ADHD Awareness – Podcast

By LifeStance Health on October 5, 2021

ADHD Awareness

[00:00:00] Welcome to Convos from the Couch from LifeStance Health, where each episode you’ll hear engaging and informative conversations with leading mental health professionals that will help direct you on your journey to leading a healthier, more fulfilling life.

Today’s episode features the very important topic of ADHD Awareness with our special guest Mindy Perry. 

People with ADHD have a nine-year reduction in healthy life expectancy compared with the typical group that is higher by two and a half times than any of the physical health problems, medical problems that we know about most people are first diagnosed with a mood disorder before ADHD usually and on average an adult will see 2.3 clinicians and try 6.6 antidepressant [00:01:00] trials before diagnosed with ADHD. Only 10% of people get that accurately diagnosed the first time.

Welcome back everyone. I’m Nicolette Leanza and I’m so excited to have Mindy Perry as our guest today to talk about ADHD awareness. Mindy, can you tell us a little bit about yourself and what drew you to working with individuals with ADHD? Sure, thanks for having me. I am a Licensed Clinical Social Worker, which just means I’m a Psychotherapist.

When my son was in fourth grade, his teacher expressed some concerns about his attention in class. And through a series of doctors appointments and meetings with the school, we determined that he had ADHD. And what was really surprising to me is, I didn’t know very much about ADHD, even though I had gone to graduate school.[00:02:00] 

And so I dove into research and learning about ADHD. And in the course of that, we sort of looked at my husband and went, this looks familiar. And he was diagnosed with ADHD about six months later. So, I was a clinician for a larger mental health agency at the time. And I just, I only worked with adults and I decided it was time to get some services out there for people with ADHD, because it’s actually really hard for people with ADHD to find clinicians who understand the disorder. So I started offering adult ADHD groups to teach skills. And within a couple of years my boss decided to start an ADHD program. It kind of pulled me into that. And so for the last four and a half years, I’ve been the Director of an ADHD program in Oregon and Southwest Washington.

That’s great. So again, I can [00:03:00] tell you come with a wealth of knowledge on this topic. So let’s dive in. I think there’s a lot of misnomer of what ADHD is. And so can you clarify for our audience really what it is and how it’s diagnosed? Absolutely. ADHD is a neurodevelopmental disorder, which means that it occurs in childhood and in the brain. That’s basically what that means. And there are three different types of ADHD. A lot of people will say, well, I have ADD I don’t have ADHD cause I’m not hyperactive. And that’s, that’s fair to say, but the diagnosis is actually called ADHD now. And so there are three different types. There’s a hyperactive impulsive type and inattentive type and a combined type where you have symptoms in both of the other types.

 I think when people say I have ADD, they mean inattentive type. So people with ADHD, it occurs in the brain and the part of the brain that’s [00:04:00] impacted by ADHD is the part that is responsible for. Things like problem solving, memory, language, motivation, judgment, impulse control, social behavior, planning decision-making and attention.

So the way that it’s diagnosed is usually the client and some people who are close to them, such as parents, teachers, or if in the case of adults like a spouse or even a sibling or parent, we’ll fill out a series of questionnaires. And then we’ll sit in an interview with either a therapist or a doctor who will then use clinical interpretation and that interview to provide a diagnosis of ADHD. So it’s not a super invasive testing process. But it does take some expertise to conduct. 

Now you’ve mentioned with your son that you looked at your husband and later six months later, he was diagnosed. [00:05:00] Looking at causes of ADHD, sounds like then there is a genetic component to it. Yes. So ADHD we’ve recently learned is considered to be an epigenetic disorder. 

Tells us more about what that means. Yeah. This is new in the last few years, a new discovery because there’s tons of research going into ADHD right now. We still don’t know everything. There’s a lot we don’t know. So genetic, you know what that means? That means that somebody in your family has it.

So it’s heritable and usually it’s a parent. There’s usually a parent with ADHD. William Dodson says if one parent has ADHD, there’s a 50% chance that a child will have it. Epic, the epic part of genetic means that there’s an environmental trigger that sort of sets off the ADHD and you’re wondering what’s the trigger, right?

We don’t know. We don’t know what it is yet. So it shouldn’t be something that occurs in pregnancy. It could be something in the environment, like an, a neurotoxin, like pesticides. We don’t know what it is yet, because this is too new of a [00:06:00] finding for us to know what. Got you. And so do we know how ADHD manifests differently with adults versus children or the agenda?

Can you test a little bit more about that? I mean, I think when people think of ADHD, they’re picturing like a 10 year old boy bouncing off the walls. And so that unfortunate. Sort of misnomer has been a detriment to many people who have been struggling, especially with inattentive type. But with kids hyperactivity, if they have, it is much more pronounced, it’s more obvious.

So kids, you know, they can’t stay, sit still. They can’t say stay seated when they should be seated in class or at dinner. They have a really hard time focusing and staying giving their attention to things. Kids with inattentive, ADHD tend to daydream in class. They don’t listen when their parents are telling them something like, go clean your room and brush your teeth.

