29: Understanding and Supporting People with ADHD

pediatrics at New York Medical College. He's a consultant for reach Out and Read, a national organization promoting child development and literacy, and is a frequent lecturer for parents, teachers, and professionals on topics related to child development, including autism, spectrum disorders, ADHD, parenting, and mindfulness. Doctor Bird's books include The Family ADHD Solution and Mindful Parenting for ADHD. Thanks so much for being on the show, Mark, Oh, thank

you for inviting me. It's really great to have such an expert on a specific goaring disability and on multiple specific going disabilities to really unpack lots of these things that affect lots and lots of children and adults. So what are the numbers right now in terms of ADHD. How many people are diagnosed with ADHD, how many kids, how many people in society in general? Well, the you know, the the number in kids is somewhere around one and fifteen,

I think is the best way of simplifying it. You know, that's going to vary a little bit from study to study, although interestingly it varies less around the world than people often describe it. So when you actually look at real studies of ADHD, that's a pretty consistent rate. So you know, depending on the studies, it's somewhere between five and ten percent, which you know obviously comes to a fairly large number

of children. And then when you look at the fact that only about half of those children outgrow ADHD, you know, there's a fairly large number of adults who go on to have ADHD as well. Right, And what are the numbers? How does they compare to numbers for some other wearing disabilities, such as like dyslexia and autism. Is it m Yeah,

that's much higher than some of the other conditions. So for example autism, you know, the estimate obviously keeps changing, but most people say it's around one and eighty right now,

or a little maybe a little lower than that. But you know, ADHD is an extremely common disorder of child development, right because most children have their executive globes aren't fully developed, so right, So, well, what you're looking at with ADHD basically is and that's actually a fundamental change in how we look at it that happened in the sort of latest rewriting of the diagnostic manual around ADHD is now

classified really as a neurodevelopmental disorder, meaning that practically speaking, for most parents and providers working with it, the best way to look at it is kind of like a developmental delay of what you alluded to, so that, yeah, there's a there's a wide range of typical development and in any skill set, you know, so we can look at typical development of language, we can look at typical development of social skills, and really for ADHD, ADHD is

kind of outgrown its name, which is what you're looking at is a developmental disorder of a skill set called executive function, which practically speaking are really all of our life management skills, and ADHD potentially can impact almost any aspect of these cognitibilities. It's not the same in every person. So children who have ADHD or adults who go on

to have ADHD. Really the core issue is one of being behind in these very vital skills for you know, everything from focus in the classroom, which is I think often the stereotype of ADHD, or one stereotype of ADHD too much more subtle things like the fact that ADHD has been linked to overweight and obesity because it has to do with impulsity and self control. I think it's many aspects of it. It's self monitoring, it's impulsiveness, it's

distracted eating one thing. You know, if we're going to talk about ADHD, you have to bring up the stress. You know, there's so many aspects of how ADHD potentially links with food and eating, and you know, you know, I often feel like the discussion with ADHD gets caught up in you know, people worrying, you know, about the label or worrying about the treatments, when really the primary reason I think to even begin to discuss ADHD is so you can have better awareness of what's affecting a

particular child or affecting a particular adult. You can't begin to address things differently until you're aware of what's really going on. That's a really good point and you know, we do get hung up a lot with the labels like do I really have ADHD or do I have something? Do you think a lot of people are misdiagnosed? It depends on where you look. So what it means to be misdiagnosed is basically that lots of different things in

life can cause distractability and disorganization. And you know, all sorts of academic and behavioral issues and also even other developmental disorders or other mental health conditions can mimic ADHD. So if you're really really anxious, you you can have a hard time focusing, and when you have a really severe reading disability, it's going to be very hard to pay attention to the classroom. So you know, many, many

different things can contribute to misdiagnosis of ADHD. And when you look at it, you know, there are some studies quoting crazy numbers like I think, I think, if I remember right, someplace is down in the southern United States, the diagnostic grade is almost one in five. Whoa which is you know? Which is crazy? I mean clearly, you know, unless something really strange New York City, Oh no, no, it down south? And if I remember right, but I

think there's really vital to separate two concepts. When you start talking about the potential of overdiagnosis in ADHD. You know, there's this societal level discussion of why is this happening and what can we do about it? Because clearly, you know, we have to try to tease out, well, what's going on here? Why why is overdiagnosis happening in these particular parts of the country. But the really core concept is I think they sometimes get kind of conflated and mixed

up with each other. Is the fact that there can be over diagnosis or the fact that there can be misdiagnosis doesn't mean anything for somebody who really has it. And I think that's a detail that often gets lost because people are afraid that they're the one being misdiagnosed, or they think or they dismiss the entire concept of ADHD, you know, so they just feel like, oh, this whole thing must not be real because of overdiagnosis goes on when you know, we know pretty much beyond a shadows

a doubt that ADHD is real. You know, the genetics of ADHD are almost as strong as the genetics of height. You know, in terms of you know, tracing it through through families. So, you know, what we really need to sort out is how to separate those two discussions. On the one level, look at what are things that are leading to misdiagnosis or overdiagnosis or equally important, how do

we help providers make more accurate diagnosis? And then the flip side of it is, you know, separating out the society level question almost like the public health issue of it. Once we really do feel like somebody has ADHD, you know, what are the most evidence based practical things we can do to help them overcome these differences in executive function? But I feel like so often the public level discussion

sort of mixes the two issues often too. One I really want to define, like one of the major, most primary characteristics of these sum things are and what's the difference between ADHD and ADD Do people still make that distinction? Great?

