get free low-cost private evaluation childDownload: Sample letters including request IEEEpisode transcriptJennifer: Hi, name Jennifer Atlanta. child take standardized assessments, tests, can't retake five months later. happens go school first you've school theirs, use good test, go get private evaluation, person you're paying lot money evaluation can't test themselves. hindsight, wished would done full neuro psych evaluation right beginning paid money up-front privately gotten big picture happening, taken school asked eligibility meeting. could performed whatever wanted do. feel like got backwards.Andy: Understood Podcast Network, "Understood Explains." You're listening Season 1, explain evaluations special education. 10 episodes, cover ins outs process school districts use evaluate children special education services. name Andy Kahn, I'm licensed psychologist, in-house expert Understood.org. I've spent nearly 20 years evaluating kids public private schools. I'll host. Today's episode private versus public school evaluations. We're going cover key things: private evaluations similar different evaluations done public school districts, families may want seek one both, look private evaluator, ways help pay private evaluation. We're also going give ideas say child different types evaluations, say. First, let's hear another parent. Michele: name Michele live Bronx, New York. paid private evaluation. 9:00 morning 5:00. last year pandemic. sort excited day felt going thorough evaluation, going helpful. evaluation report received generic, incomplete. totally really discuss son's strengths, weaknesses, services would need. paid pocket $350. billed insurance company $6,800. Andy: It's common families think getting evaluation private clinic rather school district. Different families may variety reasons. families, child may already gotten evaluation school district, want second opinion. families may prefer control private evaluation. example, may decide share pieces information school. There lot pros cons consider. starters, private evaluations really expensive. time consuming get into. school evaluations free. families go deciding needs? My first guest today going help unpack this. Ellen Braaten associate professor psychology Harvard Medical School, executive director Learning Emotional Assessment Program Massachusetts General Hospital. She's co-author "Straight Talk Psychological Testing Kids." Ellen also mom two longtime Understood Expert, we're thrilled today. Ellen, welcome. Ellen: I'm really happy here. Andy: Ellen, let's talk little bit program run Mass General. understand specializes evaluating kids learning thinking differences. also help train psychologists part Harvard Medical School program. And — understand whole variety different assessment types there, correct? Ellen: do. neuropsychological assessments, think we'll get little while. educational evaluations, intelligence testing. even school observations, well. assess children various kinds learning differences, dyslexia, ADHD, autism spectrum, developmental issues well. Andy: mentioned several types evaluations. tell little bit one they're different one another? Ellen: let give big-picture definitions. neuropsychological evaluation typically implies number different tests measure different types brain functioning. mean attention, memory, language, learning kinds functioning. that's sort like granddaddy assessment batteries.And you'll also see evaluations label behavioral emotional functioning psychological functioning. typically means think is: evaluator looked someone's behavioral functioning, psychological functioning. Things like anxiety, depression, worries. And would think clear definitions one assessments, really isn't. Depending live, area country, sort used interchangeably. would say exceptions term neuropsychological assessment. you'll also see one assessment, called core evaluation. It's battery tests used determine whether child eligible services school. Andy: Yeah, described core evaluation, parents places might hear referred psychoeducational evaluation. there's lot jargon parents wrap heads around. also want add psychologists like Ellen use word "battery," we're referring group tests. So let give quick example. psychoeducational battery commonly includes IQ test, academic achievement testing, sometimes subject-specific tests look reading, writing, math. kind battery, might use tests answer question child learning disability, slow processing speed, trouble working memory? results may point kids one other. kids might above. OK, we've talking different kinds evaluations. people evaluations? one type evaluator type evaluation? providers offer like menu choices? Tell us little bit typically what,Ellen: Typically evaluations done psychologists, even psychologists aren't same. might hear term "neuropsychologist." That's kind psychologist typically neuropsychological batteries. School psychologists typically evaluations school system. you'll also hear term "educational psychologists," "clinical psychologists" — it's different sorts psychologists licensed different sorts testing, Andy: use word "licensed," reminds me — want mention yet another type evaluator parents may hear about, that's licensed psychologist. That's am. Unlike school psychologist, licensed psychologist diagnose mental health conditions. next detail I'm going share bit confusing, it's helpful know: schools hire licensed psychologists like school-based evaluations. psychologists school-based evaluations school psychologists. Kind confusing, know. Ellen: also, there's term "psychiatrist," lot people think psychologist, it's not. Psychiatrists medical doctors specialize treatment psychiatric issues like ADHD would treat medically, typically, sometimes therapy. psychiatrists kinds evaluations we're talking today.Andy: Good know. Ellen, there's one jargony term want us cover. it's real mouthful. It's called "independent educational evaluation," IEE. basically private evaluation, school district pays it. it's free families. We're going dig IEEs minute.
My mom finally believed in my ADHD when she saw her own focus problems
In Latin culture, learning differences are rarely talked about. They’re silenced and ignored out of fear that admitting these issues makes one seem “weak.” And in my household, my parents were no different.For a long time, my mother didn’t want me to meet with a psychiatrist to find out why I was anxious all the time. It’s not that she didn’t want me to get help. But she worried what finding out would label me as. I battled with depression and my father couldn’t understand why. To him, my life was much better than his was as a child.Still, I pushed to meet with a psychiatrist. And I’m glad that I did.After a few meetings and some testing, I received a diagnosis. Turns out I was experiencing generalized anxiety disorder (GAD). And there was medication to help — though my mother didn’t want me to be on it forever. She worried about the effects it would have on me in the future, and she was concerned I wouldn’t be able to handle things on my own. Her worries, over time, made me worry. So much so that I was afraid to request an ADHD and autism spectrum disorder (ASD) evaluation.I suffered throughout my undergraduate studies. I even struggled at my first job after college. And then I decided that enough was enough. So, without consulting my parents, I sought a referral to see a neuropsychologist.When I finally told my parents, they sighed, wondering why I kept trying to find something wrong with me. My mother said, “Nothing is wrong with you. You’re unique. Look at how successful you have been, and you think something more is wrong with you?”My parents know that I’m smart, and they’re proud of me. I have succeeded as a first-generation high school, college, and graduate student. They’re not concerned about the issues I have, but they are afraid of what our relatives think. Stigma still exists in our culture and in our family.When I received my diagnoses for ADHD and ASD, my parents didn’t understand. I hadn’t shown signs of common symptoms for either disorder. I think that’s because I had mastered how to mask my challenges, overwork myself, and pretend to be “normal.” But I knew I couldn’t go on like this forever. And while it was difficult, I couldn’t take my parents’ reactions to heart.Ironically, many of our relatives didn’t finish school in Mexico because of learning difficulties. I found out that as a child, my mom had struggled with focus and learning. And at the time, she thought this was common.Then one day things changed.My mom started to wonder more about her own challenges. She was working a full-time job and going to school at night. And it was becoming harder for her to focus on her tasks.One night, she texted me, “What was that thing you had with the attention?” My mom was finally wondering what she should do about her struggles with focus. I replied, “Do you want to hear some strategies that I use to help make life a little easier?”
