Something Shiny: ADHD!

Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the 1st-6th parts of this talk, please see episode 4, All About ADHD Part I; episode 6, All About ADHD Part II; episode 9, All About ADHD Part III; episode 12, All About ADHD Part IV; episode 15, All About ADHD Part V; episode 18, All About ADHD Part VI). Gabe starts by asking about bedtime, or really any time when you have unstructured time or less to do/less responsibilities (for example, during the weekends). How can you get yourself to go to bed early, for example, when you don’t have as many boundaries and commitments already? How do you deal with variability in a routine or unstructured time? David names that you cannot make use of your time if you don’t know what you want to do it with. You can outsource choice through routine—practice going to bed/waking up at the same time, having the same bedtime routine—you don’t want your commitments to be punishing, you want them to be your commitments. David’s example is he’s not a great therapist before 10am, and knowing how he spends his mornings and how he spends his time. On his days off, he’s up at the same time, because it doesn’t make his days working a punishment—he calls them “luxury mornings,” he gets to have a coffee, and listen to this playlist, and cook a dish he gets to have for lunch. He’s not just waiting to do something else, there’s a bonus time fill. Isabelle gives an example if you get a last-minute cancellation or you get an unexpected chunk of free time: you give yourself a treat that’s only for that time, like a show you only get to watch if that happens. Isabelle saves her super weird indie films that no one else wants to watch, and it’s in five minute increments, now when someone cancels on her, she enjoys it—it’s about how to enjoy things, not giving yourself ‘free time.’ If you’re doing free time, you’re effed. When kids say they want free time, they want you to leave them alone, they don’t actually want free time, there’s always structure, like the games they want to play or who they want to play with. What about the chaos and drive within being connected to our productivity-focused Western culture? Gabe describes he behaves as he does because of the party he’s in—is it our culture as well? ADHD exists everywhere and we have different political understandings of what we call this diagnosis; ADHD is a medical issue, we can see how it processes information differently, it’s an objective difference in the development of a human, it’s not ‘caused by America’ or people being reinforced for inattentiveness. David names that he thinks ADHD is linked to a survival of the species (see below-Orchid Children article or “The Science of Success”). Referencing allele cells and epigenetic (see below)—in a nutshell, your grandmother’s environment influenced which of your genes are turned on/off—we pass on survival traits. David uses an example of humans abusing rats, where rats were abused and taught to associate a neutral smell (cherry blossom, see article below) with getting hit on the tail and eventually their tails were cut off—they later went on to have children, and those children were introduced to this new neutral smell (cherry blossom) and showed the same stress/fear response their mother’s did.  For folx with ADHD, it’s similar in that there are some environments where we are distracted, scared, in our heads, etc., and other environments where we have mastery and feel less distracted, more in our zones. So you have to think about the environmental variables that help us do a task. AJ describes his ‘dough island,’ his place of working in the kitchen where he is noticing he has less distractions (no photos, no tv, etc.). You can then figure out which environments you are more successful in or less successful in. A lot of people have a stereotype of what studying should look like, like how Norman Rockwell invented a lot of associations with what Christmas looks like—now what does studying look like? Churning, grinding, giant books, painful, quiet library, crumpling up paper. Some people may study well just studying in a group never taking notes or writing anything, and if they succeed in school, they’re going to believe they’re cheating, which makes their self esteem take a hit. But wait a minute, the person may feel safer in these environments (allele cells are being activated) and the accommodation is working, it’s not so random. First question: where does the behavior NOT happen? If every time you transition you get anxious, think about if there’s ever a time when it doesn’t happen, and if you’re always anxious, accept that you’ll be anxious instead of thinking you’re failing. It’s about embracing it, finding what works for you, and radically accepting it, and throwing out what doesn’t work. Isabelle names how there can be a resistance to things being so easy (and accommodations being so easy)—David names that there’s a belief in ADHD that things should be hard: you’re only validated if things hurt. The mixed message of that is incredible, it sets us up to self-stimulating, but figuring out how we can navigate these relationships differently. You’re like a relief pitcher, good at some things and not at others—cultivate your strengths. David references D&D (Dungeons and Dragons) and the concept of mid-maxing: you minimizing what you’re not good at by outsourcing it and knowing it’s not in your repertoire, and then maximizing what you are good at. A good tip for those with ADHD knowing what they should work on: you can tell someone what to do, you can’t tell them how to do it. And it works both ways. So if it’s a task that you want done in a specific way, you gotta do it (even if you don’t enjoy it), and if you don’t care, it doesn’t matter. This can help you figure out what to outsource (and how to talk to someone with ADHD). It’s important for people with ADHD to not get bombarded with instructions and get in their flow, which might look so different. If they’re listening to music and if it’s not distracting them, they will fill in the blank (and know what distracts them). 

Orchid Children article David mentions (renamed “The Science of Success”)

(Source: The Atlantic, 2009)

Rat abuse study (the neutral smell is cherry blossom, btw) of fear being passed down through generations of rats.

DAVID’S DEFINITIONS

Allele cells: in a nutshell, a variant form of a gene (part of the cells that make up the code that helps make you, you). For more nitty gritty on this.

Epigenetics: Environmental factors influence which genes turn on/off. Your grandmother’s, when she was carrying your mother (who herself in utero contained all the eggs she would ever have, in other words, one half of the genes that make up YOU), turned on/off certain genes. And interestingly, even if you never experience the same things your grandmother experienced, you carry the residual effects of those adaptations. David cites rat abuse studi...

Big Ol’ Disclaimer: We are not doctors or prescribers, but two therapists who have a lot of experience working with folx on/off, loving/hating, trying/not trying all types of medications and accommodations for ADHD. Please seek medical advice for all your medication questions!  Continuation of disclaimers galore: we are not giving medical advice, just our opinions. 

