Everything NEURODIVERGENT - Trauma of Misdiagnosis or Late Diagnosis

Guest: Rachel Ward, PMHNP

Do not miss this important information on the latest studies in Neurodivergence.
 
We talk with psychiatric nurse practitioner Rachel Ward about why ADHD and autism are so often misread as anxiety, depression, or personality disorders and what that costs people over years of care. We break down dopamine, “no brakes” emotional reactivity, and how better testing and better relationships can finally match treatment to the actual brain in front of us.  
• neurodivergence misdiagnosis in adults, especially women and AFAB clients  
• ADHD as attention dysregulation, not a character flaw  
• why SSRIs can cause emotional flattening for some neurodivergent patients  
• how stimulants can create a pause between emotion and reaction  
• the “anxiety buddy” pattern of running on adrenaline and urgency  
• ADHD and autism comorbidity and family-line patterns  
• using Creyos testing to map executive function strengths and gaps  
• pharmacogenetic testing, medication metabolism, COMT markers, hormone pathways  
• alternatives when families are not ready for stimulants, including saffron and guanfacine  
• addiction as comorbid with neurodivergence and treating core symptoms first  
• differentiating trauma from neurodivergence and teasing out borderline overlap  

🔗 Links & Resources:

Connect with Rachel Ward: https://www.somethinghumanhealth.com

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/

Transcript

Why Neurodivergence Gets Missed

SPEAKER_01 0:00

Today I'm talking again with Rachel Ward, a psychiatric nurse practitioner, and one of the clearest voices I know when it comes to understanding neurodivergence in clinical practice. And this conversation matters because the research is becoming impossible to ignore. Over the last decade, large-scale studies have shown that neurodivergent adults, especially women and assigned female-at-birth individuals, are routinely misdiagnosed for years before anyone recognizes ADHD or autism beneath the anxiety, depression, or treatment resistant symptoms that they've been carrying. So today we're pulling this into the light how neurodivergence gets missed how it gets mislabeled, and how clinicians can stop treating the smoke while overlooking the fire. If you're a clinician, this is essential listening. And if you're someone who has always felt like you were handed the wrong operating manual for your own brain, this episode might give you language and relief you've been searching for. Let's get started.

SPEAKER_00 1:13

Welcome to the missing piece: cracking therapy's office spaces.

SPEAKER_01 1:18

I'm your host, Helene Burst, and I'm a licensed professional counselor. Today I'm thrilled again to talk with Rachel Ward, and this time on the hot topic of neurodivergence. Welcome, Rachel. Thanks for having me. Of course. Rachel is a board certified psychiatric mental health nurse practitioner and the medical director and founder of Something Human Mental Health important, Oregon. She specializes in working with complex patients who have historically struggled to find their footing in the mental health system. She also takes a holistic relational approach, blending lifestyle changes, herbal therapies, and spirituality with Western medicine. And that is something I absolutely love. I uh um actually have personal experience of that. Rachel has been helping my daughter who deals with a lot of issues. Rachel actually put her on a stimulant, and I was shocked because she's been put on everything else but that. She's actually um have autism and she has a lot of anxiety and depression, and we've tried all the medicines. There was, in fact, five five years of trial, trial and error that we did where they literally are just throwing something against the wall and see what sticks, right? But then bringing her to you guys, um, that was just amazing. So, can you explain why that was the right call for an autistic brain and why standard treatment like SSRIs often fall short when it comes to people with um neurodivergence?

Dopamine Dysregulation And No Brakes

SPEAKER_01 2:51

Yes.

SPEAKER_03 2:51

Yeah, yeah, yeah. Um, this is a really big topic. Um yeah, that I mean the neurodivergent brain is is so different. Um, and I I think about I I actually really wish they would re rename um ADHD and autism. I've I've been talking to a lot of colleagues about this. Um I just well, first of all, attention deficit disorder is that's it's not an attention deficit, it's attention dysregulation disorder. And I think we've talked about this a little bit. I kind of think of ADHD and autism as kind of like two hands of the same coin is is they're both a consequence of dopamine dysregulation in the brain. But where that shows up based on the 28 different genes that could be effective, whether it's your dopamine transporter or the synaptic space or whatever whatever area that that your specific genetic profile and your environmental activation of that profile can lead to dopamine dysregulation in the brain. And so if you start to think about where in the brain that's happening. So if it's in the move, if dopamine dysregulation is in the movement cortex, you're going to have hyperactivity or even hypoactivity in some people. If it's in the midbrain, there can be addictions because the the satiation pathways are not satiated. There can be emotional dysregulation. There can be oversensitive like bringing in too much information into the body. That's that's one of the core symptoms of autism. If it's in the prefrontal cortex, that's a lot of the things that people talk about, and you hear about that a lot, the executive function piece of spatial planning, working memory, um, differentiating small details. But in specifically to your question, in ADHD and autism, it's not it's not a deficit issue. It's it's uh a lack of breaks in the brain.

SPEAKER_01 5:08

That's interesting.

SPEAKER_03 5:09

So it's like it's like you're driving a car without brakes, and that's why the anxiety is happening. So in the midbrain, that part it fully develops and on time, but the prefrontal cortex is delayed or doesn't develop fully. Um and people who are neurodivergents, we're seeing that their their brain fully matures around 35. It's really late. Really? I didn't know that. And on average, um, you know, teens are seven years behind their peers. So the the thing that I like to kind of pull up to help people visualize what this looks like is a teenage brain looks a lot like a neurodivergent brain under normal physiology. So they have very fast zero to a hundred reactions. They are very passionate, they fall in love quickly. Um they're more impulsive.

SPEAKER_02 6:02

For sure.

SPEAKER_03 6:04

So that's that's it's very similar. Like the normal teenage brain is very similar to an ADHD brain.

SPEAKER_02 6:12

Wow.

SPEAKER_03 6:13

But if you if you take ADHD and add it on top of that, it becomes even more pronounced.

SPEAKER_01 6:19

Okay, wow. So a teenager then with a teenage brain.