And yeah. Put away your [00:07:00] clothes. They might, might hear one of those things with adults. I mean, the symptoms, the diagnostic symptoms are the same, but it does look different on adults than it does in children. Hyperactivity becomes more internal in adolescents and so often an adult will come to me and they’ll say, I’m not hyperactive, but they’re you know, they might be like tapping their foot or they might be doodling or they might be twirling their phone or their keys. And so that’s how hyper activity comes out or they talk a lot and I can’t get a word in edgewise. So that’s kind of how hyperactivity looks in adulthood. It also can look like racing thoughts at night.

Like when they lie down to go to sleep, they have a real hard time falling asleep sometimes because that’s when their brains are so active. And that can be the case for adolescents as well. I was going to say that made me think about the recent. Sometimes I think he just jumps into the how ADHD can be misdiagnosed.

You know, if an adult maybe who’s had a history of it, not recognizing thinking, oh, I’m just anxious. [00:08:00] I was needing to move all the time. I can’t sleep because of recent thoughts. I can get confused, adjusting and anxiety per se. Is that correct? Nikki that is such a good point. Actually most people are first diagnosed with a mood disorder.

Before ADHD misdiagnosed usually. And on average an adult will see 2.3 clinicians and try 6.6 antidepressant trials before diagnosed with ADHD. Only 10% of people get that accurately diagnosed the first. That’s actually really important that you’re sharing that because I think the long that comes with that itself, frustration of like, you know, what is it, what is wrong with me?

And I hate putting it that way, but I know sometimes people really get frustrated. And so, you know, if they’re getting misdiagnosed, that means the not getting maybe the correct treatment for what’s going on. Well, and you asked about men and women, and we actually don’t have enough research to know why we miss so many women [00:09:00] who have ADHD.

But I have some guesses you know, just working with so many clients, with ADHD you know, a woman will come in and she’ll tell me she’s anxious and overwhelmed. You know, her life is just taking over and she can’t stay on top of everything. She starts describing anxiety. And so, any clinician will hear the anxiety in that and maybe miss the signs of ADHD that she is not able to manage, to regulate all the things that she has to regulate normally.

That also makes me think of jumping back to children and looking at females versus males. It might be that, that little girl who’s just not paying attention or just totally inattentive. But she’s not getting in trouble. She’s maybe sitting in her seat or she’s totally not paying attention to why it might be the little boy.

And I’m generalizing here, not to say that there aren’t some little girls that are also hyperactive, but it might the little boy falling out of his chair and kind of being all over the place that’s going to get the squeaky wheel is going to get the grease so it’s going to be that little boy that’s maybe going to be identified a bit sooner [00:10:00] because it’s annoying.

Yeah. Trouble for the teacher or for the parent. And it is true that we think that girls may have inattentive type more frequently than boys, so that may be a generalization, but it’s probably a true generalization. And so, yeah, they’re not getting into trouble. They’re just flying below the radar and then they get to be adults and they’re and they feel like they’re just lazy or they’re just unmotivated. And that can look like depression, you know? And so they get treated with depression medication, which doesn’t work for ADHD. It doesn’t help people with ADHD unless they have actual depression in addition. But I find that a lot of these symptoms that look like anxiety and depression are just secondary psychological effects of untreated ADHD.

And so if we target the ADHD often it takes away the depression anxiety, because they’re finally getting the treatment they need.[00:11:00] 

Okay. So. With ADHD one of the terms I’ve come to understand is an impulsivity, you know, and, and with that impulsivity, you’re not, you know, a kid adult might not be stopping and thinking that makes me think of like how that can bring risk or danger to the person’s life. Can you tell me more about that?

Sure, absolutely. Russell Barkley calls ADHD, a disorder of self-regulation, which I think is the best description of what it really is. So you mentioned impulsivity. But it’s also just not being able to regulate oneself. So think about it. Think about alcohol, think about substance use. Think about risky sexual behavior.

Think about driving. Think about not wanting to do school work, but wanting to play the guitar. All the things that can get in the way of having a successful life. That’s what people with ADHD can struggle with. And so he actually, Russell Barkley has been doing a long 30 year longitudinal study on people with ADHD.

[00:12:00] And he’s discovered that people with ADHD have a nine-year reduction in healthy life expectancy compared with the typical group. So. That is higher by two and a half times than any of the physical health problems, medical problems that we know about. So it’s a huge public health problem that needs to be addressed.

And it’s very easily, very treatable, but we need to catch it. And so even in these primary care offices, if a doctor is trying to treat diabetes or heart disease and the patient isn’t compliant with treatment, are they considering that the patient may have undiagnosed ADHD? That’s where we need to be catching these things so we can help people because often they want to be compliant, but they can’t remember, or they aren’t able to eat the diet that is prescribed of them.

