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Episode 96

What is ADHD and how to help your child understand it without shame?  

February 26, 2024
In Episode 96, Kyle and Sara, LPC’s have the opportunity to interview two experts on the topic of children and ADHD. Dr. Katie Fredriksen & Dr. Yael Rothman, are pediatric neuropsychologists and authors of the book “Different Thinkers: ADHD”. We talk about how parents can support their children to better understand the diagnosis free from the shame that sometimes comes along with it. This conversation will be a great resource for all adults who spend any time with kids who have ADHD.

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Episode 96 Transcript:

Welcome to the Art of Raising Humans. Hello, and welcome to the Art of Raising Humans. I'm Kyle.

And I'm Sara. And today we're going to do something new, something exciting. If you're one of our regular listeners, you may have noticed for a while there, we moved to an every other week model. We were dropping something every two weeks, and we really feel like it's important to give content weekly. So we're going back to the weekly model, and one of the ways we thought it'd be fun for our listeners and really provide value and help to you as a parent is to talk to some experts, some people in the field that, you know, Sara and I, I think we know a lot about kids, but there's other people who know a lot of other things about kids. So it's really good to chat with them about that. And so we're going to like, every other week, there'll be like a testimony from a parent about how they've made the change to a different style of parenting. Some other weeks, there'll be experts coming on talking about certain topics. So one of the most common topics to come up, Sara, is we talk to a lot of parents whose kids have been diagnosed with ADHD. And so we were able to make connections with two great people.

One is Dr. Katia Fredrickson and Dr. Yael Rothman.

And I want to take them on for, before you guys talk, I got a lengthy bio about both of you and how awesome you are. So I just want to sum it up. Yeah, you're going to- I'm going to sum it up for our listeners real quick.

So I took some highlights, but so Dr. Katia Fredrickson has a doctoral degree in clinical psychology from the University of Massachusetts, and she has extensive training in helping kids with autism, genetic disorders, learning disorders, and attention and executive functioning.

Is that correct? Yes. Yes. And for those of you who are listeners, this is one of the first ones we're doing on video. So Sara and I actually have this whole setup that's kind of, you know, put together last minute to try to make the video work, so I hope it comes out great. But Dr. Yael Rothman has her doctoral degree from Firkoff Graduate School of Psychology. Dr. Rothman has worked with children with autism and been involved in clinical research with a primary focus on autism spectrum disorders. So welcome.

Thank you for having us. You're welcome. And today we want to talk about one of the things that really interests us. You have a book now, so I want to make sure all our listeners can see this, called Different Thinkers, ADHD, all right?

Different Thinkers, ADHD. And so I want to delve into that with the first question that Sara and I were most interested in, was just kind of like, let's talk about what ADHD is and how it's diagnosed.

So if one of you wouldn't mind sharing that. Well, real quick, I want to point out, so Different Thinkers, ADHD, for those who don't have video and are listening, it's a kid's book, and it's really cute.

It has great... I loved the illustrations. And it's a book you read with your children, and I'll let you all share more about it. But it's a book that you can read with your children to help them kind of wrap their heads around this diagnosis. And I'll let you all kind of say maybe a little bit more about that, but then we want to...

That was really good, Sara. And I do want to get to the question, but I want to say, so then if you have a kid with ADHD or you're kind of thinking, my kid might have ADHD, this is the podcast to listen to because we're going to help you understand what that is and look into that. So back to that question is, what is ADHD and how is it diagnosed? Thank you so much. And thank you for having us. So Katya and I are both pediatric neuropsychologists. So we assess children with a variety of developmental differences, medical needs, genetic differences, and we support them by coming up with diagnoses and treatment plans. And so one of the things that we often do is assess for ADHD. So we thought we could talk to you a little bit about that and about our book and how it can be helpful. So ADHD, everyone may be familiar with that it stands for Attention Deficit Hyperactivity Disorder.

Sometimes people aren't familiar that there are three subtypes of ADHD. That there's ADHD predominantly in attentive presentation, which some people call ADD.

