Producer: Okay, welcome back to Full PreFrontal where we are exposing the mysteries of executive function. As always, I’m here with our host, Sucheta Kamath.
Good morning, my good friend, very much looking forward to this conversation. Kick us off, please.
Sucheta Kamath: Good morning, Todd, and yes, so I have a question for you: what do you think it takes to observe a goose foot or describe the tongue of a woodpecker?
Todd: It’s a Monday morning, you are making me think hard. I don’t even know how – I don’t even know what those are.
Sucheta: Exactly! My feeling, exactly. So, in Walter Isaacson’s biography which I recently read of Leonardo da Vinci, he describes the da Vinci’s method, particularly, he says it’s rooted in experiment, curiosity, and ability to marvel at life, and the two things that I just described were the list of things, things that da Vinci writes about that was on his to do list. So, what came to my mind is to be curious and to be engaged, means to have a flourishing interest in the world around you, and today’s children need help to remove barriers that come in their way of marveling at life and that reminds me of Jon Kabat-Zinn. He is an American professor Emeritus of Medicine who created the stress reduction process and brought mindfulness in medical practice, and he defines mindfulness as paying attention to something in a particular way on purpose in the present moment none judgmentally. So, to link these two things, the tongue of a woodpecker and mindfulness is to be a citizen of the 21st century, we need to do that, and that is what brings me to our very special guest. He is a pediatrician who love children and cares deeply about families, and what he talks about in many of the books he’s written and talks he gives, that children with ADHD, when we manage them, and not just limited to children with ADHD, but children in general and families who are managing a monumental task of raising children is to understand their needs and really give a comprehensive care to them, and particularly talking about ADHD is one needs to approach it by changing thoughts, changing the general thoughts about development, and kind of changing the environment in the house, and finally, becoming very engaged parents.
So, what I can’t wait to tell you all is we have a very special guest, Dr. Mark Bertin. He is a developmental pediatrician and author of How Children Thrive, Mindful Parenting of ADHD and The Family ADHD Solution which integrate mindfulness into the rest of evidence-based pediatric care. He is a contributing author for the book Teaching Mindfulness Skills to Kids and Teens. Dr. Bertin is a faculty of the New York Medical College and the Windward Teaching Training Institute, and on the advisory boards for the nonprofits Common Sense Media and Reach Out and Read. He is a regular contributor to Mindfulness Magazine and his blog is available through mindful.org and Psychology Today, so we will have a lot of articles that I’m going to attach in the show notes, so please refer to them, and so it’s my great pleasure and honor to welcome Dr. Bertin.
Welcome to the show.
Dr. Mark Bertin: Oh, thank you so much. I’m glad to be here.
Sucheta: So, let me start and say on this podcast, we discuss executive function, so how would you describe your own executive function and as a developmental pediatrician, when did you discover this connection between your own executive function and the children that you serve and the families that you take care of?
Dr. Bertin: That’s one of the most interesting approaches to executive function anyone has ever asked me. Executive function, I think is really the heart of how all of us manage whatever is going on today, so it’s an interesting question. I’m not sure how to answer about my own executive function. I think executive function is a skill set that involve managing and coordinating staff in general, so anything in life, I think, the way I often describe it to parents that might involve management probably involves executive function, so like managing emotions, managing projects, managing time, managing our attention, all of those are executive function-based skills, so I think my personal experience with it has always been kind of intuitive. It’s not something I thought about much personally until my professional life sort of married it, so I guess personally, it’s something that has always come relatively easily for me and I’m very thankful about that, but I think it’s much more pertinent to really start looking at it in terms of my professional field where over the last 10 or 15 years, there has been this just explosion of research into executive function that’s really changed how we look at it into very profound ways. One is, is that it is a developmental path, just like we can keep track of and try to develop language skills in kids or motor skills in kids, we can look at executive function that way, and the second one which is particularly radical is that typical brain development of executive function matures until our late 20s, so the expected development in maturation of the human brain goes on much farther than people used to think.
