SEND Parenting Podcast
Welcome to the Send Parenting Podcast. I'm your neurodiverse host, Dr Olivia Kessel, and, more importantly, I am a mother to my wonderfully neurodivergent daughter, Alexandra, who really inspired this podcast.
As a veteran in navigating the world of neurodiversity, I have uncovered a wealth of misinformation, alongside many answers and solutions that were never taught to me in medical school or in any of the parenting handbooks.
Each week on this podcast, I will be bringing the experts to your ears to empower you on your parenting crusade.
SEND Parenting Podcast
Medication for ADHD with Jane Trowbridge of Sensational Tutors
Should you consider medication for your child with ADHD? As both a doctor and the mother of a neurodivergent teenager, I've navigated this question from multiple perspectives—and discovered that much of what we believe about ADHD medication simply isn't supported by science.
The hesitation many parents feel about medication stems from understandable concerns, but often these worries are based on myths rather than medical evidence. What surprised me most in my own journey was learning about the significant developmental gap children with ADHD experience. Their executive functioning skills—abilities like emotional regulation, working memory, and self-motivation—typically develop at approximately 30% behind their peers. This means a 12-year-old might functionally have the capabilities of a 9-year-old, with this gap widening as they grow older.
This crucial insight helps explain why ADHD medication works so effectively. Rather than changing who your child is, medication bridges this developmental gap. For 55% of children, stimulant medication completely eliminates the executive function delay while active in their system, while another 35% see significant improvement. The research is compelling—with an effect size of 1.2 (compared to 0.5 for antidepressants), ADHD medication ranks among the most effective psychiatric treatments available.
Throughout this episode with Jane Trowbridge from Sensational Tutors, we explore the difference between stimulant and non-stimulant medications, address common misconceptions, and examine the serious long-term consequences of leaving ADHD untreated. Particularly striking is research showing untreated ADHD can reduce lifespan by 11 years—a sobering statistic that underscores why effective treatment matters.
Whether you're currently weighing medication options or simply want to understand the science behind ADHD treatment better, this episode provides clear, evidence-based information to help you make informed decisions that could profoundly impact your child's development, confidence, and future success.
www.sendparenting.com
Welcome to the Send Parenting Podcast. I'm your neurodiverse host, dr Olivia Kessel, and, more importantly, I'm mother to my wonderfully neurodivergent daughter, alexandra, who really inspired this podcast. As a veteran in navigating the world of neurodiversity in a UK education system, I've uncovered a wealth of misinformation, alongside many answers and solutions that were never taught to me in medical school or in any of the parenting handbooks. Each week on this podcast, I will be bringing the experts to your ears to empower you on your parenting crusade. If you're looking for a safe space to connect with other parents navigating their neurodiverse journey, our private WhatsApp community offers support, insights and real conversations with like-minded parents who truly understand. Join the conversation today. You can find the link in the show notes.
Speaker 1:In today's episode, we are going to explore one of the biggest questions for parents of children with ADHD. Should you consider medication? The podcast is the interview recording that I did with Jane Trowbridge from Sensational Tutors. In it, I will share some clear, research-backed insights on how ADHD medications work, the differences between stimulant and non-stimulant options and what the latest data and research tells us. As both a doctor and a mom of a teenager with ADHD, my goal is to cut through the noise and help you feel more informed and more empowered when making the decision of whether or not to put your child on ADHD medication. Let's dive in.
Speaker 2:Good morning, dr Kessel. Thank you so much for joining me today. As you know, I'm very interested in the area of ADHD and medication, and I know that you work in the area of ADHD and it's such a huge topic in SEND, isn't it? So I just wanted to introduce the concept of ADHD in relation to the brain and how medication functions with the brain to be effective or non-effective, depending on what your perspective is. So I just wondered if you could give us a little bit of insight into this.
Speaker 1:Well, thank you so much for having me today to talk about this, because it's something I'm very passionate about, both from a personal experience of my daughter, who has ADHD, and then also from a medical science perspective as well, which is what I really want to share and get into today. But you know, medication is one of a holistic care package that you need when you're looking at your child with ADHD. So you also need to look at good nutrition, you need to look at sleep and exercise and you need to look at accommodation at school and at home. Now, those are three other big topics which we're not going to discuss today. So we're just going to talk about medication and its role, because it is crucial, but you need all of those to actually support your child properly. But this is a key element, and I think that it's the one that's most fraught with fear, stigma and some misconceptions that even I was guilty of as well, and whereas we don't really worry so much about nutrition, we don't worry so much about accommodating at school, at home, we don't worry so much about sleep, medicine really stands out as why would I want to medicate my child? But before we go into why and the hows and how it works.