The importance of having a therapist or someone who can help you monitor medications if you are on them. Isabelle describes what it’s like to be off of her ADHD medications while she’s been pregnant/breastfeeding children the last couple of years (stimulant medications, see below, are often not recommended during pregnancy/breastfeeding, though other forms of meds are safe for pregnancy/breastfeeding—another reason why it’s so important to have empowered conversations with your doctors, prescribers, and therapists!) It’s hard when part of your accommodations is medication and that leg of your scaffold is not available. Non-medical or pharmaceutical interventions for ADHD are effective and include: diet, working out, getting adequate sleep, mindfulness activities (not all the time) but a practice during the day can help with frustration tolerance, fidget toys, finding ways to get the energy out, finding more existential interventions to get yourself excited about things instead of anxious or angry about things. David using the idea of guessing the color of the tie of the annoying dinner companions he was previously angry about having to go to—switching an annoying task to an exciting one (those meddling mendelson’s with their zebra zingers!) David also mentions there are some ideas around microdosing with mushrooms, cannibis, ketamine, etc. and he’s never seen them work, not that they don’t, but that he doesn’t even know how to begin talking about them working and is not comfortable talking about it as an expert (if you are one, email us at [email protected]! We’d love to have you on the show to talk more!). Also those microdosing interventions would clearly not work (and be illegal!) with kids. There are really different kinds of ADHD medications, including antidepressants like Wellbutrin (buproprion), which works on inhibiting the uptake (or increasing the quantity of) dopamine, serotonin, and norepinephrine in the brain (which works with the neurotransmitters affected by the brain difference that is ADHD). While a number of other medications can be prescribed for ADHD, David and Isabelle drill down into specifics about the stimulant meds most often prescribed for it: Ritalin and Adderall. Each of these meds have a line of meds that come from them (each med is more related to one or the other). Ritalin is more of a stimulant while Adderall is a stimulant with a mild anti-anxiety component to it. People will have sometimes have side effects to Adderall that makes them feel like there are ants running under their skin or a cold sensation, it’s typically a reaction to the anti-anxiety part of the med; those folks can take the Ritalin or Wellbutrin route sometimes. David shares the story of how he was lucky and Ritalin worked for him; however, his curiosity and studies wanted him to try a newer class of meds like Focalin. He noticed 3 weeks later that it was working; he noticed it was working because he picked up a piece of paper on the floor to throw it away—on the first try! Yet three weeks later he couldn’t remember his partner’s face when she wasn’t in the room and having intense intrusive thoughts of feeling awful and very depressed. He didn’t realize it was the medication right away, but his partner helped him connect the dots and it felt better as soon as he got off of the meds. Even though he tried a different med in the Ritalin family and it should’ve worked for him but it didn’t. David honors how if he was a kid, they would talk about how his behavior was improving, and how he was performing better on tasks, but he might not be able to vocalize his depressive thoughts and changes in recall—so important to not make someone take medication. If medication works, people with ADHD will take it (because it works). They often don’t want to take it when it doesn’t work. People can sometimes feel that people feel really zombie-like, or off, or not like a person—but then you see all these neurotypical-world gold stars for performance but they miss that there’s a person underneath it who is experiencing it working or not working, too. It can take so much patience and tenacity to find a good fit. David and Isabelle reveal that they also specialize in working with trauma, and even specific to survivors with ADHD, it can impact what type of ADHD medication they can tolerate. Medications that come in and out of the body really quickly (like short-release stimulants) can lead to rage-filled or anxiety-filled moments when it stops and starts, because. Imagine a triangle with a lopsided or long triangle, like a duckbill—there are medications like a Vyvanz that has a much slower ramp off which tends to be more effective for trauma survivors. If you have ADHD and you’re thinking about medication, try one. ADHD medications can be done in extended release (8-10 hours) or in short-release form (4-8 hours), that’s roughly how long you’re going to notice the effects. This means you know really quickly whether the med you are trying works for you, typically within an hour. If you’re trying a new med, ask your prescriber to avoid the XR or extended release version of the medication, because you don’t need a 10-12 hour experience to know if it helps (or is awful). Isabelle thinks of a metaphor or being on a rollercoaster which you know will end, versus the feeling when the rollercoaster operator walks away while you’re on it. This all gets to be a complicated question around kids: do you medicate to help preserve self-esteem or do you not medicate to preserve self-esteem? Whatever the kid needs to preserve self-esteem becomes a good gauge for all this. It’s really helpful for your child to be in therapy with someone who understands ADHD. A lot of kids won’t want to take medication because no one else is taking medication, because they’re normalized with their peers, but they also might want to take it for certain reasons; it helps to have a safe place to report how the medication feels because parents aren’t trained to hear what it’s like when a side effect of a medication is rearing its ugly head, for example, and professionals like therapists and psychiatrists and doctors, are trained to do. David errs on the side of going slow, having a lot of eyes on it; shame might make you want to keep this private, but it’s not about shame, it’s about making other people see it so the kids can feel better. Isabelle explains why she kept interrupting David and how her working memory was at capacity and she didn’t want to forget what she’s hearing or asking. David names that he steamrolled through Isabelle’s question and that wasn’t her interrupting him, that was on him. David was on a hyper focused rant, it was not interrupting, it was social conditioning that makes her feel like she did, and Isabelle loves David’s hyper focus and does not find it ranty, but rather part of the passion of removing the barriers to access to this information. Isabelle struggles to remember what she wanted to ask, and David prompts Isabelle to remember by retracing what they were talking about. Isabelle wonders: how can you tell the med is working? David recommends running an experiment on yourself: start a task, (like: read a b...