Understood Explains Season 2What happens in an ADHD test for adults?
Find out how doctors test adults for ADHD. What kind of questions do they ask? How long does it take? Know what to expect in a thorough evaluation. How do doctors test adults for ADHD? What kind of questions do they ask? How long does it take? Understood Explains host Dr. Roberto Olivardia breaks down the process and explains what to look for in a thorough evaluation. Get an overview and answers to common questions: What does an ADHD evaluation look like? [00:51]So, what are ADHD rating scales? [03:48]How long does this whole testing process take? [04:59]What is the diagnostic criteria for ADHD in adults? [06:02]Why is it so important to be open and honest during an ADHD evaluation? [07:42]Key takeaway, next episode, and credits [08:31]Related resourcesHow do doctors test for ADHD in adults?What are ADHD rating scales?The 3 types of ADHDEpisode transcriptYou’re listening to Season 2 of Understood Explains: ADHD Diagnosis in Adults.Today, we’re going to talk about what happens in an ADHD test for adults.My name is Dr. Roberto Olivardia, and I’m a clinical psychologist with more than 20 years of experience evaluating people for things like ADHD. I’m also one of the millions of people who have been diagnosed with ADHD as an adult. I’ll be your host.My goal here is to answer the most common questions about ADHD diagnosis. Along the way, you’ll learn a lot about ADHD in general. We’re going to do this quickly — in the next 10 or so minutes. So, let’s get to it.What does an ADHD evaluation look like? [00:51] First, I want to tell you what the testing doesn’t look like. There are no blood tests, no hooking you up to a machine, no brain scans — nothing like what you might see in other parts of a medical facility. In a nutshell, an ADHD evaluation tends to involve some multiple-choice questions and a wide-ranging conversation with a trained professional, like the kinds of providers we talked about in Episode 2. OK, so now let’s drill down into five key components of ADHD testing:The first is patient history — getting to know your past. The provider will ask for information about your childhood, including your birth weight and developmental milestones, like when you learned to walk and talk.This is also when it’s good to share details about any hospitalizations, as well as any ongoing health issues you might have. The second big part asks open-ended questions about different aspects of your life, like school, work, relationships, sleep patterns, appetite, etc. This is all essential for the evaluator to know, because ADHD can impact so many different aspects of daily life. But it can also affect different people in different ways. Let’s look at sleep, for example. If you say you don’t get enough sleep, the evaluator can really dig into this area: Do you have trouble falling asleep, but then you sleep like a rock and it takes four alarm clocks to wake you up? Or do you have trouble staying asleep because every little noise wakes you up? Is your sleep disrupted because you’re drinking too much and keep getting up to go to the bathroom? Another example is the evaluator asking open-ended questions about school. If you say you were an A student, the evaluator might ask what went into getting those A’s.Did you have to pull a lot of all-nighters? Were your parents very involved in structuring your schedule? Did the wheels fall off when you went to college or got your first job?The third part is a questionnaire that asks a bunch of quick questions using what’s called an ADHD rating scale, which we’ll get into in the next section. But before we jump to that…Another really important part of an ADHD evaluation asks about other conditions. For example, maybe your symptoms are pointing to something that looks a lot like ADHD or that often co-occurs with ADHD, such as anxiety, depression, or obsessive-compulsive disorder. That’s really, really important to keep in mind. And the last big part of the process that I want to highlight is meeting again with the provider to go over the evaluation report. This report is typically several pages long and should sound like whoever did the testing really got to know you. The report should also include recommendations on how to help. If you notice any inaccuracies or need clarifications, you should raise those concerns with the evaluator right away. And if you need certain recommendations spelled out so you can get accommodations at work or maybe for college or grad school, talk with the evaluator about that too. So, what are ADHD rating scales? [03:48] You’ll probably hear the phrase “rating scale” quite a bit during the ADHD diagnosis process. Essentially, it’s a questionnaire — a series of brief multiple-choice questions that you might fill out at home, or in-person with the evaluator. These scales ask you to rate how often you experience behaviors related to ADHD, like running late to important events or making careless mistakes when you’re working on a boring project.The answers you’re choosing from are typically something like “never,” “occasionally,” “often,” or “very often.”There are several different versions of rating scales, but they’re all working toward the same goal and are a key part of a comprehensive evaluation. Generally, different providers tend to use whichever questionnaire or rating scale they like best and fill in any gaps during the one-on-one conversation or clinical interview. Sometimes, an evaluator may also ask someone who knows you very well — like a spouse or roommate — to fill out a questionnaire. Getting other people’s perspectives is commonly done when kids are being tested for ADHD, but it can help with adult diagnosis too.How long does this whole testing process take? [04:59] The length of time an evaluation takes can really vary from person to person. I’ve had some thorough evaluations take an hour to complete. Others have taken four or five hours. Some could be finished in one visit. Others need to be spread out over a number of visits.But in general, the process tends to break down like this:The ADHD rating scales typically take anywhere from 10 minutes to 45 minutes to fill out.The patient history and other open-ended questions may take an hour or so.And then there’s the follow-up, where the evaluator explains the results and recommendations. This typically takes an hour too.There are lots of possible reasons why some evaluations take longer than others…Like if there’s a lot of personal history to review, or if there are any co-occurring conditions to go over in addition to possible ADHD.The timing also depends on how quickly the provider and patient are able to move through these conversations.What is