Speaker 1:I think we need to take a step back and look at a child with ADHD and what their brain is like and why medication can help some of the challenges that children have. So if we look at an ADHD brain, adhd is a neurodevelopmental condition. Okay, so what that means is there's a difference in the brain structure, there's a delay in development and there's a hypoactivity of their biochemistry, and those factors play a role in certain regions of the brain, like the prefrontal cortex, which is located just behind your forehead, your cerebellum, and those are involved in executive functioning skills. So by having this delay and having some alterations in the structures as well, we have children that aren't developing executive functioning skills in a way that their neurotypical or non-ADHD peers are. So I know when my daughter was first diagnosed, someone said executive functioning skills. I was like it sounds important. What are executive functioning skills? Because that's the first thing.
Speaker 2:What are they and when I started to understand no, I mean even as a doctor.
Speaker 1:It's not like rolling off the top of your head what they are, but interestingly, when you learn about them it's an aha moment because it's often where a lot of the challenges of behavior that you have with your children. So executive functioning skills start to develop when we're born and as we grow older. And they grow in like a step-wise fashion and they keep developing until we're about 28, 30. And then development stops until we get to around menopausal age in women and older age in men, and then we can see a decrease in functioning. For the rest of our lives it's pretty much static and stable. So in that period of time we develop step-wise and it starts with self-awareness, then we have inhibition, Then we have working memory, then we have emotional regulation, then we have motivation and then we have planning and problem solving. Now if you ask any ADHD mom or teacher who has them in the classroom, they will say that a lot of those things are challenges with their children that have ADHD. And that's because there's this delay. And there's actually about a 30%. That's not an exact number and it will differ from child to child, but there's about a 30% delay. So that means someone's. Like, if we think of a child's chronological age okay, how old they are versus their executive function age, there's a 30% difference there, okay. And as that child gets older, that difference gets bigger because it's 30% of a bigger number.
Speaker 1:So let me use actual examples here. So when you're little, and let's say you're about two years old, then you're not going to notice it at all. Okay. When you're six years old, they might have a executive function of a four-year-old. You're not going to notice it at all. When you're six years old, they might have an executive function age of a four-year-old. You're not going to notice that very much either. When they get older, to like nine or 10, which is actually when you start to maybe see some problems, especially in girls that you start to see some challenges it's more like they have an executive function age of a six-year-old. Now if you look at a six-year-old versus a 10-year-old and what kind of responsibilities you would expect them to do, how you would expect them to control their emotions, how you'd expect them to be organized, that's a big disparity between there and it gets bigger. So if you're a 12-year-old, you're more like a nine-year-old, and then when you're 15, you're more like a 10 year old.
Speaker 2:Yeah, these issues must become much more prevalent when children get to high school, I suppose.
Speaker 1:Absolutely. And then the pressures on them get greater too, because they're expected to be able to motivate themselves, they're expected to be able to problem solve. Their emotional regulation is supposed to be developed more, and it's not. It's delayed. So that is. I think that's really a key thing to understanding the role of medication in helping children, because what medication does is it can bridge that gap. Okay, so that's what? When you're taking the medication and we'll go into how it works and exactly what it does but just in very simple form is it decreases that gap. And so in kids taking stimulant medication, when they take it and when it's active in their system, 55% of them that gap disappears, Right, Right.
Speaker 2:Yeah.
Speaker 1:Okay, instead of being a 12-year-old who's acting like a nine-year-old, they have the skills now of an actual 12-year-old and they can do the tasks that they're required to do as a 12 year old.
Speaker 2:That's why the medication is so crucial, isn't it? Yeah, quite remarkable, and 55%.
Speaker 1:And then you have 35% who have an improvement, but it's not 100% improvement, so you might have to put other accommodations. My daughter falls into that, so she's improved so much. I mean, it's been like switching the light bulb in terms of what she can and cannot do now.
Speaker 1:But she still needs some accommodation with things as well. So it's not a hundred percent. And then there's about five to 10% who don't respond. But it's the minority, not the majority. And I think you know when you're thinking, when your child is finding life really challenging at home, at school, or at both socially at school, doing work at school, doing stuff at home, like things that are like independent living, things like getting ready, getting their backpack, getting ready for school when that's causing so much angst and you can find something that can bridge that gap for them, you know why wouldn't you use it? Why wouldn't you?
Speaker 2:Yeah, of course, and I mean mean when you see your child becoming anxious, whatever the reason. And we know that ADHD does provoke so much anxiety in children and the ADHD children I find are so often misunderstood, because they're they're coping with so many different problems and challenges at home and at school and I suppose they can let rip more at home, but they have to really struggle to contain those emotions at school and that heightens their anxiety, doesn't it really?
Speaker 1:They just Well, also, if you think about it, they're constantly being asked to do something which is out of their capabilities, which is what's reality. I used to think like why can't she do the stuff that my friend's kids can do? Why is she still, you know, unable to do this, unable to do that? And is it me Am?
