Ep. 40 - When Does Distracted Become ADHD?

ADHD gets talked about everywhere now, but living with attention struggles is rarely as simple as a label.

Dr. Andrew Rosen and Dr. David Gross take a step back and look at how focus, distraction, and restlessness actually show up over time. They move between childhood and adulthood, where things don’t always look the same but often feel just as frustrating.

They sit with the gray area. The overlap between personality, stress, environment, and diagnosis. The ways people adapt, compensate, or quietly struggle without ever having language for what’s going on.

There’s some humor, some honesty, and a steady thread throughout about how easy it is to miss the bigger picture when everything gets reduced to a trend.

Contact the Docs:

Email: twoshrinksandamic@gmail.com

Transcript

SPEAKER_01 0:04

Hi there. I'm Dr. Andrew Rosen. I'm a psychologist. And I'm Dr. David Gross, psychiatrist, and we are two shrinks and a mic. Today we're going to talk about a disorder that is pretty prevalent and also has become very popular in the social media, and that is attention deficit disorder, now technically known as attention deficit hyperactivity disorder, either the type with hyperactivity that's called the mixed type, or the inattention alone type, where there's no hyperactivity impulsivity. And hopefully we can help uh dispel some of the myths and provide you some valuable information on it. Historically, uh it goes back to the 1960s and 70s, a long time ago, when kids who were just restless, always on the go, difficult in classroom, were called hyperkinetic kids. And then we then developed a descriptive disorder called minimal brain damage, which was horrible because of how pejorative and labeling it was. Ultimately it got clarified into a disorder of attention concentration, distractability that can include impulsivity and hyperactivity, or just as I mentioned, uh inattention alone. And uh used to be ADD, and I guess the American Psychiatric and American Psychological Association started to keep everybody confused and unsure to change it to ADHD, but it really is with hyperactivity or without.

SPEAKER_00 2:29

And so you can have a little bit of ADHD, and you can have a little bit of OCD, but I think the when it's a little bit, we take off the D's on the end, meaning it's not a disorder. We can all have distractability and problems with attention and be kind of unable to focus on something. I can recall when I was a kid in school, probably every day I had ADD because I was every day thinking about when is the class going to be over and thinking about other things or paying attention to what was just going on outside the window. That's a form of distractability and difficulty with attention. But when I was doing things I really like to do, all of a sudden I wasn't so distractable. Um, so it's really, really important to know the difference between what we would say is kind of normal levels of attention or distractability issues versus when it's a disorder. And maybe you can talk a little bit more about the how we distinguish the disorder part.

SPEAKER_01 3:30

I was just thinking as you were talking about uh being easily distracted in school, then the the the era of the hormones hitting when you're a male or a female and and you go through puberty, you start thinking about other things besides school. And it's uh easy to s to say that you've got uh uh attention concentration problems, you just focus your attention elsewhere.

SPEAKER_00 3:50

Aaron Ross Powell But once I was focused on that, I wasn't distractable.

SPEAKER_01 3:54

Well, the actually one of the one of the the truths about attention does disorder, and most people will tell you when they get to be adults that if it's something that really interests me, I can hyperfocus. Sure. And that's part of the disorder. Um one of the problems in talking about it is that we've deal we're dealing with uh what I call the uh the Adderall Rage, which is individuals who want to use a stimulant, and that's what Adderall is, it's an amphetamine, um, either to improve their grades in school, uh, get better uh grades on their exams or SATs, et cetera, or just to get uh revved up in hyper and high, and and and they'll often go to their physician or they'll ask to see a psychiatrist claiming they've got ADHD, and now with the internet you can do all your own research and tell people the symptoms that you really don't have, but you convince a doctor that you have them, and before you know it, you get a prescription for Adderall, and that's a real problem. Um, but um the the distractability impulsivity um can be a real problem if you have both the hyperactivity and attention concentration issue. These are the kids when they're in grade school who become dentists and menace. They get into lots of mischief, lots of trouble because they can't sit still, they speak out of turn, they're impulsive, um, they they they crack jokes when it's inappropriate, and um they they often get labeled as uh a bad kid. And if the diagnosis is not made um at the time, a combination of their academic difficulties and and inability to keep up with their peers academically, along with the trouble they get into, it's easy to come out of that labeling yourself as a black sheep and and a good no-good nick and never going to do well in school, et cetera. And that can lead to lots of further difficulties. And so um it's it's important to recognize that ADHD is a disorder that begins in childhood. There's controversy over whether or not there is a freestanding adult ADHD in which the symptoms came on in adulthood. But if if there is, it's it's not very common. Uh most individuals who come into my office as adults and think they have ADHD either became suspicious because their child was evaluated for ADHD. And when they sat down with the psychologist or the person testing them and heard all the symptoms of ADHD that their child had, they said, you know, that's just that's me. And that's when they decide to go for themselves for an evaluation. And then there are other individuals who, um, as adults uh have trouble at work and have one job after another, can't hold a job, and ultimately decide to go for an assessment to find out if there's anything wrong psycho psychologically. And it's during the course of that assessment that it becomes clear that they've had undiagnosed attention hyperactivity disorder, and that needs to be addressed. But so for most people, it's a disorder that starts when they're a preteen, uh, and uh the oftentimes the uh hyperactivity impulsivity as they get older quiets down, although the attention concentration, distractability may not and can lead to the typical problems with adulthood, whether it be problems with marriage, problems with keeping jobs, maintaining friends, et cetera.

