ADHD Uncovered: An In-depth Discussion on Impacts and Management Techniques

What if we told you that ADHD is far more complex than just behavioral disruptions? In this part-1 of my discussion with Kim Zahlaway, I ask her specifically about ADHD and how that can be a misunderstood disorder, how can we distinguish between anxiety and ADHD and the spectrum of ADHD.

Let's broaden our understanding together, as we sit down with mental health therapist, Kim Zahlaway, to delve deeper into the intricate world of ADHD. We shed light on how this evolving perspective allows us to recognize ADHD in children without hyperactivity, and discuss the anxiety that is often synonymous with this disorder.

We pivot our conversation towards rejection sensitivity, a concept that is largely overlooked in discussions about ADHD. Kim guides us through how the intensity of emotions, combined with unique brain wiring, can contribute to feelings of social anxiety or rejection. This is not just about understanding the realities of ADHD, but also about addressing the impact it can have on social relationships. Together, we'll discuss the common signs of learning differences and the struggles teenagers with ADHD face in maintaining friendships and dealing with anxiety.

Lastly, let's talk technology. Kim shares with us practical tips for parents on setting boundaries and expectations around their children's device use. Discover how technology can actually help regulate emotions for younger kids and promote self-awareness in teenagers. This episode is packed with expert advice, innovative perspectives and a wealth of resources for parents helping their children navigate life with ADHD. Do not miss out on this enlightening discussion!

Bio:
Kim Zahlaway is a Licensed Clinical Social Worker and founder of U Got This Counseling Services, LLC in Berwyn, PA, providing children, adolescents, and adults counseling services for over 25 years. In addition, Kim offers Parent Coaching sessions to parents of kids of any age and Life Coaching to young adults through her Young Adult Transformations Coaching Services. ADHD and Anxiety, and their impact on school, family, work, relationships, daily life, mental health and life’s transitions, have become Kim’s areas of expertise. 

 Utilizing a strength-based, individualized approach to support the social, emotional, and cognitive well-being of her clients, Kim has developed a three-phase treatment model called S.D.E.P.S. through which she engages clients of any age in a process of Self-Discovery, Empowerment and Problem Solving.  Kim’s training and treatment orientation includes CBT, Mindfulness-based cognitive and behavior therapy, Family Systems, Integrative, Humanistic, Attachment Theory, Relational and Solution Focused Therapy.

Kim also provides consultations and presentations to parent groups, community organizations, educational settings, and professional organizations on topics relevant to raising teens in today’s world including anxiety, parenting and the use and impact of technology and social media.

 Resources:

1. Chadd.org
2. Additudemag.com
3. Inattentive ADHD Coalition - www.iadhd.org

Transcript

Speaker 1: 0:01

Hi, kim, welcome to the podcast. Thank you so much for your willingness to talk to me about such an important issue that we are seeing more and more with you know teenagers, young adults, but also I'm kind of seeing it more and more younger in my practice, and so I'm really excited to talk about ADHD, which kind of gets goes unnoticed at times and sometimes we are hyper vigilant about. You know what that means for our kids and us. So I'm excited to have this conversation with you and before we kind of get and dive into ADHD, could you tell us a little bit about how you came to be a mental health therapist?

Speaker 2: 0:56

Sure Hi, thank you so much for having me here to talk with you today.

Speaker 2: 1:00

It is such an important topic and and is becoming, I think, more and more evolved in terms of our understanding and the research, and the more I think we understand the brain and the neuroscience behind ADHD, I think, the better able we are to recognize it and understand how to work with it and help people learn to live, you know, really successful and happy and fulfilling lives with ADHD. I came into the field through working with children always. I've done it in different settings. I've worked in schools and I've worked in community mental health centers as well as in private practice, and I started my interest working, working my way through college and several majors till I realized that, you know the calling was there to to work with children, teens and families, and so I started off in Boston working in a mental health center and then found my way into public schools and private schools and alternative education settings, and so I really got to experience children in various home and school school settings and the different ways that they take and operate and the challenges that they're facing and managing.

Speaker 1: 2:35

Yeah, and I'm sure after COVID that has kind of become more prominent, especially in terms of teens and adolescents struggling so much with different issues, especially when it comes to school, because a lot of our attention is focused on how they are doing academically right. So in kind of working with adolescents and teenagers for such a long time, are you seeing something, especially after COVID, that kind of resonates with you that you would sort of you would say, okay, this is something kind of more evolved or I'm seeing more in my practice?