Thank you, And that's a great question. It is probably where we should should have started, I know, so I had thought about it either though, So I'll start with the simpler question, which is that in the last couple of versions of the sort of national standards for diagnosis, ADD was combined with ADHD. So the terminology we now use is that there are ADHD with different predominance of symptoms. You know, ADHD with predominantly in intentive symptoms, ADHD with

predominantly hyperactive impulsive symptoms, or a combined type. But because the parts of the brain responsible for ADHD evolved you're almost thirty, the symptoms themselves change over time. So the far more important thing than the exact symptoms going on or the exact you know, is it an attention or is it hyperactivity, is really just you know, is ADHD going on, because as children mature, their symptoms often change.

When you look at what it means to have ADHD, there's really kind of two broad concepts I think that are important. You know, from a strict diagnostic point of view, what we're trying to do is use the traditional kind of eighteen symptom checklist, meaning there are nine symptoms having to do with inattention, like distractability and difficulty following finishing tasks and forgetfulness and things like that that are more internal.

And then there's a hyperactive impulsive list of symptoms, which are often again a stereotype of ADHD, which is the fidgeting, the impulsiveness, the elevated activity level, and you know your base looking to confirm that that pattern of symptoms is going on in multiple settings and over time. But I think a simpler way of looking at it is to say that you know, in spite of all the medical research around ADHD, we don't have a diagnostic test for it.

So what you're really trying to do is just prove to yourself that this is a internal trait. It's a it's a neurologic trait that that we can show through. You know, sometimes observation over time, sometimes through gathering a lot of history and direct observation is persistent over time is showing up and so it's not just the developmental stage as someone goes out of it's persistent in different settings.

So it's not just because you know, school is challenging or something's going on at home, although that can be a very nuanced one because depending on the demand being put on somebody, they're going to show up really differently. The symptoms aren't. It's not going to be an identical description, but we're looking for some consistency across settings, like you

alluded to, before you know, a good diagnosis. The next step is looking at what else might be mimicking at So before we jumped the conclusion that it's ADHD, we have to look at you know, could it be something else fooling us? For instance, you could be in a really boring environment, right right, So one of the one if you're just like, what if your life is really suck boring? Like, yeah, I mean, I hope you would

tease that out. But that is one of the things that's on the list to me is actually, what I'm just going to say, is developmentally typical is one of the things that you know, somebody comes in and somebody might I mean. One of my favorite sort of bodies of research recently is Steve Hinshaw's research looking at misdiagnosis of ADHD, particularly and over the academic kindergartens. Yes, you know, because kindergarteners aren't supposed to be doing a lot of academics.

Yet if you create this sort of artificially intense academic environment for kids who aren't developmentally ready for it, a lot of them aren't going to be able to attend or they're going to start misbehaving, and that can lead to misdiagnosis of ADHD. So on that long list of things you have to consider when someone comes in with a complaint of could this be ADHD? As well, is

what's going on actually pretty typical? Or another way on the other end of the spectrum, to look at the age range, I shouldn't say the spectrum the age raam should look at is you know, everybody nowadays feels pretty distracted and pulled out to different ways. You know, that

doesn't mean you have ADHD. And then really the most important reason to even talk about diagnosis is that the last step to diagnosing ADHD is to say that these symptoms are occurring to the point where you're impairing your own life in some way. So, so lots of people are kind of distractable, lots of people can be disorganized, impulsive. I mean, that's you know, human nature. It's the fun

of life is that we're also different. But to even discuss whether someone might have ADHD, they have to cross the line to where they're impairing their life in some way in relationships. Well, yeah, that you can't get the label officially unless it's impairing your life, correct, Yeah, yeah, I kind of know that. So I didn't know that, And that's actually really interesting because lots of people might feel as though they have ADHD, but it's just not

really impacting their life in a detrimental way. Correct, That's exactly it. When you see people who get I mean to me, well, I mean it isn't fair to them either, but it's a nuanced thing. I shouldn't make quick statements like this. But in general, when yeah, when you see someone who says, you know, who implies like, oh, I have ADHD, but but you know, but I overcame it, you know, kind of true whatever, you know, the issue is,

you know, maybe it's totally possible they did. But the other thing you always have to think about is like, if you really truly have a diagnosis of ADHD, then

somebody has documented that it's impairing your life significantly. See, and that can be very you know, in your face, and you know, really obvious stuff like failing school or getting in trouble you know, socially, behaviorally, and it can be really really subtle stuff, which is to say that, you know what we haven't talked to you about yet.