Sucheta: Yeah, and thank you for taking the time to answer this. I know this question often stumps people, particularly experts like you who probably are very successful primarily because a lot of these orchestration skills were intuitive, which has contributed to your success. I mean, you would not be writing four books and manage all that to do in a very successful way without the help of a phenomenal executive function. So, I appreciate that.
So, let’s start with defining ADHD. I find that being in practice the last 20 years, I am very confused and puzzled by people’s resistance to receiving a diagnosis or wanting to not have it somehow, and also, different experts are involved in diagnosing, so since you are a developmental pediatrician, you’re the first point of contact for most families. So, how would you say, what is ADHD and how does one define it and diagnose it?
Dr. Bertin: Well, I think there is two or three initial things to consider when it comes to ADHD, and I think the first one, which I know we are planning to come back to later is just recognizing that executive function, that these self-management skills are a very vital and important to developmental path for all children, so that we need to start from the point of view which is actually a big change in my field – it’s amazing. I guess before I started practicing but not long ago, relatively speaking, like 30 or 40 years ago, there was still debate about whether there was typical development, so we know, and I think it’s kind of intuitive that children develop at their own pace, and then we can try to build skills in kids who fall behind. So, that is useful in both about kids who are developing typically and about kids who are having difficulties.
When it comes to executive function, it is practical to have some sense of what to expect of a five-year-old versus a 15-year-old for any parent. When it comes to what it means to have ADHD, the amount of judgment and resistance really just makes it that much harder for parents. It is important to recognize that the genetics of ADHD are basically as strong as the genetics of the high, meaning we know, beyond a shadow of a doubt that when someone really has ADHD, it is a medically-based disorder. So, first step, now we can discuss separately. It can be misdiagnosed and that is a different issue, but for any individual who has said, it is a developmental delay, practically speaking, of executive function, meaning you have a child who, just like a peer who might be two or three years behind in language skills – that’s very upsetting – and no one needs to be happy about it or should be happy about it, we don’t blame anybody and we try to get them services. When it comes to ADHD on a practical level, ADHD has long outgrown its name. It is not an attention disorder. By the way, when we talk about ADHD, it now includes the term ADD; it is all considered one umbrella, so that is also confusing because some people have this condition that has hyperactivity in the name without hyperactivity, but that is all because in the end, to have ADHD, it needs your significantly behind an executive function to the point that you are undermining your own life in some way, and it’s just as real as any other developmental delay.
Sucheta: This is such an important point that you make, that ADHD equals executive dysfunction, and to me, this is a recent conversational topic amongst those who diagnose and relay this information. I find that very amusing that even a lot of parents who come with a diagnosis and the neuropsychological testing, they would like to not share that with the teachers are educators somehow because they are afraid for what that means, but I like this explanation that you gave. It is a genetic disorder and it is a determinant as height is as genetics contributes to hide, so I appreciate that.
When is it that when people come to your practice – I’m sure you have seen a range of children that you serve, not just ADHD, but when you see it, a lot of pediatricians that I work with have told the parents to wait and watch. What is your stand on that?
Dr. Bertin: Well, as a specialist, I only see the people will have gotten referred already. I think the most important thing about the initial evaluation of ADHD that really needs to be reframed for a lot, I think – not needs to be but it is helpful to reframed for a lot of people is that the initial evaluation is really just informational. I think a lot of people get overly wrapped top in feeling like a diagnosis of ADHD is a commitment to treating with medication, and it really isn’t. In the beginning, you just want to know why someone is having difficulty and you can choose to support them and walked the different ways, but it can really shift a lot, just in essence take the blame out of a situation to realize that somebody is behind an executive functioning skills primarily.
So, sometimes, you have to watch and wait just depending on how much difficulty somebody is having because there is a developmental aspect to executive function to ADHD, and we can watch for short spurts at a time. Although I would often suggest too that a lot of the nonmedical interventions are just going to be helpful anyway, so if you realize that executive functioning skills, your sort of life management skills, like managing your schoolwork for managing your social situations are challenging, most kids are going to benefit from the more behavioral approaches regardless, but at the same time, at the beginning, there might be a short stretch of time to watch and wait but you never want to let anyone struggle for very long without trying to offer them some help.