Big Ol’ Disclaimer: We are not doctors or prescribers, but two therapists who have a lot of experience working with folx on/off, loving/hating, trying/not trying all types of medications and accommodations for ADHD. Please seek medical advice for all your medication questions!  Continuation of disclaimers galore: we are not giving medical advice, just our opinions. There are a lot of doctors in the world who know what medical terms actually mean and what they mean long term, we very much are aware that psychopharmacology is not our specialty, but we have a lot of experience with people trying medication. Nobody really talks about medication without being hyperbolic: it’s talked about as something that saved your life or that is awful. Most people who find something really effective medication or accommodation don’t talk about it everywhere. They just take the win and talk about it with their therapist. People often get the pop-psych version of what antidepressants, antipsychotics, anticonvulsants, stimulant, etc. meds are, v. How often we talk about something like insulin or blood pressure medications: they carry more shame, stigma, myths and misperceptions. ADHD is a medical condition that can have psychiatric consequences. This is something that is medically warranted but not psychiatrically warranted at all times. People think you can’t go to a regular doctor and get ADHD medication, but you can: it is a neurological difference and a medical condition. Not every person with ADHD needs medication AND it’s not a deficit if you have to take medication. A dilemma David experiences as a therapist is that he is hired by his clients to help wean them off of a medication; we have these thoughts around dependency and what it means to be on meds. What’s strange is how differently we view medication as opposed to other accommodations; for example, no one suggests you work a program to improve your vision to remove your need for eyeglasses (if such a thing exists, barring LASIK), but it’s something we do with medications. David just accepts he’s wearing glasses because they’re super effective. We don’t talk about how effective ADHD medication is for those who want to take it. Isabelle pauses to do a real-time look up of the numbers on efficacy, it is so much more effective than it is for other psychiatric conditions because it is a medical condition (70% of adults and 70-80% of children shortly after starting treatment, per the Cleveland Clinic—see the link below; this is contrasted to a 50% efficacy for antidepressants per the National Health Service—also see link below.).  Also a way to think about how quickly you find a med that works for you, versus an antidepressant. It’s important that an ADHD med can help you and not be the right medication for you. Individuals with ADHD require more stimulation to do boring, nonstimulating, low-novelty tasks, so they’ll self-medicate with their own emotions, using anger, excitement, anxiety or fear—all of those make your heart beat faster, arouse your nervous system. Those emotional states are stimulants. David describes gamifying pairing his socks to make his self-stimulant through excitement rather than anger. For people who find anger or anxiety shutting them down in life, when those things get in your way, you might want to think about ADHD medication—it’s not just about impacting focus, it’s about the emotional consequences that come with ADHD. David reviews how non-stimulant medication (eg. Like Strattera) works like small chemical restraints, slows you down. More effective for anxiety-heavy ADHD. Stimulant medications (eg. Like Adderall and Ritalin) are more a way to stimulate your nervous system so you don’t need to self-stimulate to reach that condition.  David describes that he didn’t get medication until he was in undergrad or college, the before moment was: “someday I’ll read a book.” And the after was “I could read a book,” this is why he’s such an advocate for people finding what works for them, medication nor not, medication for David was the difference between being a C/D student to becoming an A student. The closest he ever got to as focused as he was on meds was when David convinced himself he would be homeless if he didn’t finish a book in 8th grade, aside from that he didn’t read. To name the abuse of stimulant meds: people can abuse any substance: you can abuse food, for example. It’s important that these drugs are prescribed with therapy, so that a person starts to learn what a medication works for and what it doesn’t work for. The medication doesn’t change your life, you take the medication so you can change your behavior, to fix your life. It’s not speed and doesn’t make everyone do a lot of work; rather, it changes to give people with ADHD a more accurate appraisal of their work, but people without ADHD will appraise their work higher (while their actual performance doesn’t change, it just makes you think you performed better). Because of how impacted the self-esteem is of folx with ADHD, this boost in appraisal makes it so they become more accurate when on the medication (e.g you’d normally think you’re horrible at a thing, but on the medication you might recognize you are slightly above average). It reminds Isabelle of Jessie Spano in Saved by the Bell abusing caffeine pills and recognize how horrible Zack Morris was on that show (see links below if you missed this cultural moment) and how the show is essentially a symbol of toxic masculinity. Returning to caffeine—it has a very different impact on your body if you have it every day v. once in a while. If you drink it regularly, it can be a vasodilator (which helps your blood pressure) and helps you with dopamine and serotonin, v. If you have it once in a while it increases your blood pressure—why a random coffee feels so much worse than it did before. This is also why any client that tries medication often has to re-evaluate their caffeine intake. Which is why if you take ADHD meds and also have caffeine, you may turn into Jessie Spano, having a horrible day, feeling anxious and scared.

Articles Mentioned:

Cleveland Clinic source on ADHD med efficacy

National Health Service reference on antidepressant efficacy

Saved by the bell clip Isabelle is referencing — Jessie Spano “I’m so excited, I’m so scared” 

Zach Morris is Trash (short clip show from Funny or Die; in case you want to catch up on what led up to the moment Jessie was so scared and excited): “That time Zack Morris got Jessie Hooked on Caffeine Pills”

DAVID’S DEFINITIONS

Psychopharmacology: The study of medicine used to alter brain states and behavior.

Self-Stimulants (emotions you use to make your heart beat faster, arouse your nervous system, up your stimulation level): anger, excitement, anxiety or fear. 

What are some types of medications for ADHD? 

Non-stimulant: small chemical restraints, like a heavy blanket. Slows you down by slowing down your blood pressure. Often more effectiv...

Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the 1st-5th parts of this talk, please see episode 4, All About ADHD Part I; episode 6, All About ADHD Part II; episode 9, All About ADHD Part III; episode 12, All About ADHD Part IV; episode 15, All About ADHD Part V). The audience checks in about the things they’ve remembered from previous lectures—the need for structure, wins, energy bar (making sure you use your energy during the day)—inability to integrate past memories into future experience means you have to develop metacognition, thinking about your thinking. What are we going to do about ADHD? ADHD is most often scapegoated for the world’s crap. For example, people dealing with all kinds of things, but the one diagnosis a parent will share on the playground after their kids shows all kinds of behaviors is ADHD, not the OCD, Bipolar II Disorder, etc. that their child is also experiencing. We also only attribute things to ADHD when they’re negative or could be viewed as negative—for example, after a meltdown—“It’s my ADHD” when no one ever completes a task brilliantly and says “it’s my ADHD!” Are people born having ADHD? Yes, you are born with it, you are genetically predisposed to it, if you have it someone in your family likely has it, and in places where ADHD is not present in the entire family, there is a family traumatic experience that can prime you, and even specific gene setups that can link to being more or less vulnerable to environmental factors (See Orchid Children article below). David talks about ADHD as a gift, referencing his incredible friend, Bill, who’s excited and about to make anything exciting when he talks about it. He travels the world giving speeches, writing articles, or improving his investment portfolios, the man does not relax—this is also about ADHD. It’s genetic, not a choice. What we do have a choice in is how we develop frustration tolerance, developing a sense of who you are, developing your self-esteem: that’s the variable. You have to believe you can do “it,” no matter how realistic, the belief needs to be fostered. The second most important thing is advocating for accommodations: knowing what you need and asking for it. The third most important thing is metacognition (thinking about thinking): knowing why the accommodation works, knowing you can do it because you’ve done it before—understanding why it works—for example, knowing you’re frustrated because you didn’t use your energy bar. Some people are born like an orchid, some are born like a dandelion: a dandelion can grow through a concrete slab, you can mow over them, they grow right back. David describes the orchid he is purchasing for his love and partner, Robin, and got this orchid and then he says he’s going to take care of it, and he killed it in a week. You can also put one ice cube on the orchid a week (or sprays)—and let it run with water. Students in schools are all treated like dandelions; but if you water an orchid like you water a dandelion, it’s dead. But orchids are beautiful, they last so long, they grow on some of the most inhospitable things, they add color and beauty to anything. What are the environmental watering instructions for someone with ADHD—it’s constantly having a menu and having to do things differently. Knowing why you struggle with something—a school would never take someone in a wheelchair and asks them to walk—they would create accommodations. So why take someone with ADHD and ask them to do something that they need to do differently and ask them to do it the same? ADHD is not a learning disability, it’s a sitting still, a pacing disability (when things move slowly, David turns into an insane person—like a slow-walking person…but put him in the trenches and he’s ready)—so he crosses the street, he goes out of the way to mitigate his frustration.  Using a relief pitcher metaphor from baseball, a relief pitcher doesn’t pitch the whole game, or run, or hit the ball—it’s hard to define them as a baseball player…but they’re highly coveted for what they do.  Now imagine a relief pitcher saying to their school: “I want to be a baseball player” so the school focuses on the running, hitting the ball, etc. but…it misses the thing that person does and does well. So part of the accommodation is knowing where you a relief pitcher, what you do well, and staying in your lane. For example, David and his partner set it up so that he has an allowance and passes money to her—not because he’s in shame about how he manages money, but because it helps him stay in his lane and not spend all his money on jujubes. The best accommodations are ones we make ourselves. One type of accommodation is Differential Reinforcement of the Other (DRO) which means that you make the behavior you’re trying to avoid not an option. For example, if you’re trying to not bite your nails, you wear gloves or bandaids so that you can’t bite them. So you get a win without having to deny yourself all the time. Like if you want donuts or marshmallows but you don’t buy them so they’re not available when you crave them, so you win even though you don’t have to try to ‘win.’ Another example: you’re struggling to study in study hall because you want to talk to your friends: switch rooms so you’re not with your friends. Instead of expecting yourself to regulate the distractions, which you cannot do well with ADHD, you change your environment to eliminate the distraction. It’s not wiring together the urge with the thought with the behavior, because it can set you up for lower self-esteem and self-confidence—if you keep failing at resisting something, you believe you can’t resist it. Another comparison is like a smoker trying to quit smoking—you can’t break the urge to smoke, but you can not have cigarettes on you when the urge hits. David emphasizes that one accommodation fits one person, there isn’t a one size fits all: instead it’s changing how you think about making accommodations. The group brainstorms ways to do DRO accommodation when you’re always facing something—like when you’re trying to eat healthy when eating out, but tempted by all the options. You can try to not have a menu—or having a time window when you are a sticking to a boundaried diet (10-2p)—so harm is reduced. Harm reduction is one way to think about it, versus abstinence.

Orchid Children article David mentions (renamed “The Science of Success”) (Source: The Atlantic, 2009)

DAVID’S DEFINITIONS

Differential Reinforcement of the Other (DRO): Making the behavior you’re trying to avoid not an option. How to succeed without having to combat an urge. 

For example: not having the amazon app so you don’t buy things impulsively, not buying the marshmallows so you don’t have them at home when hit with the urge to eat them. If you struggle in study hall because you want to talk to friends, you switch study hall to a room that doesn’t have your friends in it. 

Metacognition: Thinking about thinking. Knowing why something works, like an accomodation. A crucial skill to hone to help you work with your ADHD. 

For lecture slides, full show notes, and more, check out ...