But it's really a vital concept in ADHD is that is what executive function is, which is where we started you know, it is your ability to just manage day to day, so that one of the more subtle impairments that's common with ADHD is just the internal stress and anxiety of not having a strong skill set that just helps you, you know, do what you need to do every day, and that's clearly a really important skill set.

Let's talk about some potential upsides of ADHD, and maybe I know that you have a lot of really interesting ways of thinking about this, because in a lot of ways, what you might see is that it's someone has ADHD, but they also have other characteristics that are very positive,

that are very helpful with creativity, with other things. And then the question is it really the ADHD that's helping or maybe they just have ADHD and these other things and if they train their executive function, they'd be even better at these other things. Right, I'm of a very open mind and trying to figure out and disentangle all this.

I'd love to get some of your thoughts because there's a lot of talk in the gifted education literature gifted kids with ADHD and how a lot of them might get misdiagnosed because they are really bored because the work isn't challenging enough, right, and they get misdiagnosed as having ADHD. So there's various things to unpack here. I'd love to

hear your thoughts. Yeah, well, I think it's important, you know, whenever we can't to try to actually separate those threads a little bit in that because and this just comes a lot from my experience working with families. I mean, when you start tying together ADHD too closely with the ADHD part too closely with everything else, it can almost like intimidate people when it comes to just even the non medical interventions because you don't want to even behaviorally

address something that's you know, it's supposedly a positive. So I think the most important thing again to me, is to recognize that, you know, whenever you're working with someone who's struggling in any area of life, we need to find a way to build a larger focus on what's going well and help them develop their talents and skills, you know, separate from whatever is causing that difficulty, so that that's like the like a foundational concept that you

know that you need to start from always, so that if you have someone with ADHD who's massively creative. You know clearly you don't want to do anything that's going to mess with the creativity. And yet, in terms of like why even discuss ADHD, it's because you know, the ADHD diagnosis part directly involves impairment in some way. And it's a perfect example. And when I come across frequently, I think I just saw someone this week where this

discussion came up, the high school senior. I actually don't even know if he has ADHD yet, but one of the things his parents were concerned about is they feel like he's brilliantly artistic and he's never finished in our project.

And that is so commonly what ADHD can look like, in that you are massively creative, you have all these wonderful things you can be doing, and yet because executive functions is what's required to plan and organize and finish what you start and learn from mistakes and all these other skills that even artists rely on, you know, you end up with someone who has the potential, even in the art world, to do a wondrous thing, but can't

get there because their executive function is getting. The way you know their ADHD is getting is a synonym to me but practically speaking, but you know, their ADHD is getting in the way. So instead of I think assuming it's the ADHD, that's the positive, because that sort of implies like, well, we don't want to touch this at all. I think you you know, it's just important to be more nuanced and say like, well, whatever we're going to call all this, you know what part of ADHD is

causing me? You know, this this hurdle that I can't get past, and what can we do about it? And I think that's really the core point to me. So I think that is a core point. And I think, you know, I appreciate your writings and preparing this for this interview. I you know, reading some of your work the way you think about this stuff helps me unpack and even think about my own writings maybe in a different way. I've written, as you know, I've written articles

about the potential creative gifts of ADHD. And when I say that, what I'm really saying is just like you use executive function as a synonym for in a way synonym for ADHD, I view kind of like daydreaming as the synonym as well, Like you know, as someone who you know us does a lot of daydreaming, that's all over the place. But there's no reason why a person can't have characteristics of ADHD without having ADHD. And maybe

that's what I really need to entangle. Maybe that's what would be really helpful here, is to you know, I talk about these characteristics that tend to give the diagnostic label, but I'm not really talking about ADHD because ADHD and I'm realizing that now by the way, so thank you.

What I'm really talking about are are some of those prominent characteristics such as mind wandering and you know, reduced executive functioning, And because the creativity literature does show that reduce executive function is conducive to divergent thinking certain part

parts of the creative cycle. So yeah, I just wanted to open that discussion with you because I think maybe that's really I'm talking What I'm talking about are just these characteristics, but ADHD really is something that needs to like you said, it needs to impair some aspects of

your general life functioning really to get that label. So I think, I mean, that's a I think that's a fascinating way of looking at it, and I think, you know, that's worth some potential exploration I don't even know if someone is, you know, I'm trying to think about kind of cress studies looking at it the way the way you just described it. But I think it is potentially

true that you know that. Like many things, I think there's other more physical traits where this is true too, of like you know, having some of it could have some benefit and having to having too much of it no longer does the highly true exactly. There's a lot of things in life that work that way. And what you're talking about around creativity might be that you know,

