Ep 205: Making Sense of ADHD: Diagnosis, Treatment Options & Strengths with Shirley Hersko

ADHD is one of the most common concerns parents bring up—but it’s also one of the most misunderstood. What does ADHD really mean? How is it diagnosed? And what actually helps kids who struggle with focus, organization, or impulsivity?

In this episode of Your Child Is Normal, Dr. Jessica Hochman sits down with ADHD specialist Shirley Hershko, who brings both professional expertise and personal experience as a parent of children with ADHD. Together, they explore:

• What ADHD looks like in the brain (and why dopamine plays such a big role)
• Why girls are often missed or misdiagnosed
• How to think about diagnosis when symptoms feel “subjective”
• Medication vs. non-medication options—what parents should know
• Practical behavioral tools and environmental supports for kids
• How to reframe ADHD as not just a challenge, but also a source of creativity, empathy, and resilience

Resources & Apps Mentioned in This Episode:

• Google Calendar
   – for scheduling and time management
• Trello
   – for visual task management and organization
• MyHomework
   – homework planning app to keep assignments on track

Book & Website:

• ADHD Is Our Superpower: The Amazing Talents and Skills Behind the Symptoms by Dr. Shirley Hershko 
  
  
• Learn more at drshirleyhershko.com

Whether you’re just starting to wonder if your child may have ADHD or you’re already navigating daily life with it, this conversation is full of insight and reassurance.

Your Child is Normal is the trusted podcast for parents, pediatricians, and child health experts who want smart, nuanced conversations about raising healthy, resilient kids. Hosted by Dr. Jessica Hochman — a board-certified practicing pediatrician — the show combines evidence-based medicine, expert interviews, and real-world parenting advice to help listeners navigate everything from sleep struggles to mental health, nutrition, screen time, and more.

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Instagram: @AskDrJessica and Tiktok @askdrjessica
YouTube channel: Ask Dr Jessica