Joined by Isabelle’s husband, Bobby, who also has ADHD, Isabelle and David explore their origin stories in the first recording of Something Shiny ever (from over 3 and a half years ago). Isabelle describes how she first became more familiar with ADHD through working with David and working with clients who had the diagnosis, turning to David for help. She would then come home and tell Bobby the tips and kept telling him he had ADHD, not like it was some bad thing, but like it would only help him to know. She started noticing how sessions with her clients with ADHD had a different feel to them, and she really enjoyed them (as well as sessions with her neurotypical clients, it just had a different speed). One day, after about a year of this more focused work, she was talking to a fellow clinician who was sharing her ADHD origin story with Isabelle. She described what it was like to go into a room to get a cup of coffee, only to clean the kitchen, only to pick up three things and forget what she was doing. Isabelle started shaking and realized it was just like her. She had a flash and thought “somebody else does that?” She came to David the next day and said, “I think I have it” and he said “I know. Welcome to the tribe!” And she cried and felt so welcome and love it. She wonders how she went so long without getting diagnosed. Her mom was called into a parent teacher conference when Isabelle was in preschool, thinking she would need ESL support (English is Isabelle’s second language, her parents are Polish immigrants), and the teacher’s feedback was that Isabelle would not stop talking. She would get this feedback throughout her schooling and recognized that she was always talking and distracting other kids, but she was really lucky to have teachers who would redirect her, give her extra work, let her read and hyper focus on what she wanted to do. She then wonders how she got through Harvard, and realized retrospectively that she was prescribed Wellbutrin, which is a medication that also helps with ADHD.  After weaning herself off of it, she was running around to her friends describing that she thought she had ADHD, who dismissed it as withdrawal symptoms; she accepted this explanation at the time, though she could not longer focus and magically do her work, and then went all over the place the next couple of years. After landing a corporate gig, she was able to focus on pretty boring stuff, but she had undiagnosed hypothyroidism, and any time her meds would increase to bring her thyroid to a normal level, she would again notice ADHD symptoms increase dramatically. David and Isabelle clarify how the hypothyroidism, which would normally produce lethargy, was taking away Isabelle’s impulsivity and ADHD symptoms, working like a lead vest. When Isabelle started to suspect she had it, she came home and cried and Bobby thought she had cyberchondriac’d (see definition below) herself into a diagnosis, because he saw her as focused. He had just come to terms with his ADHD and couldn’t believe his wife had it, too, because she seemed so different to him. Then she suddenly appeared to have it, very obviously, seeming much more scattered and he wonders if its because she didn’t have to fake it anymore (see Masking definition below). Isabelle notes that her and Bobby are a very small sample size, so she only has to be more focused than him to appear focused. She resonated with David describing how you can self medicate with anxiety, she noticed that she did it all the time to leave the house and make transitions. This connected to how when she realized she had it, she unmasked and suddenly didn’t want to use anxiety to help her transition anymore, making it harder for her to do things like leave the house. David then shares how he has symbol recognition disorder in 5th grade, and it was never validated that he had ADHD and was labeled as lazy or like he wasn’t trying. The struggles in school got significantly worse as he got closer to high school, and the group all agrees that no one ever says that middle school was the BEST. David wasn’t testing well, he went to a really prestigious school with all the resources, and he was never diagnosed because he was deemed ‘too smart.’ However, freshman year, he got the label of having behavior disorder, which meant school got worse, really fast. He ditched school, got a ‘screw you’ attitude, playing Mortal Kombat with all the delinquents and got kicked out of high school. He was kicked out of school because of behavior problems and sent to an alternative school, still without an ADHD diagnosis, but he had a much better time in school. He got his homework done because all homework was done in class. In his previous school, he would go home, not do his homework, and then be too ashamed to go to class the next day; he thought he was an ‘idiot’ because he didn’t do his homework. Suddenly, when he has to do homework in school, he has no attendance problems, he graduated and went to Western Michigan University. His first semester there, he goes to a doctor that diagnosis him with ADHD; he had him do a World Health Organization ADHD questionnaire (link to this is below): gave him medicine. His life changed. Before he got medicine: a lot of fights, a lot of behavior problems, C-student, kicked out of school, would relentlessly defend people until he got into trouble. The first day he took his medicine, he didn’t have the urge to run outside immediately after class, and he thought: “this is what a normal person does.” And then, later that night, he was able to read a chapter. He used to read a line and then skip and read the wrong line, he thought it was connected to Symbol Recognition Disorder, but actually it’s an eye tracking issue linked to ADHD (see below). Suddenly he’s reading for 25+ minutes, finishing his homework and getting straight A’s. The years he went undiagnosed, felt worthless because he couldn’t read a book, wanting to die, he wanted to save people from ever feeling that way. He got involved in all of these organizations (see below for a full list) that specifically focused on mentoring kids with learning differences; he also worked with the State of Nevada to help kids with learning differences across the state. He learned from all of this that if you’ve seen one person with ADHD, you’ve seen one person with ADHD. All of these folx are different and yet they all feel like they didn’t get validated, that they are lost, forgotten, marginalized, shut out, and the only way they know how deal with it is to internalize it and make it all their fault. That’s why education about ADHD is so important, so partners, parents, everyone doesn’t think it’s it’s on purpose or someone’s fault. David recognizes that the reason we share these origin stories is because someone has to go first, someone has to model that we’re supposed to make mistakes, we’re supposed to ask for help, we’re not supposed to have the answer and we only learn in groups. And because he’s impulsive and doesn’t have a sense of the response cost (the consequences further on down the road), he wants to change the world. Isabelle and Bobby agree wholeheartedly and agree to make a podcast to try and change the world. 

Organizations David mentions:

Eye to Eye

Special Kids Network

SAFE (sadly the website is no longer active, not sure this organization still exists :(

PEN

David describes his recent dream ADHD scenario: he was craving sweets (rare, for him) and went to 7-11 and got four different kinds of donuts, then had a bite of each one. He didn’t have to decide which one to get, he didn’t have to prioritize, he could just eat a bite of each one and then change his mind to cheese fries. Bobby describes similar dynamics, except with candy bars, and how he gets candy for Isabelle to justify what he did. Is it disordered eating or ADHD? Most of the time, Bobby doesn’t do this, thinking about how he feels after he does this. David is jealous of Bobby’s skill to think ahead to what it’ll be like afterwards: response cost - knowing the consequences of your actions. Isabelle shares being on a conference call that had such poor quality that she couldn’t concentrate to say what she didn’t want to do, and is proud that she didn’t shame spiral fully—noticed the shame spiral. ADHD is not a deficit of attention, it’s an overabundance (and variability) of attention. The click of the ceiling fan you can’t tune out and find yourself yelling to be heard over. Most folx with ADHD are overstimulated by uncomfortable stimulus, but it’s different for each person, for some it’s sound, or texture of food, etc. But neurotypical folx don’t think twice about advocating for themselves (eg. I can’t hear the conference call, can we redial? v. It’s my fault I didn’t hear). It is revealed that this is the first time that David, Isabelle, and Bobby were recording Something Shiny. Long term consequences and threat of a consequence do nothing for folx with ADHD. Bobby gets up to turn off the fridge and David points out that folx with ADHD will feel authorized to advocated for themselves when they have a feeling or sense of mastery or expertise for something. Bobby shares his origin story: being awarded a spokesman ship award when he was little (for talking a lot). He tried a friend’s Adderall in college and it was his most productive day, but he was so scared it was a drug and that he shouldn’t do it, and was wrapped up in the shame and stigma of it all that he didn’t do it again. After being diagnosed about two years ago, he finally tired meds, but not without first watching a documentary on Netflix about the dangers of ADHD meds (see below). He mentioned his five hour energy consumption and how calm he felt to his therapist, and his therapist said “we need to get you some medication.” Bobby and Isabelle see a scary documentary on ADHD meds, so Isabelle was scared of Bobby going on medications, and then he said “I’ve had my brain be a crowded room my whole life and you’re telling me that there’s something that can help and now you’re telling me I can’t have it?” David pauses to say: I don’t think people realize what it’s like to take medication and then be like—“what? People can read a book? People can just sit down and decide to not eat.” And how most people feel like they’re cheating, and it starts to reinforce the notion we are lazy and flawed. The predominant factor that stops people with ADHD is self-esteem issues, thinking “I can’t.” ADHD meds help you have a better assessment of how you did, not actually perform better. It increases your stimulation and you don’t have to self-stimulate. We don’t think about what kids needs, we give them medication three times a day no matter what they do. Why don’t we teach kids what they need the medicine for? The medication doesn’t make you work. More meds do not equal solving the problem. The medication is going to help you with whatever task you’re doing. Have some food, start your task, and then take the meds, and you can trigger the hyperfocus. 