SPEAKER_03 6:23

A teenage with a teenage brain and ADHD. Now you have this very pronounced, you know, zero to a hundred. It's like tantrums almost, impulsivity, where they're making what we grown-ups feel like are are inappropriate choices. Yes. Um, but also very passionate. They tend to be very excited about things, think deeply, and um create wonderful things.

SPEAKER_01 6:46

Exactly. There's very beneficial things too. Yeah.

SPEAKER_03 6:50

And so, but it's it's like driving a car without brakes. So if you think about normal anxiety that you would have, your normal emotional response, that emotional response is not inhibited by anything in the neurodivergent brain. If you give that person serotonin, first of all, they already have enough serotonin in in most cases. And so the only thing that you're giving them is emotional dullness. You're flattening everything.

SPEAKER_01 7:16

Yes, I've heard clients say that.

SPEAKER_03 7:18

Yeah, they feel very flat. And and that's that's not healthy. No, it isn't. You want to feel the full range of your emotions. That's important. That's an important part. Absolutely.

SPEAKER_01 7:28

I've heard clients say this. It's like, I want to be me. And yes, SSRIs make me feel like I'm not me. I'm just like this person. Yes. That's dull. Yes and boring.

SPEAKER_03 7:37

Yes, yes. And in fact, sometimes I see people who are put on an SSRI as a teenager and then continued into mid-adulthood. And when they come off of the SSRIs, they don't have the skills to be able to manage their emotional landscape.

SPEAKER_01 7:53

Oh wow. So dysregulated a lot.

SPEAKER_03 7:57

I think it's harmful because they don't have that distress tolerance.

SPEAKER_01 8:00

Exactly. They didn't create the tools to regulate themselves. Right.

SPEAKER_03 8:05

Yeah. But in the case of a person who's neurodivergent, so we give them an SSRI, they become flat, and they're kind of better. Right. Yes.

SPEAKER_01 8:15

I guess so. It's uh it makes me think a little bit like the lobotomy. I don't know what it's going to do. Yeah, like that thing in the brain. Oh, they're better.

SPEAKER_03 8:26

They're kind of better. Yeah, they're brain dead. But they're they're kind of brain dead. Yes. Yeah. But if instead, if you give that anxious, neurodivergent person a stimulant, it gives them breaks. So they feel the full range of their emotions, but they have a split second in some cases. But a split second might be better than nothing of time in between I'm having an emotion and I'm having a reaction to that emotion. And that little space, every time you flex that muscle, it strengthens the prefrontal cortex. So actually, in the first year of treatment, after you've been on a stimulant and you get that little space of time, the the prefrontal cortex grows.

SPEAKER_01 9:11

Wow.

SPEAKER_03 9:12

So there's some curative effect too for these people.

SPEAKER_01 9:16

Yes, we talked about that before. Yeah. They don't necessarily have to stay in things forever.

SPEAKER_03 9:21

Yeah, yeah, or and not as high of a dose.

SPEAKER_01 9:23

Not a high dose, yes.

SPEAKER_03 9:25

But yeah, so so now they have this little bit of time to decide what their reaction is gonna be. And that every time you flex that muscle of of self-control, of emotional tolerance, emotional distress, it becomes easier. And the anxiety decreases. So that's one piece.

SSRIs Versus Stimulants For Anxiety

SPEAKER_03 9:45

The other side that's really tricky is that um norepinephrine can bind to dopamine receptors in the brain. That is a normal physiologic response. That's what happens when like the mom lifts the car off of a baby.

SPEAKER_02 10:04

Oh, okay, yes. Okay. Yeah.

SPEAKER_03 10:06

Norepinephrine is another another word for adrenaline in the body. Okay. Um, but it's specifically it's adrenaline in the brain. So norepinephrine floods your brain and it binds those dopamine receptors under an emergency and allows you to focus.

SPEAKER_01 10:21

Okay, yes.

SPEAKER_03 10:22

So people who haven't been, who just don't have enough dopamine at at the receptor sites for whatever reason, usually they will have found ways to recruit from that norepinephrine system. Um that can look like creating false urgency, um, doing way too many things in your life all the time. Okay. Um I mean, it can look a lot of different ways, but those are the two. Crisis, crises, every creating a lot of crisis. Yes. Yeah, kind of creating a lot of case chaos around yourself. Interesting. Um and even that can look very normal. So that that can look like um they just are functioning at a very high level. Like they've got a whole bunch of kids and they've got a fancy job and they keep their house completely perfect.

SPEAKER_01 11:13

They're always busy.

SPEAKER_03 11:14

They're always busy, but then when the door closes, they just fall apart. Um so in those people, um, that overuse of the norepinephrine system over time leads to fatigue of cortisol, where cortisol is not as effective. And norepinephrine feels really anxiety driven. It's very anxiety-driven.

SPEAKER_01 11:38

Yes, no, for sure. That high adrenaline.

SPEAKER_03 11:41

High adrenaline, yeah, yeah, feels and the sleep gets dysregulated, and it's kind of a cycle that feeds into itself. So if you give that person a stimulant, at first they'll feel very tired.

unknown 11:54

Okay.

SPEAKER_03 11:55

Because they don't have that they don't have access to that, and it's a very it feels like you feel like a superhero, you feel amazing, you feel like you could do anything.

SPEAKER_01 12:04

Yeah. Yes.

SPEAKER_03 12:05

Um so they'll it it feels kind of like a let down to focus on dopamine instead of norepinephrine.

SPEAKER_01 12:12

Yeah.

SPEAKER_03 12:13

Um, but if you inhibit that that binding of norepinephrine over time, the anxiety will come down as a response to. And they can learn to not create chaos in their life.

SPEAKER_01 12:25

Wow. So they could be an initial rise, but then it comes down. Is that what you're saying? Or is it not necessarily a rise at the beginning of anxiety?

SPEAKER_03 12:34

It's rather Usually those people feel I call it the anxiety buddy. Like they had an anxiety buddy that was helping them do a lot of stuff. But the anxiety buddy is kind of a false friend. Okay. That's a good way to put it. Yes. Um, and then we remove the anxiety buddy, and now they're very tired until we get the stimulant to the right place. But um, it's just a very different type of focus.