Speaker 2: 3:21

Well, I think that you know it's important to integrate the COVID effect on on every everybody, all ages. You know what age people were when COVID hit and and what were they missing sort of relative to typical pre COVID life and development. So I think you know what I see now is, you know, is a long reacclamation process for some kids. I think there's a lot of anxiety going back to school, for example, some deficits in academic skill attainment. Family dynamics are a big part of that, and then, of course, technology, because that's what kids had to communicate with, to entertain themselves with, to to cope with. So I think probably that had you know what might be a standout area.

Speaker 1: 4:27

Yeah, and I mean, even in my own practice, I'm seeing more and more anxiety, more and more depression, especially with teenagers. How would you kind of you know kind of shifting gears here a little bit? In your practice? You've been seeing a lot of kids with ADHD. For our listeners, would you kind of explain what ADHD is and you mentioned something earlier on in terms of it evolving, and so what does that look like? What does that mean?

Speaker 2: 5:07

Sure, sure, I mean. I think the the way we are identifying and the way that ADHD is presenting are are different. I think as language evolves, we understand how to observe and what behaviors to observe a little differently. Research informs that, and so I think the main shifts have been that ADHD, you know, used to really be identified through three main factors in attentiveness or distractibility, hyperactivity and impulsivity. And I think now what we're coming to understand is that the predominant features of ADHD are really a hyper focus and an interest based brain, emotional arousal and emotional regulation, self regulation and rejection sensitivity, and I think we're seeing the worst. What that's allowing us to see is the prevalence of ADHD not just as a behavioral interrupter at school, but as as understanding the root causes, and also it helps us to identify girls or people or boys with, without hyperactivity, and so it's not just about the boys who can't stay in their chairs or who are aggressive on the playground or who have disorganized lockers or backpacks or aren't turning in homework.

Speaker 2: 6:44

It's really about you know understanding what's causing some of these behaviors and that so many kids and teens and adults struggle with some of the roots of ADHD that we just didn't really understand before, and a lot of that looks like anxiety and that sort of segues into how I think that some of the increases in rates of anxiety in kids is really understood through the perspective of ADHD as well.

Speaker 1: 7:20

So so much to unpack there. Honestly, I tried writing down all of my follow up questions, but I'm lost a little bit, so I'm going to kind of go back to what you were saying initially in terms of sort of even the language evolving right. So could you talk a little bit to what again? What does that mean? How is that language evolving?

Speaker 2: 7:48

Sure. Well, again, I think you know, instead of looking at just a behavioral, the behavioral representations, as a way to observe or identify ADHD, I think what we can, what we're, by understanding ADHC through this new lens of more around self-regulation, we can use emotional language in a different way. So, instead of just identifying behaviors or external representations of a brain that's impacted by executive functioning deficits or again like an intraspaced brain, like that, that discrepancy we see between why can my child spend five hours on one task or one Legos or video games or talking with friends but not spend 20 minutes on something that they're not as interested in or not as motivated by, and so by understanding this, we have the language to be able to talk about. What are our kids strengths, what are their challenges and how do we work with that? And what might the challenges and strength profile tell us about what our kids might be struggling with when we're trying to discern between things like anxiety or ADHD, or learning differences or social?

Speaker 1: 9:12

issues. Yeah, no, that makes such a lot of sense because a lot of times I feel like, as parents as you know, parents who are trying to motivate their kids to do the best that they can we end up sort of focusing on what they cannot do or what they cannot achieve, and a lot of times it is that, oh, if you are good at, for example, math, then why are you not doing great at English? So it's, I feel, like it's such a natural way of focusing on what we, even ourselves, are not being able to do, but then also focus on what our kids are not able to do or achieve, or, you know, whether it's emotions, whether it's behavior, right, and we're so.

Speaker 2: 10:05

I think we're all uneven learners.

Speaker 1: 10:07

Oh, I love that.

Speaker 2: 10:08

I think that's the beauty of humanity right that we're all uneven.

Speaker 2: 10:12

Our profiles, our interest profiles, our strength profiles and our weakness profiles are all different and that helps us to evolve into who we are here to be.