SPEAKER_00 7:06

The problem in adulthood, one of the problems in adulthood is that there are um many, many more stimuli in that person's life to manage. So if you think of it as a radar screen, maybe in childhood and adolescence there are ten objects on the radar screen, but then as life moves forward and uh you're in college, or then you're married, or then you have a job, and then you have children, and then you have all of those responsibilities to manage, then you're overloaded with stimuli. And if you had maybe sort of a low-grade case of it earlier on that was manageable, once you hit that level of adulthood with all of those responsibilities, then it may actually become more obvious that you have ADHD. But you know, typically you can in most people that we see as adults who have ADHD, as you say, you can you can track it back, whether it be because they actually were diagnosed and had difficulties, or on self-report, looking back, they'll say, Yeah, you know, I had this problem and that problem when I was in school, and it really made it more difficult for me, but nobody paid attention to it, or uh I tried to contain it and keep it secret, whatever. But uh ADHD, uh, we see a lot of it in adults, however it came about and whatever the factors are that bring it out. There's a concept called, we talk about all the time, the kindling effect, which is basically, you know, when you rub two sticks together long enough, it heats up and then you'll get a flame. And some of that I think does relate to ADHD for these people who have higher, higher levels of stress. They may come in reporting not ADHD kinds of problems. They may come in saying they're overloaded, they're anxious, they can't keep up with everything. And then when we do our digging, we do find ADHD in there, which it gets treated.

SPEAKER_01 8:55

You know, one of the common components of ADHD is something we call executive function difficulties or executive dysfunction. And that really refers to the ability to prioritize, problem solve, organize, um, keep things in uh the the proper order that you need them to be in. And what I what I typically see um in in an individual who is an adult uh when they come in to see me, I ask them when it began to become big began truly to be a problem. And and the story that I'll hear is uh, you know, when I was in grade school, um I did okay. Then I got to middle school, or in our days, junior high school, but that we're aging ourselves. Uh but middle school, you go from having one class in grade school to suddenly you have several classes and several teachers. So the multitasking aspect of middle school makes it more complicated. And then you go to high school where there's even more multitasking and more different classes and more stress and pressure, and then you're beginning to think about I'm gonna get myself into a college and there's the pressure on that, and uh do well on the SAT or the ACT exams, et cetera. So as the multitasking increases, the demands on the ADHD brain increase as well. And then you go to college. And the difference in college, besides the fact that the multitasking continues, is for the most part, mommy and daddy aren't there. You know, prior to that time, mom and dad would help keep you on top of your work and work with you on study skill development and try to keep you on task. But now suddenly you're in college by yourself and having to self-supervise. And, you know, many of the individuals who uh manage to compensate for their undiagnosed ADHD in in high school, when they get to college, it falls apart. And oftentimes what I see at that point is they stop going to class, they give up on school thinking it's uh a waste of time, they get into uh alcohol, marijuana use, partying, uh anything that uh allows them to not have to pay attention to the emotional pain that school has become. And so that's that's why coming up with a diagnosis early on is really critical because it allows an individual to get the proper treatment for it.