SPEAKER_01 13:00

Yeah, that's fascinating because I would have never thought to give somebody with ADHD or somebody with anxiety to give them a stimulant.

ADHD And Autism Share Deep Roots

SPEAKER_01 13:10

Well, um, yeah, could you say a little bit more about the link between autism and ADHD? Because, you know, when I I do um I've heard you explain it so eloquently, but it's still hard for me to explain to people what's the connection. And um, we were even talking about the genetic connection then going down the family line. Um but specifically, I like your analogy of the two hands of the same body, right? Autism and ADHD. So could you say a little bit more about that?

SPEAKER_03 13:42

Yeah, so um in studies that were done, and mind you, studies art in psychiatry almost universally are done on men. So um That's not fair. That's not fair. It's not fair, but that's what would that's the data we have. But the heritability rate, or the not heritability rate, I got ahead of myself. The overlap between comorbidity, between ADHD and autism is 80%.

SPEAKER_01 14:06

Really? This isn't studies that they do that. Wow.

SPEAKER_03 14:09

Very high.

SPEAKER_01 14:10

Very high. So you will maybe have both. Is that what you said?

SPEAKER_03 14:14

For sure.

SPEAKER_01 14:15

Okay. There's a big chance.

SPEAKER_03 14:17

Yeah.

SPEAKER_01 14:18

Wow.

SPEAKER_03 14:18

Yeah. And in fact, I usually only test for one. I I don't I only test for ADHD. And if I diagnose ADHD, I assume that you probably have AD autism as well.

SPEAKER_01 14:29

And you find that a lot too, that they will be those same uh sensory disorder problems. Oh, for sure. That in the ADHD too.

SPEAKER_03 14:36

For sure.

SPEAKER_01 14:37

Yeah. Wow. Yeah. That was fascinating.

SPEAKER_03 14:39

Almost it's like very extremely rarely do I find somebody that feels like pure ADHD. And and even then it's like it's only a matter of time before they're like, oh yeah, I I just really I just wear the same clothes every single day.

unknown 14:55

Yes.

SPEAKER_01 14:56

These are the only ones that don't scratch me. Yeah.

SPEAKER_03 14:59

Yeah, yeah. And because the the problem is also with both ADHD and autism, there's a very big difficulty with interoception or under understanding what's going on in your body, knowing what your symptoms are.

SPEAKER_01 15:12

Yeah, no, that's fascinating. I had no idea about that. Um, but we do see it in family lines too, right? Is that you spoke about that specifically, is that usually if you are you're treating a teenager with this, very likely the mom or dad or both could have been just been undiagnosed, but they have similar things going on in them.

SPEAKER_03 15:35

Yeah, there's kind of there's a theory that birds of a fl feather flock together. Yes. Like people with the same way of thinking, same neurotype will do the same hobbies and same careers, and so they will find each other and marry each other and have children together. But on top of that, um if one child is di so the what the American Psychiatric Academy recommends is if we diagnose a child, we recommend the whole family be assessed.

SPEAKER_02 16:05

Okay.

SPEAKER_03 16:05

Because if one child is diagnosed, then at least one parent has it. If two child children and their first degree, their full-blood siblings have a 50% chance of having it.

SPEAKER_02 16:18

Oh wow.

SPEAKER_03 16:19

If two children are diagnosed, then both parents have it and everybody in the family has it.

SPEAKER_01 16:25

Oh wow. So it is a family affair.

SPEAKER_03 16:27

It's a family affair.

SPEAKER_01 16:30

Oh my goodness. Yeah, and actually, you know, I've also seen um where somebody has such a high degree of it, say autism three, right? So there's they're non-verbal and everything, and the focus are so on them that the other kid also has something, but they just fell through the cracks. Yes, because it's not as huge. But the chances of them having also maybe autism one or ADHD or both, right? It's absolutely very high. Very high. Yeah. Wow.

SPEAKER_03 17:05

And the other thing is too that the um sometimes parents will have come up with coping mechanisms in their household and kind of created a neurodivergent oasis or really normalized symptoms because everybody has it, everybody does it.

SPEAKER_01 17:21

So normal.

SPEAKER_03 17:22

It's very normalized, yeah. Yeah. And so people are like, well, no, everybody, everybody uh is picky eaters or everybody.

unknown 17:32

Yeah.

SPEAKER_01 17:33

And then you're looking at them like, no, not really. It's not a thing. I can see that happen for sure. Yes, yes, the normalization. I mean, that's just true for all types of things in families, right? Where um many times uh people tell me, oh, they had a lovely upbringing. Uh, there was nothing wrong. And then when we start to dig a little bit, there's like seven aces, right? So they there's just all these other child expenditures. But to them it was just normal. It was very normal.

SPEAKER_03 18:04

Everybody has that.

SPEAKER_01 18:05

That was just a Tuesday, man. Yeah.

unknown 18:08

Yeah.

SPEAKER_01 18:08

Now I can see the normalization of neurodivergence too, right? Yeah. Yeah. So um, could you talk to us a little bit

Creyos Testing And Executive Function

SPEAKER_01 18:16

about? Well, let me first say this. There's two testings I want to talk about. I want to talk about genetic testing and then also the ADHD testing specifically that you do, which again is unheard of for people to do it out the gate. And I am so in awe of you guys doing it that I had you over so you can talk to all my colleagues, right? Because I think it is uh something that's being been missed. Because if you don't have those components or if you don't know this person has a neodivergent brain, uh and it's not always so easy to tell by just seeing someone, then you're gonna prescribe the wrong thing, right? That's exactly right.

SPEAKER_03 18:55

Yeah. Yeah.

SPEAKER_01 18:56

So so talk to me about those tests a little bit.

SPEAKER_03 18:58

Yeah. So the test that I use in my practice is called um Krayos, uh, C-R-E-Y-O-S. And um it's uh I always tell people it's it catches about 90% of cases. Um which is pretty good, yeah. Um and the reason I started using it interestingly is that I was finding a very hard time differentiating between personality disorders and autism.