Sucheta: I love what you said. I think this approach is very distinct because pediatricians that tell the families I have worked with, for example, wait and watch, they do not introduce the term ADHD, but they say wait and watch. What I’m hearing you say, that initial evaluation is more informational. I think that is so powerful because one, you are giving an explanation, the potential rationale behind such presentation, nobody is making this up. This is legit, and second, you’re also offering such a compassionate patient-based approach that parents can feel that yes, I do not need to resist medicine as if medicine is the only approach.
I know Dr. Thomas Brown, we were at the conference where we heard him as well, that believes that medication is absolutely mandatory, so what do you think about medical management in terms of – I’m not saying in isolation, but do you believe to manage ADHD, medicine is essential?
Dr. Bertin: Well, again, I think we are jumping ahead to quickly on some – I mean, I’ll answer the question, but I think the discussion of medication often just scares people away, and I think the way to look at ADHD initially is that somebody is behind in skills that often, we don’t think of as skills. Kids get mislabeled as being lazy or not caring enough, or not trying hard, but executive function are the skills we used to persist and plan on and work hard, and show good judgment, so that I think the international reality of looking at executive function, ADHD, is just to kind of come back to where we started. I think they may be simpler understanding of mindfulness is something all of us can connect without practicing mindfulness. I don’t insist everyone practice it, but the concept is just to see life with clarity on some level. We’re just all caught up in assumptions and reactions and habits, and behaviors that’s just the way we see the world, so we have somebody who is struggling at home and we have been caught up understandably in all these cycles and arguments around it, and it’s really confusing. It’s not an absence of skills where some days go well and some days don’t, and the whole thing can be really challenging, so to come back around your question about the medication, I think far more important initially is just trying to see things with clarity, just let go of all the assumptions and just, for example, when I do teacher training, one of the examples I use a lot is forgetfulness is an ADHD symptom, so if you blame someone and just keep marking their grades down for forgetting to have their homework in, mostly, you’re just going to undermine the motivation because that’s actually a symptom of what is going on and it may get easily labeled as just not caring enough and if we just push you more, you are eventually going to remember, when it really needs a much more complete solution than that. It needs the grown-ups to come and teach someone how to be less forgetful, so that when I approached ADHD, just there are so many parts to it. You don’t want to get overly focused on the medication because there’s many, many pieces to it. The medication does not fix everything, and yet the reality of ADHD is the research says, two or three things that are not the common perception and medications have been around close to 100 years, they have been shown to be quite safe and quite effective when they are used appropriately. Most people, if they are managed well, don’t have persistent side effects – they shouldn’t. I mean, the goal is none that is attainable for most people if they are managed well. So that the real and most important thing I think for understanding ADHD medications is that it is an evidence-based recommendation that is quite effective for most people if they are managed meticulously and that they really are not inherently any better or worse than anything else being used in pediatrics, so if we, for example – or in life, really, if we have high blood pressure, for example, we might try managing it with diet and exercise first. If that does not work, we are definitely going to treat our high blood pressure, and with ADHD, if we are going to make a decision on medication, often, you need to sort of cut through and let go of all the garbage you are reading online and just recognize – there’s just so much misinformation online. I guess that sounded a little negative, but that has been documented. I mean, medical information online is quite often misleading, so you just want to look at the facts and the facts are, that used well, they are often quite effective, they don’t change personalities, they don’t have persistent side effects for most people. You can stop them if they do, and that is the reality of medication, is they are an evidence-based quite safe option for ADHD. That is really the short of it.
Sucheta: Wonderful, and so this question again, what I am hearing you is your approach is very big picture, take the entire child into consideration, bring back this focus that presentation is an indication that somebody is behind, not intentionally creating a ruckus or a challenge for managing that child.