Speaker 2:I a bad parent.
Speaker 1:Like you know, both of us, we couldn't figure it out. She's getting frustrated. I'm, you know, wondering. Actually, it's a neurodevelopmental condition. She's unable to. It's just like. I like to use the example of an asthma inhaler. Right, we would. If a child is struggling to breathe, we would give them an inhaler, wouldn't we? We would. And then we'd see them getting better but we cannot see an ADHD brain.
Speaker 1:We can now with MRI imaging and with genetic we can. Now we can actually see that yes, it does exist, we've proven it. It exists, but we're not giving them the same way we would give an asthma inhaler. We're not giving them the medication they need to bridge that gap and we don't see the results of it. So it makes it much more challenging, I think, for parents to understand the benefits of it. And unfortunately there's also a lot of research. You know the Scandinavians did a sorry, not Scandinavians. The Swedish did a longitudinal study looking at you know what happens if you don't treat attention deficit hyperactivity disorders?
Speaker 2:That's the question I wanted to ask you. Yes, exactly.
Speaker 1:What if we don't? What's the long-term consequences of that? And they've done another study in England too, in the British Journal of Psychology, looking at this. Psychiatry, looking at this as well and this is a key factor that I didn't realize either is okay. It's not really a choice, because if you don't treat and support your child with ADHD, the long-term life impact is quite scary in terms of quality life and also in terms of mortality. So, depending on the studies that you read but there's lots of you can decrease mortality, which is how long you live, by 11 years.
Speaker 2:Wow, I didn't know that. Actually, that's news to me.
Speaker 1:Yeah, wow, and if you and if you also include increased motor vehicle accidents and suicides. In severe cases that can go up to 21 years. Yeah, wow, that's a lot so it's a huge impact, but it's not just that life impact, it's also quality of life.
Speaker 2:Yeah, every day, isn't it?
Speaker 1:Yeah, they have increased. They don't do as well at school, they don't get into college as much. They have failed careers, failed marriages, um increased rates of prisons. Uh, you know substance abuse, motor vehicle accidents and addictions. So that's a pretty dire outlook.
Speaker 2:That's hard, you know I mean, would it it be good to start with talking about what ADHD medications we're aware of or how they're divided, because I know that there's stimulant and non-stimulant medications? Would it be?
Speaker 1:Yeah. But before we go to that point quickly, I just also want to say, because that's a doom and gloom kind of picture, but when you do treat and support children with ADHD, you can negate those long-term consequences.
Speaker 1:So, that is quite important because if you know that you can give your child the support they need. But that doesn't have to be a reality. It's not a fait accompli. You can with the right holistic support, and medication is a huge part of that. That does not need to be where your child goes, and the types of medication, to your point, are divided into stimulants and non-stimulants. Okay, and they work on that area in the brain that we were talking about, the prefrontal cortex. Okay, stimulant medications are considered first-line medications, All right, and what they do is they act on the cells by decreasing the reuptake of dopamine and noradrenaline, which are hypoactive in the prefrontal cortex and in the areas where you have executive functioning. So it increases the amount of dopamine and norepinephrine available. Okay, or noradrenaline it depends if you're on the US or the UK, how you call that and that then helps children to be able to have better executive functioning skills when they're on the medication okay, yeah, and I suppose this comes under the umbrella of Ritalin, the well-known drugs.
Speaker 2:yeah, yes.
Speaker 1:So, and the generic names and the ones approved to the UK for child use are methamphetidate, which is the first line treatment, and then dexamethadine, okay. So those are the two. So the first drug that you would try as a parent, with your psychiatrist would be methamphetidate, and you know of children that use that 70% have a really good response. The remainder then, through the other treatment options that we're going to talk about, we'll have a really good response. The remainder then, through the other treatment options that we're going to talk about, we'll have a response up to 95%. So that means that they're going to get better executive functioning skills and they're going to be able to deal with the challenges that they have, which then has a knock-on effect that you don't see those disruptive behaviors because they're coping and they're able to do well. So that's the stimulant medications, and then you have non-stimulant medication, and the real difference between them is non-stimulant medications primarily work on the noradrenaline pathway Okay, and they work indirectly on dopamine.
Speaker 2:Okay.
Speaker 1:And these are often used kind of like as second line treatment options if the first line hasn't worked. So those the percentage 35% that haven't responded. But they also work well in children that have comorbidities. So if they have obsessive convulsive disorder, if they have anxiety, perhaps if they have autism, that might be a better use. And the two examples of those are adamoxetine, which is an adrenaline reuptake inhibitor, so it stops noradrenaline being reuptake, so there's more available. And then guanfacine, which works on the postsynaptic alpha-2 receptors, also increasing noradrenaline. It has some other cellular activities too, but it's going to bore my listeners.