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Transcript

Unknown: 0:00

Hello listeners. This is Dr Jessica Hochman. I'm excited to share that I am now booking sponsorships for your child. Is normal for this fall. If you have a product, service or a message that you think our listeners would benefit from, whether it's for parents, kids, health care or family life in general, this could be a great opportunity. You can find details on how to sponsor by checking the show notes. Just click the link that says how to sponsor an episode, and I'll let you know for a good match and get back to you. Hi everyone. Welcome back to your child is normal. I'm your host. Dr Jessica Hochman, today we're diving into a topic that so many parents are thinking about right now. ADHD, it's one of the most common concerns I hear about in pediatrics, but it can also be one of the most confusing. Parents often wonder, What does ADHD really mean? How do you know if your child has it? And most importantly, what actually helps? My guest today is Dr Shirley hirschko, a clinician and ADHD specialist who not only works with families in her practice, but she also has personal experience raising children with ADHD. What I truly enjoyed about my conversation with Shirley is that her perspective blends both science and real life strategies, whether you're wondering about a possible diagnosis, struggling with day to day parenting challenges, or you just want to better understand how an ADHD brain works. I think you'll find this conversation practical, useful useful and reassuring. And also, be sure and check out the show notes below. I link some of the tools and apps that she mentioned in her conversation to help kids with ADHD stay better organized. Also, thank you so much for tuning in. I know your time is valuable, and I really appreciate you being here and listening to your child is normal. I want to take a moment to tell you about tiny health. Tiny health is the first and only at home microbiome test designed specifically for kids. So as a pediatrician, I'm often asked, Should I give my child probiotics? And if so, which one? And the truth is, everyone's microbiome is unique. So without testing, it's nearly impossible to know what your child may actually need. So that's where tiny health comes in their Easy at Home test gives you a clear snapshot of your child's gut microbiome, and you'll get back personalized science based recommendations. The results help you know exactly what supports may be helpful, and sometimes you'll find that your child doesn't need anything at all to try tiny health for your family. Go to tinyhealth.com and use the code. Dr Jessica, D, R, J, E, S, S, I, C, A, for an exclusive discount. Hi Shirley. Welcome to your child as normal. Thank you so much for reaching out. I'm so excited to talk to you about a very pertinent topic that comes up a lot these days. ADHD, thank you. I'm so happy to be here. So tell me what drew you to specialize in ADHD, okay, so my interest in specializing in ADHD began with a combination of professional and also personal experience. Early in my career, I worked with both children and adults, sparking my curiosity about ADHD, and over time, my passion grew into expertise as I witnessed the profound impact of proper ADHD support on people's lives, and you said you have personal experience with ADHD, who in your life has ADHD, and how do you think that's influenced how you've looked at ADHD? So my husband and also my three daughters have faced the daily realities of ADHD challenges, with the focus, with the impulsivity, organization and also emotional regulation. So my work became less about labels and more about collaboration and understanding, and it is a personal mission, my clinical training, research and family life inspired me to add vote my career to making sense of ADHD, bridging scientific knowledge and also life experience in everything I teach, write, share everything. So now the term ADHD gets used a lot. A lot of people are self diagnosing or they diagnose others. Can you explain in simple terms, what exactly is ADHD? Yeah, of course. ADHD is another developmental condition characterized by persistent patterns of inattention, hyperactivity and impulsivity. It affects functioning in various areas of life, making tasks like organizing, focusing and regulating emotions more difficult. It's not just being distracted or very active. It's a complex disorder that impacts millions of children and adults worldwide, and I know that there's not an actual genetic marker or there's not a medical test that you can run that says yes or no, somebody has ADHD. So can you explain from a neurologic per. Perspective, what exactly is happening in the brain of somebody who has ADHD? Do we see it light up in certain areas? What does the brain of someone with ADHD look like? ADHD involves differences in brain structure and function. Neuroimaging studies show that certain areas, especially the prefrontal cortex and also basal ganglia and networks involved with executive function look and operate differently in people with ADHD. These areas are responsible for planning, impulse control, attention regulation, and also working memory. So one of the key factors in ADHD is how the brain manages dopamine, the neurotransmitter that plays a major role in attention, motivation and the brain's reward system and in ADHD, dopamine pathways tend to function less efficiently, and making it harder to sustain efforts or focus on non stimulating tasks. This is sometimes described as the brain seeking stimulation, because dopamine transmission isn't optimal. For example, in fMRI scans, we see people with ADHD often show less activation in attention and inhibition related areas when performing routine or boring tasks, but may show dramatic spikes in activity when something is highly engaging. This explains why someone