Speaker 2: 10:23

And I think that's true for kids too, and I'm not sure that it benefits children and or teens and young adults to try to even them out Right? I think it's. I don't. I think we have to address deficit areas and help them, you know, if it's impacting them in a way that helps them communicate better or understand their emotions better or perform better at something that they are wanting to do or need to do, right. But I think that it's okay, too, to be identifying the strengths and and along the way in cultivating the strengths and the interests, and particularly true for kids with ADHD and a lot of the young adults that I work with who are sort of struggling with who am I? What do I want to do? What am I good at what? Where am I heading? That kind of conversation isn't always familiar to them. It's like a new conversation to go oh wait, finding a job is about figuring out what I'm good at or what I'm interested in, and that's okay, I can do that, and you know I always encourage that.

Speaker 1: 11:36

That's, you know, that's the direction to go, especially when you're, you know, struggling to find that, yeah, and I, and to your point of sort of the interest based brain, I think it's again sort of to me it's so interesting that, as we focus on what our kids or even we are able to achieve or focus on right, especially with teens who are, who are struggling with ADHD, how do we as parents kind of differentiate between, oh, I love doing this right. And versus okay, this is not my strong suit, so I'm not going to focus on that Right? How do you kind of even decipher whether it's okay, my kid is just not interested in something like this, or my child is struggling with something more and I need to help them, right?

Speaker 2: 12:42

I mean I think that we want to try to allow our children to experience as much as they can so that they can determine their interests. For some kids that comes very easily. They fall in love with a sport early on, or music or dance or art or animals, you know whatever their interest is, and they hold on to that and it's an anchor for them and we can build around that for them. They develop some social, their social life around that. Sometimes they develop their sense of competency and confidence by evolving in that thing that they love.

Speaker 2: 13:23

And other kids jump around a lot and that and I think sometimes that creates some anxiety and parents, you know they always change their mind. Or they want to do something different, or they're not sticking to anything, you know, or they're not. They don't seem interested in anything and that's compelling in some way and I usually encourage them to hang in there with them let them try different things, because for those kids it might not be about that particular thing.

Speaker 2: 13:54

It might be that what they're getting from the experience is social engagement or is, you know, an exploration that creates, that stimulates that interest seeking brain too. So it's, I think it's important to does that speak to your question. I think you know trying to help every kid find their flow is so important because it's connected to the essence of adolescence, which is the sense of belonging, and sometimes, with ADHD, struggle to find that.

Speaker 1: 14:26

Yeah, yeah, so I think part of what I was also getting at is how do we differentiate between sort of a teen who is, or a child who is not interested in something or is then hyper focused on, say, you know, building Legos and wanting a career and that eventually, but you know, is it the differentiation between sort of this hyper focus which could be ADHD? How do we know the difference?

Speaker 2: 15:07

Well, I think, when you're going to, when you're looking to identify ADHD, I think you might be looking at different, different things. I think you know the I think a hyper focus is a new word, for you know things kids used to like, or their passions, or the things that they were motivated to do, and so I think, as long as we're seeing kids who are motivated by something, who are growing through an experience, growing internally themselves and their own self awareness, and understanding and developing that.

Speaker 2: 15:50

Stick to it If, ness, that we want to, you know, seeing kids helping them to, I think, to persevere, you know, and to pursue next level of things, you know, whether that's so upping their game as they age up to, even if it's around the same area of interest, I think, is really those are, those are, I think, sort of you know, normal yeah, I don't know if that word, but like you know, natural ways of evolving for kids and so that's not in and of itself problematic, I think, if they get stuck and they're not socially developing along the continuum, the way that they the developmental pathway that they need to, or if it's in, you know, if it's an ostracizing interest, right, so they're not building social capital as they're continuing to

Speaker 2: 16:40

age through elementary, middle and high school. Those are areas that we would might look at and say, oh okay, like what else is happening here? Does this child need support in order to expand their interest or trying new things, or is anxiety interfering with this process in some way?

Speaker 1: 16:59

Oh, thank you so much for explaining that, because a lot of times I do hear parents sort of say hey, you know, these are some of the things we are noticing, and then, of course, professor Google has a lot of things to say about that. One of the other things that you mentioned sort of within the research that's coming up with ADHD is rejection sensitivity. If you could talk a little bit more to that, sure.