One quick question about ADHD and the comorbid disorders, what do you think about or can you comment a little bit about this complex ADHD presentation where the child is not just not paying attention but may have anxiety disorder or conduct disorder, or depressive elements. How should one go about thinking about all these groups of disorders that go hand-in-hand?
Dr. Bertin: Well, I think it has been so well documented that most people with ADHD have more than just ADHD going on, that that is really how – it’s just something we need to keep in mind anytime ADHD is around, and I think there are several different components to it. It is one of those things where you don’t overthink it. It’s not like it’s going to be headed, but at the same time, if things are not going as smoothly as they might or as you are being in that evaluation, you do want to have some perspective on some of the more common things that go along with ADHD. One of the most significant ones, which we have not touched on yet is the huge impact it has on family and marriages, and parents, so in essence, that is part of – the term comorbidity you are using, by the way, is to put it in simpler terms means that most of the time, other things tag along with ADHD. So, medically speaking, what comorbid means is that one thing is happening with something else, so when it comes to ADHD, family stress is really important to manage because many parents of kids with ADHD are feeling swamped and overwhelmed – their children are delayed in the skills that allow them to be independent, self-sufficient, which is exhausting for parents, not to mention the stress of just watching your child struggle.
So, if a parent with ADHD is going to feel grounded and resilient to manage ADHD, you want to bring that into the discussion, a parent’s experience of it all, and then for kids with ADHD in adults with ADHD, the research again says that up to two thirds of people with ADHD has something else going on, and if you think about that medically, the way I often describe it is if two thirds of kids with asthma also have kidney disease, clearly, we would screen everybody for kidney disease at the point we diagnosed asthma, and that’s kind of what goes on with ADHD, so one group of conditions, one group of concerns you have to think about are that at least half the kids with ADHD often also have a learning disability, so that when someone shows up with academic difficulty and ADHD, it can be easy to assume it is all due to the ADHD, but for a lot of those kids, they often need help with some specific area of academics. That is one group of issues that can go on, and then there is a whole longer list that includes behavioral concerns, oppositional behavior is one although I tend to be slow to use the term oppositional defiant disorder which is one that is commonly used which is simply because if you have an immature brain manager, you are going to come across as oppositional quite often even though a lot of that has more specifically to do with your ADHD than actually choosing to be difficult, but there is a behavioral component to it, and then there’s real complexity to what you can look at is that a lot of these things that can mimic ADHD are also the things that can cooccur with ADHD. Anxiety is one of the biggest ones, so if you’re anxious, it can be hard to focus, but if you have a life management disorder like ADHD, it clearly causes tons of anxiety, and then you can just have both conditions. Some people say up to 30% of people have symptoms of both ADHD and anxiety, and the bottom line is really just getting the right supports in place. A lot of the times, the way you are going to start all that out is by, especially beginning in nonmedical interventions like parent supports and educational support and therapy, and then also, one nuance, again, comes back to executive function which is anxiety alone, you wouldn’t typically expect to be disruptive of the big picture of executive function to such a degree, like organization and planning, and foresight, and all the rest of executive function.
Sucheta: I love the way you are pulling it all together, that life management disorder requires life management support which is often so missed, and particularly coming from a medical professional, it is such an assurance to me because you giving that advice will confirm it for the families that it is a testament disorder, not something that you need to occasionally accept or it’s not dependent on acceptance. I always tell people, do you debate with your doctor if the doctor diagnoses your child with diabetes? You would not say, “Sometimes, he has diabetes and sometimes, he doesn’t.” So, similarly, I think if they view ADHD with much more seriousness as a disorder and not behaviors that sometimes present themselves are not.
So, let’s talk about parenting with child with ADHD, and you have some wonderful advice, as well as methods that you prescribed to the families. How should one consider treating ADHD?