Speaker 1:But basically those are the treatment options that are open and you start this first loan and you have different formulations with all of these. There can be long acting or short acting and I think as a parent you first start out and you work with your clinician. They'll start you on a short acting one because it gives you more flexibility and it is a very personalized. You know kids respond differently, the way they metabolize drugs is differently, so there's no like, oh, just take this pill and it's going to be fine. It's very personalized to your child. It has to be gauged doesn't it?
Speaker 2:And watched and monitored. I suppose, like any drug, especially one that you know, like you say, it has a different response in everybody who takes it.
Speaker 1:So we just have to monitor it, you have to monitor it and you have to monitor it through life as well. And what was interesting, which my clinical psychiatrist didn't tell me in the beginning, was it can get worse before it gets better. So, like for the, for the first week to 10 days your child's behavior might become more erratic and actually harder to deal with. And I almost stopped the medication and luckily my father, we were on holiday, because I can do it in a period of time where you're not at school, where you have time for your child to adjust, there's no pressure and they have that time to onboard on and he's like Olivia, keep going for a month. And that was great advice. And when I went back to talk to the clinician, you know, he said to me oh that's really common, Dr Kessel, and I'm like well, that would have been nice to know, you know, because then I wouldn't have.
Speaker 2:It's so important to know these things. And I had a pupil who was 17. He's in his 20s now and he got diagnosed at 17 and started medication and he came off it. A mutual decision with his mum to come off it because it seemed to have that effect at first and again he wasn't aware. So she said in the end they went back on it because they didn't know what else to do and stuck with it and now he lives a very sort of so much as such an improved life in his late twenties. I think he is now actually and medication was the turning point for him, I mean it's, it's been, it's been instrumental in my daughter, my life.
Speaker 1:I mean it really has. You know, she's gone from. You know and it continues to. She grows from leaps and bounds. Because, also, once you start to be able to do things like get ready in the morning, get your school bag ready, do your homework, you start to create habits and behaviors that become part of you. So you no longer have to use the executive functioning skills. It becomes part of habit and you don't need to rely on those skills. So you're giving them the opportunity to be able to do these skills and then you're building those neural networks that build the habits as well.
Speaker 1:So, if you forget, we used to have to take the medication very early in the morning so that she could do her school morning routine. We don't need to do that anymore because now she knows how to do her morning routine. It's a part of her habit. So we take the medication with breakfast. So it's, you know it's and actually the medication can affect how your brain develops and the brain structures in your brain. This is really hot off the press research that they're looking at now, so that some children you know the areas of their brain develop to a point where they don't need the medication anymore, which I also, you know. I don't think parents are aware of either that you know it can actually have long-term positive impact on your child's brain, Because I hear from parents you know, oh, it's going to change my child's personality, it's going to make them less creative, it's going to you know it doesn't? It's really working on those areas of the brain that they're struggling with.
Speaker 2:These are myths, aren't they? I think people feel the same way a lot of the time about antidepressants they have preconceptions about a drug without really knowing the reality, and I know it is a brave step to take, but when you try it, you can be so pleasantly surprised. I've worked with because I, as you know, I'm a specialist SEN tutor and I've seen the difference between ADH pupils who are on medication and those who aren't, and for me it's a no-brainer really.
Speaker 1:Well, and also, if you're looking at ADHD medication you talked about antidepressants there what's the effect size of ADHD medication? It's actually one of the most effective psychiatric medicines out there, so it has an effect size of 1.2. And the larger the number, the so it has an effect size of 1.2, and the larger the number, the more effect it has. Okay, if you look at antidepressants, it's about 0.5. Asthma is about 0.5 as well, so it's, it's really efficacious, right? And then you're like, oh well, then it must have terrible side effect profile. It must be. No, actually it's highly tolerated. It does have some side effects, but those side effects can be managed and they can decrease over time.
Speaker 1:So you can have loss of appetite, you can have dry mouth, you can have difficulty sleeping, although you can also have an improvement in sleeping. But it's been studied so much. It's been studied more than any other childhood drug. You know they have large research studies looking at the safety of ADHD medications. You know not so much research is done about Calpol, which we liberally dose our children with.
Speaker 2:You know, yes, of course I know it's just. I think it's just certain areas in society, it's certain drugs, people, they're just taboo areas. I think both ADHD medication and antidepressants are now becoming much more acceptable in the wider sense. You know, we know it's so valuable and we know what impact they have. But you have to really work hard to convince people. Sometimes it's because you can't see it right.
Speaker 1:It's not like a fever and you take Calpol and the fever goes away, and it's like with hormone replacement therapy. It's a similar thing too. But when you look at those long-term consequences to children as they grow up into adults, you really have to stop and think. And you know, I, would you know I, if I'd had all this knowledge? When I started, and even as a doctor, I questioned would I put my child on medication or not? But then I did a lot of research into it and read a lot of clinical trials and listened to a lot of experts.