Speaker 2: 17:32

Sure, I think there's a lot more information about this. I don't know exactly when the word sort of hit the scene, but it's very prominent now and on social media A lot of times. The starting point for my work with teenagers, young adults and adults is what are you learning about yourself online?

Speaker 1: 17:56

Absolutely. What are you talking about?

Speaker 2: 17:58

yourself with right, but I actually think that there's a lot of parallels between rejection sensitivity and social anxiety. I think social anxiety is the more commonly understood term for what people who are experiencing rejection sensitivity are experienced. You know, are have no-transcript. You know, with rejection sensitivity you're talking about an intensity really, and the intensity is around the feelings we experience to feeling vulnerable to other people's perceptions of us. So you know it's, how do we, how do we experience social rejection? How do how do we feel when we're not invited to the party? Right, that's like in all ages experience you know, For for children, for high, for teenagers, for adults.

Speaker 2: 18:56

When we are not included, we are left out, and feeling left out feels differently to different people, and how people cope with that feeling I think has a lot to do with prior experiences, how we understand ourselves, our Ability to bounce back, but it also has to do with our neurology and how our brain is wired in terms of the intensity of emotions, and so there's an unmatched experience and a mismatched experience between what happened and how it's making us feel about ourselves, and I think that creates inhibition. That creates the, the anxiety about going, putting yourself out there socially. It creates a lot of anticipation, anxiety about Upcoming events that are in the social world, and I think that that's why we're seeing a lot of more Diagnoses of social anxiety, because it's a lens that we can understand this and we're in a lot of the Clinicians that are working with kids with social

Speaker 2: 20:09

anxiety or groups that are focused on social anxiety are hitting it through a cognitive, behavioral lens, because you're really working on. You know, the self regulation of our emotions comes from how we change, how we think about a situation. Does it really mean we'll never be invited again to this thing? Does it really mean I'm totally unlike? They talk about me, they don't want me around, that? Or could it mean their parents said they can only invite so many people, or that you know they didn't think that I would want to be there, or that they they had to.

Speaker 1: 20:49

You know the all the other reasons that you know can be used that that don't mean the personalization and the intensity that the person experiences with rejection sensitivity so if I understand correctly that since we I mean the brain is wired differently for different people, but especially with Sort of a diagnosis, with ADHD, that intensity in terms of Rejection is much higher, or it's again a spectrum over?

Speaker 2: 21:30

Well, I think there's a spectrum, but I definitely think that there's an intensity. Right, we used to say my, you know my child's sensitive right. The sensitivity, and I think what we're Experiencing is that there's, you know, an internalization of pain, physical pain, emotional pain, social rejection. That hits differently for kids with ADHD, you know it's. It could be that you know there's the sensitivity to tone of voice for kids with ADHD.

Speaker 2: 22:03

You know what a parent changes their tone in response to a situation. Maybe it's a consequence for something that happened or a seriousness of tone, and the child Experiences it as you're yelling at me. Why are you yelling at me? Why are you talking to me in that way? There's, so there's a sensitivity, or appear brushes past you, you know, in the hallway, and and brushes against your arm, and the description from the child who was brushed is you know I got punched in the hallway or somebody almost knocked me over. You know there's. There's this discrepancy between the experience and the, the external experience and the internalized experience, and on the emotional Level, I think that that's where it's really becoming clear that it's. It's the way that is a systemic experience and how the body is experiencing the level of pain around the incident and then it pairs up with executive functioning and that emotional arousal piece.

Speaker 1: 23:11

So I'm also wondering how it is different from anxiety, because a lot of sort of and and you mentioned social anxiety, I'm wondering sort of anxiety beginning in in the body, right, and Kind of similar to what you was saying in terms of you know Someone brushing against you and if you're, if you are a person who experiences anxiety, might experience that heightened Emotional state or cognitive state. How is that different in terms of someone who has ADHD and, may I say, versus someone who has anxiety or then is, are those two kind of Linked in certain way, right, right?

Speaker 2: 24:04

Yes, I would say that almost anyone who has ADHD Experiences anxiety, but not everybody with anxiety has ADHD, and some of the differences there are the the executive functioning parts, and they are executive functioning.