Maybe you've heard of that. That means you just have attention challenges. There's ADHD predominantly hyperactive impulsive presentation, which is a more rare sub subtype. And this would mean you just have the hyperactivity and impulsivity and you don't necessarily have the attention challenges. And then there's combined presentation where you have both attention challenges and hyperactivity and and or impulsivity.

Now a lot of times people tell us, oh, well, we all have little ADHD. I don't know if you've heard something like that before. But really to get a clinically significant diagnosis to get to meet criteria for a diagnosis, you do need to show a very specific amount of criteria. There's nine symptoms of inattention, nine symptoms of hyperactivity or impulsivity. And you need more than six of them, six or more across settings. If we just hear from a parent that they're seeing this at home, if we just hear from school that they're seeing it there, if we don't, if we only see symptoms in our office, that doesn't matter. You need to see something across settings to make sure that the diagnosis is relevant. And this diagnosis can be made by many different professionals. So pediatricians can make the diagnosis by usually giving questionnaires to parents and other providers, maybe teachers, something like that. You can go to a psychologist, you can go to a psychiatrist, you can go to a neurologist or you can come to us, like pediatric neuropsychologists, where we would do a more extensive evaluation that would look at many areas of function.

Would you say real quick that that may be the most comprehensive way to get that diagnosis? It is. It still would be equivalent to the diagnosis you got in other settings. But we would take into account other aspects of functioning. So the pediatrician would just be looking in the questionnaires about the attention and hyperactivity impulsivity. We might be looking at how it impacts academics, social emotional functioning. We take a look at skills like your language abilities, your planning skills, your organizing. So it would be a different type of assessment that you would be going to for each of these. I know in the book, you guys, a big part of the book is helping kids understand their diagnosis.

So I could ask you, why would you say that's important? Tashi, would you like to take that one? Sure, absolutely. So we feel that it's important for kids to understand their diagnosis for a number of reasons. And this is sort of resulting from an evolution in our field, right? So very much over time, for example, when we were doing our training, the emphasis was more on simply providing feedback to parents. Then you would write up your report.

Parents would theoretically share a report with school. So the adults surrounding the child would know what was going on, but the child wouldn't necessarily, right? But the fact of the matter is, I mean, as I'm sure, I mean, as the parent of, I think you said three kids, right? But as you guys know, I mean, kids, they pick up so much more than we necessarily realize, right? We don't necessarily realize the depths of sort of what they're noticing, and they may not come directly to us to discuss those things. But so many kids are aware that something is not quite right, okay? They are, you know, why is it that people get mad at me when I tag them on the playground during, you know, games, or why is it that the teacher keeps telling me to stop, you know, stop moving around, you know, or why am I struggling with learning, you know, reading, writing math, whatever it is? And so, unfortunately, I mean, an aspect of human nature, of being a human being is we tend to be quick to assign negative attributions and labels, right? And so very often kids have developed their own labels that they have applied to themselves that are sort of A, inaccurate, and B, pejorative, like, you know, I'm just not good enough. People just don't like me.

I'm just stupid, whatever it is. And we would much rather substitute in the appropriate diagnostic label because A, it opens up. It's not pejorative. It's just a description of how your brain works and certain things that, just like all of us, certain things that are harder for you. We all have things that are harder that we need to work harder at. And B, it opens up a community, you know, like, oh, well, there are lots of other people who have this diagnosis who share sort of these difficulties and I'm not alone in this. And so we really, really, really think it's important for kids' learning and emotional well-being to really understand what's going on with their brains and why certain things are more difficult. Yeah. I think we see a lot of shame around it, you know, like you said, all those behaviors, those negative attributes are given. But then the kid, because they have this kind of black and white concrete way of seeing the world, it really is either I'm a good kid, the kid who does those things the teacher likes or my mom and dad prefer, or I'm a bad kid.

And so all of a sudden it's like, wow, it's almost like I was born to be a bad kid. And sometimes the own parents shame around their own hyperactivity, their own inattention. Then their story tends to bleed into the kid's story. And so I think what Sara and I really enjoyed about the book, because we've seen some books, there are some ways I've seen kids who have ADHD, they have fun exploring people who throughout time probably had it and they'll go, oh, cool.