the diagnostic criteria for ADHD in adults? [06:02]There are three official types of ADHD, and each has a different threshold that patients must meet for a diagnosis. There’s the inattentive type of ADHD, which used to be called “attention-deficit disorder,” or ADD. Patients need at least six symptoms of inattention for a diagnosis.To be diagnosed with the hyperactive/impulsive type of ADHD, a patient needs at least six symptoms of hyperactivity or impulsivity.Many folks have a third kind, which is called the “combined type of ADHD,” where you qualify for both types I just mentioned.The official diagnostic guidelines are part of a big manual that’s called the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM lists the criteria for the three kinds of ADHD. These guidelines are also looking to see if you started having symptoms before a certain age and if you’re having symptoms in two or more settings, like home and work.But these criteria are all really nuanced, which is why it’s so important to talk one-on-one with the evaluator. For example, it may seem like you’re mainly struggling in one area, like time management. But that one area could have a huge, negative impact on your life — like getting fired, losing friends, not achieving goals, etc. Context is also really, really important. For example, are you noticing fewer symptoms in some settings because you’re getting more support in those areas? A highly trained evaluator can suss out these kinds of things during your one-on-one conversations. Why is it so important to be open and honest during an ADHD evaluation? [07:42] As you’re going through the ADHD evaluation process and you’re filling out the rating scales, it’s pretty easy to guess which “often” and “very often” answers lead to an ADHD diagnosis.But I want to caution you against trying to answer in a way to ensure you get a diagnosis. If you don’t truly have ADHD, then getting treated for ADHD may not help you. And it could be dangerous if you’re incorrectly prescribed ADHD medication. It might actually make it take longer to figure out what’s really going on, like if you have a sleep disorder instead of ADHD. Different conditions require different treatments. So try to be as open and honest as possible. Key takeaway, next episode, and credits [08:31]OK, that’s all for Episode 3. The key takeaway I’m hoping you remember from today is why ADHD evaluations need to be so thorough.Evaluators ask so many questions to make sure that you do, in fact, have ADHD and not some other disorder that looks like ADHD. And since ADHD often doesn’t travel alone, it’s also really important to tease out any co-occurring conditions so your provider can develop a comprehensive treatment plan. Thanks for listening, and I hope you’ll join me for Episode 4, which explains what you need to know if you’re thinking about getting online testing for ADHD.You’ve been listening to Season 2 of Understood Explains from the Understood Podcast Network. If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources, as well as links to anything we’ve mentioned in the episode. One important note: I don’t prescribe ADHD medication and I don’t have any affiliation with pharmaceutical companies — and neither does Understood. This podcast is intended solely for informational purposes and is not a substitute for a professional diagnosis or for medical advice or treatment. Talk with your health care provider before making any medical decisions.Understood Explains is produced by Julie Rawe and Cody Nelson, who also edited the show. Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show.For the Understood Podcast Network, Laura Key is our editorial director, Scott Cocchiere is our creative director, and Seth Melnick is our executive producer. Understood is a nonprofit organization dedicated to helping people who learn and think differently discover their potential and thrive. Learn more at understood.org/mission.
How to Have Meaningful Family Dinners
Families today are busier than ever. Everyone’s on a different schedule. And between work and taking care of the kids, you may feel you don’t have the time or energy for a sit-down family dinner.Having a child with learning and thinking differences can make family dinners seem even harder. But there are real benefits to sitting down to dinner as a family. And there are ways to make the process easier.Why Family Dinners Are ImportantStudies show that kids who have regular family dinners have higher grade point averages and more self-esteem. Regular family dinners might also be linked with lower rates of drug abuse, depression and teenage pregnancy.“Dinner conversations can help increase a child’s vocabulary.” Eating together can be especially beneficial for kids with learning and thinking differences. By taking them away from distractions like video games, family dinner may help them focus on the meal and dinner conversation. And if they struggle with homework, regular dinners can be a welcome break.Dinner may also be a good time for your child to talk about his day. If he’s feeling stressed out, keeping the conversation light and discussing things he enjoys may improve his mood. If you’re not sure what to talk about, the Family Dinner Project is a great place to explore. It offers conversation starters and tips on navigating tough dinner discussions.Tips for Making Family Dinners Work in Your HomeHere are some ways to make dinner easier and more pleasant for everyone:Have your child help you make the meal. This lightens your load and lets your child feel valued. Depending on how old he is, you might ask him to wash vegetables, set the table, or peel and chop ingredients. Or he could be in charge of toppings—preparing bowls of jalapeños, cheese, and avocado for chili night, for example.Eat at the table. When families eat in front of the TV, they aren’t paying attention to each other. That means they don’t get the same benefits as they would sitting at the table, studies show. Is there a program everyone wants to see? Watch it as a family and then discuss it over dinner at the table.Talk and tell stories. Dinner conversations can help increase a child’s vocabulary. Plus, hearing his family’s stories can help build your child’s resilience. This is especially important for kids with learning and thinking differences.Keep the focus on dinner. Try to make sure that if your child needs to get up and run around, he can do it for the sake of the meal. Put him in charge of clearing plates and getting glasses of water for people, for instance. And ask everyone to put away their phones during dinner to limit distractions.Don’t forget to explore the Family Dinner Project for more tips on how to make family dinners easier.