Speaker 2: 24:22

I mean, that's a whole topic in and of itself, but that's basically, like you know, the office manager in our brain that's responsible for planning and organizing and managing time or tasks, and also for managing our emotions and regulating our emotions and figuring out how to respond to things or how to feel about things. So I think that kids with ADHD are Trying hard to figure out what's expected of them at any given moment, which creates a lot of anxiety, and so I think that it is very similar in that regard that that creates a sensitivity to. You know who am I, or how do I meet the moment, or what's what do I need to do here, or I'm being told again that I need to do it differently, which means I'm not doing it right, and how does that feel. And you know how do I be me. You know and also fit into some of the expectations and norms in the school environment or in my family or in social relationships.

Speaker 1: 25:35

Yeah.

Speaker 2: 25:35

Yeah, do you? I think it's really rooted in that. You know it's rooted in the same place the executive functioning organizing yourself around your emotions. And that's what anxiety is about. To write how do I learn to be comfortable being uncomfortable? Because a lot of things make me uncomfortable and those things are my thoughts about experiences I'm having. And so if I can learn to work with my thoughts on those experiences, then I can learn to calm my body and my anxiety and navigate that the situation in a success way or meaningful way. But our lives don't always allow for that process to slow down.

Speaker 2: 26:24

So people and brain ADHD, brains move fast and so it's, you know, a forward moving experience. So that's one of the differences, because anxiety sort of slows us down, it creates that pause like, well, I don't know if I want to do this right. No is safe. If I say no to this, then I know what's going to happen. If I say yes, I just opened up the door to all this uncertainty and now I have to see how I'm going to feel about it and figure out what's going to happen. I feel more vulnerable.

Speaker 1: 26:57

Yeah, oh, that's such a good differentiation, sort of with anxiety. Yes, you're pulling back with ADHD it's more like you're pushing forward, at the same time feeling kind of confused about how you're feeling, right, right, do you think that there or is there sort of a difference when it comes to teenage years? Because, like you've mentioned before, with sort of identity and who am I and how am I doing this, and the intensity sort of developmentally in teen years, existentially, I mean, teenagers are going through a lot developmentally, harmonially, that going through a lot, but then through an ADHD, do you have you in your practice, in your research scene, that there is something more that we are looking at or something different we are looking at during those years perhaps?

Speaker 2: 28:03

I think that things I would say it like it can catch up to you then right. So I get a lot of young adults or adolescents who have never, where ADHD has never been addressed or questioned before, and a lot of what I hear when I'm sitting with them is a lot of anxiety. The difficulty concentrating over long periods of time, trouble maintaining friendships, perfectionistic, perseverative, overthinking a sadness, not understanding a lack of understanding of themselves and why things aren't working.

Speaker 2: 28:54

What they're, a mismatch between what they're doing and the outcomes that they're seeing in their own lives and I think, and also a mismatch, academically, putting in a lot of effort but not getting the outcomes that they're hoping for because their strategies maybe aren't working with their executive functioning deficits or challenges. So I think I see a lot of whereas younger kids, it's more parents concerned about kids behavior or socialization. And I say like oh, you've just found your family's pacer.

Speaker 2: 29:40

Now, every family sort of has a pacer, and like this is your pacer. You know they're either slowing you down and you're a fast moving family, or you want your slower moving family and they're full steam ahead, and you know. So how do we work with the family around some of that? Whereas for adolescents I think because their internal world becomes so much they're dialed into it in such a different way as an adolescent they're not always talking about everything that's happening. You're not seeing them acting things out, although for some adolescents.

Speaker 1: 30:20

We do see a lot of acting out.

Speaker 2: 30:22

So it kind of depends on the presentation, but I think that there's more questions that they're asking about themselves and a lot of times what it's how it's coming out is depression or anxiety. That's why it's so important, I think, as parents with adolescents, to really pay attention to changes. It's the changes that we're going to that are going to tell us that something's going on, when they're not telling us exactly what's going on.

Speaker 1: 30:57

Yeah, and as you were sort of mentioning the behaviors and the emotional sort of aspect of ADHD for teenagers, I am also thinking about how, as parents, we are reacting to that. Right, Because a lot of times we don't really understand what ADHD means to, especially during teen years for our teens. But also, if we haven't experienced that, we don't know how to be. How do we sort of help them right with what's going on, without getting frustrated, frustrated ourselves? Yeah well, yeah, right.