Documentary on ADHD meds we reference: Take Your Pills (available on Netflix) 

DAVID’S DEFINITION

Response Cost: a neurological skill that helps you know the consequences of your actions later on down the road

A note on medications: ADHD medications are very effective and also everyone gets to make their own choices about medications. For those of us folx on ADHD meds, we are often prescribed medication with zero education about how they work. Especially with kids, we don’t teach them what they need the medicine for. Medication can be used like a scalpel, where you know when to apply it; on their own, medication will not help you do your task…it will help you do whatever it is you were doing when you take the medication (eg. Playing video games, binge watching Squid Game, etc.). One idea is to take some food, start your task, then take the medication (as prescribed) to trigger hyperfocus. Please note that neither David nor Isabelle are prescribers and are talking about meds from the perspective of professionals who work with folx who have ADHD and also as folx who have ADHD. We will continue to expand upon and explore this topic in future episodes, so stay tuned!

For full show notes, lecture slides, and more, check out our website!
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Cover Art by: Sol Vázquez

Technical Support by: Bobby Richards

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Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the 1st-4th parts of this talk, please see episode 4, All About ADHD Part I; episode 6, All About ADHD Part II; episode 9, All About ADHD Part III; episode 12, All About ADHD Part IV). Gabe wonders at how structure can be a win, and Isabelle gives an example of how instead of ruminating in the middle of the early morning, she came up with a structure that helps her get back to sleep (borrowed from Fred Rogers, thinking warmly of people she has met in life). AJ asks what a neurotypical partner can do when their partner with ADHD is struggling with a transition, and David answers: leave. He points out that anything that reduces a person’s dependency on their neurotypical partner and helps them not additionally feel embarrassed or shamed could be a wonderful intervention (such as eating cantaloupe calmly while waiting in the airport). Don’t ask the person who’s running around trying to find their coat to grab three more things in the house, they are likely to grab four things and none of them being what you asked for. When you depend on a relationship for your structure it generates aggression (e.g. “You always help me, where were you?!”) Like missing the sun when it doesn’t come up: you would freak out when the thing you need to get a task done is not there. AJ and Christina finish up their almost missing the plane story with the fact they actually did make it on the plane, and Christina was eating cantaloupe in the lounge waiting for AJ. David shows old data from 1998-2000, which applies to the childhood of adults with ADHD now. ADHD is one of the most high risk populations you can work with therapeutically—this often gets overlooked. Only 10% of people with ADHD will attend a college or university, less than 2% will complete their studies (and of these, 2.5% will go on to get their Masters degree or any higher education); 40% finish high school on time; 50% will abuse substances; 30% are in prison; 30% own their own business. The probability of you succeeding with ADHD in the 90’s was abysmally low, so if you did it, maybe go and buy a lottery ticket because you are that lucky! Then it’s time for Q and A. Gabe wonders about outsourcing what you’re not good at—but then you said that you don’t want to build dependency into an accommodation? David explains that it’s the difference between agency and control. You can control a situation but you can’t control another person’s agency—like you can control who comes to the party, but not how they act once they’re there. If you need someone’s help, you can’t control how they offer it or when. For example: I need help now! The answer: okay…why? You are starting to dictate how or when someone does something, you’re building dependency. Isabelle wonders if it’s about how you ask, in the heat of the moment v. planning ahead: and David points out it’s about having lots of sources to outsource to and lean on, your partner gets to pick what they help with. Knowing who would be a good lab partner or source of support, for example, becomes a good skill that folx with ADHD have, that they don’t recognize as a skill, being able to make diverse friends and allies quickly. An awareness of this skill helps demystify why it works sometimes and places and not in other times or places. Gabe asks: what are the actionable steps from getting all of this information? David notes that this will be covered in the next part of the lecture series, and that it’s actually important to get information first: the most important thing to realize is that there isn’t a lot to fix, there’s a lot to repair. Feeling better about who you are and that you’re not too much. And yes, the lecture series will continue with more actionable steps, too!

Here is that study on shocks being more painful if you think you were shocked intentionally

When building accommodations: take dependency on others out of the equation, because dependency builds aggression when the person you depend on is removed. (A quick note here on dependency in child and caregiver interactions: kids do and should depend on their parents or caregivers. And when they can't have consistency, get surprised or feel let down, our understanding of dependency helps us understand their rage and frustration. We’re going to spend more time on this in future episodes, but for now, one idea for outsourcing that still respects a child’s dependency on their caregivers is having your child use an alarm to wake up and having a visual timer they can use to help them have agency around time, instead of you being the clock and waking up your child (with no alarm)).

For lecture slides, full show notes, and more, check out our website!

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Cover Art by: Sol Vázquez

Technical Support by: Bobby Richards

Isabelle, David welcome Isabelle's husband, Bobby, and David’s friend and clinician, Noah (who also have ADHD) and all connect four weeks into the lockdown of 2020 to meet virtually and play online game to help beat the pandemic fears and the scared and cooped-up blues. We’re overstimulated with grief, shame, sorrow, anxiety, etc, and yet under stimulated with the lack of transitions, being cooped up in our house, seeing the same two rooms every day. David talks about missing novel chaos, and also, what game should they play? After spending a while playing some online games together, Isabelle talks about gaming as a coping strategy; game play as a way to cope. The opposite of play is not work, it’s depression, or neural death. A play state is new neural connections firing and wiring together (neurologically similar to learning, see below for more!). We’re often play-deprived anyway as adults. We’re in a place of a lot of pain and depression as a society; toxic positivity aside, people are experiencing a lot of loss, and we experience grief and depression when we have loss. When we’re in it for so long, it’s important to know how we get out—and play might not be a go-to or feel intuitive or easy—even David wanted to not play but talk about other things, like functioning in a society without clear rules or boundaries. But it meant a lot to David to try to play. Noah points out that we are missing human interaction, limited ability to be in the world, getting that social itch scratched in a safer way. Bobby had fun playing a game. Isabelle drops some knowledge about play: play as an impulse, like sleep, common to social mammals. It’s an impulse that can even be prioritized about other needs, such a food. Example of polar bear playing with huskies while starving and waiting to go into their hunting grounds (and then returning when not hungry) How we need play as neotenous (juvenile) brained creatures. Washing dishes could be play, even—if you’re in the flow state, not something you have to do, but maybe you hum on the way to the car. Really social, too. Recognizing that play is a hard subject for those of us who experienced neglect or other traumas that impacted whether or how we could play. Safety needs to be established for play to happen: play happens whether or not you believe you did in the past, but how you viewed your past as playful or play-deprived or whether you had enough safety.