In ItParenting while anxious
Being an anxious kid has its challenges. But what happens when that anxious kid grows up to be a parent? Being an anxious kid has its challenges. But what happens when that anxious kid grows up to be a parent? In this episode of In It, hosts Amanda Morin and Gretchen Vierstra have a candid conversation with Morra Aarons-Mele, author and host of The Anxious Achiever podcast. Morra describes herself as an “extremely anxious introvert.” And she often wonders how that anxiety affects her parenting. Hear Morra describe her own strengths and challenges — as an anxious kid, a neurodivergent adult, and a mom.Related resourcesAnxiety in people who learn and think differentlyThe difference between typical anxiety and an anxiety problemAnd check out Morra’s book: Hiding in the Bathroom: How to Get Out There When You’d Rather Stay HomeEpisode transcriptAmanda: Hi, I'm Amanda Morin. I'm the director of thought leadership for Understood.org, and I’m also a parent to kids who learn differently.Gretchen: I'm Gretchen Vierstra, a former classroom teacher and an editor here at Understood. And this is "In It."Amanda: "In It" is a podcast from the Understood Podcast Network. On this show, we talk to parents, caregivers, teachers, experts, and sometimes even kids. We offer perspective, stories, and advice for and from people who have challenges with reading, math, focus, and other types of learning differences.Gretchen: Today, we're talking about being a neurodivergent parent and parenting neurodiverse kids. Amanda: And our guest for this episode is someone I have known and admired for a really long time. Fellow blogger, fellow podcast host, fellow introvert Morra Aarons-Mele. Gretchen: Morra is an expert in online marketing, and she hosts a fabulous podcast called "The Anxious Achiever" for the Harvard Business Review.Amanda: Morra also wrote a book that is really near and dear to my introverted heart, "Hiding in the Bathroom: How to Get Out There When You'd Rather Stay Home." And it's an Amazon best-seller.Gretchen: Last but not least, Morra's married and is a mom to three kids between the ages of 6 and 12. Amanda: Morra has had her own challenges — as an anxious kid, as a neurodivergent adult, and as a mom — and, as you'll hear, she's someone who's not afraid to get in it real fast. So this conversation may be a little more focused on her journey than the kinds of conversations we've had before. Gretchen: Morra, welcome to the podcast. Morra: Hello!Gretchen: So happy to have you. And I know we gave a little bit of an introduction, but can you start by just telling us a little bit more about what you do in your professional life?Morra: Sure. I feel like I have a really amazing job. I have actually two jobs. By day, I am a digital communications executive. I actually just sold my business, Women Online, which was a digital consulting firm, to a public relations firm called Geben Communication. And there I act as EVP of social impact and I get to work with lots of amazing nonprofit world-changing clients and create digital communications programs. And then I, as you mentioned, am, geez, I've been a blogger since 2004 or 5. I write books and I have my podcasts. So I get to talk to really smart, interesting people about all matters mental health and leadership. Amanda: And I know you've described yourself as sort of an extremely anxious introvert, which I totally relate to. Can you tell us a little bit more about what makes you different in terms of how you think and exist in the world? Morra: Yeah, so, I am introverted, but more than that, I am pretty socially anxious and I have pretty intense clinical anxiety that manifests in many different ways. And I got my diagnosis when I was 19, and I'm 45. I also have major depressive disorder. So, I can alternate between periods of high anxiety where, ironically, I'm super productive and kind of, like, go-go-go. It's not manic, but it's also not far from manic in its look and feel. And then every couple of years, it seems, I will get hit with a pretty strong depression. And that's way worse for me to deal with, frankly, than the anxiety. The anxiety is with me a lot but mostly manageable, but I find depression, even after all these years, just really awful. Amanda: That is really relatable to me. Gretchen: I'm wondering, um, how does all this show up in your day-to-day life? Maybe give us a hint of what it was like when you were a student and then now, as an adult.Morra: Oh, it's tons of fun. Um, you know, I was always a very anxious kid. When I was 3, I had such bad agoraphobia that I wouldn't leave the house. You know, I was always a pretty highly strung, anxious, temperamental, intense child, apparently. And then by the time I got to college, a string of events in my sophomore year set off a really, really bad season of my life, where I had really intense panic attacks and clinical anxiety, and then also severe depression. So, I would say that I sort of learned to cope. You know, anxiety is really comfortable for me. I don't know if any of you out there can relate to it. Like, in our society, when you're anxious but you can also channel it into your work, you get rewarded, right? It's kind of unfortunate, but it's the truth.That's why my show is called "The Anxious Achiever," because so many of us have become socially conditioned to sort of throw our anxiety into our work. And it works until at some point it doesn't, and then we really have to change things. So I would say that my pattern has been sort of when I'm in a highly anxious phase, I think it's really difficult to be around me probably.And my experience of life is very hard, but I'm also very productive and outwardly quite successful. Amanda: And that's hard in its own right. It's hard to be anxious and productive because sometimes people don't believe you can be both at the same time.Morra: A hundred percent. And I have OCD, as well, although it's less. But I think that OCD and anxiety — again, not a scientist, not licensed to say this — but my totally layperson's opinion is that very anxious people who are perfectionistic can really get a lot of OCD symptoms, uh, that are not about washing your hands a hundred times necessarily, but are about driving to completion something that may not need to be, and also intrusive thoughts that can really power you forward. And so I find those really difficult as well. Amanda: Totally. Does that affect how you parent?Morra: Oh, of course. Right? And it's only as my children are getting older and we as a family are doing a lot of exploring and therapy that I'm realizing that my anxiety totally affects how I parent, and it affects how my children live in the world. I'm really trying to work on that right now, because I think it's one thing for me to try to deal with all of my anxieties and intrusive thoughts and fears, but I don't want to infect my kids. And I'm really trying to work on boundaries while also, of course, modeling to them that feelings are normal and it's OK that Mommy gets sad sometimes and blah, blah, blah. But, like, I want to protect them from my fears in a very strong way.Amanda: Our household, you know, I think I mentioned this to you, Morra, at one point, that it's like neurons gone wild in our house. We have, we, you know, I have anxiety and OCD and sensory processing issues. My husband has ADHD. My kids have learning and thinking things, are neurodiverse. Do you have a household like that too?Morra: I do. I don't want to go into too much detail because I think I'm not as far along in my journey, maybe, as you are, Amanda, but, yes, my house is definitely neurons gone wild. Um, and the funny thing is it's all we know. Gretchen: Right. I'm wondering then, you know, you have three kids, and that seems like a challenge enough. What is, like, a day in the life, or, like, what are some of the typical challenges that you might encounter in your household because of all that's going on?Morra: You know, I think also the thing that I've realized and the pandemic helped me realize that I'm going to throw in as a layer is that, um, my kids have two very career-driven parents.You know, we try to be really great parents, but we are very, very career focused. And before the pandemic, we traveled a ton, you know; we've had long periods where we both worked for ourselves, which adds its own pressure. So, there's that. I would say that what has been super interesting over the pandemic is that one of my kids has had pretty severe mental health issues of his own, anxiety and depression.And so that has been a huge wakeup call for me as a parent, really trying to be super conscious about my own actions and how I parent, as someone who struggles with this. I also have a kid who has an ADHD diagnosis. He's been diagnosed now for five years. And so, you know, when you have a child who has that sort of diagnosis, you learn to work with it as well. So every day in our house is an evolving circus. I'm trying to keep everybody calm, and that includes Mom and Dad. Amanda: I'm going to tell you something really personal that, you know, when my husband and I first started thinking about having kids, we worried about how our own differences were going to play into how we parented, whether or not our kids would be a little bit, you know, at the time we were calling them "quirky and complex," kind of, right? Do you mind answering whether or not that's something that went on in your mind, too, when you first started parenting? Morra: OK. Well, I'm going to tell you something super personal. When I first got pregnant with my first son, I had the worst depression I've ever had in my life. So, I think we're all pretty familiar with postpartum. This was prepartum. So, it hit me so bad in my first trimester that, like, it was like, uh, the world's coming to a halt in our family because this is a crisis. And thank God I got help. And I would say by the mid-second