Dr. Bertin: Well, obviously, that is a very private question. One of the most important part is just recognizing that everyone is doing their best from the beginning, so there is no specific should to it because that, I think, is a set up for someone to feel like they are not doing what they should, in essence, which could only make things worse, but the bottom line, so would you really want to think about is individualizing it to your child which has many components to it. The first one I often describe is really beginning – if you’re going to understand ADHD, it does mean, like we have been doing today, looking at it as a delay in executive function, and then I think that shift in perspective to sort of suggest, like in any situation, what if my child is – hypothetically could be several years ahead in a particular skill, could be several years ahead of peers in more concrete skills like reading or math, or some sport, or even cognitively, whatever you want to look at, but they are three or four years behind in executive function, and that initial sort of mental exercise is a major shift often. You can look at the morning routine, for example, kind of just take the judgment out of it. What is my nine-year-old has more like a four or five-year-old’s ability to manage the morning? In the long run, we have to catch them up. In the short run, really, everyone is going to be happier and more successful if we just meet them where they are developmentally in that moment, then the way I think about intervening for ADHD is kind of like showing in a pie chart, there is no one approach. It is knowing it, clearly seeing it, clearly without judgments, this is ADHD, and that looking at what can we do to support kids, and one of the fundamental starting points is recognizing that ADHD affects planning and persistence, so the person with ADHD is in a unique position as far as I’m aware which is to say that any plans that they should or could be making to manage their own ADHD is going to be undermined by the fact that they had ADHD, so especially in early childhood, really all the way through middle school and sometimes even high school, it is no different than if you have a child who was really behind in any other skill. They are going to rely on the grown ups to come up with a routine they learn from and it’s very hard in some families with ADHD. It is so highly genetic, but if there is a component of it that has to do with adult support, that needs to be implemented at school, at home, and the because children are living within that structure, they are going to learn from those types of supports, and that could be anything from managing time in the morning routine through studying and writing skills, and that there is a huge behavioral component too which is that even wealthy kids with ADHD, they are often being corrected with more than their peers, and they need it, so we can’t get rid of that – they are off task, they are forgetting, they are doing these things, so that they need to be reminded, they need to be corrected, but that cumulative effect eventually begins to influence how they feel about themselves and their confidence, and their mindset, said that being really structured in how we parent kids with ADHD almost always has benefit because it does take effort. If you can think of for example, the average busy family morning, your right to rush out of the door and your child may get two or three things get done totally on their own independently, and then the first feedback they are going to get from us is, “What are you doing? You are leaving without your backpack!” or “What are you doing? You are leaving without a shirt!” whatever it is. I mean, whatever kids do stuff, but the point is, if the first feedback we’re going to get from us often is that correction which – and the only way to sort of shift their self perception – kids are so driven by just their immediate experience; they need to feel supported and they need to feel successful, and they thrive off of positive feedback, and empty feedback has no value, which means we Just praised them for just standing there unless that’s what we have asked them to do, but most of the time, we need to come up with specific things – and it just takes work, it takes structure. I often described behavioral management of kids, even well-behaved kids with ADHD, kind of like putting a dietary intervention to place for someone who has some sort of disorder where they can’t eat gluten or something, it is fairly disruptive and takes a lot of work, but we do it, and after our kids with ADHD, that is the sort of two sides of being a parent with ADHD, is doing what we can to create the structure they are going to learn from and doing what we can to create the structure that is going to help them develop confidence and mindset as they grow up.
Sucheta: Well, as you are describing this and having done this for 20 years, that talent, I noticed, there is, I call it – there is an apple and there is a tree. Those parents who are trying to bring structure or implement processes that require overtime monitoring and supervising may fall through the cracks, and them because they themselves struggle with ADHD and are not consistent, which creates quite a chaos at home, and that is why I love that you talk about not only the holistic comprehensive approach to managing ADHD, but you bring in this mindfulness perspective, so let us talk about mindfulness. What is mindfulness and how does this apply in the context of raising children?