SPEAKER_00 11:09

Even something as simple as uh w when you're home, let's say you're in high school or in middle school, junior high school, chances are you have your own bedroom where you might study. And when you get to college, if you're go to an away school, now you have a roommate, and you may have more than one roommate. So you don't have the privacy and the quiet that is needed for some brains. Now I know for myself, any external stimulation, noise, music, conversations, anything would be so distracting to me that it would I I couldn't do it. I would need quiet. So when I was, even when I was working on my doctorate, I'd have to find a cubicle in the library where nobody was so that I wasn't distracted. But I know some of my own kids included, they can't study unless there's music on or TV on when they were in college or in high school. And I'm like, how can you possibly concentrate when the TV is on or the music is on? And that's because everybody's got a different brain.

SPEAKER_01 12:13

You know, when I when I was in college, um, I used to do the same thing. I would sleep in them at eight o'clock at night in Rochester in the cold and the dark to the psychology building. They left it open. So you could go into the psychology building and find an empty classroom and just sit. And and and that was, and I had no ADHD. I just had the need to be able to not have distractions. And um many of the libraries uh which are supposed to be quiet and uh non-distracting, aren't and there's too much social interaction. Um the other aspect of of the ADHD is that the uh the the drive to be socially interactive and date and make friends and and be popular socially uh can get in the way in somebody who's got ADHD because you have different priorities. And uh, as we talked before, once those hormones hit, um it's very difficult to maintain the concentration like you'd like to have. And so um uh educating the individual about attention to disorder, that it's not a bad disease, it doesn't mean that it's going to get worse, but it needs something. It requires that attention be paid to it because if it's not treated uh and you don't know that you have it, and that's the reason why your grades are not good and then why your life is out of control and unorganized, and uh your room is a mess and you can't stay on top of things for yourself, and you forget to do the laundry and et cetera, et cetera, you'll end up walking away from that with lots of negative self-identity and concept. And that then leads to anxiety and depression, and it can become a downward spiral.

SPEAKER_00 13:46

Yeah, ADHD and self-esteem are so related to each other because if you are, if you have a task, whether it's just sitting and learning and listening or it's actually reading something and trying to decipher it and memorize it, and you're frustrated with it and you you're just not getting it, and yet your neighbor is like just whizzing along and they seem to have no problem with it, you can quickly uh start to feel like I can't do it, and then just become a pa what we call a passive learner, where you just don't exert yourself, you don't give it the extra, you don't go and ask for extra help because of other self-esteem issues. And so quickly, if you have ADHD, any form of it, you start to kind of give up. And if you have that plus any other aspect of uh emotional issues as you're growing up, such as social anxiety or other things, you can quickly give up on academia and turn to other things that were, you know, not so good for you, whether, as you say, whether it's alcohol, drugs, or just withdrawal, or just finding something that you're good at, even if it has no real value in life. So if you have ADHD, the problem is many times we I don't know if we use the term much anymore, but I remember talking about a person being stimulus bound. So if they could connect to a stimulus and have a good connection to it, like if it was interesting or exciting, then they would stay connected to it. But if not, it would be like when in the old days when you had a radio station that would go in and out. It wasn't the the broadcast wasn't strong enough so you could hear it, then you couldn't hear it, and you couldn't quite make out what they were trying to say. And that's basically what it feels like when you have ADHD. You you you know the there's a broadcast coming towards you, but you can't really understand it because you're not really staying connected to it. And that's where, no matter how hard you might try, you need extra help. And that's where you come in.