SPEAKER_02 19:27

Oh, really?

SPEAKER_03 19:28

Yeah. Um uh A, because a personality disorders are so stigmatized. Yes, so and people want to believe that they have autism.

SPEAKER_02 19:40

Okay.

SPEAKER_03 19:41

Um and so I I was finding it very difficult to differentiate between the two. And so I needed a tool that could help me. I we have so few objective data in psychiatry, too.

SPEAKER_01 19:52

Not in exact science, right? Still, we're struggling. It's not enough. We don't know enough.

SPEAKER_03 19:57

Yeah. And so I I use that, and then it let's say it's negative and I'm still suspicious of ADHD or autism. I may send them on for neuropsych testing, which is the gold standard in psych psychologist. With a psychologist, it's expensive. That's the other thing, is that it's it's very expensive. It while it is the best way, it's very expensive, it's time consuming, it's hard to access. And we need objective data and good diagnosis. Our patients deserve that.

SPEAKER_01 20:28

Yes, especially if you're gonna prescribe them to put in their bodies. And it needs to be as accurate as possible. Exactly.

SPEAKER_03 20:36

Yeah, plus, on top of that, as I started using the tool, I was like, actually, this is useful in so many other ways because it tells me exactly where they are struggling in terms of their executive function. And so it becomes a really useful tool for creating lifestyle interventions that are specific to the patient.

SPEAKER_01 20:58

Wow. Um, that makes sense.

SPEAKER_03 21:00

Yeah, and monitoring them as we go through therapy to see where they are in terms of their function, whether it's working or not.

SPEAKER_01 21:08

Well, so yeah, because just treating um executive functions, problems with executive functions very vague, right? So this test helps you to actually uh point to certain areas and be like, this will be good to have some behavioral help with this.

SPEAKER_03 21:25

Exactly. Yeah. Okay. Yeah. So it it tests five five different areas. It's looking at spatial, um, spatial awareness, which seems like that shouldn't have anything to do with ADHD, but it totally does. Um that's like uh people talk about like assembling furniture without instructions or yes.

SPEAKER_01 21:47

Okay. Yeah. Um light's going off in my head.

SPEAKER_03 21:51

You're like um, but also like the task of uh deciding how long something's gonna take and Creating a block that you're going to put on your calendar. That's a spatial awareness task. And then so that's one another is working memory. That's like your ability to hold a set of data and draw from that data in order to complete another task.

SPEAKER_01 22:16

Okay.

SPEAKER_03 22:17

Um another one is differentiating small details. So that's important for like multiple choice exams, like test anxiety that can show up, or um people who really like perseverate around decision making, have a lot of anxiety around decision making, or impulsive decision making, because you can't tell what's the difference is, and so you just pick something and move on. Oh wow. Um and then emotional uh reactivity, so difficulty with emotional inhibition.

SPEAKER_02 22:54

Yeah.

SPEAKER_03 22:55

Um, and then ability to perform when something's boring.

SPEAKER_01 23:00

Oh, the boring thing. The boring thing. Yes, I just told you earlier on, right? Maybe I'm just bored again. Yeah. Because yeah, some of those neurodivergent traits that come up is boredom and could be novelty seeking. Yes, because even detrimental to the point of not being able to hold a job, right? Because this job is so boring. Or I need something new, I'm done with this now. Uh so yeah, I can see that that could be very debilitating for sure. Well, so this test actually, I want one of those tests. I need to give it to my clients because I'm like, so smart to know those things, to know the actual details, yeah, right? It's really because you can just help clients so so much better.

SPEAKER_03 23:44

Yeah, having something quantifiable. Yes, I guess. Like I always come back to that. Like psychiatry is so qualitative. Yes, we really need quantitative data.

SPEAKER_01 23:53

We really do, don't we? Yes, that's one of the reasons I love EMDR because it's at least a quantitative element there that I can use. Hold on to. Yes, exactly. Well, um, yeah, and and genetic testing.

Genetic Testing For Medication Metabolism

SPEAKER_01 24:06

This is also the first time ever I've heard of this when you would you told me like you want to do genetic testing with my daughter. I'm like, what? So explain a little bit how this actually interacts with psycho psychotropic medication.

SPEAKER_03 24:19

Yeah, so this is very important, especially in neurodivergence. Um, I think even more than other other disease processes in psychiatry. But um, and I'll talk about more about that in a minute, if you remind me. But um the what it's actually testing for is the how well your receptor sites in your liver work, essentially. Um so it's it's looking at the different receptor sites and deciding whether you are a fast metabolizer of medication or a slow metabolizer of medication. The other thing, as I started using it more, and and there's a couple other markers that they have on there. One is um has to do with the metabolism of your own hormones, which is super important, especially for women. Yeah um I've seen the abnormal and men's tests, but I haven't really figured out what to do with it with a men's test yet because there's just not data.

SPEAKER_01 25:16

Yes, the area on their side where they see it.

SPEAKER_03 25:19

Not tested or yeah, studied at all. And then let's see, it also tests for um it's called C O M T. Um that it has to do with the metabolism of your own neurotransmitters, which is very important for understanding it's not diagnostic in and of itself, but understanding whether or not you have a buildup of dopamine and serotonin norepinephrine in your brain, or whether you metabolize it so quickly that you just don't have enough of it available to you. Um and so that can guide medication decisions in a certain way.

SPEAKER_01 25:57

Yeah, for sure. I can see that. Well, can you say just something more about the buildup? I sorry to have to interrupt you, but this is just something I yeah, the buildup?

SPEAKER_03 26:06

Uh you're like, what? That's everybody's talking about adding more. Yeah, yeah. And it's that's not always the best thing. Wow. Um, so what I have found, especially with OCD type, like fear-based disorders, is they will have um a genetic profile that is met met. Um that means that they are slow metabolizers of their own um neurotransmitters. And if you give that person an SSRI, they they have OCD and the first line treatment is a high dose SSRI.

SPEAKER_02 26:39

Oh, it'll it'll have to be.

SPEAKER_03 26:41

They will feel terrible. They feel it's oh, it's the worst. It's the worst. You have to give that patient an antipsychotic.