some is great. It allows for the types of thinking you're talking about, and you know, but at the same time, when you again, when you pile too much of it on, it passed the point of utility anymore. Absolutely, they actually have done studies showing you with schizotypy, which is a mild reform personality variation of schizophrenia. You know, if you have one or two indicators, it really is an inverted U shaped curve, like if one or two indicators of schizotiphy,

it actually increases your creative productivity. But then three and four and you see a spread very steep. It's actually

there's actually a cliff model of this. I mean, one of the things your questions you're raising that I'd be interested to, you know, see looked at too though, is that you know, on the one hand, daydreaming and mind wandering has been linked with creativity, and on the other hand, of the ADHD literature, it's also been shown to happen at very unproductive times, often so that they've done research looking at you know, people who are being motivated like

by money. You know, you complete more of this task, you learn more, and you can still see their mind dropping into you know, daydreaming mode anyway. You know, in spite of versus a typical population without ADHD who you can see that are motivated for money and their frontal lobes, the part of the brain responsible for executive function just kind of locks in and sustains itself for the task.

So you know, you can so that you know, there's just like you're saying that there may be times where you know, I think this is a whole other discussion.

I think one of the things we're just getting lost in our world of you know, being able to quickly engage our brain and mindlessness all the time is going to be daydreaming and creativity, because that's where it's not just creative by the way, I don't think, because it's important to realize that even for people who don't consider themselves artists, you're also talking about creative problem solving, you know, which are which which for all of us is important

in day to day life and when we're you know, when we're not doing letting our minds you know, go into that sort of daydreaming not quite fixed on anything mode because we're playing candy Crash constantly, you know, like it's interesting to one, you know, to start thinking, like, what are we missing out on there? No, it's a really great, really great point. You said, there's a biological

component us there. Certainly there's also an environmental component in the sense that you know that there are certain environments that can make it worse or better. Are there people that like that actually you know, have ADHD, like have diagnosed and then they go into an environment where they structure their entire lives like an artist maybe, or like they structure their entire lives in a way that it just no longer is a problem for them, and then

therefore they don't really what do they have? Then then they're just creative. Well, I mean, that's a nuanced question, but it comes back to what we're saying before. So I think there's kind of two sides to that coin.

On one side of it, really one of the core concepts and working with ADHD and executive function is Russell Barkley's concept that he calls externalizing the system, which basically means, you know, creating the structure around you that will support the parts of organization and planning and everything else that are challenging for you. So on the one hand, you know, absolutely part of living well with ADHD means, you know, creating the structure and lifestyle that helps support you in

your in your daily living. You know. The flip side of that comes back to still that you don't really have a diagnosis of ADHD. You know, if you don't have if we can't define where the impairment is, And I think that just becomes a very nuanced discussion, like if you I don't know, you know, I don't know where you draw that cut off point. Just honestly, the bottom line is someone's doing well in the label doesn't

matter at that point. But I think you know, you might argue that if it's requiring that much structure to in essence live with your executive function ADHD. You probably still have the diagnosis. You're just doing a good job managing it. You know. It's not that the ADHD has gone away. It's that you're just doing a particularly good job of well. I don't even like using the word good. That's very judgmental. It doesn't mean that anybody else is instuent.

But that's a I'm glad I caught myself there. It's not about good or bad at all. You know, it's like you've been fortunate enough to come up with a plan that works for you. Because there's plenty of people who are doing a great job trying to manage the around ADHD, but they're still not getting on top of it. So so and I do think, you know, I'm kind of glad I caught myself on that because it's a really important language around ADHD that I just you know,

that needs to be dropped. I mean, it isn't anybody's fault. Yeah, right. We talked about some common symptoms of ADHD, but in your book you talk about how they these symptoms they extend beyond inattention interactivity. You mostly focus on inattention, right, but where are the other things? So that's thank you for coming back to that. And I think at one point earlier I said I wanted to come back to that.

You know, when you look at ADHD as a difference in executive function, then you can really appreciate the broader umbrella of stuff that it impacts. And one thing I think that's vital for anyone living with ADHD too, is when you hear words like executive function and you know whatever, other like you know, neurologic terms, get to turn around is you really want to make them practical because they're

not really useful otherwise. So when you look at executive function, you know, it's just as easy to you know, it's like life management skills. And when you look at it from that umbrella, it starts with attention and monitoring your own actions, which is kind of the ADHD part, and then the rest of it the way I typically describe it as task management, which is organizing, planning, prioritizing, keeping track of time, information management, which is kind of like

the realm on a computer. It's like holding on to and organizing your ideas in your head. And that's a that's a that's just a huge one ADHD. So it's where you keep track of it to do list if you haven't write it down. It's where you organize your thoughts. Like even as you're sitting here listening to me and you're trying to gather information for me and coordinate with what you already know and decide what you're going to

say next, that's all information management. So information management often off ex communication often makes learning stressful if the classroom is moving out a pace quicker than you can hold on to that information. So information management is vital. It also has to do with a lot of skills. Like writing is very executive function dependent. So you know a large number of kids and adults of ADASHU struggle at