I'm not weird. I'm just like that dude. And that person was successful. They were okay. Yeah. Yeah. And then, but what yours is doing is taking away, like demystifying, I guess, what's happening in them neurologically, right? And then I think going back to what you said, the change in the field is when you share this information with the kids, it's just empowering. It's empowering for them to know I'm not broken, like just my brain, my brain's wired different. And yeah, it may mean I need some support, but all kids need a little extra support in different ways. Right. And we know so much about this diagnosis.

We know so much about the kinds of supports that can be helpful. And so if we can tap into that, oh yeah, there's plenty of stuff out there that can be helpful to me. And I also think you hit the nail on the head, Kyle, when you mentioned about how this can run in families, right? And so a parent's reaction to a diagnosis can be very tied up in what they experienced in childhood with similar sort of characteristics, but unfortunately, in a period of time where there was less recognition and understanding of what those things might mean, right, and of how to help with them. Yeah. Yeah. And also, our goal is to empower children to be their own self-advocates. That's really a main goal is you are going to learn how your brain works, and then you can ask for the things you need in life.

And that's really important for us to teach to our kids. You know what I've seen is really cool is when like a kid maybe got diagnosed in elementary school and they initially put him on some medication to help him and support him to be successful in that kind of environment. And then as they grow up, you know, lots of times I'll meet with these teenagers who are like, I really don't want to take the medication anymore. I really just want to learn the skills because I don't like the side effects. I don't like how I'm not as hungry or those kind of things that come up, right?

Their eating's kind of off. And so it's really empowering to see them go, you know what, I've accepted the fact that I have this diagnosis. I want to know how to use it to benefit my life instead of it always being something that hinders me, you know? We definitely want the young people to be a part of their treatment plan. That's the whole point is for them to understand what do I need?

How do I get to where I want to go? We know medications can be very helpful, but we also need the young people to be on board and appreciate that. And really the point of a lot of the stimulant medication is to make you more available for all these learning processes, to help them learn all the support they could require. We also know that the prefrontal cortex is developing, and as the young person matures and more development is happening, you might need a little bit less of some of these things. One thing I really appreciate about it, I find in working with some families, it's they want to be careful their child understands what's going on and doesn't feel bad about it, but they don't always know how to do that.

They don't know how to talk about it. They don't know a language, like how do I help my child understand what's going on? And I liked the piece of the book, and I'd like to hear your thoughts on this, just of creating a language around it, what is happening in their brain, what they can do, how to view these behaviors that maybe they'll say, oh, they're hyper or they're always running around, but it gives them language to talk about what's going on and what they're doing instead of it just being, you can't sit still, you know, it reframes it and explains it. Yeah, that's an excellent observation, and we just oftentimes, yeah, Alan, I think about the whole idea of the can't do versus won't do kind of thought process, right? And so part of how you're sort of describing and thinking about these behaviors that can cause problems for the child, it really affects your thinking when you pause to consider, well, you know, is this a product of something that the child just isn't quite ready to do yet, right, versus they're making this choice to behave in this inappropriate way that is bothering people. And I mean, of course, we're all human beings, and every now and then kids are going to push buttons on purpose, and that's just part of, I mean, you know, that's just part of normal development, but most of the time when kids are doing things that, you know, are problematic and you're finding yourself giving them a lot of negative feedback about it, there's a reason why they're doing it, right? And so that's another sort of element to this, you know, I was reading the other day about how kids with ADHD get a much higher proportion of negative feedback than a quote-unquote sort of typically developing kid. They're hearing like messages all the time around things they need to stop doing or, you know, problematic things they've done or said or whatever it is, and that's just, you know, damaging over time, that persistent negative feedback. You know, something I was going to add, I've seen as a, I was a school counselor for seven years in the elementary school system, and there was times in the process of learning about this, how to help kids with ADHD and engage with them in the classroom, is man, there would be, I'm thinking of one kid in particular that was at my school, he was a kindergartner, and he was just getting in trouble all the time.