Speaker 2: 31:49

Right, yeah, I mean, I think that you know. First we're looking for their frustration, their anger, their reactivity, because that's the tell, or quietness, withdrawal, isolation, because that's the tell that things aren't working the way that they thought that they were. And sometimes kids who don't have learning differences, but do you have ADHD and maybe don't know that they do. Yet They've experienced school very easily and we're trained as parents to look at school as the indicators of a problem and so, but they're not having academic issues until they're getting into later, middle school and high school, when they're really being asked to draw upon their executive functioning and things just aren't working as much.

Speaker 2: 32:38

Or hormones come into play and they're, and they're, so they're, they're more reactive or more emotional, or and so when, when it's when they're putting in the effort and they're saying I'm doing all these things and it's not working, that's when we know we have some bigger questions to be asking, that maybe they, they only know what they know, and so they're doing their job by letting us know whether they're acting it out or talking it out or voting it out, and hopefully we can pick up on those changes and use that as a way to say you know, I think we need to figure out more about what's going on. Maybe you need some specific help with study skills, maybe you need to. You know, talk through understanding what this is. Maybe we need to have an evaluation to better understand. And sometimes you know it's subtle and sometimes it's really obvious. You know, and so, if you know, schools tend to pick it up when it's, you know, failing grades, missing classes, work not being turned in lack of engagement in the classrooms.

Speaker 2: 33:57

But if just because it doesn't reach those levels doesn't mean that it doesn't exist and that it's, it's not a school problem, right, it's a life. It's not something that just shows up at school, shows up as we age up, more and more in our work, in our relationships and our self esteem and our confidence.

Speaker 1: 34:21

And that definitely something that I see in my teen clients as well is sort of that lack of confidence and struggling with making friends and having long lasting relationships, friendships generally. How are their friendships affected, especially because now you have a, you know ADHD, but now the underlying consequences of ADHD are that we see are also depression and anxiety a lot of times, and so in terms of their friendships, I'm thinking it's and it does get affected a lot. What are you seeing?

Speaker 2: 35:07

I think some of the themes are challenges maintaining friendships, difficulties in groups, so it might be a preference towards one on one relationships. They're a little bit easier to navigate, a little bit more predictable. I think that rejection, sensitivity plays in and anxiety play in because there may be inconsistency about how much about following through with plans or what they're feeling comfortable or able to do socially. So they may feel left out because they're saying no sometimes and so maybe they aren't being included. But the no is the anxiety in and so learning some skills for that kind of self regulation and coping and how to do that becomes important. And I think also the interest areas that can sometimes be different. So they can, there might not be, they may not necessarily stick with a particular group or interest or they are quick to leave or jump around when things aren't going well or meeting their needs.

Speaker 2: 36:29

There's some perspective taking challenges. I think understanding other people's experiences or emotions can be a challenge for social relationships as well. And I think the frustration, tolerance, sometimes, you see, you know quicker, quicker to move on or quicker to to give up or to make decisions you know in your best interest, versus the groups, for example, which you know they. That has its consequences sometimes, but also this is back to sort of learning what's working for your own child, and as a parent we're quick to react to things and often that's from our own framework or our own experience, and so there's such a tricky balance there between learning who our kids are and who we thought they were to be, or who we were we're nurturing them to be you know and yeah, they often, they often.

Speaker 2: 37:35

It often feels to the parents that I coach around who have kids with ADHD that they're they're the child that's not reflecting their parenting the most. That is a hard thing to reconcile. You know like we come to parenting with our own best interest. You know our own best intentions. You know we're doing the best we can.

Speaker 2: 37:59

There's tons of information out there, but we're still human and we're still who we are, and we've still never done it before so it's new to us and you know, and so sometimes that's what the starting point is oh my gosh, like I don't, I can't, I don't, I'm getting so angry. You know they're. They're not reflecting what my parenting they're, they're. They're speaking rudely, they're not following through with things, they they don't follow the rules. They're lying, or they're, or they're. You know they're full steam ahead. They're not sleeping. I can't get a break. I can't.