narrative writing if they don't get support. So again, if you understand executive function, you can proactively build that support into their education. There's an emotional component of executive functions, like self regulation. Yeah, and that emotional component like several decades ago that was like actually part of the diagnosis. And I think it's just important to always recognize, like when you know, when you're trying to help someone get

a handle on things. I think it's sometimes helpful to realize that it's not like a whole bunch of different things going on. You know. The emotional reactivity click to frustrate, equip to yell, quick to get upset, quick to shut down is another component of executive function. It's another component

of ADHD. And then there's a really nuanced one. It's hard to you know, from the outside, it can be really hard to almost hard to accept or hard to see what's going on at least, which is effort management, which is the ability like I alluded to in that study about to sustain attention when you're motivated, you know, the ability to sustain effort over time and to do it efficiently as part of executive function. That's also grit.

It's related to all these terms. I think it's it's a great you know, you talk about grit and resilience and mindset and all these different terms. There's an awful lot of overlap between all these terms where the common thread you know, and the same studies have happened, like

the Marshmowt study around executive function. You know, all these different studies point to these core cognitive traits that help us just you know, deal with the fact that life's challenging, you know, and then just to help us persist and take care of ourselves and solve problems. Any many terms that are really yeah, they overlap a lot and what

they're in what they're referring to. But even on like Angelo duck Rose script Scale, because I work with her a little bit, and yeah, you know, we administer the scrit scale. I mean some of as items are literally like the reverse coded are ADHD. Like there are things like I maintain my interests over time. You know, it's just interesting. But that's why ADHD is so important to

do something about, because you're right, ADHD. When you look at what ADHD causes in many ways, it's the mirror image of a lot of what the research is showing helps people survive and to thrive exactly. So you're absolutely correct. Yeah,

you're absolutely correct. So for any of that overall, like for any of those areas of executive function, the most important thing I think, like if you're listening, if you're coming across it for the first time, listening to this or somewhere else, is to try to get enough information

so they're just gonna make practical use of it. So you know, some of the examples I use a lot are like, you know, part of attention management is being distractable, but part of attention management is being able to transition your attention. So that if you're living with someone a child or a spouse even who tends to hyper focus and get really sucked into things, and then you try to talk to them while they're hyper focused, you know

you're not going to get a lot of compliance. They're not going to listen to you, and honestly they're not being difficult, you know, they just can't shift attention. So if you can understand that aspect of executive function, you know, the solution is a much more practical one, which is, you know, they're just not somebody because of their attention shifting issues who probably can have a conversation while they're also you know, playing a video game or really engage

in newspaper or something. So you know, again, if you can understand that, So that's an example of how if you can understand executive function, Like when I'm working with parents that's often labeled as oppositional behavior. You know, if he's playing his video game and I said we had to go, and when I came back in ten minutes.

He was still playing his video game. Certainly some kids can choose to be oppositional, but an awful lot of the time with ADHD, what actually happened was I said we got to go into and it's while he was playing his video game, and he couldn't shift attention to even register the question. Really, maybe he'd grunted and say oh huh, but he didn't really register the information didn't get in. Switching issue is also prominent in autism. It is although one of the subtlety's there is about half

of kids with autism could be diagnosed with ADHD. And this is where, you know, we could probably talk all night about. Yeah. While the rule of most of the disorders of child development, you know, as they've done more and more research, is that most of them have a lot of comorbidity, meaning again for someone not familiar with the term, that you know, when one thing happens, there's

almost always something else going on too. That's actually an important concept around ADHD in particular because it means that you can't really do a good ADHD evaluation. I use the word good there intentionally that time you herely do a quality ADHD evaluation without the screening for the co morbidity, because about two thirds of the kids have something else

going on. But it's also why ADHD isn't called executive function deficit disorder at this point because basically, it really isn't clear yet whether you know, there are other conditions that have differences in executive function. For sure, there's there's plenty of them, you know, and at least some of those situations, it's really that they have autism and the DHD or learning disability and ADHD, but it's still kind of fuzzy whether some of them can have you know,

learning disability and executive function differences, but they don't have ADHD. Yeah, And that's why that's why the research that you know, that's that's one of the many reasons why in spite of the fact that practically speaking, we should call ADHD and executive function definicit disorder, or at least think of it that way, you know, the label the name actually

hasn't changed yet, right. I always found it interesting that there's so many psychopaths, a lot of them have ADHD, like a very high proportion, you know, I don't know, I don't know about that one in particular, honestly, but it sort of evolves around the executive issues I imagine. Yeah, I mean, you know, I mean, I don't. Again, I

can't draw that line for you. I'm not sure that about that research, but in general, you know, I mean, there's two things looking at You're looking at the direct impact of what executive function does any daily life, and then you're looking at the fact of what, you know, the stress that causes over our lifetime. You know, you get to Quoterus Barkley, he Russ's best one line description of of ADHD is probably it's not a disorder of not knowing what to do, to disorder of not doing