SPEAKER_01 26:46

Wow.

SPEAKER_03 26:47

Because it's the only type of medication that decreases neurotransmitters.

SPEAKER_01 26:51

Wow. Wow, what that's mind-boggling to me.

SPEAKER_03 26:54

Right?

SPEAKER_01 26:55

Yeah.

SPEAKER_03 26:55

Yeah. Yeah. So using, again, objective data to try and help um help psychiatric patients.

SPEAKER_01 27:03

Yeah, and genetic testing, because it runs in families, right? That's uh before even thinking about genetic testing will work for that. I remember a psychiatrist telling me, like, whatever worked for you might work for her. Exactly. Um, because in family lines it it run it runs in family lines.

SPEAKER_03 27:22

Yeah, and we've known that for a long time, but a lot of people are very hesitant to adopt the genetic testing, don't feel like it's a evidence-based tool. Wow. But I how could it not be?

SPEAKER_01 27:33

Yes, how could it not be? Exactly. Plus, um, so many times people in the older generations they've never been diagnosed with anything. So they had this stuff, but they don't have the pulls. They can't say, like, for me, I can tell my kids this kind of medication worked for me. It will probably work for you. But we don't have that. We don't have that data. Hence, genetic testing.

SPEAKER_03 27:55

Right. Well, even if we did have that data, like sometimes I'll have a parent who tried a lot of things and is very against Western medication, has been burned.

SPEAKER_02 28:03

Oh, yeah.

SPEAKER_03 28:04

Um, because they had, you know, hallucinations from an SSRI or whatever weird thing happened to them.

SPEAKER_02 28:10

Yeah, it didn't work.

SPEAKER_03 28:11

And very reasonably don't want their kids to be on meds when meds really could help. Yes. Um, and so understanding which, you know, which metabolism pathway the medications are going through, understanding like maybe this medication could work for you, but maybe we need to do a very low dose. Um or um no, we really don't want to give you birth control because it's gonna make you psychotic.

SPEAKER_01 28:38

Oh wow. Those things you can actually pick up in genetic testing. Wow, that's amazing. Yeah.

Medication Stigma And The Trust Factor

SPEAKER_01 28:43

Can we talk a little bit about just the stigma surrounding medication though? Because I feel like when I was in college, I one professor who did the neuro pharmacology with us, right, was talking specifically about this, said like some things need to be medicated. And so he wrote the three on the board, and I can still remember that. He was saying ADHD and then uh schizophrenia and what was the other one? Bipolar. Bipolar.

unknown 29:14

Yes.

SPEAKER_03 29:14

You know, I was trying to decide if it was gonna be the same ones that I would say. Yeah.

SPEAKER_01 29:18

And so so tell me a little bit what your thoughts are on that. Do you do you believe that really uh say for instance a a a parent tells you they want you to help this kid, but they cannot go on any medication, waste of medication. They don't believe in that, they don't want you doing any of that. But this is a kid with ADHD, maybe even severe ADHD in front of you, and knowing that actually a stimulant is the only thing you can treat it, um, or is it? That's a boy, that what that's a loaded question. I know, there's a lot. It's like 10 questions in one.

SPEAKER_03 29:51

Um stimulants are by far the best treatment for ADHD. Okay. They're they are effective 90% of the time. Um that being said, it's understandable that people don't want to take Western medication for one reason or another.

SPEAKER_02 30:10

Yeah.

SPEAKER_03 30:10

Um, and I and I think we talked about a little bit earlier too, the the benefit of taking medication. You're you have that brain growth over time. So there there is benefit. And all of our patients are on their own journey that has nothing to do with me.

SPEAKER_01 30:26

That's true. So you will never press the issue. No, right? You will try and find something else.

SPEAKER_03 30:32

I'm gonna find because also the even more important than the right medication is the relationship that I have with my patient.

SPEAKER_01 30:39

Yes.

SPEAKER_03 30:40

Because if if they can trust me, then maybe down the line we can try something else that would be more effective. Yes. But if if I haven't earned that trust, they have no reason. I have no right to demand that they do something with their body. I don't have any right to demand that they do something with their body anyway. But right.

SPEAKER_01 31:00

No, I know exactly what you're saying. I mean, the the relationship is so crucial. Yeah. Um even the data shows that, right, in therapy, for instance, the relationship is the biggest yeah, more than the modality, more than any other thing. I mean, first of all, it's the client that walks in the door. That's the biggest part, right? Whether they're ready to change, whether they're in a place that they can change. Um, but then when it comes to the therapist or the clinician, it really is the relationship. The modalities and stuff, like you just said, is like 1%. It really doesn't matter that much. And I agree with you because I do get that a lot, actually. Um, clients who do not want to go on any medication. I'm thinking in the back of my head, I've got to send them to Rachel because this sounds like ADHD or whatever it is, right? But they are not ready for that, or they've had some bad experiences, like you said, specifically because they have a neodivergent brain and they didn't get the right medication for that. But then again, sort of walking it through with them because many of them, well, they come to see me because I do trauma, right? And so I'm like, we will do all the trauma treatment, we will do the things, and then we'll talk again about medication afterwards, right? Welcome. So it there's also sometimes uh a time for it, I feel. Because at at some point I did tell myself, man, why didn't you just see this? You should have been on medication ages ago. But then thinking back about this conversation if they were not ready. They weren't ready. So just like people are sometimes not ready for therapy, they're just not ready for medication, right? So what are some of the alternatives that you go to?

SPEAKER_03 32:31

Yeah, so um saffron's my favorite. Saffron? By far and away, yeah. It raises dopamine, norepinephrine, and serotonin. Oh wow. Um so it can be used as an antidepressant, but also, especially in kids, it can be used as a as a treatment for ADHD to kind of get started. Um and it's effective? It's effective, yeah. Yeah, I wouldn't say it's not as effective as a stimulant. Nothing is as effective as a stimulant.

SPEAKER_01 32:59

Yes, because it works instantly alive.