Speaker 2: 38:35

You know, or they're worried all the time, or you know all of these things that kind of put us at our at a stop as a parent to say okay, wait, something's going on here, yeah, and a lot of times I think we blame ourselves.

Speaker 1: 38:50

what am I doing wrong? Right, and that's one of the things that comes up a lot with parents of teens, because there's just so much going on at that time. Do you see sort of a gender difference when it comes to diagnosing ADHD?

Speaker 2: 39:15

Definitely. I mean, I think that's one of the more exciting areas of research right now. And I say exciting because girls have been suffering for a very long time with not by not being diagnosed with ADHD, because ADHD is loaded with strengths too right these are? You know these, this is not a doom label, you know, this is about you know, coming to understand yourself and you know and your interests. And for girls, I think the biggest differences are that there's more internalization of behaviors, there's more happening inside.

Speaker 2: 39:57

It's harder to see, and so the boys were the ones that were being were getting the diagnoses, because we were looking at hyperactivity and impulsivity, as we were saying before. I think for girls it's daydreaming and inattentiveness, feeling anxious or sad, kind of exhibiting maybe a silliness or an aloofness in their interactions with people, kind of trying to get by a little bit in situations. Acting shy is another one. Sensitive shy kids or girls trouble maintaining friendships. Perfectionism is another aspect of that. Picking like fidgeting and picking, being really talkative, interrupting a lot, not being able to listen to another person. So I think that those are some of the things that we see and I think what's happening with ADD and ADHD is that, you know, at one point we separated these diagnoses out attention deficit, hyperactivity disorder and attention deficit disorder. I think that was an indicator that we were on to something that not everybody with ADHD has hyperactivity. I think now the way that the DSM is set up, it allows us to recognize that those original attention grabbers, like the hyperactive kids or the impulsive kids, aren't the only ones that have ADHD. And so now we look at do they meet the criteria for hyperactivity, do they meet the criteria for inattentive type or do they meet the criteria for combined type? And there's actually even others too. The Amon Center has done a lot of work around ADHD subtypes and helping us understand that, and so that's benefited girls, because before all these things that we're talking about were just being labeled an anxiety.

Speaker 2: 42:10

But I, you know when you see the kids come in with anxiety, yes, they have anxiety, right, that's not a misdiagnosis necessarily. But if we're not asking why, where's the root of that anxiety? Sometimes anxiety is its own root, and we look at the sensitivity in things like perception and reactivity and we look at situationally and environmentally, where is this coming from? And genetically, where is this coming from? And other times it's rooted in things like executive functioning. You're so stressed out all the time that you're trying to keep up. You feel like you're different as a learner than anyone around you, and your MO is to hide that. You are creating a ton of anxiety and stress in your system and it's in it.

Speaker 2: 43:04

You're just trying to do the best you can with what you have. But if you don't understand how your brain works, how emotions work, tools for coping and and and slowing things down a little bit, sometimes medication has a job to play that is beyond the child or adolescent's ability. Right, that's how I assess the need for medication. Is there a piece here that, no matter how hard they're trying, they can't do? Then that's, you know. That's an important consideration. And family, you know dynamics too. It's very rare to have a child or teen or young adult sit in the room and be the only one in their family with anxiety or with ADHD. That is so true.

Speaker 1: 43:52

That is so true. We cannot talk about teenagers without talking about phones and screens. So one of the things that I have been sort of hearing and looking into is sort of screen addiction, sometimes getting misdiagnosed as ADHD, and in your sort of practice research, have you come across that, have you noticed that? What are your thoughts on that?

Speaker 2: 44:29

Well, you know again I bring it back to the neuroscience, the, the. The kids with ADHD, anxiety, depression, are vulnerable to brain chemicals like dopamine, serotonin, endorphins and more, and so I think technology really sort of creates an extra challenge for those kids. Regarding self-regulating technology, that can be amount of time on technology like video games and things like that, or YouTube, or it can be social media that there's, you know, there is that high level hit of dopamine that comes from scrolling or using social media or video games and all of those things, and so there's a susceptibility for kids with ADHD, for sure, or just based on the brain chemistry and how that works. So the way that sometimes I see that play out is tech for younger kids, for example, technology can sometimes be used to help entertain kids or to help parents get a break from things, right to a hundred examples. But what I, what I try to look at is how is there behavior before they use technology and compared to after? And so some kids actually can use technology as a way to calm down, to transition, to entertain themselves, and it's effective and it works and it, you know, it works for the family and that's okay when kids start being handed devices when they're feeling angry or agitated or frustrated, and they go into a zone while they're on it, but they come off in the same way, or even heightened then we know that that brain's not regulating through tech, through the technology, and so we have to use other means to help them learn how to regulate. And then technology can be used for, you know, socialization or and or entertainment or those other things, but we're also monitoring how their bodies respond to that.