what you know. You know, you you're most of the time know exactly what it is you want to be doing next, you know, or what you should be doing in life, or what you should be planning for what you know, there's a lot of shoulding. When I was working in the mindfulness class, somebody once said, I really

just have to stop shooting on myself so much. You know, you just get me cycled that like, well, I should know that, I should know better, and I should have done this better, and I could A lot of it that's do with prioritization, and I think, you know, in terms of neuroscience, not only the executive network is important in understanding ADHD, but I would also argue the salience network, which is not as well understood, but has to do

with what tagging information is relevant and irrelevant passing the baton to other networks for intentional process. You know, it's

kind of like everything's like equal valiance of interesting. Yeah. So, I mean, and that's an important point too, which is, you know, if you're really going to get seriously into the research, I mean, the concept of the front part of the brain and executive function being the core of ADHD is practical, but like you just said that, the research is far more complicated because that part of your brain really integrates with most of the rest of your brains,

and anywhere that integrates with is potentially affected by the fact that they're you know, they're they're coordinating for each other. So when you look at the broader being brain research, there's there's a whole lot of parts of the brain that have been implicated with ADHD. So so absolutely, I mean, this is a this is a useful model we'll be talking about because I think in day to day life.

It's helpful because it is kind of the foundation of the research, but the nuances of the research are really, you know, very subtle and fascinating. Subtle and yeah, utterly fascinating because you do you do see that people in ADHD, right that they're like they're they're tagging lots of things that they should be prioritizing, and it makes it very overwhelming to decide and so you kind of, you know, you get disorganized because I'm paralyzed. It can be paralyzed. Absolutely.

What are some research Are there actually research proven practices or techniques that increase academic and social success for people with ADHD? And how far are we in the science with finding some interventions that actually really do a nice job working helping We are actually pretty far along in the science what helps with ADHD. And I think the you know, there's a core concept that I know one thing really you know, there is no like one cookie cutter,

single thing that helps ADHD. What we have are a lot of tools to choose from an individualized care around that have been proven to be successful. And the way I typically lay that out for for people I'm working with lately is that there are kind of three foundational areas of intervention that have been shown you know, most likely to make a difference and any for any individual. I mean, you might choose one of them, you might

choose all three. Those are you know, a law long list of evidence based educational supports that help with ADHD. The core concepts are basically, first of all, that you know, motivation comes from you know, positive feedback and success, but only if they're actually valid. So you have to set up an environment where someone who's actually being successful so that they can, you know, so that there's a behavioral side of it all is how do you make that happen?

A lot of which ties into the second one, which is you know, as a kind of thought exercise. I think the core concept is you're working with a student who has a development of the land self management skills, and kind of the one line, a great one line description of that is simply something like, you know, forgetfulness is an ADHD symptom. Right, you know, if you continually punish someone for being forgetful who has ADHD, you're in

essence punishing them for having a disability. You know, so you need to you know, once it's established itself as a pattern. It's not it's not useful. Just keep marking the grades down or keep yelling or whatever it is. You know, and you have to come up with a plan to teach them how to be less forgetful or they're not going to overcome it because Sonny, I forgot our anniversary, don't come because I have ADHD. Right, Well, it's not that either. That's why you have to you

have to combine the awareness with a solution. Yeah, that's what it is. But the punishment all on its own isn't going to do it right, So it has to be you have to be aware that. That's where awareness that it's ADHD matters so much. Right, once you've establish it, the forgetfulness of ADHD and then example you brought up in relationships is vital. I mean, it's a it's funny, but it's vital because you know you don't it's not

like you're just off the hook for everything. And it's not like you have to just completely forgive so long with ADHD for forgetting your adversary. But there is a subtle shift in perspective if you can at least recognize that you know it's forgetfulness related to ADHD. You know, we have to come up with a solution here, and I'm really frustrated and angry about it. But it wasn't intentional either as an important shift in perspective, right, No, for sure. So school was one area that you know,

there's a lot of evidence. I don't know how much I'm going to I'll give you a quick overview. You can tell me where you want to go into detail. So there's a lot of evidence based practice. Most students with ADHD benefit from supports outside of school. There are a whole list of things that have you know, basically initially struggling from that same concept of how can we

create an environment that supports executive function? So those are things like cognitive behavioral therapy, ADHD coaching, parent training programs that help you create the structure and life that both accommodates for executive function where that's needed, and also teaches aspects of executive function where that's possible. So that the second part, the third part is the medication around the ADHD, which you know, as its whole. We could speak for

hours just about that because it's become so controversial. But you know, the short of it is the reason or research backed recommendation exists for ADHD. Excuse me. The reason the recommendation exists for ADHD is because the research really suggests that for many people it's very very helpful and that you know, used appropriately, which is a big can of worms itself. They're not always used appropriately. They don't