More on play

• Stuart Brown, MD - Ted Talk that mentions consequences of play deprivation
• National Institute for Play (co-founded by Stuart Brown)
• To check out more about play and learn more about the polar bear story, check out his book (co-written with Christopher Vaughan): Play: How It Shapes the Brain, Opens the Imagination, and Invigorates the Soul
• Husky playing with polar bear story (Real Wild documentary) — please note, initially the polar bears were hungry, and then they would return every year and keep playing even when not (for the full story, see above book)

ISABELLE’S DEFINITIONS 

Play: an impulse and a human right, according to the UN. Borrowing from Stuart Brown’s definition, includes a purposeless, a continuity desire (want to keep doing it) and is often a simulation where you can take risks with no consequences (or limited consequences, like animals play fighting, they’re not going to bite down as hard). Play can be daydreaming, writing, art-making, watching a movie, doing dishes, humming a song. On a neurological level, play in the same as learning (a neural state where neural connections are being wired), which is the opposite of the brain state of depression (or neural slow-down or death). 

Flow state: A term coined by Hungarian-American psychologist Mihaly Csikszentmihalyi, it’s a state of being or performance where you are in the zone: fully absorbed or engaged in your task, you lose a sense of time and self (you get lost in it, your worries or self-consciousness melts away).

For more on flow, check out Csikszentmihalyi’s seminal book: Flow: The Psychology of Optimal Experience

For a cool article on how flow may work in the brain: The Neuroscience of the Flow State: Involvement of the Locus Coeruleus Norepinephrine System

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visit somethingshinypodcast.com for full show notes, links, and more!
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Cover Art by: Sol Vázquez

Technical Support by: Bobby Richards

Just in time for the mounting stress at the end of the year, here’s an ADHD-friendly gift guide! David and Isabelle have ideas, accommodations, and acceptance around giving and receiving with neurodivergent folx. How hard it is to buy things for folx who impulsively purchase all (cheaper) things for themselves? How to tackle the mystery of huge shopping carts and no good memory if you bought the thing after all, or not? What to get your brilliant neurodivergent child (psss…it’s the experience, not the shiny thing!)? And MORE!
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David and Isabelle record this ADHD gift giving holiday special live (a few days out!), reviewing the challenges and tips for gift giving and receiving as folx with ADHD. Aside from discussing how Isabelle has a cold and David thinks they could be like Voltron, David describes how he only buys things he can touch or get a use out of: dopamine will make you think something that looks shiny and cool (like a skin in a video game) is the thing to buy, but then the rush fades and your left without something useful. Dopamine releases around the potential of awesomeness, not actually the awesomeness. Think about how quickly something Isabelle gets hooked into having loaded shopping carts at various websites, especially around gift giving—she’ll spend two hours hyper focusing on what to get and getting it, but when it comes time to buying something, she freezes and forgets to buy it and then doesn’t remember if she bought it or not. David points out this is the inattentive part: the difficulty of making the choice. You also then log a memory of the check out screen (but not if you actually bought the thing or not). The shopping cart loading is externalizing your memory, using an accommodation to assist with working memory as you find things that might be potential gifts for people. David makes a point around buying something with a use case, even more so than quality of experience: can you specifically use it for something? Does it do something other than just sit there? Sometimes we don’t want to use something up (like candles) because it feels too precious to use them. David names that he gets overwhelmed with too much stuff: he wants it all, but he doesn’t want it all. For example, at a birthday when he got all five video games he wanted, when we get all that we want, all at once, we don’t actually want it all. Give him five video games, but give him one each throughout several months. What if you could rotate toys (Isabelle calls this toy store with her kids) and wishes she could do this with herself. They hit upon that subscription boxes as a cool solution. David names as that someone who is impulsive, there is nothing he wants under $20 he hasn’t bought for himself. If you’re debating getting the expensive thing but caught with decision paralysis, average out how much the thing costs per use (for example, a coffee machine ends up being $1 per cup of coffee for a whole year) and then decide if it’s worth the 5% boost in your day. David names finding the win for yourself: finding the win/lose condition and setting yourself up for a win. That includes receiving gifts: make it simple for your gift givers! You like bunnies? Get bunnies. Set up your givers for a win. Isabelle describes loving to browse a store, but hating to have to make a buying decision, while David thinks of the gift that someone would be embarrassed to buy for themselves but could not reject (without it being silly, such as a 15 lb. Bag of gummy bears). Both inattentive and impulsive types of ADHD lead to self-doubt, but it’s how many times we touch that doubt: for inattentive type, it’s a lot before buying something. For impulsive type, it’s huge the moment you hand the gift over and wonder if you haven’t made a mistake. Isabelle ponders a giant sized Toblerone, David recalls how disconcerting holding a huge gummy bear actually was. For kids, consider the experience of going to the store and getting to impulsively choose the thing they want for themselves. Preserve the magic of the buy: the parent/guardian/gift giver has zero interest in how great the gift is: if they have buyer’s remorse, that’s learning, it’s important, not a failed gift. David and Isabelle reflect on the podcast so far. Why we are doing this podcast: we want to remove the paywall to good information, we want everyone to feel seen, and we want everyone to feel that their difference is not a deficiency. That it’s okay to talk about this and not be ashamed and that everyone’s experience of ADHD is different. There is no one way to ADHD: it’s the opposite of Highlander.  Isabelle and David are both grateful to each other and to all of you incredible listeners. So much more of the podcast to  come!