SPEAKER_03 33:01

But if you have, let's say, a family where they are very supportive and well regulated, they're doing a lot of behavioral interventions for the kiddo. Um they're they've got a lot of um supports in place at school. Saffron can be a great treatment um to do instead. Or um if they don't want to do a stimulant, they're kind of nervous about that. Guapazine is a really good option for kiddos with ADHD, which is Western medicine. But sometimes if it's not a stimulant, it's a little bit less stressful.

SPEAKER_01 33:36

Yes, yes, because parents are always afraid also, just like with benzos and all the other things, afraid of the uh addictive factor that there is. So so uh what would you say to a parent who's worried that their kid are gonna they're gonna get hooked on a stimulant?

SPEAKER_03 33:52

That's uh yeah, that's a reasonable concern. So what I usually tell people is um and in fact I wrote a blog post about this, is that it's kind of like giving blood pressure medicine to somebody who has a blood pressure pot problem versus giving blood pressure to s medicine to somebody who does not have a blood pressure problem. And you can imagine the consequences that would come. So you know, if you give somebody who has normal blood pressure some losartin, they're gonna pass out. Yes.

SPEAKER_01 34:22

Yes.

SPEAKER_03 34:22

Um but if you give somebody who has really high blood pressure some losartin, they'll they'll feel fine. They'll survive.

SPEAKER_01 34:29

They'll they'll they'll feel better. Yes, much better.

SPEAKER_03 34:32

And in a neurodivergent brain, the dopamine levels are very low. Or they're not reading reaching there because the transmitters are working, or whatever, whatever the problem is. Um so if you give them a stimulant, they're gonna they're coming up closer to neurotypical levels. Okay. So the risk for addiction in a neurodivergent person is significantly less than it is in a person who is neurotypical.

SPEAKER_01 34:57

Okay.

SPEAKER_03 34:58

Because when you give a neurotypical person a stimulant, they feel high. Right, exactly.

SPEAKER_01 35:02

Yeah. Where, like you said, it just for near a neurodivergent person, it just brings it up to a normal level where they're not running with weights on their legs. That's right. You know, they just they can be normal, if you will, whatever that means. Closer. Yeah. Yes, and closer. Never normal.

SPEAKER_03 35:19

Don't don't oversell.

SPEAKER_01 35:20

Don't oversell.

unknown 35:21

I won't. I will. Good point.

Neurodivergence And Addiction Comorbidity

SPEAKER_01 35:25

Well, I wanted to ask something more about specifically that part with the meds. Uh uh, we made a little turn there at addiction. Do you also then get maybe a lot of people who come to you with addiction who are neurodivergent, but the addiction really happened because they didn't have the right medication because they were just sensory seeking not sensory seeking, they were dopamine seeking.

SPEAKER_03 35:46

Oh, this is one of my favorite topics.

SPEAKER_01 35:48

I'll hit it.

SPEAKER_03 35:51

Um People are so afraid to medicate people with substance use with a stimulant. So afraid. And the the reality of there's a couple realities about this is that addiction and neurodivergence are comorbid 75% of the time.

SPEAKER_01 36:11

Really? It's that is so odd. It's so high. It's just sort of like a given.

SPEAKER_03 36:18

Yes, almost a given. Yeah. Yeah. And um whenever I have somebody come to me who is struggling with addiction, the first thing we do is we go through every substance they've ever tried. And I ask them how it made them feel, how long they took it, how much they took, uh what it reacted, what was the come down, because that is so much data. They have tried so many medications before I even got to them.

SPEAKER_01 36:45

Right. That was self-medicating in this time.

SPEAKER_03 36:49

They tried so many medications, yeah. So, for example, somebody has a history of cocaine use. They they are a person who is gonna need a very high stimulant to be effective.

SPEAKER_02 37:00

Wow.

SPEAKER_03 37:01

Wow. And the and the research shows this. Why is that? Um A, the cocaine it interacts with it, it breaks down the receptor sites.

SPEAKER_01 37:12

Okay.

SPEAKER_03 37:12

But B, if they were using cocaine to just kind of get through their day, they probably had severe ADHD to begin with. To begin with, and needed that support badly.

SPEAKER_01 37:23

Yes. Yes. And then I mean, people try so many things, right? Yeah. We spoke briefly about pornography. They um uh well, eating disorders, uh, that looks like an eating disorder, but really it's just trying to get dopamine out of that food, beach eating disorder, especially, right?

SPEAKER_03 37:40

Yeah, yeah, yes. This is and actually eating disorders are the same, it's the same neuropathway, it's the same disease process as substance use disorders.

SPEAKER_01 37:49

Wow, that's why vibans get off-label prescribed for bean eating disorder. That makes a lot of sense. Yes.

SPEAKER_03 37:56

Yeah, and so usually what what I do very first, we go through all the substances they've ever tried. And obviously, I'm not gonna put somebody on heroin or something heroin adjacent.

SPEAKER_01 38:06

Hopefully not.

SPEAKER_03 38:07

But but you know, if they're telling me, you know, let's say that it was a lot of impulsivity, and they when they drank alcohol, they they or they used heroxycodone, they they just felt a lot less impulsivity. You better bet your bottom dollar, I'm gonna try naltrexone for them.

SPEAKER_01 38:26

Yes.

SPEAKER_03 38:27

Because that's satisfy satisfying the opioid receptor without getting them high. Yes. Um, you've tried a lot of medications because we're destigmatizing substance use.

SPEAKER_01 38:39

Yes, we are.

SPEAKER_03 38:40

I was like, you've tried a lot of medications. If I can find a better medication for you, would you be willing to stop that one? Because I have ones that have fewer side effects.

SPEAKER_01 38:49

That's a good way to put it. That seems very tempting to me. It's like, yes, please, ma'am, sign me up. Yeah, yeah.

SPEAKER_03 38:57

And so, you know, just taking away the shame around it. Um, but then also it's like as you start, I don't even try to wean people off of substances before I start treating them.

SPEAKER_02 39:07

Wow.