And all the time when I'm in the teacher's lounge, I just heard nothing but negative conversation about this kid. And then this, the mom was a single mom. She eventually was able to finally get him in to get a diagnosis.

He was diagnosed ADHD. They got him on some medication. And all of a sudden, the kid was an angel, you know, all of a sudden, like now everything the teachers were saying was positive. And something troubled me about that, about just like, he's the same kid, he's not a different kid. The point is, he just got some support, but it kind of bothered me that the teachers had, this narrative about him, that he was almost like Dennis the Menace. And now all of a sudden, because he got some medication, like the medication didn't change him. He's still the same kid. No, I mean, I imagine it made it easier for them to see the strengths, right? I mean, because, you know, our brains just orient to negative data, right? It's a survival mechanism of how we've developed over time neurologically, and we orient to the negative. And I can imagine, I mean, I'm not a teacher, but I can imagine you sitting there in that classroom with, God knows, like maybe 30 kids, I mean, something, and there's this one kid who keeps needing to be, you know, needing additional support, and how sort of over time that could be stressful and hard, and you might slip into a more negative sort of thought process.

And it's so nice when you can, you know, that stuff, if those sorts of issues reduce, and then you can really see the strengths that are there underneath, right? And I think that's another reason why we think the label is important, because we'd much rather that teachers and other people involved in the kid's life really understand the cause of what's going on, instead of some of, again, the more pejorative sort of labels people leap to. We wish that wasn't the case, and that, you know, we all understood that actually, almost in every case, children never want to be bad, they want to be good, they want to be pleasing, they want to get love and attention. But it is challenging when, like Katya just said, you have a class of 30 children, and maybe there is one that is causing more shift from the lesson plan and all of the things for a teacher who doesn't have the support that they need, maybe in the classroom. So unfortunately, we do need to reframe that with a lot of educators and sometimes with parents too.

But that's what our job is, a lot of what we want to do is education. And so just to piggyback off that, because I had a thought, and I'm at an age where I'm going to forget my thoughts. Do it! Well, so I was thinking of your example, Kyle, of, say, the single mom, right, with the young kid, and that's another reason why we wrote this book, is that that single mom, you get on that waiting list for an eval, it can take ages, evaluations cost a lot, takes time, takes money. I mean, that's part of the reason why we wanted to put this book out there, because not everybody can come and see a professional, and this is a way to sort of, you know, for parents to understand better and to present this data to the child without, you know, it's just more accessible way of getting to those things. Well, and something I think the book helps too is I'm kind of obsessed with this metaphor of having a closed hand or an open hand. It's simply a picture of a closed kind of fixed narrative or an open kind of growth mindset narrative, right? And I think what a book like this does, at least for the kids I see that I know have ADHD, when they're able to get information like this, and you go, oh, let's demystify this. There's nothing like, you know, because up until then, it's been like this closed narrative of I need to get my act together, I'm the disruptive kid, or I'm the kid who's always not paying attention. And they've heard that in a lot of demonstrative ways from the adults around them, that basically the shame message is you're not good enough. And instead of like saying, wait, if we look at it with a growth mindset, if we have an open hand about it, and those who are listening, I have my open hand right now.

It's just like, it's this idea of I want to look at the story of who they are in a more, you know, open way, that there's other ways of explaining that behavior than the way it's been explained to you, you know? And so that kind of leads me to the question is, how would you advise a parent who's gotten this diagnosis? Because this comes up a lot for Sara and I, we're helping parents, maybe they've got a diagnosis from a pediatrician, and all that kind of, and they're afraid. They're afraid if they tell the kid they have ADHD, they have this idea that the kid's going to go, what, I'm just crazy, being wild is who I am, I'm out of control. And so sometimes they'll hold off, they won't even want to tell them the diagnosis. They'll be like, don't tell them, because then now it's like, they're going back to that closed story. If we tell them this, that he's going to grab onto this, or she's going to, and now it's going to become a self-fulfilling prophecy, right? And the kid's going to start acting. So what's some advice you give to parents who've received the diagnosis, and they're saying, okay, I believe this to be true, I can see the data there that shows it, now how do I tell my kid about it? You go ahead, you go ahead, you both are like, I got it, I got it, good. Well, I was just going to say, well, we always, so number one, we always, before parents sit down and talk about anything with their kids along these lines, you just want to be sure you're comfortable with it yourself, right?