have typical they don't typically have side effects. Is actually very hard to cause a long term side effect with an ADHD medication, but they don't do anything long term, so anytime you stop them, you go back to baseline. But I don't even want to go that far. I just I think the most important thing is to realize,

you know, it's become very polarized artificially. You know, we can all agree that no one should take medication they don't need with or without ADHD, and if there's a plan that works without ADHD, that for anything, that's always ideal. So you know, you evaluating as an individual, whether somebody wants to try them or doesn't want to try them. It's you know, it's just important to approach you with

that level of objectivity. All medications have potential side effects, you know, used appropriately, they have potential benefits and that's you know, from a pure statistical point of view. You know, if you have a drop pie chart of like what is going to affect ADHD, that's you know, in most studies that one of the bigger pieces of the pie for having potential benefit. Do you prefer any over another? Like do you like riddle in? Do you think they're all?

Basically it's all idiosyncratic, you know, basically everyone responds differently to medication. The most important bullet point about it is that it often is a kind of arduous but not very prolonged trial and error to get it right. So when they're managed, you know, when they're managed closely, you can make relatively quick changes. But truthfully, again you can look at individual studies here and there, but on a practical level, all the stimulants are equivalent of each other.

I mean, different lengths of effect and different you know, different individual to in visual but there's no one better than any other one really. And then the last aspect of ADHD, that's sort of the foundation, the sort of last aspect of ADHD. I think that for many people

helps really take them more fully past. ADHD are kind of a broader umbrella of things that have to do with kind of daily living, and just the recognition that you know, ADHD affects sleep, but better sleep helps with ADHD, and exercise helps with ADHD, but ADHD can make it harder to maintain exercise routine, and nutrition might be involved, and all those other things are part of the picture too, you know. So it's like, you know, you've got to look at that too, and what's the impact of that.

You have someone who's you know, whose ADHD has made it totally undermine their ability to sleep consistently, and that's going to exacerbate things too. And then within that sort of list of like lifestyle habits you can use that are evidence based and very practical, there's mindfulness, which I think you know is very uniquely supportive for people with ADHD for a whole host of reasons, not the least of which that ADHD because it affects life management skills

by nature, makes stress a whole lot worse. When we're stressed and feeling overwhelmed and not at our best, it makes it that much harder to do the things we want to do around our own ADHD. So that providing somebody with stress management tools like mindfulness can help give them the you know, the strength to sort of take or the resilience to take that next step and start actually doing something different about their own ADHD. It kind of breaks the inertia in a way. Do you like

any forms of mindfluss over any others? Because there are a lot on offer, a lot of different kinds. Would you like to return to breath form? No? I mean I wouldn't say there's lots of kinds of mindfulness. I mean a different way of looking at it is that mindfulness is a lot like physical fitness. You know, when you're when you're looking at what mindfulness is, it's it's really it's no one thing. It's trying to build a set of traits that help us manage day day life.

And there are a whole bunch of different ways you can do that, and a whole bunch of different tools you can use to do that. And with ADHD, you know, sometimes people want I shouldn't even say with ADHD everybody wants to approach it differently, so you know you can do I mean, one thing I would say for people again not familiar with mindfulness, is that the basic practice isn't one of being completely still or completely be relaxed. It's just kind of recognizing that we all spend a

lot of time distracted. You know, while we're distracted, we're kind of on autopilot and not really paying conscious attention much to what we're doing. And there's some value just to developing more awareness. And that's kind of a very brief description of it. You know, it's more nuanced than that, But we can try to build that awareness, you know,

many many different ways. So breathing, you know, focusing on the breath is one, and again it's not meant to do anything with the breath or to be magical in any particular way. It's just that the breath happens to be there, especially if you're someone who has ADHD, but this can be true for anybody. Some people prefer more movement based practices like yoga can be a mindfulnance practice.

I mean, one of my favorite questions that comes up every time I lead the Mindfully DHD class is, you know, one of the first instructions but leading mindfulness is that you know we're all going to get distracted. There's no perfect you know, you're trying this mindfulness practice, you're going to get restless and your mind's going to wander no

matter how many years or decades you practice it. And the whole core of the practice is without getting frustrated, judge yourself, just coming back again when you notice the distraction, and someone in the ADHD group will will inevitably ask me, you know, do you say that to every group or just this group of people with ADHD, And the answer is it's every group. There is nobody who can completely

still their mind. However, when you look at what mindfulness is really asking of you, it's just as possible for someone with ADHD as about. Interestingly, the challenging part tends to do more with the executive function stuff we were talking about, which is just getting into the routine in the first place. But the mindfulness practice itself isn't asking you to sit still. It doesn't ask me to hold

your mind still. And in fact, you know, mindfulness is uniquely helpful with ADHD because you know, like, for example, if you are developing that self awareness, you might be in a conversation that's really important in a really distracting situation.