SPEAKER_03 39:08

So I start, we start treatment, and as their other symptoms improve, substance use naturally declines. And then we get down to a very low level, they're doing therapy at the same time, and they are able to come off. I I'm telling you, like uh I don't know, nine times out of ten, maybe more. It's and it's really you destigmatize it, take the shame away, treat their core symptoms, and then the substance use resolves on its own.

SPEAKER_01 39:42

Wow, that is fascinating because yes, we still do not have good modalities to treat um substance abuse, but what if that was never the problem?

SPEAKER_03 39:52

What if that was never the problem?

SPEAKER_01 39:53

We are treating the smoke here, but there's a fire that we're not even looking at. Exactly. Yeah. Yeah. Wow. Now that's actually very hopeful, you know. I think people listening to this and hearing that.

Twice Exceptional And TikTok Confusion

SPEAKER_01 40:05

Um, because yeah, there must be a lot of clinicians out there with neurodivergence too. Which brings me to another thing that we talked about before, people being very smart, right? Uh and I forgot what the name was for that, but you did talk about twice exceptional. Twice exceptional. Wow. Well, talk more about that. That's super interesting.

SPEAKER_03 40:25

Um, so having very high intelligence all in of itself is is sort of its own neurodivergence. Um, even without being neurodivergent, when you're very uh you kind of think about like the the absent-minded professor.

SPEAKER_01 40:40

Yes. Oh yeah, I was thinking of just that.

SPEAKER_03 40:44

Um yeah, it's like they're they're have so much of their brain function devoted to higher level thinking that they struggle with basic tasks. Yeah. Um and then if you add neurodivergence on top of that, it can create a lot of chaos. Um but I can see that, yes. That can be pretty hot. Yeah, and they can be very high functioning in some areas and very low functioning in other areas. Yes and that can create a lot of cognitive dissonance around your sense of self because why why am I able to be a complete boss in this area and I'm a mess over here? Yes.

SPEAKER_01 41:20

Um I've actually heard um that Intel uh started these groups for autism because so many of the engineers have some they're on the spectrum somehow. Oh, for sure. And uh and that they've actually did that just realizing this is a big chunk of their population.

SPEAKER_03 41:38

It's a thing. Yeah. I think I the there was a study I read that like seven in ten medical professionals have some type of neurodivergence. It makes sense. If you think about like the norobenephrine system, the chaos seeking, the like yeah, it makes a lot of sense. So thinking deeply, yeah. Anyway.

SPEAKER_01 41:59

Wow.

SPEAKER_03 41:59

Okay, no, I'm learning a lot about myself too.

SPEAKER_01 42:04

That's probably a good thing. Probably not a bad thing, right? Yes, yes. Wow. So um just neurodivergence in general, there's it became like a I said a hot topic at the beginning because right now it is everywhere. So it's on TikTok, it's everywhere, people talking about it, saying, well, everybody has some autism and that kind of stuff. Uh, with a lot of things that's happening with this generation just being so smart and having all this knowledge at their fingertips, but not everybody has it, right? Correct. So um what what do you say about that? And do you actually have people wanting you to diagnose them so badly?

SPEAKER_03 42:43

Yeah, I um I gotta be careful because I don't want to create stigma, but I that definitely does happen. Um and that's part of why I started using that Krayos test and to help me differentiate. Um but yeah, I I mean I talk a lot to especially teenagers about normal development, be and we kind of talked about this a little bit, is that normal development in a teenager looks a whole lot like ADHD.

SPEAKER_01 43:12

Right.

SPEAKER_03 43:12

It's impulsive, it's emotionally reactive, it's passionate and you know, impulse Yeah. So not all teenagers, all teenagers look a little bit neurodivergent, but not all teenagers have neurodivergence.

SPEAKER_01 43:28

Okay, so maybe also a reason why it's so prevalent under teenagers, right? Talking about this and thinking that they all have it. Yes. Um yeah, I remember uh talking to parents often when they they want to know this. They're like, oh, how do I know my kid has a any kind of mental disorder or they they're just a teenager, you know?

SPEAKER_03 43:49

And um and so that's where testing comes in very and that's really important because um the the importance of early treatment. Um, you know, if you can get that brain growth early enough and not um have the struggle of the poor sense of self that happens from the negative reinforcement from being neurodivergent. I mean it's so important, but but we need those of that objective data.

SPEAKER_01 44:18

Early intervention, right? So important. I always wish in kindergarten everybody would just be tested because it could be so helpful. Yeah. Um my daughter, for instance, was diagnosed only pretty late and um all those years. So we know she knew she had sensory disorder because you know, she was tiny when she started like taking off those socks everywhere and can't handle clothes that itches, all the things. But um but that happens a lot to misdiagnosis or or just finding a piece.

SPEAKER_03 44:47

Like I'll I'll have teens come in and say they've been to an audiologist who diagnosed hyperacusis or like uh you know, very intense hearing.

SPEAKER_01 44:56

Yeah.

SPEAKER_03 44:56

And I'm like, well, that should have triggered them to look into autism.

SPEAKER_01 45:00

To look further, yes. So again, just that staying with the client and listening to them uh instead of just running with something because that uh I have to always be careful of that, that I listen and wait it out and listen for more because it's so easy for me to hear something and my brain just runs with it, and I'm like, oh, I know what's wrong with this line. This is what's happening, you know. And instead to be like, I don't want to fix everything with a hammer here. Let me pull back a little bit and see if I see all the pieces.

SPEAKER_03 45:34

The importance of that differential diagnosis. Exactly.

SPEAKER_01 45:37

Uh, we're coming to the end here, but anything that we miss that you still want to talk about about neurodivergence because it's a huge

Trauma Versus Neurodivergence In Diagnosis

SPEAKER_01 45:44

topic, right? And it's a huge topic. Is it something that comes to mind for you?

SPEAKER_03 45:48

There's one other thing that comes to mind often is the differentiation between trauma and and neurodivergence. Oh yes. You said that and it made me think of it. Because trauma causes differences in memory and sleep and exactly. It can look like like brain injury. Exactly. Exactly. And and that's not a person who's gonna benefit from a stimulant typically. No, not at all.