What is Voltron? I mean, the logo alone… 

Quick visual searches (not endorsing any particular brand, just for reference):
Giant Gummy Bear
Giant Toblerone  

DAVID’S DEFINITIONS 

Rejection Sensitive Dysphoria (RSD), where you interpret feedback or questions or redirections as being very harsh and personal, and then really take it to heart—even if that’s not really what is being communicated to you. Can be present a lot with folx with ADHD.

Use case: Does a thing do something other than just sit there? There is a case for how you’d use it.

Thoughts on gift giving

• Dopamine releases around the potential of awesomeness, not the actual awesomeness. 
• Make it a win/lose, and set yourself up for a win, and those giving you gifts for a win: pick something you 
• Harness your impulsivity: follow your first instinct. Be outrageous.
• Don’t expect doubt to go away: there’s a chaotic variable in giving in a gift, a novel way the person could react.
• Think about things that people maybe would never buy for themselves but they would not reject (run the scenario, pretend you’re mad at the gift you just gave)—for example, two 15 lb. Bags of gummy bears. It’d be silly for someone to reject it and it’d make a funny story if they do.
• Advice for kids: create a day to go to the store with the kid so they can pick out what they impulsively want that day. Give them the power to choose. Predetermine budget or safety issues, but otherwise, no micromanaging. Even with buyer’s remorse, there’s a lesson and it’s okay. 

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Cover Art by: Sol Vázquez

Technical Support by: Bobby Richards

Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the first, second, and third parts of this talk, please see episode 4, All About ADHD Part I; episode 6, All About ADHD Part II; episode 9, All About ADHD Part III). David describes how deep self esteem injuries go for folx with ADHD. That and a lack of response cost (see definition below) and how frequently you fail—means that folx with ADHD will jump on a grenade to save someone they care about. There is a sacrifice aspect — “It’s my fault.” Self esteem is so injured that people don’t even realize it’s injured: you think you’re wrong asking for an accommodation, regardless-it’s your fault. One example is when Isabelle was on a conference call where she couldn’t hear what anybody else was saying, she didn’t speak up the whole time, thinking it was her fault. But if a friend were to say “hey, I’m having trouble hearing you,” she would stand up for them in that meeting, no problem. As soon as people find an accommodation or medication or something that helps them: they feel like they’re cheating (“I should be able to do this without that thing!”). David judged himself for needing medication to read a book, but he also wears glasses to see—yet he judges the accommodations only he needs for ADHD, rather than the accommodations everyone (neurotypical and not) uses. ADHD best marked by an increase in stimulation, using emotions like anger, excitement, sexual arousal, and fear-the emotions you will use to stimulate yourself in the absence of medication. When people ruminate at night after not using up your energy, its stimulating with emotions. These are neurological habits, they are hard to notice and even harder to interrupt without finding something else to stimulate yourself with. So, make your externals go as fast as your internals: fueled up by anger, go for a run, go move. Therapy will often be biased toward calming, cleansing breaths, grounding activities, etc. David talks about Wim Hof breathing techniques (or other energizing breathing techniques-see below for more). Another intervention is jumping up and down and allowing your feet to land hard on the ground (which creates joint compression). What does it feel like to not fit in and not be normalized by your peers: either you have to make choices to fit in or stick with who you are and be ostracized, which happens to a lot of folx with ADHD. There is a +/- 3-5 year maturation delay with ADHD—which means a ten year old can act like a 13 year old or a 7 year old, depending on the environment they’re in. The big way this impacts self esteem. People with ADHD can take more hits than most people, but feel the hits differently than most people, and that doesn’t get validated. Could be as an accommodation you need a lot of structure—but also not. Folx with ADHD can do well in school, but then flounder when the structure/accomodations change and they hit big life transitions (like leaving school, starting work, starting major relationships/coupling up, starting a family). Adult onset ADHD does not happen: it’s about how your environment has changed and your accommodations have changed. It’s not just major life transitions, it’s all transitions, that are hard and handled differently. Don’t know what to do, forget things, get angry/anxious/self-stimulate (same with getting married, having kids, etc.). Things get lost in transition. The second you don’t remember that, is the second you blame yourself for it (instead of realizing that without structure, transitions are hard). How do you want to restructure your life: that’s the accommodation. It’s not just typical therapy; “that sounds awful,” it’s “that sounds awful, what are you going to do with your time?” Some people with ADHD will avoid transitions because the entire time you are transition can make you uncomfortable. If you’re on time, if you’re not running late, if you have all your stuff, etc. it will be more uncomfortable (absent structure because you haven’t gotten your needed dopamine to manage all that change). Typical scenario: one parent with ADHD screaming the whole way getting the whole family out of the house and then you get to the place and suddenly all is well. As Bobby mentions, when he does set up a structure, and it works, it sets up a win/lose condition so that when he does it well without the stress, he feels like he’s winning. The parent (or person) is screaming: they’re the ones who need the accommodation. If you outsource the structure (another cue, another person, a written note, something). It’s not a control issue: it feels good to set up a win/lose. People with ADHD will think they’re are “controlling” but actually it’s giving yourself something to do, which helps, and creates structure. Giving yourself something to do helps. 

Wim Hof: Also known as the Ice Man, developed a breathing method to endure cold temperatures and holding his breath a long time. It’s a breathing method that can help you stimulate yourself and ground yourself using a cold shower, for example. 

+/- 3-5 year maturation delay: While data suggests there is a delay in development for those with ADHD, clinically I see this as a plus or minus in maturity. Some places people will have more maturity in some places than other places. Maturity is not a fixed number or age. It's dependent on behavior in context.  "In children with ADHD, the brain matures in a normal pattern but is delayed by three years in some regions, when compared to children without the disorder," said the study's lead investigator, Dr. Philip Shaw, a child psychiatrist at the National Institute of Mental Health.Feb 27, 2008

Four emotions we self-stimulate with (in the absence of medication): Arousal, Excitement, Anxiety, and Anger. To tell someone to calm down doesn’t help—because you still need the stimulation. 

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Cover Art by: Sol Vázquez

Technical Support by: Bobby Richards