might hyper focus on video games but struggle to finish homework. So describing ADHD in simple terms, it's a lifelong condition affecting how your brain manages focus energy and self control and can be managed with the right understanding and support. Of course, when you mentioned the video games and how kids with ADHD can hyper focus or sustain attention with video games, that puzzles a lot of parents, so that's interesting, how you describe the effects of dopamine and how that allows them to hyper focused in certain areas. Now, the diagnosis of ADHD is something that I find interesting. Can you explain how is ADHD officially diagnosed? Of course, diagnosing ADHD in children and adults is a multi step process. I rely on detailed interviews and the rating scales that map symptoms across settings like home, school, work, there's no single blood test, like you said before, or brain scan diagnosis comes from observing behavioral patterns and reported history rather than laboratory findings. Now, honestly, what I find so interesting about this is I've looked at that questionnaire many times, and sometimes myself. I wonder, the test that we offer feels so subjective. So how do you, as a clinician and somebody who diagnoses ADHD, how do you handle the subjectivity of the diagnosis, subjectivity is an inherent challenge. You are very right many diagnostic questions like, do you lose things frequently seem relatable to many people, especially in today's fast paced world. Like you said, I address this by probing for severity. How much does it interfere daily, also by chronicity? Has it persisted six months or more, also by settings? Does it happen both home and at school and developmental expectations? Is it above what's typical for age? So gathering input from multiple informants, parents, teachers, partners, maybe it helps to make this diagnostic procedure really accurate. I think that's very helpful, because it's true that when you look at each question on the diagnosis scale. Just like you said, all of us can probably think of examples where we've lost things, our kids have lost things, or misplaced things, where we feel like we're running late, maybe easily distracted. So thinking about the chronicity, how long it's lasted, how severe it is, it's more than just the questionnaire. Beyond that, you have to probe, ask questions, dig deeper, because so many people read these questionnaires online and they're diagnosing themselves, and it's not necessarily an accurate diagnosis exactly. I also like the point that you brought up, that in order to truly have ADHD, we find that the symptoms are not just there at home, they're also there at school, because so often I talk to. Families where they wonder about their child at home, they don't listen. The parents say, can you do this chore? Can you do your homework? They're easily distracted. But then you ask them, how does the teacher feel about the performance at school? And if the teacher's saying they're fine, they're a good student, they're paying attention, the diagnosis becomes less likely. Exactly. It's very important. I just wanted to throw that out there for anybody listening who's thinking, Oh, my kid may have some of these symptoms. You definitely want to find out. How are they doing at school. So now, another common concern that I hear from parents is that there's a lot of girls that slip through the cracks of an ADHD diagnosis, and this is because girls tend to be more of the inattentive type compared to boys, who tend to be more of the hyperactive type. Can you explain why do you think girls get missed? Do you think people aren't aware of the symptoms? What do you think a common reason why ADHD gets missed in girls in particular, ADHD is often missed, especially in girls, like you said, because the symptoms don't always match the classic picture, girls may show less external hyperactivity and more internal inattention and the social expectations can mask their struggles away. Common reasons for misdiagnosis, they include compensatory experience high intelligence or the presence of anxiety or depression that overshadows attention issues. That's interesting. I agree with that people that are smart, they may overcompensate, so you might not notice, because they may be doing well in school, for example. And I also agree some of the symptoms of anxiety, you're fidgeting, you're distracted, there's some overlap. So absolutely that makes sense, that those kids may get overlooked Exactly. We group these symptoms together under one lump, ADHD diagnosis, the kids that are both inattentive primarily, and the kids that are hyperactive. I've often wondered if it would serve them better if we thought about them separately, because they're so distinct, in your opinion, why or why not? Should this be lumped under one diagnosis? Okay, I think it's important to recognize that ADHD actually manifests in two main types, one with hyperactivity and one without, often called the inattentive type, the core change of attention difficulties is common to both types. This shared foundation justifies grouping them together, even though the presentation can look quite different from person to person. Also the treatment is similar and their brain function is similar, so this is why they're together. But you are right, it looks really different when we see them in a daily life. All right. So now the next question I have for you regards treatments for ADHD. Treatments are something that a lot of parents are puzzled about, to treat with medication or not to treat. So in your opinion, when it comes to treatment, what are common questions that you hear from families that are hesitant about medication? Why or why not? Should they consider this as an option when families hesitate about medication? And I can understand it, and medication may offer significant benefits, but it's only one piece of the