Dr. Bertin: Well, I think mindfulness is having [0:25:43] moment in the sun so it’s getting very – it’s sort of being boxed in very minimally. Even going back to the classic definition, I think you can start teasing out the aspects that are really practical in everyday life. So, mindfulness is really much bigger than most people think. It is an ongoing practice a lot like physical exercise, specifically trying to build traits in ourselves that help managing difficult situations, managing the reality of life easier, so it is not one specific thing. It is not sitting still, it is not perfection, it’s not always being calm. It’s really very actively looking at the fact that when we don’t give life our full attention, we are often distracted, we’re often not paying attention, we are often sort of giving things just like half our attention, and that is inevitable. Practicing mindfulness does not change that, but when we’re not giving things our full attention, we tend to be on autopilot, we tend to be just falling into habit, we tend to be missing details, falling back on assumptions, so the practice of mindfulness, to go back to that definition, the beginning practice is really several different things we are working on. The first is more moment to moment attention, not with perfection – our minds are going to be busy whether we meditate or not, but we get better at catching ourselves when we are distracted and coming back hopefully just giving more attention to having dinner with our kids were giving attention to a work project we got to complete instead of all the distractions of modern life. So, there is a piece of it that has to do with that, and then one definition is giving more moment to moment attention to our lives with unbiased awareness, and that is the loaded comment, really, because typically, we are living our lives, really caught up in a lot of habits we have developed over time, assumptions we are making about ourselves or our kids with the world around us. There’s just a lot of reactivity and kind of fixed thinking about things, so the unbiased awareness part is catching ourselves and settling, and that’s really – there is really kind of three components the way I’ve been thinking about mindfulness later, so the first part has to do with dealing with your reactivity and distraction – we are catching ourselves, we are settling, we are building our own resilience, our ability to kind of be fully aware but not reactive at any moment, and then do that, it’s kind of like trying to deal with a snow globe. We just keep shaking the snow globe up all day long which is our minds are often like, we’re never going to really see what is inside clearly, to because we get out of stressing reactivity, we generally start to see things differently, and we can only begin to live differently and make changes, and when we create that kind of space, to really just observed, like wow, I always say that, and really, the first thousand times I said it, it really didn’t change anything, so you catch yourself, and may be before you know what else to say, you catch yourself and just don’t say anything that time, and it may be over a couple of weeks, that homework discussion goes differently. There are so many layers to this. One of the most common ones in parenting that people describe that we all have – I mean, it’s actually not just parents but everyone describes is the sort of inner judgmental – self-judgmental voice, self-critical voice, just pervasive in parenting – “I should be doing this better, I should know what to do now, I can’t believe how I handled that,” but that is not necessarily a productive voice.
There may be – and really, research has pretty profoundly that if we can begin creating some space from that perfectionistic harsh voice, we tend to be – it changes how we relate to people around us, it allows us to problem solve better, it allows us to persist and motivate ourselves better, so too sort of come back to a more concise take on it, mindfulness practice is a way of hitting the gym and building the traits that let us just manage the fact that parenting is challenging more easily to the benefit of everyone else, and that the other last component of mindfulness practice, is it’s not meant to be self-help. The real core assumption for anybody, but particularly for apparent, that when we allow ourselves some time to build our own resilience that totally benefits everyone around us too. It helps our spouse and our kids, and everyone else we are dealing with all day.
Sucheta: Wow! That is very – and then not something I typically thought of mindfulness, so can you just reiterates those three parts one more time, the way you conceptualize it?
Dr. Bertin: Sure. I mean, so there’s an initial component to it which is putting the effort into improve our own ability to stay focused and settled without perfectionism, but just improve on it, and then another way, the analogy – another way of looking at that part of it has to do with stress, just managing, just staying more settled under stress which leads to the second part which is because when we are more settled, because we are able to see our lives with more clarity, we can start working with some of the habits we have fallen into, non-judgmentally, we all have them, so we can start working with clarity on living a little differently wherever we see it. It could be with our own inner world, it could be literally how we deal with situations around us, and of the third part is, that bigger part having to do with really the concept of compassion of just because we are living that way, we can start to interact with everyone else around us differently, see their perspective it more clearly, and it affects everyone else too.
Sucheta: Okay, so then tell me a little bit about this last part that you mentioned, mindfulness is not meant to be self-help. Can you help me understand that a little bit more?