SPEAKER_01 46:14

No, it yeah. So um, so even that, right? You're you're also looking at that, looking if this is maybe we have to get a therapist on board here too. And um there's always a therapist. Always a therapist. Always a therapist. I like that a lot.

SPEAKER_03 46:31

I know all my patients, I'm like, I'm only 50% of the work here. Don't take a pill and run off.

SPEAKER_01 46:36

Well, yeah, isn't it true becoming a thing? So I'm telling people, like, actually, we should all have uh uh acupuncturists on hand. We should all see regularly a therapist for other things, you know, because life is hard. There's a lot of things that happen.

SPEAKER_03 46:51

Yeah, and we can't expect our primary person we love to be all things for us, right?

SPEAKER_01 46:56

Yes, exactly, exactly. So so you also, even if it's somebody who didn't speak necessarily about their trauma, you will also test for that for PTSD. Always okay, yeah. I like to hear that. Um because yes, it's um it like you just said, it's a huge difference in the brain too, right? The brain is also running at a very high adrenaline and cortisol if people are have it's the same vigilant state, isn't it? But it's just to get it from a different way, yes. Yeah. That fight and flight always going.

SPEAKER_03 47:31

Oh yeah.

SPEAKER_01 47:31

Which, if we can speak of that for a second here, is very debilitating. It's it can make people very ill, right? So we're not made to stay in that state.

SPEAKER_03 47:42

No. And that's the same that's the same state that's happening when you're using that norepinephrine system, your anxiety buddy, to help power your function. It's the same thing. It starts to look a lot like trauma.

SPEAKER_01 47:54

Yeah, yeah, and and sometimes they do overlap, right?

SPEAKER_03 47:58

Well, yeah, and then the yeah, the incidence, the likelihood of experiencing trauma when you have ADHD is higher.

SPEAKER_01 48:05

Why is that? Do you know?

SPEAKER_03 48:07

Uh well, if you think about the impulsivity and creating chaos in your environment, and it it's like kind of setting yourself.

SPEAKER_01 48:16

I I I just no, definitely. It's and even just so somebody undiagnosed ADHD, undiagnosed uh autism, it can create its own trauma in the sense of something is wrong with me. People treating you differently, and you you're looking at people around you and they're not acting like you're acting, and and it's that feeling of something is very wrong.

SPEAKER_03 48:40

Something's wrong with me fundamentally. Yes. So or if you think about the emotional inhibition and and you put that in a whole family system, that can create a lot of uh messy family dynamics. Yes, can lead to trauma.

SPEAKER_01 48:53

Exactly, because it does influence a lot of relationships, right? It does play out in relationships actually.

SPEAKER_03 48:58

And that speaks to the overlap between borderline personality disorder and neurodivergence. Again, the yeah, yeah.

SPEAKER_01 49:04

So so there's a lot of things to tease out because um I have made lists and stuff of just looking at the overlap between borderline and um uh complex post-traumatic stress disorder because those two look the same so much. So that Dr. Schwartz, who you know uh did internal family systems or developed that, he says that yeah, he doesn't really think there is such a thing as borderline, it's all complex post-traumatic stress disorder because it you treat for the trauma, and then so many times. Now, this person who had borderline, many other clinicians said they had, doesn't have it anymore. Yeah. So uh, and then do you find the same thing? Is that actually this borderline person come to you and you medicate or give them the right medication because you tested them? And was that you autism or something else, ADHD?

SPEAKER_03 49:55

Absolutely absolutely, but the I mean the overlap is so high because of the emotional inhibition um piece. But you know, complex PTSD and borderline really is is the same diagnosis. Isn't it?

SPEAKER_01 50:08

Yes, that's what I feel too.

SPEAKER_03 50:10

But I always tell people, I'm always kind of excited when I diagnose borderline or see PTSD because that's something you can heal from.

SPEAKER_01 50:17

Yes, I say that all the time. We can treat trauma. This is the good news.

SPEAKER_03 50:21

This can go away. ADHD doesn't go away, that's kind of an annoying diagnosis to get. But the the trauma one, I'm like, okay, good. Like this is we can fix this. It's treatable.

SPEAKER_01 50:31

Yes, trauma is treatable. Thank goodness for that, right? Yes, exactly.

Where To Learn More And Wrap Up

SPEAKER_01 50:36

Yeah, but I love how you just look at all the overlapping and all the things, and I really think we should. That's um why I'm hoping this podcast will be helpful to other therapists. You know, I said at the beginning, if you find a puzzle piece on the table that we didn't, why don't you bring it in? Because there's definitely so much to look at, and I think we should never stop learning, right? Because as the field develops, um, we have to keep our finger on the pulse for those things because they're very important. Absolutely. I think we have seen nothing yet. I'm actually very excited about where the brain's gonna go, right? Me too. Hopefully, one of these days we can just zap a certain part of the brain and person is totally cute. Boy, that would be amazing. I don't know. I don't know if that'll happen, but fingers crossed in my lifetime. Maybe when pigs fly.

SPEAKER_03 51:21

Maybe when pigs fly. That's right.

SPEAKER_01 51:24

Well, as always, Rachel, so much fun having you. I just love talking to you about all these things. And you know what? I'm gonna have you back for some more of these topics. But thank you so much. It's bringing your expertise and um also your compassion, you know, for your clients. It it just shows in when you talk about it, shows that you you care about people. You don't, you know, you don't care about the money, you don't care about the meds. It's it's the person in front of you that you care about, and that's that's truly inspiring.

SPEAKER_03 51:53

Thank you.

SPEAKER_01 51:53

Again, if you guys want to hear more about Rachel and all the wonderful work that she does, uh something mentalhealth.com to F.

SPEAKER_03 52:03

Somethinghumanhealth.com. Something Human Health.com.

SPEAKER_01 52:08

So sorry, Rachel. That's okay. But yes, and also uh you find links on there to her blog. She was referring to some blog posts. She writes excellent blogs, so go and read some of those and um you can contact her uh the place again or the business that she has is something human mental health.

SPEAKER_00 52:38

Thank you for joining me. I'm Hollywood Hurst and this is a piece.