Because if you have any sort of subtle lingering doubts, or you have, I mean, many times parents have fears, like what does this mean for the future, et cetera, if that colors your presentation of the information to your child, right, then it becomes an anxiety-provoking, fearful thing for the child. So you really just want to sort of take care of yourself to start with, and get your T's crossed and your I's dotted in regard to your understanding, right? And another thing I always think, you know, I tend to think about, the principal at my kid's school has three, like, teenage, young adult children with ADHD, and she and I were talking, and she was saying how the message in their house is ADHD is an explanation, it's not an excuse, right?

So we still, we understand that X, Y, Z is harder because of your ADHD. That doesn't mean we give up on X, Y, Z, that just means we need to work harder at them, right? And we need to sort of figure out what are ways to support those things. And yeah, I've heard that at my house too, oh, well, I can't do this because I have ADHD, and that's not good enough. I mean, sure, it's harder for you, and I'm going to give you more support, but we're still going to do the thing, right? It can't be used as a means of avoidance, and I certainly think that parents worry about that sometimes, right? Yeah. Definitely that can be something that is talked through with parents and their kids to discuss, but it's not as common to have this as a self-fulfilling prophecy. More often, I would say that it becomes an understanding. So like we said before, this young person is thinking something is wrong with me, and they're giving themselves these negative labels. And then you give them an understanding of their brain, and it actually usually opens up to, oh, and if I do this, that will work, and I won't get in trouble, and kind of spirals from there.

So that worry that parents have does not always take place, but like Katya just mentioned, then you have discussions about it, that this is, oh, yeah, you're right, this is harder for you, and that's why I learned how to create a visual schedule together with you. So let's set that up together. And then hopefully at some point, the kid is even saying, I want a visual schedule because I think that will help me, Mom or Dad, right?

And that's where it gets really exciting. And I loved how you were saying that a minute ago about the parents' own story and them being reconciled with that, because I definitely see that if a parent hasn't done that, and a lot of what we do on this podcast is we really want parents looking inward first and really understanding the parts of their stories playing with their kid. And I really think that's kind of an emphasis we have, that change always begins with me. And so I want to make sure I'm first holding this story without shame, that there's nothing wrong with me. If I have it, there's nothing wrong with my kid. And then that way, then when you talk about it, it kind of takes all the energy out of the room. It makes it so it's not, you know, like the parents, I know they do that successfully.

They talk about it really matter of factly. And that the kid is able to talk about it really, it's almost like having some kind of, you know, like I've got dyslexia, or I've got some, it's just like, I have this, it's no big deal. It's just, and then I've learned how to work with it, you know? Right. You know, and that's an excellent point, because I feel like sometimes parents worry that, you know, like we alluded to earlier, oh, well, I had a similar sort of issues when I was in school, and I really struggled, and it was so hard, and I had this awful experience, and it wasn't until I got older, and I really, you know, found what I wanted to study in college, and then I took off. You know, they have, they've had this sort of series of negative experiences, and they associate it with the diagnosis, right, as opposed to the fact that, you know, this was maybe like 34 years ago, and there was not as much known, and, you know, and so they didn't get the sorts of supports they needed. And sometimes the flip side is when a parent just, it boggles their minds, like, that the child is struggling with something.

You know, it's like, well, so-and-so is eight years old. They should be able to do X, Y, Z, and we have to just rewrite that narrative around, okay, should is one thing, but, you know, can they really do it, and maybe our expectations are not accurate, and maybe we're basing this on what we saw with an older sibling who doesn't have ADHD, or ourselves, we were like a type A high achiever, and here's our kid with ADHD, sort of struggling with homework, and like, why are you struggling?