Dr. Bertin: Yes, I can certainly do that and it’s actually far more straightforward than it seems. I mean, if we sort of talk about it more on a philosophical level but on a very concrete level, really, the assumption is that everything that we do impacts everyone around us, whether we want it to or not, so that when we think of – I mean, one example is sometimes you use, and I sort of has to did a little to bring it up because it’s important to recognize we all fall into these patterns, so this is not judging anybody. We all do this at times but if you think about, for example, you are having a rough morning getting out the door and get all caught up in it, the last thing that happens before your child gets on the bus is sort of bickering back and forth for a moment, and then they get on the bus, you can start to recognize that on a very specific level, that interaction, we are unsettled, and then the next interaction, unsettles our child within who knows what they do on the bus because that whole – it’s just that’s the reality, that is the cause and effect of life – these things happen, and again, all of us are not going to do that sometimes, but at the same time, the sort of underlying premise of practicing mindfulness is if we get better and better at catching ourselves and maybe as we feel ourselves getting caught up in the case of the morning, settling for a moment, that is the moment where we might catch ourselves and realize what we are about to say and recognize maybe this was not the most skillful thing to do, and that we handle that moment a little differently, which clearly, our children benefit from, our family benefits from, and then out from there. So, that is more the depth of mindfulness practice, is recognizing that.
And then, it is tough to say no, you are going to be ending soon to open up such a big topic, but there actually is a specific practice was in mindfulness we can do a really actively reminding ourselves as everyone is trying to – everyone in life in their own way is trying to be successful and trying to find ease and peace in whatever way they are doing it, and that is a more nuanced concept than it seems, so if you think about a child with ADHD who is constantly struggling and/or constantly isn’t really fair, but having a lot of difficulties is a better way of saying it, it can be really valuable in a particular moment to just catch ourselves long enough to remind ourselves that they are showing that tantrum in the store because they really, really want that toy and it does not mean they are going to get that toy and it does not mean they should not get in trouble, but there is a perspective we can bring to that situation of just reminding ourselves, like we’re both really stressed here. Now, we are both trying our best and it does not fix – again, I would normally open up an idea like that and I talk about it for the rest of the session, a long time, but the core concept is, like in the middle of whatever we have to do practically to manage the situation, it has a lot of psychological value, a lot of practical value to remind ourselves that in the middle of this difficulty, just doing my best as a parent and you are starting that tantrum for a reason, and I don’t love it and it’s trusting us both out, and I’m still not going to buy you that $4000 whatever it is, $400 whatever it is, and there is a reason behind what you are doing and I can still see your struggle, so there’s many, many layers to all of this.
Sucheta: Thank you for taking the time. I think what I am hearing you describe is this incredible patience and a deep kind perspective of a universal goals that all human beings have, is our desire to have peaceful lives, desire to succeed, and then those particularly in care, under our care particularly as parents, they are struggling, it is our job to offer that optimism and just kind love while they struggle, so even maybe allowing that struggle to be – not removing the pain and suffering so much, but kind of [0:34:58] I’m hearing you say, right?
Dr. Bertin: Yeah, it is a part of it, and just to really hold it down, and that all just starts – you don’t have to go down there to just start practicing mindfulness. Mindfulness just begins with catching ourselves and settling. We are not trying to force ourselves to feel any way; we are not trying to create new pressure to think a certain way or act a certain way. It is not artificial at all. It’s meant to be very practical and accessible in the beginning point and it’s perfect is that is all it ever is, it’s just recognizing that our minds tend to get distracted, caught up in all these different fearful thoughts and activity, and negativity, and all these habits, and there is value to just practicing coming back more often without any belief that we are ever going to be perfect anyway, but we can work with it, just like we can try to exercise regularly, even though aging still can happen too. [0:35:53] things are true.
Sucheta: Got it. So, at the end, this idea of mindfulness is so essential and valuable, but what if the children are not buying into it? How do you suggest, particularly teens who probably benefit a lot from this when they are going to start driving or they are going to take a lot of decisions that may not be favorable to their future, how do you see that being implemented?