Speaker 1:I think it would be negligent of me not to put my child on the medication and to try it Now like, look, we did say five to 10% of people, children, it won't work on. But that's still 95, 90 to 95 that it does work on. So you know it's worth trying and also knowing that you might have to fine tune it, just like you have to with antidepressants, just like you have to do with hormone replacement therapy. But the results and the impact for children I mean my daughter, you know she remembers to take it, she wants to take it because she knows it makes her life easier.
Speaker 2:And once they see the difference, they start to gain it. She wants to take it because she knows it makes her life easier. And once they see the difference, they start to gain confidence. They believe that they can achieve so much more and they can see a future for themselves that they want to see. It's not so daunting for them, is it?
Speaker 1:Because their lives have changed so much and then, you know, playing around with the doses too, like we were doing really well in terms of inattention, in terms of other aspects of her ADHD, but her emotional dysregulation was still quite, you know, and she's she's going through puberty as well. And so the clinician said well, look, why don't we raise the dose a bit? Because if you raise the dose a little bit, it actually has more of an impact on emotional regulation. And we've done that and it's actually it's, you know, we did it slowly, slowly, slowly, and it has had an impact.
Speaker 1:And she's able now and it's one of the main, I think, positives of it is at school, where she used to lose it and cry and maybe have a. You know, and people, kids, don't like that. You're too old to be having a tantrum, you know. You're too old to be doing it. Now she can pause and she can I mean, she can say, like you know what you guys need to stop, because actually you're going to make me cry now, whereas before it would just she. She would have no, she would just be an explosion, you know yeah.
Speaker 2:So, and that's so important for teenage years to have that ability to socialize and to you know, yeah, absolutely no, I totally get it. I totally get it. And it is lovely to see how especially I mean the teenagers I've worked with who are on medication, and how much they sort of can see where they were then and now where they are with their work and with their friendships and with their relationships with their teachers. It's just so much better. You know, it's not like a complete healing process immediately, but there is such an improvement for so many children.
Speaker 1:It's. Uh, yeah, and you know, unfortunately, social media and ADHD is a very popular topic now and there's a lot of there can be a lot of negatives about it. You know, oh, we're just medicating our children so they behave for teachers. No, that's not what we're doing. You know what I mean. And it's we, it's it, you know, like the asthma example, like if you have a type one diabetic who needs insulin, this is not, this is. This is not about. Yeah, it's, you know.
Speaker 1:So we need to. We need to really look at the hard facts, we need to look at the research, and when you've done that, I don't see why you wouldn't give your child something that's really going to make their life a lot easier and enable them to succeed. And but, as I said before, it's one part you also need you know to to put the accommodations, which you must be well aware of, in the tutoring role that you have, and you need to put that scaffolding in place. You need to have the right nutrition as well, and you need to have make sure they're getting sleep and exercise, because that's another key component.
Speaker 2:Yes, of course I mean just talking. I mean, obviously, like, have you ever worked with anyone who holds negative views about ADHD medications? I mean, this is, I suppose, what we're saying, but we know the sort of generic views, but have you actually had to deal with that yourself in your line of work?
Speaker 1:You know I've had I think more it comes from people who haven't tried it yet and actually the fear of it or having disagreements with one's partners about whether or not to try it.
Speaker 1:And I've had people come up to me who've you know I've spoken on this publicly, who've who've been like this is such a relief we're going to give it a try, and understanding that that onboarding process can be, you know, challenging and then how much it's helped them. I run a SEND parenting community too and the feedback on that is wow, this has really changed our lives, not just the child's life but the parent's life as well. So there are those 5% to 10% who don't respond. There are children that struggle with appetite and things like that and you have to make accommodations for that. But the overall majority of parents and children once they're on it and they've got the right formulation. So there can be some challenges getting the right dosage and right drugs. So I think you know you need to go into it with that kind of it's not you're going to take it and everything in the world is going to be wonderful.
Speaker 2:No, life doesn't work like that generally, I mean, unless you've got heartburn and you take Gaviscon and it fixes it or something like that. But no, it's not going to be like that, but it's just a slow, gradual move in the right direction, isn't it?
Speaker 1:And I think understanding how it works and then understanding the neurodevelopmental delay with ADHD, then it can start to make sense.
Speaker 2:Absolutely yeah. I mean, there's just so many myths surrounding ADHD and I suppose that's what's got to be quashed really over the next I don't know a few years. It'll take decades, I suppose, until we get to a place where people just fully embrace it. I don't know.
Speaker 1:I think with ADHD UK, I think, said that, like of all the children diagnosed with ADHD, currently 62% of them are on medication. So I would say that number needs to be higher.