ADHD is described is not attentional [00:13:00] deficits, but attentional differences. I don’t know if we’ve ever heard it described like that. Tell me more what that means to you when I say attentional differences. Yeah, absolutely. So if it’s a disorder of self-regulation it’s more attention, inconsistency disorder.

So I hear from my clients, you know, I cannot pay attention in my math class at all. But if you put my guitar in front of me, I can just lose myself in that for three hours. And it’s almost like a superpower we call that hyper-focus. So people with ADHD have the ability to hyper-focus they do it three or four times a day.

And it absolutely drains their battery because it takes so much energy, but it’s something they’re passionate about. And so I always tell my clients, especially my young adult clients, if you can find something you’re passionate about to make money doing, you’re going to be a superhero doing it.

But if people get stuck in jobs that they’re not interested in, they have a lot of difficulty because they have difficulty focusing. I love that you called it a superpower because it shows that [00:14:00] there are positives to this, that you can manifest it and outlet it in a very positive way, productive way.

Absolutely. Yeah. And there’s actually a lot of strengths to ADHD brains. People with ADHD tend to be very creative. They tend to have lots of ideas. They think outside the box and they can be very helpful, you know, in a meeting where everyone’s just sort of going the way we’ve always done things, because they might think of ideas that none of the typical brains will think of.

So there are a lot of strengths to the ADHD brain. And let me ask you this, can it be pretty difficult for some people with ADHD to find professionals who understand ADHD? Very difficult. As you know, as I mentioned earlier, they can often go through a number of clinicians or doctors before they find someone who understands ADHD.

In fact in a study out of Cleveland clinic, 65 psychiatrists who said that they were competent to assess and treat ADHD, misdiagnosed adults who presented with [00:15:00] only adult ADHD. Wow. Wow. Yeah. So we’re trying to get out there and train clinicians more, trying to get the word out with primary care physicians, pediatricians, and just give more training on ADHD.

Can you tell me what is the treatment for ADHD or what are the different treatment forms? Absolutely. So there’s one very good study done, a longitudinal study called the MTA study. That really determined medication stimulant medication is the gold standard treatment for ADHD.

It works for 75 to 85 percent of patients with ADHD with minimal side effects. And just to give you an idea of what it feels like for clients with ADHD because I know stimulants can be kind of scary for parents or for individuals. I asked my son when he had been taking his medication for about a month, I said, what does it feel like?

And he said, it feels like the eyes in my brain are open for the first time. What a great description. Yeah. [00:16:00] That’s our frontline approach is, you know, I’m not a big medication pusher. When people come to me with depression or anxiety, I assume you’re there for therapy. But when I do an ADHD eval, I always mentioned medication evaluation as a frontline approach and at least to consider it and then we also do treat with psychotherapy.

In our program, we, we have group psychotherapy for kids starting at third grade. And for adults, we also have a parent workshop where we educate parents about raising a child with ADHD, because it is different than raising a child without ADHD. You can also access coaching. For ADHD specifically, there are some great resources online that can hook you up with a coach. And especially with this online world, you can get a coach from anywhere. And coaches are great because, you know, they kind of come into your world and they’re really positive and they can help you achieve specific goals. But I always say education is really important if you have ADHD. There are some wonderful resources out there online.

There’s some great YouTube channels, some great podcasts where you can learn [00:17:00] about ADHD and just always be educating yourself because we’re learning more and more every year about ADHD.

Mindy, can you share some resources you can provide for individuals who have ADHD? Absolutely. ADHD is such an individual disorder that really researching for yourself and learning about the components of ADHD that you struggle with is the best way to go about that. If you are a YouTuber, a video watcher I recommend Jessica McCabe’s YouTube channel, which is called How to ADHD.

She has a fantastic team of researchers and her information is solid. There are some excellent podcasts on addressing ADHD through some of the advocacy groups. So CHADD which is CHADD is an organization that advocates for children and adults with ADHD in the United States. And they have an expert podcast as does [00:18:00] Additude magazine, spelled A D D I T U D E.

Additude magazine online is for consumers and they have a great expert podcast as well as lots of ADHD friendly articles that are easy to read, just a slide, the slides, you know, it’s it’s for the ADHD brain. And then of course there’s some great books out there. If you’re a book reader Ned Hallowell’s Driven to Distraction was my first book I read on ADHD.

And a great book for parents of kids with ADHD is Joel nigger getting ahead of ADHD. Set out to bring the newest science and research to parents because it usually takes a long time to get that information to parents through clinicians. And he’s actually doing a really great longitudinal study here in Oregon on ADHD.

So there’s just some, those are some resources that people can access. Thank you for sharing that wealth of resources. I much appreciate this, so thank you. And I want to say thank you for coming on and sharing your knowledge with us, and [00:19:00] we hope to have you on again someday.

Thank you so much for having me, Nikki. That was fun. Thank you.

Thank you everyone. For listening to Convos From the Couch by LifeStance Health, where we are re-imagining mental health. Please take care.