trimester I was in really good shape again, you know, emotionally and sort of, like, worked my way out of it.And then when I met my first son, this miracle happened, like I fell in love with him. But the fear of what I had experienced being pregnant with him, I don't know if that's ever gone away, you know, and that experience colored everything. And I worried because my mental health challenges were so strong with that first pregnancy. Would that be epigenetic, like, would that be genetic with all my subsequent children? I've been under a psychiatrist's care. It's been a process now. I love being a mom more than anything else. And I wouldn't, I mean, I had three kids by choice. Like, it's not, it's not even an issue for me, but there is always that layer of, you know, did I make my kids this way? Am I shaping them? How is this affecting them? And I don't know that that — I don't know, is that ever going to leave me? I don't know. And then when my son got his diagnosis, you know, again, it was this moment of, oh my God. Right? We sort of knew that things were needing addressing with him, because he had had a lot of issues in school, but when we got the ADHD and anxiety disorder diagnosis, I definitely had a moment of real questioning in myself.Gretchen: Well, can you tell us a little bit about the son that you fell in love with, your oldest? What is he like now? What's going on? Morra: So here's the thing, right? So I'm going to brag, OK?Gretchen: Please, yes, please.Morra: He had really wonderful early intervention. So he got diagnosed when he was 8. And being a mom with mental health issues who had been extremely therapized my whole life,I was like, let's do this, you know? I mean, there was no group we didn't go to. I went for it and I'm so glad I did, because I joke that, like, putting a kid, basically, in some form of therapy, five days a week, since they're 8 years old, can really make a kid self-actualized. My son is independent. He has incredible empathy. He has incredible social skills. There was a back-to-school picnic last week. And there was supposed to be a parent on-site for each kid — to supervise. But my son was like, "Nope, I'm going by myself, Mom, I got this." He came home. He ordered a pizza. He had it delivered. He paid for it. He took our little cute dog to the picnic 'cause it was outside and he knew that a dog is the best way to meet new people. Like what's better than like, "Oh my God, I love your dog." Right? So he rocks out carrying the pizza and the dog and his little picnic blanket and walks to school and walks to the picnic. And that was it. And I can't even tell you, like, I had this moment where it was, like, my kid is amazing. He's self-sufficient, he's independent, he's solving problems, and he understands, like, how to talk to people in this giant school. Um, I'm going to cry. So it's been such a bumpy road, but I really believe in the power of great adults. And my son has had the best support teams. I mean, I am so lucky. I think he's going to do great things. Amanda: You know, one of the things that I hear in that story — first of all, as a former early intervention specialist, woo-hoo, yes — go, intervention, for the win! Also, I think one of the things I'm hearing there is that you understanding him, right, because of your own differences and lens on the world, interacts with him in a way, too. Do you think that you have a better understanding — or maybe not a better understanding — of how to parent this child, this wonderful, amazing picnic-going child that you have?Morra: Well, I mean, I think that one of the amazing things about parenting is that you learn to understand and parent your kids differently, right? Each kid is so different. I think the thing about my son is that we kind of swap skills, because I'm a big believer in cognitive behavioral therapy techniques to manage my day and my OCD and all of my issues. I don't have ADHD, but when I'm in a really anxious phase, I get really distracted, and it's really hard to pay attention. I don't know if any listeners out there can relate to that feeling of being super anxious and sitting in front of your computer and, like, your heart is racing and you can't sit still. And like you're not getting anything done, right? Because your mind is an F1 engine. So, sometimes I'm like a person with ADHD, and I need to break things down and schedule and plan and use techniques and breathe and use mindfulness. And so, like, I'm on that journey too. And my son teaches me a ton of things.Gretchen: Well, Morra, you've brought up things that have affected your life, you know, and are different. So, I'm wondering as a parent then, do you think that makes you better? Does it make you more empathetic? Does it give you more tools? Like, what do you think? Morra: I, you know, it's, like, I hesitate to call myself a better parent because every day the other shoe could drop, with three kids, but I definitely think that our children, they're nice. They're empathetic. And we work really hard at trying to stop and take other people's perspectives in our family. And I think that that's probably because we all have a lot of feelings that we can just dive straight into. I call it a feelings tunnel, when you're so flooded by your own feelings it's really hard to step back.This is one of my worst character traits is that, like, I get flooded and I lose perspective. And so I think that, like, we, as a family really work on that. And I have to say that as a result, I think my kids are, like, nice and empathetic in a way, they open to the world. And I'm proud of that. Even if the reason we do it is because it can be a struggle sometimes.Gretchen: And it sounds like your kids have impacted you, right? And perhaps have made you better in some ways. Morra: Oh, yeah. And especially my two older ones, you know, they check me. Sort of, like, the, "Not now, Mom. OK, Mom, I've got this. It's going to be OK, Mom." One of them broke their wrist biking this summer and I, like, oh God, that was really hard for me. And my husband was great too. He was, like, "They're boys. It happens. It's going to be OK." Like, you cannot lock them up forever and not let them leave the house, because of course that's what I wanted to do. So they definitely can be like, "No, Mom, this is what I need to do."Amanda: That's amazing. It's also interesting what I hear you describing is, it's like the inside things that you do, the flooding and talking about the emotions, you're doing them outside, right? With your family. You're, you're doing it out loud. And I wonder if more parents need to be doing that. Morra: The flip side is you shouldn't be doing that, right? Because you're putting too much on children, who don't need to carry your crap. Amanda: That's fair. Morra: Sometimes. Absolutely. I mean, I will say, and, you know, in full disclosure, I've had therapists very kindly suggest to me, "You have one kid who's extremely empathetic, as you are. He's sort of an emotional sponge. Maybe, like, try to not emit so many emotions." So, I don't know how I feel about that one. Amanda: That's fair. And I appreciate you saying that out loud. You know, we started this whole conversation, talking about anxiety. We went in all these different directions, Morra. And I'm wondering if there's something that we didn't ask you that you wanted us to ask you. Morra: Wow. This is going to sound corny, but it's something I've been thinking about. I'm 45. And while not from a generation where people with learning differences were sort of shamed or punished, from definitely a different generation than now.And my mom actually tested for IEPs. So, I was immersed. I knew what an IEP was when I was 6. But I learned from the public school system and the amazing educators that, like, there is not shame about this. Kids are so open about their IEPs and their ADHD and their anxiety. I feel like adults need to learn from kids.When we struggle with our own feelings of either getting our child's diagnosis, that makes us uncomfortable, realizing that we are ourselves neurodiverse and having bad feelings. I mean, when I see kids who I know really well from, you know, having been in the system for so many years, they like themselves. They're cool. They integrate with everyone else in school like it's not a big deal. Amanda: Morra, thank you so much for sharing such personal stories with us today. I really appreciate it. Gretchen: Thank you so much for being with us. Morra: My pleasure. Thanks for inviting me.Amanda: You've been listening to "In It," part of the Understood Podcast Network. Gretchen: You can listen and subscribe to "In It" wherever you get your podcasts.Amanda: And if you like what you heard today, please tell somebody about it.Gretchen: Share it with the parents you know. Amanda: Share it with somebody else who might have a child who learns differently.Gretchen: Or just send a link to your child's teacher. Amanda: "In It" is for you. So we want to make sure that you're getting what you need.Gretchen: Go to u.org/init and find resources from every episode.Amanda: That's the letter U as in Understood, dot O R G, slash in it. And please, share your thoughts. Email us at init@understood.org. We'd love to hear from you.Gretchen: As a nonprofit and social impact organization, Understood relies on the help of listeners like you to create podcasts like this one to reach and support more people in more places. We have an ambitious mission to shape the world for difference, and we welcome you to join us in achieving our goals. Learn more at understood.org/mission. Amanda: "In It" is produced by Julie Subrin. Justin D. Wright mixes the show. Mike Errico wrote our theme music. Laura Key is our editorial director at Understood. Scott Cocchiere is our creative director, and Seth Melnick and Briana Berry are our production directors. Thanks for listening, everyone. And thanks for always being in it with us.