Speaker 2:But it's not bad, but that's not bad at all. I think the narrative is changing, as it is in many areas of SEND, but we just have to be patient with it. Like anything else, you can't rush people to change their mind about things. It's a process that questioned it.
Speaker 1:But actually they had a lot of confounding you know confounding factors in that study. There's been other long longitudinal studies that haven't shown. But you know they do a cardiac workup on your children, child, before. If you have a cardiac history, you know they'll monitor blood pressure and stuff like that. So they are, they are uber careful in that. But that also that's kind of like HRT and breast cancer to a degree. You know it's a big headline that can scare people. That doesn't actually have reality in the research. Same with well, aren't I giving my child cocaine? Isn't it like a stimulant medication?
Speaker 2:It's not. I was just going to ask you about that because, yeah, it's such a common sort of thought process, isn't it? It's a stimulant, so it's like cocaine. Is it addictive, you know? Yeah, exactly.
Speaker 1:And how you absorb it. Okay, when you're doing cocaine, you're snorting it, you're injecting it, you're smoking it. This is an oral tablet. It's not cocaine. It's slow release, it's low dose. It goes over hours. Okay, it's in no way similar. It is not addictive and, interestingly enough, children that are not treated with medication tend to have higher uses of drugs because they actually self-medicate with drugs.
Speaker 2:Right, so they medicate in the wrong way, really.
Speaker 1:It helps them In the wrong way. Yeah, sure, but you'll also see with children that they'll drink Red Bulls, they'll drink espresso coffees, because it helps them the way their physiology works, the way their physiology works. So, actually, by medicating your child, research shows that you actually have decrease in substance abuse issues in children and you don't find them to get addicted to substances. So you're actually it's protective and it is in no way like cocaine.
Speaker 2:No, no and yeah, no, of course not. But I think, again, it's a myth. It's just a panic button that people press, don't they Like again with antidepressants? I keep equating it with that because I've known so many people who refuse antidepressants and eventually they try them and they think, oh gosh, I wish I'd done this before. You know, but because of the myths, or possibly because a partner says, no, you're not taking antidepressants, it's you know, you can't do that, why? And then they have all these sort of reasons that aren't really logical, but that's what they believe. So, yeah, I think people are scared. I think that's what it is. People fear medication, but only some sort of medication for certain things, not for others. You know, which is interesting? You talked a little bit before about. You touched on the lifetime consequence of not treating and supporting ADHD. So I mean, would you say that you know the longer ADHD is left, the bigger this sort of potential risk is for the sufferer?
Speaker 1:Yeah, I mean, if you go and look at how many people in prison have ADHD, it's staggering, you know, and you look at people who are addicted to substances and you looked at people who are. You know it. It it has a real impact because you're not, you know it's. It's very challenging, very challenging at school, and then you, if you, if you don't do, you know it. Just it has knock on effects and all that self-esteem, all that confidence, it all gets eroded and it makes life very challenging.
Speaker 1:And that's why I think a lot of people, as you say, the hype is oh, everyone's being diagnosed with ADHD, everyone has it, it's over-prescribed. No, it's actually under-prescribed, still under-diagnosed. In the UK the numbers are coming up, but in certain ethnic groups, in women as well and girls, it's underdiagnosed still. So that's not true either. So we need to realize that that's a falsity and that it is a real issue and if it is untreated it has real lifelong consequences. And as a parent, we want the best for our children. So why wouldn't we explore this and why wouldn't we, you know, with a qualified clinician, see if we fit into that 95% that are going to have a good result with it?
Speaker 2:You know it's pretty high odds there. I mean absolutely. So what would you say? That in the US they have much more of a grasp on? The reality of the numbers of children and young people that have ADHD, would you say.
Speaker 1:They're ahead of us in that sense.
Speaker 1:So take that with a grain of salt as well.
Speaker 1:In Europe, there's certain countries where it's very much like France and other countries where it's not so accepted or looked at, and also even in the UK, minorities who don't think that children have it, ethnic minorities or teachers don't recognize it either. So there's underdiagnosed populations within all countries and it's less accepted or less known in some other countries. But there is a wave right now that is happening in terms of people becoming aware, in terms of even, you know, mothers who's, you know, are looking at their children and finding them support and then saying you know, wait a minute, a lot of this stuff sounds very, you know, similar to what I'm going through and I'm still having challenges. And then people get diagnosed. You know, wait a minute, a lot of this stuff sounds very, you know, similar to what I'm going through and I'm still having challenges, and then people get diagnosed, you know so, and then they might tell their mother and their mother's been, you know, diagnosed with all sorts of mental health issues, and actually, no, it was all along underlying.
Speaker 2:ADHD. A lot of girls get diagnosed. So would you say an adult who gets diagnosed with ADHD would you say it makes a massive difference to their life, like it does to a child. Would you say it's actually very important to follow that path and see if medication would help you as an adult.