And what mindful communication about being mindful? I hate using word mindful like that it isn't it sounds something I don't know of being mindful in that moment, you know, aware in that moment, might just be recognizing, you know what I'm feeling really distracted now I'm not capable of

fully still, you know, fully stilensing my mind. So what I really think we should do is pause for a second and go move somewhere where I can pay attention better, you know, And that is working mindfully with ADHD, you know, so that it's it's not asking anybody to be anybody

but who they are. But if we don't start living mindfully with ADHD or without, we tend to just you know, fall into the same ruts and maybe in that situation, you know, because we're you know, we you know, we we stick with the conversation even though we can't really hear what's being said, or we get frustrated and then escalate in some way or or shut down in some way, or we just go down these paths because we're not this we're an autopilot. So the practice of mindfulness is

non judgmental awareness of what's actually going on. You know, I wish I could pay attention better right now, but I can't. So let me pause and come up with some different solution to this, or it might be you know, looking at some entrenched other problem in life and saying like, look, you know, because i'm ADHD have a hard time paying my bills on time, and you know, and I'm you know, I'm frustrated with it, and it causes stress with my spouse,

and it causes all this other whatever it is. And then you know, the mindfulness part of it is pausing and looking at ADHD objectively. You know, mindfulness isn't a miracle anything, but hopefully it gives you a little more space to say, I'm not happy with it, but I got you know, this is where how executive function affects my life, and then looking at it and saying, well, I've been doing it this way up until now, and

that didn't get me anywhere. So you know, I'm not going to judge myself for the past, but I'm going to try this new thing moving forward. So that bigger picture of mindfulness and ADHD or mindfulness and anything else in life isn't trying to force it, it or yourself into any particular box. Is trying to give yourself the

tools you need to start proactively doing something moving forward. Right, It so has a good in the toolbox, and I'd respect that and find mindfulness helpful for my own anxiety issues. I mean, I definitely realize the value of it. It looks like it has a lot of value for lots of different things. But there you know, clearly there could be some moments where you it's not helpful to be mindful, but it's good to have that toll in your toolbox.

You know, you've been really generously your time here, and I want to I want to wrap up. I thought we could close with maybe one or two pieces, a concrete piece of advice for parents or or children with ADHD or even listening to this podcast that can help them build their self esteem and healthy relationships. And you probably some of these techniques you already mentioned would be very helpful. But do you have anything in particular you

could end on? Sure? I mean, I think there's really probably two or three important concepts if you're you know, either living with ADHD or worried you know somebody has ADHD,

especially if you're a parent. I think one of the most important things for acknowledge is that you know, being a parent someone who has these difficulties, life management skills is inherently stressful, and that part of getting on top of ADHD has to be, you know, allowing yourself or working with someone who can help you work with that impact on a whole family, you know, And I think one of the often overlooked parts of ADHD is that parents need support. You know, to work with a child,

you have to work with the family. And I think for any of us doing any type of caretaking role in life, finding that little bit of time maybe less than when you weren't to parents, but the little bit of time that lets you take care of yourself you know, feel better, will help you manage the ADHD overall, and just acknowledging that it impacts families in that way is vital.

And then the second thing I'd say, which is which comes back to where we started, is that, you know, I think looking at ADHD, the most important thing is to in essence look at it all through the lens of executive function and problem solving initially, which means that that's not a too wonky I think, but means on a practical level, just sort of doing what you have to do to be educated enough to say, like, what aspect of this challenge going on is just purely executive function,

and that's where the solutions come from. So, you know, so it's very hard to you know, we could pick almost any problem and break it down into you know, how could we work on this and look at it around distractability, intention around organization, and planning around emotional reactivity,

And that's where all the solutions really come from. And if you want to fully gives a child with adsue to benefit of the doubt, initially, it can just be a useful exercise to say, you know, how can we fully explain this from the perspective of like this as an executive function delay And obviously that's a simplification. People are way more complicated than that, but it's a step.

Like I saw someone this week who said, you know who I've probably in about six months now, who said, you know, not everything's gotten better at Helme yet, But I'm so much less angry now that I realize he's not intentionally trying to be difficult, right, you know, And so so instead of you know, picking one specific Senate problem, because there's just you know, there's too many different aspects of ADHD to say, like, you know, this is what you need to do for this one thing, I would

say the broader concept is to just you know, familiarize yourself enough you don't have to become an expert with what it means to have delays and executive function, and then problem solve from that perspective. You know, how can we set up the homework environments of less distractability, or how can we create a routine so that helps the time management, or and just look at you know, whatever is going on and one thing at a time, address them in that way. And that's typically the path past

the influence of ADHD. That sounds really great. Mark, Well, this has been a really helpful and unlightening episode, so thanks so much for giving all your great insights. Well, thank you again for having me here. Take care, have a good night too. Thanks for listening to the Psychology Podcast with doctor Scott Barry Kaufman. I hope you found this episode just as informative and thought provoking as I did.

If you'd like to read the show notes for this episode or here past episodes, you can go with the Psychology Podcast dot com