Speaker 2: 46:57

For teenagers, I do the same thing with emotions, right. So I want you to stop and think about, before you start sprawling, how do you feel on a scale of one to ten. How do you feel about yourself? How do you feel about where's your anxiety? What was your day like? You know, and then, and then take your time and use your you know devices, and then how do you feel after?

Speaker 2: 47:22

So, just creating some self-awareness around. You know I hung up and all I did was focus on who wasn't with me or where everybody was on snap maps or you know who, what kind of response I got to a posting that I did, or how I feel about myself after I look at all these videos of other people. What information or misinformation, maybe that I've been getting from TikTok or YouTube or the videos I'm watching. So, adding some thought and some pause and some reflection, I think helps teach them how to be responsible users of technology, but also, you know, creating the limits and boundaries around it as parents, because kids can't do that yet until their brains really reach a certain point of development in the prefrontal cortex, and we can't. I think we have to be careful about expecting them to be yeah, you know, and and it's not a black or white world like they need the technology a lot of times, and especially as they get older, and it's and it's, you know, it's a it's a very complicated.

Speaker 1: 48:39

We could do a whole right, absolutely right, that the boundaries and kind of really it's hard to kind of have those boundaries with screens with our teens, especially because they're doing everything on their computers and on their phones right up until midnight. So it's a hard challenge sort of trying to figure out screens and where do we put those boundaries. One of the things that has really helped that someone another therapist had suggested, which I now kind of have my teens follow, is take breaks from screens, versus I'm going to take away your screen and so it's like a 10 minute break or 15 minute break. Go out for a walk, sit in the backyard, play with the dog, like those 10 minute breaks, and I think that really helps yeah.

Speaker 2: 49:44

I think for younger kids a good rule of thumb is you can't go from screen to screen so in between, using some device you have to because there's so many ways too.

Speaker 2: 49:54

It's you know that they're accessing or defaulting not not their fault, but they're defaulting to the screen. So I think, if you can find some rules right where you're not taking away and not and they evolve over time, you know. But, and you know, really the goal is we're trying to raise responsible users of technology because that's a part of your life and so you know, if we can get them to that point, and we need to do that through monitoring, through limiting, through questioning and conversation. You know, I think once you get to the age where you're allowing your kids to start with social media, you know, I think it's really a good idea for them to feel that sense of eyes on and and self-monitoring. Extra monitoring creates self-monitoring. So, and you know, inevitably you get the privacy pushback from teens. But you know, I think that there is legitimacy to the fact that it's not private. That's not that they're posting is private, nothing that.

Speaker 2: 50:58

So you know, so the last person you're going to keep it as private from is me, and if you're that embarrassed about what you're seeing or you're worried about it, then maybe you need to be thinking twice about it, or you know and but also like doing that with in a respectfully communicating way.

Speaker 2: 51:16

You know, not humiliating, not reading texts in front of kids, or you know, if you're going to monitor, you monitor from a distance the way we observe social behavior of our kids on the playground. You know you're informing yourself about how to parent your kids. It's we don't need to be involved in the play by play of all of our kids.

Speaker 2: 51:37

They're going to learn through their you know their social interactions among themselves as well. So we just want to have we want to try to limit the surprises or and be able to find any, you know big concerns yeah, yeah, absolutely.

Speaker 1: 51:55

Um, um, thank you so much for talking with me today. This was such, I mean, really really helpful um conversation, especially around ADHD, um, and so thank you for that. Um, I'm going to put some of the recommendations that you have for parents, uh, in terms of resources, in the show notes, um, and hopefully that will be helpful as well.

Speaker 2: 52:21

So thank you so much, okay thank you so much for having me. It's a big, big, important topic, so I'm glad we're starting to break it down a little bit yeah.