Speaker 1:I think you have to look at like where you're at in your life, what you're finding challenging, and I think it can be very self-validating for people as well to understand the challenges that they're having and that then they can see the role that medication can help in in in the challenges that they're having. You know, at home, at work, you know, along with other accommodations, and it's kind of can be an aha moment and it can take some of the it's all my fault, you know, um, this was me and and all of that battering of the self-confidence and all of the. You know, some, some women have been just, you know, diagnosed with, you know, just, different disorders that haven't added up, so they've been in a place of real unhappiness, you know. So I think it, you know it's, it's validating and you know, uh, you know, I really I believe that, so I do too, I do too.
Speaker 2:I had a neighbor who has autism, but he didn't know it until he was 56. And when we were growing up he was sort of described as a little bit odd, a little bit weird, because you know how we used to well, in my generation that's how we used to talk about children because we didn't understand, we just didn't get it. And then you know, and I remember sort of bumping into him about five years ago maybe more, and he said I'm autistic. He said, and it's just such a relief to know I can't tell you what a difference it's made to to my, just his. I think what he was saying is mental well-being, just to know that that's what he had and that's what he's always had, just yeah. And then I went, oh yeah, it kind of clicked into place for me as well and I kind of thought, wow, we just were so ignorant in those days, we just didn't get it, we just didn't know.
Speaker 1:No, and it's just. You know, we want to support our children, we want to give them the best chance in life, you know, and we want to. You know, make sure that their mental health, their physical health, is taken care of. And if they have ADHD and it isn't treated and it isn't supported, then we're missing a huge part of their trajectory. You know, yes, you know so, and it's so hard, and I know it's so hard, for parents to even get a diagnosis. It can be. You know the waiting lists are just out of this world. You know, going privately is so expensive, so it is challenging.
Speaker 1:Um and so medication sometimes isn't something that a parent can do, even though they you know, they're a hundred percent. You don't have to convince a parent. Really, they kind of know, even though you know, for me I doubted myself with my daughter because she didn't present the way I thought ADHD was, which was a hyperactive little boy. So for me I didn't get some of the you know, the daydreaming, the not being able to follow instructions, the you know sleep problems. I didn't realize that that was all part of her ADHD. So it took a while for the penny to drop in my head. But you know there's a lot you can also do if you suspect your child has ADHD before medications. But you know, I also think that you know I always advise parents like if you think your kid has ADHD, put yourself on a list immediately. Just when you have that, you can always take yourself off the list and someone else can take that spot. But if you don't have the money to go privately, you know, then the sooner you get on the waiting list, the better.
Speaker 2:Right, yeah, okay, so yeah, it's worth knowing that, isn't it Really Definitely? I mean, do you have any opinions on alternative treatments that are out there for ADHD? You know, apart from the orthodontic methods that we've been discussing, such as herbal approaches? What are your views on parents' charm?
Speaker 1:I don't know if you even want to open this Pandora's box of how I feel about it. I just think there has always been a propensity to sell snake charm oil, especially to parents who are in need and are desperate with their children and who are really struggling and their home has become chaotic. And it's a very, very ripe place to have charlatans come in and say I can sell you something that's going to fix your child. And I, as I said, I run a SEND parenting community and I had one of my members come and say oh, I've just watched this great presentation and has anyone used this? It was some like combination of saffron and something else and you know, omega. It costs a lot of money, but has anyone else use it? And I had to. I deleted her posts and I I said to her I'm really sorry, but this is not something that has been scientifically proven. Oh, but, but I have, I have, I have the, I have the slides. I said send me the slides, let me look through them, let me look at it from a medical perspective. I will send it to nutritionists. Let's have a look at this. It's a case study of one, one little boy we've given in saffron and he's doing fabulous. Now All his problems are solved. I am sorry.
Speaker 1:No drug that works that way, no herbal cure works that way and it's unregulated. And if it's costing a lot of money and it's promising a lot, it's probably too good to be true. Most of our drugs are developed from plants and herbs and stuff like that. It can also have bad effects. Do you know what I mean? I know patients of mine who you know they're on estrogen therapy and then they take a natural occurring estrogen as well and then they get themselves into troubles because they're ODing on estrogen. So just because it's herbal doesn't mean it's safe or better. Why not go with something that's been tested, has got longitudinal research studies on the side effect profiles are known, the efficacy is known. We've discussed those today. Why not go there first? Why do you feel it's safer to go with a herbal remedy that hasn't got those longitudinal research studies, that hasn't got a safety profile and that has not gotten proven efficacy and that you're going to spend more money on.
Speaker 2:I think it just goes back to really the myths associated with ADHD medications and what people think is true and what actually is the reality. And they don't you know, they probably will get to the point where they take the orthodox medications, won't they? Those parents, I would think?