treatment puzzle. I respect family concerns and never pressure them. Instead, I lay out evidence on efficiency, side effects and alternatives, emphasizing that the decision should be informed and individualized so to decide when medication is appropriate, I consider severity distress and impact of functioning if symptoms severely impair learning relationships or self esteem and behavior strategies aren't enough. So medication might be the next step, but if families prefer starting with the non pharmacological tools, so we begin there and often with noticeable gains, I think that sounds very reasonable. Now my next question for you is, besides medication, this is something that I would love to learn more about from you, because I do meet a lot of families who are understandably hesitant to start their child on stimulant medication. Besides medication, what are some behavioral tools, some environmental tools that you can recommend to families? I recommend cognitive behavioral therapy, CBT. It really helps change thinking and actions. Teaching skills for impulse control and organization, also parent coaching. This is very important, in my opinion, because it really helps the parents to know how to behave with. The children. Also, mindfulness and sports are powerful tools for managing stress, improving attention. Sports builds social skills and self discipline, mindfulness, exercise and also coping and also, the research found these are the best treatment after the medication. These are great tools. These are great recommendations. But I just want to ask you a little more specifically, when you say cognitive behavioral therapy CBT, can you give an example so parents can understand a little bit more what CBT means exactly. Okay, so CBT is supposed to change the way we think and also the way we behave. So it really gives you tools, how to behave, how to do things, if it's organization or time management, it's very practical. It's not just talking about it, and it's not a long treatment. I like hearing that it doesn't take a ton of time, because I think that's just very realistic with today's busy parenting schedule. Exactly now with parent coaching, I like when you mentioned parent coaching, because I do find that the more that parents understand how a child's brain works, with ADHD, how to know that it's not personal, that when a child acts in a certain way, it's not the fault of the parent. I think coaching a parent sounds like it would be a very helpful tool. Exactly, I agree. And then you mentioned mindfulness and sports. I couldn't agree more with sports. I find so many kids that have ADHD symptoms. They thrive when it comes to finding a sport that works for them. One of my favorite examples is Michael Phelps. I know he was diagnosed with ADHD, and his mom found the pool, and next thing, he was swimming three hours a day, thriving at it, and it was a way to really harness his symptoms into a very positive outlet for him, exactly no he was actually an obese child. Wow. Okay. And then I love talking about the non medication strategies, because even if a kid is on medication, medications don't solve all the problems, the medications don't last all day, and parents often get frustrated because they're so distracted. What are your top behavioral management strategies to help kids manage their distractibility, their procrastination, their inability to focus on questions that are asked of them. Do you have any top strategies to offer parents? Yes, of course, for families seeking alternatives. I think there are several top behavior strategies that help manage inclusivity and distractibility and procrastination. First, break tasks into small steps with clear visual cues, use checklists timers so kids can focus Mark progress and avoid overwhelm positive reinforcement like reward charts for specific behaviors, builds motivation and confidence, also building routines that work for ADHD kids, for example, a bedtime routine might include a visual checklist, maybe brush these pet school bag layout clothes and gentle points to keep things moving and so for the executive functioning tools, I like the visual schedules posted on the fridge and drop zones for school materials can also help. What are drop zones for school materials. Can you describe what that is? It's like a special location for the things you need to school because of the organization problems I see. So this is the area of the house where the backpack goes and the homework goes. This is where we're going to put your clothing. This is where your school lunch will be. That makes a lot of sense. My kids don't have ADHD, but my youngest has a whiteboard in her room, and she does have a checklist of homework and bedtime routine, and she loves it. I think visually, it's really fun. She makes it colorful, and she puts a check after She brushes her teeth, she puts a check after she puts her clothes out for the night before, a check after taking a shower. So I do think for any parent listening, having a checklist can be a really helpful tool. Yeah, amazing. It really helps. What do you think about bedtime? I think sleep is so key for all kids. Do you find that getting a reasonable amount of sleep makes a big difference? Yes, but we know that with ADHD, many problems with sleeping. They have hard time to go to sleep and to fall asleep. So we need to help them, because of course, it will influence the attention difficulties. I also find that they wake up so early in the morning, and I'm not sure why that is, but parents will ask me, Do you think this will ever change with. Ever sleep past 6am in that situation, what would your advice be? I tell parents to try to get their kids to bed as early as possible. Yes, sometimes it's actually impossible to get an ADHD child to bed early. They have really difficult time to fall asleep, but can teach them to be alone with it so they won't