Understood Recognizes the ADA 31st Anniversary
July 26th marks the anniversary of a milestone that allows many of us to thrive.Today is the 31st anniversary of the Americans with Disabilities Act (ADA). The ADA is a monumental civil rights law that prohibits discrimination against people with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places. The ADA protects anyone with “a physical or mental impairment which substantially limits one or more life activities.” Life activities include things like eating, seeing, hearing, speaking, learning, reading, concentrating, thinking, and communicating. The law is meant to be very broad. For instance, ADA covers people who use wheelchairs and people with food allergies, anxiety, depression, HIV, diabetes, and learning and thinking differences.The anniversary of the ADA is a time for companies and individuals to consider both how far we’ve come, and how we can continue to improve and make progress for people with disabilities. We are just getting started, and have a long way to go.For example, while last year the 30th anniversary marked a huge milestone, Understood noted that there is still a long road ahead in making an accessible world for those who learn and think differently. Though conditions like dyslexia, ADHD, and anxiety are covered under the ADA, many still don't think about these invisible disabilities, or the barriers that people living with them face every day. While it’s important to celebrate our success, it’s also important to always reflect on additional opportunities for progress. Over the past year, the pandemic changed what it means to be accessible. As schools and offices went remote, accessibility and usability became more prevalent. Organizations are paying more attention to people with disabilities and what it means to provide an accessible work environment. The pandemic allowed more digital experiences to become a part of everyday life, providing accommodations for those with both visible and invisible disabilities. At Understood, we focus on invisible disabilities. Our commitment to accessibility and usability includes principles of decreasing friction, increasing access, prioritizing clarity, and continuous improvement for those with disabilities. Because we’ve seen proof that when you build experiences with neurodiversity top of mind, things become more accessible and usable for not just those with disabilities, but everyone. It’s about designing for people, not just disabilities.Of course accessibility applies to physical experiences too. Just this month, we opened our new office in New York City. Our new home goes above and beyond accessible design and ADA standards and is built for flexible learning and collaboration inclusive of our workforce with disabilities — including the neurodiverse. Every aspect of our new space either meets or goes above and beyond the ADA recommendation. We wanted to make sure that our office set the standard for accessibility and usability. It doesn't matter if it's physical or digital space, accessibility and usability need to be top of mind. These improvements benefit everyone. Our goal is to shape the world for accessibility and usability, rather than it being an afterthought. While it’s important we celebrate the progress we’ve made, there is more work to be done. Let’s use this anniversary to consider the work that we need to do in the future for those with physical and invisible disabilities, so we can shape the world for everyone.
In ItHow to talk to your child’s pediatrician about ADHD and learning differences
Overwhelmed by talking with your child’s pediatrician about ADHD or learning differences? These tips can help.If your child is struggling at school or at home, and you think it may be related to ADHD or a learning difference, communication is key. Talking with your child’s pediatrician can be a first step to getting support. But sometimes it’s hard to know what to say to your child’s doctor. In this episode of In It, hosts Gretchen Vierstra and Rachel Bozek welcome behavioral pediatrician Dr. Nerissa Bauer. Dr. Bauer offers tips and strategies for talking with your child’s pediatrician about ADHD, anxiety, and more. Tune in to get her advice on questions to ask, materials to bring, and how to make the most of your appointment.Related resources5 steps to work with your pediatrician when your child is strugglingHow to organize your child’s IEP binder Learning disabilities and ADHD: Resources for patient educationTake N.O.T.E.: Are you wondering why your child is struggling?Check out Dr. Nerissa’s website, Let’s Talk Kids Health Episode transcriptGretchen: From the Understood Podcast Network, this is "In It," a podcast about the ins and outs... Rachel: ...the ups and downs,Gretchen: ...of supporting kids who learn and think differently. I'm Gretchen Vierstra, a former classroom teacher and an editor here at Understood. Rachel: And I'm Rachel Bozek, a writer and editor with a family that's definitely in it. Today, we're talking about how to work with pediatricians, so they understand and support you in raising your child who learns and thinks differently. Gretchen: In fact, Understood and the American Academy of Pediatrics have developed a resource hub, to help pediatricians start those important conversations with families. Rachel: Our guest today is a member of that academy. Dr. Nerissa Bauer is a behavioral pediatrician with a practice in Indianapolis. She also has a company and website called "Let's Talk Kids Health," where she offers interactive virtual courses for families raising kids with ADHD. Gretchen: We were delighted that she was able to join us. Well, Dr. Bauer, welcome to "In it." Nerissa: Thank you for having me. Gretchen: The first thing, let's do is, talk about yourself a little bit. So, where do you sit in that Venn diagram that has pediatricians on one side, and kids with learning and thinking differences on the other? Nerissa: Oh! I am somewhat in the middle, I would say. So, as a behavioral pediatrician, I tend to help families with kids who have ADHD, learning disabilities, autism, anxiety. And, I also myself have ADHD. I was just diagnosed a couple of years ago, late diagnosis. And then, I have my own kids with ADHD and anxiety as well. Rachel: So, you are really in the middle.Nerissa: I am in it. Yeah. Rachel: You're in the right place. Nerissa: Yes. Rachel: So, speaking to you with your pediatrician hat on now. If a parent is just starting to notice that their child is struggling in school, what should they do? Is this something they should share with their pediatrician? Nerissa: I will always urge families that, first of all, you have to trust your gut. You know your child the best. When you start thinking, "Gosh, something is amiss here," I really encourage parents to first go to their pediatrician. The pediatrician really is the person who's known your child, hopefully, you know, since birth — or at least have that long-standing relationship with you — so they've seen your child grow through those developmental stages. And together, they can help listen to your concerns, observe your child, talk with them directly, but then also help orchestrate like what's next? What other data do we need to fully understand how your child is functioning, both at home and school, to really delineate, is this something like ADHD? Is it a learning disability? Is it anxiety or is it a combination of these things, right? Or is it just that we need additional support at this time and continue to monitor? But the pediatrician really should always be a family's, you know, first step in helping to partner-decode some of these issues. Rachel: That makes a lot of sense. And, this is just a follow-up question related specifically to ADHD, do pediatricians prescribe medication for ADHD? Nerissa: They do, they do. Actually, there is a growing trend in the fact that over 50% of general pediatricians are now able to identify and co-manage ADHD in their practices. I