Speaker 1:But if you're worried about giving your child something and you're giving them something that hasn't been tested and just because it's something you cook with, you think it's safe. That's not. It just doesn't make logical sense. Just because something's natural or herbal and actually you think it's safe. That's not, that's not. It just doesn't make logical sense. Just because something's natural or herbal, and actually you know. You know you can buy any amount of dosage of herbal medicine. I actually did a paper on it in in in medical school. Because we don't regulate herbal remedies, so we don't. You know, it's the wild west, you know Germany regulates it quite a lot, but we don't hear, nor do they do in America. And they are potent, they can be potent. Okay, so it's not safe. And I think that's the first thing. Is it safe or isn't it safe is the first question. And how has that been proven? And then, does it work? And then, how much is it costing you?
Speaker 2:Yes, and there's no real proof that it really works at all, is there? It's just like loose. No, there have been nothing. Yeah, I know you started today talking about the link between ADHD medication and brain development and how it's so important to understand that link. What would you summarise as the permanent benefits in brain development for someone that's on a path of medication that's working for them?
Speaker 1:I think, first of all it bridges that gap, as I discussed right.
Speaker 1:So you have a neurodevelopmental condition that has a delay in the functioning of your executive functioning skills and it gives you a gap with other people.
Speaker 1:So the medication helps to bridge that gap so that you can have the skills that you need at the age that you're at to be able to meet the challenges that you have in your life, so that you don't start having behaviors and anxiety and are unable to actually use those executive functioning skills. And then also we've now the new research is showing that it actually develops your brain so that you're getting permanent positive changes in your brain so that you might not need the medication later on. And as I said to you as well, like, look at my daughter as well. She's been able to. Now, if she doesn't have the medication because she's been able to do it enough amount of times that it's become a habit, she's not using her executive functioning skills anymore, you know. So it's given her the crutch to be able to see how to do it until it's become a habit. So I think you know, and some people are going to be on medication their whole lives and that's also you know a possibility as well?
Speaker 2:Yeah, of course it's like. And go back to antidepressants, you know you can come on them and off them, or you can stay on them for life. It depends on the person, doesn't it? Yeah?
Speaker 1:And some people take it. You know, when they get older they might just want to take it when they're doing university exams or if they're going to work. You know you can use it in certain situations, you know. So it's, it's a flexible and and you change it with your clinician and you look at it over time and you reevaluate. You know how's it working as I go through hormonal changes, how's it going as I get older, how's it going when we reach that point where you're 28, 30 and your prefrontal cortex has, you know, stopped developing. So there's, you know it's an ever evolving kind of picture and as you grow older with ADHD, you can change too in terms of what subtype you have and and you know whether you're more inattentive, whether you're more hyperactive. So it, you know hyperactivity tends to decrease with age. So it's, it's not a static picture, you know, neither with your ADHD nor with your medication, so it's very personalized.
Speaker 2:You have to be prepared to go on a journey, and there's lots of different pathways and routes, as it were. I mean so, I mean, obviously, talking to you, it's clear that you've seen so much evidence of the benefits as I have as well. So, yeah, I just sort of feel hopefully, when people listen to this they might sort of start to if they're not already feeling positive about it, they might start to feel a bit more sort of confident about the benefits of the medications that are out there.
Speaker 1:And there's a great podcast I did with Dr Gioroli of the Gioroli Center.
Speaker 1:Oh, yes, yes, I know 45 of the SEND Parenting Podcast, which he's fantastic. He's so passionate, he's just he's. You know he is so passionate about autism and ADHD and he does a really great description of it you of it that we've touched upon here as well. But every parent that I've spoken to who's been feeling these doubts and who's been afraid, who listens to this, who's listened to that podcast and who's taken that leap with their child, I have only heard positive things back and I've only gotten big, huge thank yous, Olivia. This has changed our life. This has changed my child's life. So you know why wouldn't you try it?
Speaker 2:Dr Giaroli, that was yeah.
Speaker 1:Dr Giaroli, episode 45 on the SEND Parenting Podcast.
Speaker 2:Brilliant. Well, it's been really fascinating talking to you, so interesting. Is there anything I haven't asked you that you think I should have asked you, that I might have missed?
Speaker 1:No, I think we've covered everything. It's a big topic and you know, I think we've done it justice and I hope that you know it's helped people who are maybe on the fence about this to explore it.
Speaker 2:I hope so too. Thank you so much, Dr Kessel, it's been a pleasure Thank you as well.
Speaker 1:Thank you, thank you as well. Thank you, thank you for listening. Send Parenting Tribe If you haven't already, please click on the link in the show notes to join us in the private Send Parenting what's Up community. It's been wonderful to be able to communicate with everyone in the community and for us to join together to help each other to navigate challenges and to also celebrate successes. Wishing you and your family a really good week ahead, thank you.