need to interfere with your evening or with your morning and like maybe read a book or do something on their own. Because we need to realize that ADHD goes along with the difficulties in sleeping, but it can get better, but not always. Yes, and I do think there's a little bit of a chicken and egg that I find often happens because kids with ADHD, they seek the stimulation of screens, and a lot of kids, in general, on screens. But in particular, kids with ADHD, they gravitate towards the screens. They stay on them for a long time, then their brain is stimulated after the screens are turned off, and I think it's harder for them to go to sleep. So I think this is a tricky scenario, because on one hand, the parents, the kids, they like being on the screen, so they tend to stay on them. But then it also can backfire when it comes to getting sufficient sleep. Yeah, I agree now, and you had mentioned in your book some apps that are available, or some technology tools that might help kids with time management and organization. Can you describe some of those for parents listening? Yeah, of course. Apps can make a huge difference. Sometimes. My favorites include Google Calendar and also Trello for task management, for homework planning, apps like my homework keep assignments organized so it can help the children to be more about things. Those are great suggestions. I'll link those in the show notes below, so that parents can have an easy reference to remember what those apps and tech tools are. Now you had mentioned at the very beginning of our interview, that in your family, you try to reframe ADHD, not thinking about it negatively, but really trying to emphasize the positives, the creativity, the empathy, and I think that's great, because I think ADHD can be really difficult for kids and for family life, but if we can refocus these symptoms into the positive, I think that's better for everybody. So do you have any advice for parents to help kids leverage these strengths, these strengths of ADHD? Of course, ADHD brings not just challenges, but real strengths, I think, creativity, empathy, curiosity, and out of the box problem solving so parents can help kids by naming, celebrating and integrating them into daily life. I recommend share stories of successful people with iDSP like Michael Phelps that you mentioned before, and also discuss why your ideas are special. Also support interests and let kids teach others about their favorite topics. And if parents can help children see themselves as talented, resourceful and capable they fulfill not just success, but well being confidence and lifelong self acceptance. I think what you're saying is 100% true. And so if you can focus on a child's interest and really let them flourish, I think that's a really helpful way to think about raising kids with ADHD, because if you're just focused on the negative aspects, that doesn't feel good, and that's not a fun way to go through life. And while, of course, ADHD has its challenges, there's no denying that if you can focus on the good and what someone's own personal strengths are, I think that's a very important, big overall message to give to your child. I agree, and it's very important say, and that's interesting, that you say that kids with ADHD have a unique talent at problem solving, and I wonder if that's because it's more of a survival skill, learning how to think outside the box. Yeah, exactly. It's a survival skill. So the difficulties can be also benefits sometimes. Now, do you find as a practitioner who specializes in ADHD. Are there some big misconceptions that you wish more people understood? Yeah, many believe ADHD means lazy or a bad kid or bad parent. So I wish more people understood that ADHD is a real brain based condition that's highly treatable and with the right strategies, can be a source of both connection and joy for families. Actually, I wrote my book Making Sense of ADHD so people really can understand it. What you're saying really resonates with me. It's easy to feel down. About a diagnosis, to feel down about a label, because the truth is, nobody wants to think that their kid's going to have a harder life. But I do think it's true that from struggles can come a lot of positive and I think this is a very good example of that. I agree. So for parents listening who are wondering, maybe my child has ADHD, what is the first thing you'd want them to know? I think my first advice is observe patterns over time and in different settings. Occasional attention problems don't mean ADHD, but persistent, disruptive patterns at home, school and with peers might So trust your instincts, but sync input from teachers and health professionals if needed, okay, reach out to your pediatrician and reach out to a therapist. Reach out to people in your life that may have some expertise. That's a good starting point, absolutely now for families that are already living with a child who has ADHD, can you offer maybe one small, practical piece of advice that they can do today to make their life easier? Yes, of course. One practical tip is to simplify all things. Pick one thing to make easier today, small, consistent tweaks, move the needle over time. Don't aim for perfect. Aim for better. Fantastic. Well, thank you for coming on, spreading awareness, offering tips, offering solutions for families, and I wish you the best of luck in your mission, continuing to help people understand ADHD and in turn, improve their life. So thank you very much. Thank you very much, Jessica. Thank you so much for listening to your child as normal. I'm so grateful you're here and part of this community. If you're enjoying this podcast, it would mean the world if you shared an episode with a friend subscribed and left a five star review. And don't forget to follow me on Instagram at ask Dr Jessica for more parenting tips and updates. See you next Monday. You.