SPEAKER_01 15:49

Yeah, sometimes. But you know, the the other interesting thing about ADHD is that when the hyperactivity component is prevalent, these are the kids who are the wild and crazy kids. They're they're they're fearless. They're adrenaline junkies, they'll climb the tallest tree, they'll jump off the roof of their house, they'll impulsively do things that their peers who don't have ADHD won't do. And that just leads to more and more difficulties. And um it's almost like if you're the if you're the uh fastest gunslinger in your town in what in the days of the uh old wild wild west, uh, you have to maintain that identity. And and kids with ADHD who are wild and crazy develop that identity and believe they have to maintain it because it's part of their self-worth. And these are the kids who often get into trouble, as I mentioned, in school, outside of school. Um, when you talk with them about it, they're not happy about that level of hyperactivity impulsivity. They'll say that, you know, I I cancel my body down. It feels like I'm driven by a motor. I'm not able to sit at the beach and just relax, doing nothing. I've always got to be doing something. I can't sit in a chair and relax. I can't sit in the classroom and pay attention to the teacher because I'm always knocking my leg up and down or or swiveling in the chair or playing with uh the pencil or the pen. Um interestingly, the hyperactivity responds to medication as well as the inattention does as well. And I've seen a whole bunch of uh adults who come into me and and get diagnosed for the first time with attention deficit hyperactivity disorder, who when they've responded to medication, we'll be talking about that probably in the second part of this of this podcast, but um the hyperactivity aspect of it responds to the psychostimulants, as does the attention concentration, when they've responded, and suddenly the mind is quiet and their body is quiet, and they're able to sit and they'll say to me, Oh, gee, it's like a light bulb went off in my brain. I can sit and read a book for the first time. They then say, Boy, I wish this I had been diagnosed when I was younger because I've corrected lots of grief and difficulties I've had for much of my life. And and, you know, I have to let people know that, well, at least we're diagnosing it now, and the main thing for us to do is to uh focus on how you can correct some of the misbeliefs you had about yourself in terms of your own identity that came that were acquired, as we talked about because of excess baggage, that was due to the uh untreated, undiagnosed ADHD.

SPEAKER_00 18:16

It does become an identity thing, especially for kids. Uh I remember when my kids were young, we had uh some friends and they had uh one two children, one was a boy, and he would personify ADHD. And when he'd come to visit, it would be like, oh my God, you just couldn't wait for them to leave because he would be like a tornado just came through your house. The problem with it is he starts to feel like people are annoyed with him, or people are always scolding him or telling him to stop or whatever. And that that seeps into the Charles identity where unbeknownst to him, and not because he couldn't he was doing anything bad intentionally, he would start to feel like, you know, people are annoyed with me, people don't like me, people are pushing me away. Uh and and maybe even a little bit later would know. People are saying, well, why don't you just don't bring him? And so that follows along, changes their whole path. And then, you know, I'm sure you've had experiences where you're out to social events with adults, and there's always somebody at the table who may be adult age ADHD, the real hyperactive part, and it's hard to relax with them. It's hard to just feel kind of calm and peaceful. It's just revved up. Um, so it it does follow through even into adulthood.

SPEAKER_01 19:34

Yeah, that's the person who's uh buddy into conversations, won't let somebody finish the sentence or will finish the sentence for them. Um and and it does make you uncomfortable because you you you want to tell them to be quiet, but they it's not like they're doing it volitionally. They they have no control over it. And uh you can sometimes see the verbal diarrhea that develops as a consequence of it. Um it's interesting that that the individuals with uh ADHD will often end up being in in active sports. They'll be pitchers, catchers, um, they'll be playing uh uh soccer, uh rugby. And the more activity, the more action there is, the more they can focus. And that's true for all aspects of ADHD, whether it be the hyperactive type uh hyperactive type or the inattentive type. It seems that the action aspect of it really helps focus their brain. Um and it's interesting, I saw a uh uh very famous uh successful stockbroker who had horrendous uh hyperactive ADHD. In fact, I have a relatively small office with a lot of uh what I call tchotchkis and doodads, and he was getting up and and picking up everything in the office, walking around, looking at it, examining it. And I didn't know that he was a uh stockbroker at the time. And uh I then finally got to the part of the evaluation where I asked him what he did for a living, and he told me he was a stockbroker and then told me how successful he was. And I said, How do you in a million years manage to do what you do? And he said, It's easy. I stand up in front of two monitors, and I have both of my assistants, one to the right and one to the left. And if you think about it, uh trading and interacting with stocks is an active process. And so he's actively engaged in the trading, which helps him super focus, but it's the people to his right and his left who take down all the information and process it. So he's able to compensate by having them doing it. It's amazing how many people with ADHD are extraordinarily successful because they've learned how to compensate. Uh, another person I saw was a uh very successful CEO of a Fortune 400 company, huge company that was an uh interstate company, and uh found out that he had clearly had ADHD. And and and I said, How how do you manage to control this company with the difficulties you have? You know, how do you deal with spreadsheets and Annual reports and all that stuff. He said, simple. I go out and make all the deals and and I I hired anal vice presidents who who take care of all the other stuff. They protect my flanks, and I'm I'm the rainmaker, but they then do all the hard work. And it's uh that's a good way to compensate. And and but he was finding that it was interfering with his marriage and friendships, et cetera. So there are other reasons for him to want to be able to uh get treated and get things stabilized.