will say, though, over the years, the complexity of ADHD has really risen. So, no longer are we only just seeing ADHD, especially after the pandemic. We're seeing kids with coexisting anxiety, depression. That complicates the picture. Or we're seeing kids much younger, also having attentional issues that many general pediatricians will then at that point say, "Oh. I'm not sure, so let's go on and refer." But I think that a lot more pediatricians do feel comfortable at least starting the initial workup, having that conversation with families, before deciding whether or not they need to enlist the help of someone like myself or a psychiatrist. Rachel: So, if a family kind of goes another route, right? and the child is diagnosed with ADHD before the conversation happens with the pediatrician, what is the process or what's the best way to go about sharing this with the pediatrician? It sounds like it should definitely be shared with the pediatrician, but how does that conversation work or what does it look like? Nerissa: Yes, that's a great question. I will often tell parents that I think it's, first of all, important to keep a binder of the most important documents that you are accruing as you're on this journey with your child. I mean, it is not uncommon for parents to, you know, go through testing and then have tutors and therapists and different people on their team. And what's most important is making sure everybody's on the same page. And oftentimes when you're talking with either the pediatrician and bringing them up to speed, or a specialist new to the team, it's so helpful to have those documents in a binder along with contact information. So that when people ask you, "Who has done this? When was the date of this? Did you try this?" You know, you have that information at your fingertips. And, you know, I can't tell you how much time that helps to save so that we can just, you know, kind of keep moving forward. Rachel: We have a resource actually on Understood, called the IEP binder. It sounds like that could be tailored to just like your general binder, right? Nerissa: Yes, absolutely. Rachel: Yeah. We recommend contacts, all that kind of documentation. And so, is there ever too much information though, right? So, it sounds like you definitely want to tell your doctor about any diagnosis your child may have. But, if a patient shows up with a binder that's filled with everything from, like, you know, the progress reports to, you know, any discipline challenges. Does that information help pediatricians or is there ever a point where it's just too much? Nerissa: Well, I would say it's always better to have more information than less. Because the thing is, with any mental health condition, ADHD or otherwise, I tell parents that there is not a singular blood test or an imaging study that helps make the diagnosis, right? For us, context is everything. And the conundrum with ADHD is that children and symptoms can appear different depending on the environment. And so, I don't want to make it a burden for the parents to have to figure out like, "Well, does this doctor want to have this or this?" Like, I would rather them just give me everything and then I can kind of sort through really quickly what I think I need. Because again, context is everything and just being able to see how symptoms have evolved — depending on who's reporting, who's seeing that child — can make such a difference in helping us understand the full picture of how this child is really doing in these different environments. Rachel: So, once a family is working with a specialist, to what extent should parents keep the pediatrician in the loop on things like, if there's a change in medication or even if it starts or stops somewhere along the way, or a new therapist? Or anything else that's kind of in the ADHD zone for the child. Like, it's another kind of "How does this conversation work," but, how does that work? Nerissa: That is such a great question. And it can be confusing, especially depending on how many people are on the team. So, what I will often tell parents is, when I first meet with them as the behavioral pediatrician, sometimes they come to me because the general pediatrician does not feel comfortable either identifying or managing the ADHD. So, when I know that, I will tell parents to think of me as the pediatrician managing ADHD specifically, whereas I will keep the pediatrician in the loop about what's happening, because they need to know it's part of general health, right? Because brain health is just as important as physical health, OK? We don't want to make that distinction. It's the whole child, right? We're treating the whole child. But, knowing who you need to call when certain things arise is so important. And so, that's why it's really important when you're working with a specialist, to really establish that role on the team. OK, so if you're prescribing the medicine, who do I call if I have a concern about a side effect or if I need a refill, right? That conversation needs to happen. And so, typically, the person prescribing the medicine will need to be the person you call, because they're going to be overseeing that. Now, if it's not your general pediatrician, absolutely, they'll want to know what's going on in general. Because if your child gets sick and you need to see your doctor for, you know, flu or regular medical care, they're going to want to know everything your child is taking. So, that's why we want to keep everybody in the loop to some degree. Rachel: So, we've been talking a lot about ADHD. Do pediatricians diagnose or give parents information about other learning differences, like dyslexia, maybe. Or is it primarily things just like ADHD and anxiety?Nerissa: I mean, I think to a degree that pediatricians, they know of all these things. A certain pediatrician's comfort level with identifying it may differ, but they are certainly well aware of, you know, differential diagnosis is what we call it. You know, what are some of the possible explanations for why this child is struggling in school and not making the grades or not having the output? So, sometimes it may be detected a little bit later if their comfort level or their awareness of a certain possibility is not quite up there. But, you know, I think that's why parents need to feel empowered to continue to talk with their pediatrician about their concerns. And if they're not feeling like they're feeling heard, right? it's OK to seek a second opinion. Rachel: So, on that note of perhaps not feeling like they're being heard. I think some families do have some anxiety, you know, about having this kind of conversation with the pediatrician — whether it's about ADHD or anxiety or dyslexia — and maybe they're concerned that the doctor will be dismissive or simply not understand the complexities of what's going on. I've definitely heard mixed things from parents trying to have that conversation or concerned about having that conversation. So, do you have any advice for people who find themselves in that boat on just how to have the best interaction possible and make it a productive conversation? Nerissa: Yeah. So, you know, I think obviously always preparing for that appointment in advance if you can. Just because the general pediatrician typically will have a briefer visit time with you. And it's not that they don't want to listen. It's just they're really busy, right? And so, we want to make sure that, you know, we make the most use of that time. And what I really love about the resources that you guys have on your website is "Take Note." That is a great resource that I refer a lot of families to. So, you know, you want to gather information. You want to talk about it with your child's teacher, "What are you seeing?" Talk to your partner about it. Gather that information, right? And then, you want to also talk with your child. How are they feeling? And then, when you present that information to the pediatrician, with data — you know, you've got the report cards, you've got like examples of school work or whatnot, emails with the teacher — and then you can always use those statements of, "I've been noticing. I have been hearing my child tell me these things. We are up until 11:00 doing homework and this is a stress for our family." So, you know, trying to come with concrete examples, to really bring that story to life helps your pediatrician really understand the gravity of what's happening. Now, sometimes parents will say, you know, "We've talked to our doctor many, many times and, you know, we still feel like we're not heard. We've tried maybe a couple of things or we've been told to wait. Let's wait it out." You know, and I wasn't there, so I can't comment on that, but we really want to help our families know that sometimes you just have to trust your instincts. And if you try to keep going and you're not getting heard, it's OK to seek another opinion. Rachel: Sometimes — I mean, I've had this experience with all different kinds of things, not even necessarily this particular conversation where — you're in the office with the pediatrician and you feel like the conversation is going fine and then you leave and you realize you totally did not get what you needed. And it's not their fault either because you're like, "OK, thank you!" And it is kind of like, "Now what? Now what do I do? Because that really didn't satisfy the need of, you know, what I was trying to figure out."Gretchen: Yeah. I wonder — I have a nuts and bolts question related to this — you know, sometimes I feel like me personally, with my own kids, I used to just have a little Post-it note, right? And I'd be jotting things down and saving it for that one yearly appointment. If you are suspecting that maybe your kid has a challenge like ADHD, does it make better sense to say, "No, I want to make an appointment about just this," versus like, "It's part of my yearly checkup?" Nerissa: Gretchen, yes. Please, please, please. Your pediatrician, even though you see them annually for your well-child visit if there is any concern that comes up — just like a cold or, you know, if your child skins their knee or, you know, falls on the playground — you need to bring them in. This is just the same. And that's why I wanted to bring it back to, you know, brain health versus physical health. Pediatricians treat all of that, the whole child. And I think that's one of the things that parents need to remember is that, you know, if you have this nagging concern about how your child is thinking or learning or behaving, it warrants at least a phone call to the pediatrician office to start that conversation. And I know that the pediatrician would really love it to have dedicated time to focus just on that concern. So, absolutely call your pediatrician office and ask specifically for a separate appointment to discuss this, because we have to have time to peel back all the layers. Rachel: OK. So, as we get towards the end of our conversation, I wonder if we can bring it back to the beginning for a moment. Is there anything that you think your family or pediatrician could have done when you were a kid so that you could have gotten an ADHD diagnosis earlier?Nerissa: Yeah. I mean, I think it's multifold. I mean, I think just being asked, you know, "How is school going?" and not just kind of at the surface level, right? I mean, I would just imagine that my parents would have said, "Oh, she's doing fine. Her grades are A's and B's, you know. She's not failing anything, right?" And so, then it just is "OK, check, check, check," right? So, I think when parents have a specific concern about attention and learning to not just say, you know, "I wonder if this is ADHD." I really want us to think about what are you seeing, what examples can you provide? And let's go from there. Because I think even when I'm interviewing my own patients, I will ask the child themselves first. I'll have that conversation with the child too, not just the parent. But ask them like, you know, "How is school going? What is an example of a class that's going really well for you and why? And then let's talk about the fact that not everybody can be good at everything. And so, what are some of the more challenging subjects or classes that you have and why is that?" You know, and I'll try to probe and push kids to say, well, you know, sometimes they'll say, "I don't like writing." Well, what is it about it? Is it that your hand gets tired? Is it that when you're asked to write something, you get overwhelmed, you don't know where to start? Or when you're starting to write, you don't like the editing part? You know, like, what is it about that? You know, so if we can really dig a little bit deeper and not say at the superficial level, I think that gives us a little bit more insight into how that child is thinking and feeling when they're struggling in school, right? I think giving voice and really inviting them to think a little bit deeper about what it is about that, that they're struggling. First of all, validates that experience for them, but then also helps them be able to give voice to that. Rachel: I love that very specific questioning. It's good. Nerissa: Yeah. Because we know ADHD is a challenge of motivation and interest. And so, that's part of the thing that I like to teach parents in general, it's not a deficit of attention, even though that's part of the name, right? But it's that we have a hard time regulating that attention and focus, that interest, that motivation. It waxes and wanes. And that's part of the problem, like, it's so stressful for kids and families to understand, you know? "You're just being lazy." I hear that a lot.Rachel: So, is there anything else that you'd like to add that we haven't covered already in this conversation? Nerissa: Well, with that invitation, I will just say that I honestly, again, just want to impress that ADHD is not necessarily good or bad. And I try to teach that to families, you know, all the time. I want them to recognize and not be afraid of ADHD. I think so much of what I've seen is that kids come to me when they finally come to see me, they've had a hard time. You know, they've struggled. They've gotten messages that, you know, "Why can't you do this? Why are you always forgetting this?" They're internalizing a lot of that and they're feeling like they're just not good enough. And I'm here to tell you that, regardless of the diagnosis, we need to invite kids and educate them alongside their parents. We have to talk with them, not just to the parent, because they're in the room. They're hearing things, are observing things. And I always wish, you know, that when we're talking with kids that we fully turn our attention to them, show them that we care, and then really help them sort of learn to love who they are, their whole self. You know, I tell kids all the time, "We can't give you a brain transplant. You know, ADHD affects our brains, but the brain is what makes us who we are. And we just have to learn that, how your brain is working so that way we can work with it, right? We can work with it and we can thrive." So, we want to give them that message that having ADHD can be an incredible opportunity and a gift. But it's so important in those early stages of how we talk about it to really set a positive tone. Rachel: That's a great way to end this conversation. Thank you. Nerissa: Thank you so much for having me on. Rachel: You can find links to our pediatricians hub, which includes a conversation starter toolkit in our show notes for this episode. Rachel: You've been listening to "In It" from the Understood Podcast Network. Rachel: This show is for you. So, we want to make sure you're getting what you need. Email us at init@understood.org to share your thoughts. We love hearing from you. Rachel: If you want to learn more about the topics we covered today, check out our show notes. 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