Dr. Bertin: Well, mindfulness is not anything you can tell anyone else to do. It is challenging for many parents because it seems like most of us, if we realize that it would be beneficial for our kids, but it is really a way of living. I mean, the bigger picture of mindfulness is what the perspective we are bringing to the challenges of life. So, the bottom line on some of our role as a parent always is just practice that and don’t get caught up in making your kids do it. Trust the fact that if your kids see you living that way, they are going to learn from it, and for many families, that is more than enough – that’s wonderful, and then if your kids start to show interest, it’s more like planting seeds. It’s like because it becomes part of family life, because it just becomes part of our living, then you could just gauge your child’s interest, and the most important thing is just making it developmentally appropriate as in clearly, it is going to be different for different ages. Teens want to be separating from parents often, and often, if they hear it from parents, they are less likely to engage than if they hear it from a school or a peer, or a peer group, and then younger and younger kids, maybe you fold it into bedtime, you make it part of relaxing for sleep, or there’s many different ways to do it, but the most important thing is once you start trying to force someone to do it, it is really going to actually probably make it harder for them.
Sucheta: So, in closing, what are the best places or tools that you recommend? I think your books are phenomenal, so that is a great resource, but is that parents need to learn the technique of mindfulness, what resources do you recommend [0:37:45] training?
Dr. Bertin: Well, I mean, we are living in an age now where getting started is relatively straightforward, so I think there are – it’s everywhere at the moment. I mean, the easiest thing for many people to get started, although again, if you want to really explore, you tend to have to move on from apps, but the structure is most – you’re trying to form a new habit of catching yourself a couple times a day and practicing, so that starts which is starting in essence, so there are many, many – I have lists on my websites of these types of resources. There are many apps that are available with guided practice is, there are countless books that are available that sort of explained the bigger picture of mindfulness, there are classes that are available in many communities you can find online in many different ways.
One of the things that is happening a lot with many psychologists nowadays have a background in it, so [0:38:31] family because of whatever else is going on in life, you have been working with a psychologist, they can often introduce it too.
Sucheta: Wonderful! I myself have done many meditation classes myself, but I do an integrative – I am training. I have done I am and I practiced that in my daily life. As you mentioned, it is truly, truly a habit and it is so easy to get off the habit and the benefits are incredible.
So, Mark, what I love though, your approach is I think rarely, physicians bring and this holistic approach to managing a disorder that has such a complex presentation and lifelong consequences, so families who encounter your approach are truly blessed because they are set on the right path to consider ADHD in a different light, and thank you for bringing that perspective.
In closing, do you have any final thoughts regarding what is the most pivotal thing to think about, even if ADHD is not fully managed and struggles have not gone away, do you have any closing thoughts about that?
Dr. Bertin: Well, I think it’s always about – and again, we’re talking about two different things. I think any parent, it can be worthwhile to understand executive function because it really does help you see at different ages what is realistic to expect of your child – early elementary school versus high school, so there is a broader perspective of just seeing things clearly and that’s really what is most important with ADHD. So, most kids with ADHD, if you really look at it, there’s a lot of struggle to ADHD in the short run, there’s a lot of risk to ADHD if it’s not treated in the long run, but the most important thing is that if we see it realistically and really just work on it and understand what it is, kids do great and families do great, and I think that’s always the bottom line, is if we see it with clarity, that most kids are going to thrive in the long run.
Sucheta: Well, once again, thank you so much for taking the time to be with us and explaining this very complicated topic, and bringing a very warm and really truly implementable approach to managing executive dysfunction and ADHD, so once again, thank you so much, Mark, for being on this podcast today.
Dr. Bertin: Oh, you are so welcome. It was good talking to you. Have a good day.
Producer: Alright, that’s all the time we have for today. If you know of anyone who might benefit from listening to today’s episode, we would be most grateful if you would kindly forward it to them. So, on behalf of our host, Sucheta Kamath, today’s guest, Dr. Mark Bertin and all of us at Cerebral Matters, thank you for listening today and we look forward to seeing you right here next week on Full PreFrontal.