SPEAKER_00 22:28

There's a flip side, sad story. A number of years ago, uh somebody came to see me. They were at the time 23, I think, and they uh had severe hyperactivity disorder, so much so that they were always getting hurt and injured because they never sat still. And they got involved with exports, which was great, great release for them until there was a uh a real tragic event and they became paralyzed from the shoulders down. And his dilemma was, you know, I've been all body, all physical all my life. Now all I have is my brain. And he had he had no release for anything. It was just it was it was just an amazing, unfortunate scenario. And it was like my the goal was can we find a way for you to adapt and use your brain in a way and give you some set satisfaction like you used to use with your body. It was a real bad challenge though.

SPEAKER_01 23:33

Well, I can't imagine what that had be like because if you have the hyperactivity component and suddenly you're paralyzed, the brain is still sending out those messages to be hyperactive, but the motor system isn't responding to it. It was horrible. Yeah, wow. I I had another patient who uh was an alcoholic, and and once he got sober, he began to experience the attention concentration, hyperactivity symptoms that the alcohol masked. And it's not uncommon to see that. And once he got sober, uh, as a lot of people in AA will do, they want to give back. And so what he did is he started volunteering in jail, uh, talking to uh alcoholics in recovery in jail. And when I saw him after he was doing this, he came back and he was horrified. He said, You know, now that I know what ADHD is all about, the number of prisoners incarcerated with ADHD is huge. And it makes sense. If you have the hyperactivity impulsivity, you're gonna end up not using good judgment, getting into trouble. And before you know it, you've been in trouble with the law, and before you know it, you may be incarcerated. So um he began to go around uh the the prison system educating uh individuals about ADHD and the need for treatment.

SPEAKER_00 24:47

You know, before we move on to some of the medicines, I think it would be important to also note that a lot of times people come in to see us because of anxiety. And it turns out that the driver of the anxiety is the uh underlying ADHD, because if you have so many things that you're trying to manage at the same time and you just can't, and you know many of these things are really crucial to manage, you're going to get anxious from that. So many times ADHD medicines actually help reduce anxiety because it makes it easier to manage all of the things that you have to manage. You know, you're absolutely right.

SPEAKER_01 25:26

I've I've seen a number of people, I think I mentioned this the last time in one of the other podcasts who came in with a chief complaint of anxiety and uh became quite clear that they had ADHD. And usually somebody with anxiety, if they get on a medication for ADHD, which are usually stimulants, uh, will get worse. It's like having too much caffeine if you're anxious, but they calmed down and the anxiety got a lot better, and and that's exactly what you're talking about. Um I don't want people to walk away from this podcast thinking that this is a horrible negative disorder. The reality is that individuals with ADHD are extraordinarily creative, uh, have successful lives because of that creativity. And so the goal really is to take advantage of the positive aspects of ADHD, uh, the creativity, the ability to hyperfocus, uh problem solve with that hyperfocus, et cetera, uh, while attending to the negative aspects of it and the executive dysfunction. And uh, I'm Dr. David Gross, psychiatrist. And Dr. Andrew Rosen, psychologist. And we are at Two Shrinks in a Mike, and we'll see you next time where we'll talk some more about the treatment because the treatment's not just medication. There are important aspects beyond medication that we need to talk about.

unknown 26:40

Right.

SPEAKER_01 26:41

Bye-bye.

SPEAKER_00 26:42

The Two Shrinks in a Mike podcast is for informational and entertainment purposes only. The views expressed are those of the hosts and guests and do not constitute medical, legal, or professional advice.

SPEAKER_01 26:55

Please always consult a qualified healthcare provider before making any medical or wellness decisions. Our content is not a substitute for professional medical guidance, even though our mothers tell us we have the best advice possible.