This should be easy for you. And that's just so frustrating for parents and so unproductive for the child, right? And so that, I feel like, is another point where that comes up pretty frequently. Yeah. If I could share a quick story that I think kind of sums this up, too, about this interplay between kids and parents, there was this kid I was helping that was a teenager, and she, for quite some time, had had a lot of big blowups. It was their parents, like nightly blowups about, you know, a lot of things that are typical of kids with ADHD. So a lot of times not being organized, not, you know, being distracted, not being on time, all this stuff. So the parents were very kind of type A, and there was a big blowup, especially between dad and the daughter. And there was this really moving moment that happened where the dad went, took her somewhere, she got a diagnosis, right?

And then dad actually did his own work. He studied it. He talked to a counselor who was skilled in this and explained what it is, and it hit him that, oh my gosh, my daughter has this. And even, it was obvious somewhat to me, because even one time in order to do better on a test, she actually took someone's Adderall and used that and did great on the test. And so she was feeling a lot of shame, and dad was mad that she had taken this drug and, you know, all this stuff. But there was this moment where he said, I want her to come into the session with me, and I want to talk to her about this.

So she reluctantly came in. She wasn't sure, but she trusted me. So she came into the session, and I was like, this is going to be great, right? So dad starts telling her, he's like, tears in his eyes. I'm so sorry about how I've handled this all your life. But now I know this diagnosis and what it means for you and how hard it is for you.

And I want to say I'm sorry. And I thought she was going to be like, dad, but instead, she looked at him, she was very mad and she said, oh, okay, so now you know I'm broken. Now you know that there's something wrong with me. And now you feel sorry for me. And I could see that she, there was all this shame of all those arguments with dad, and dad did something awesome. Dad looked at her and he said, you know, you're right. I do that sometimes, where I come across as arrogant, like I know more, I make you feel bad for who you are, and I am sorry about that.

That's not what this is. I really have, I've really messed this up, and I want to do this better. And like, then you saw the girl soften, tears came in her eyes, and it was just this beautiful moment of the diagnosis brought understanding and dispelled shame. And that brought up compassion, you know, this sense of like, wow, I could have been suffering with you through this, helping you with this. Instead, I was just, you know, rejecting you because of it. And it was just a neat moment of freedom that that family felt in the moment.

What a great thing to witness, right? Yeah. Yeah. Yeah. And especially how the dad was able to even double down. Yeah. Right? He originally laid himself bare and she wasn't receptive to it, and he took that even extra step.

That's pretty amazing. Yeah. Yeah. No, I was quite happy because I was really worried. Once she came back mad, I was like, but I give that story too, because I wanted to, the shame that she had been dealing with for all that time, you know, that she wasn't going to risk, and she didn't believe the compassion was real.

She had really bought into this. There's something wrong with me. There's something messed up, you know, so, so I really, so, so in, I, Sara and I really want to thank you both for taking the time. I want to once again, show the book. So for those who can see on video, it's called Different Thinkers, ADHD. And so tell, tell them real quick where they can find that book.

Yeah, you can buy it wherever books are sold right now. If you buy your books, Amazon or Barnes and Noble, our publisher, Boys Town Press sells it on their website as well, but it's available many different places now. Okay, good. Well, yeah, I want to thank you for your time again. And so for all our listeners, I hope this was a very helpful episode. If you have any questions or any thoughts, does my kid have ADHD, I hope this gave you a resource and some information to better know how to handle that, how to share that story with your kids. There doesn't need to be any shame or fear about this, that at this, this day and age where we're at, there's so many ways to support you and your kid, to be able to make this actually a thing that unites you, brings more intimacy in your family rather than pushes you further away.

So I want to thank you for your time and thank you listeners. Thank you. You're welcome. And for those of you who liked this episode, please like it, give it a rating.

We love five-star ratings, right? We love the comments. If this was helpful to you and there's other subjects that you're like, Hey, could you have an expert on this? Let us know because we want to find those people and to be able to give that information. So I guess that's it, right? Yeah. Thank you for listening. The Art of Raising Humans podcast should not be considered or used as counseling, but for educational purposes only.

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