When East Meets West
When East Meets West
S4E10 Unraveling ADHD: Beyond Distractions and Misconceptions
Think you may have ADHD simply because you get easily distracted? Discover why that's not always the case in our latest episode. We unravel the complexities of adult ADHD, breaking through common misconceptions that have proliferated in our tech-driven, fast-paced world. By emphasizing the critical importance of professional diagnosis, we'll guide you through the different types of ADHD— inattentive, hyperactive, and combined—while underscoring the difference between occasional distraction and genuine ADHD.
Our discussion doesn’t stop there. Join us as we explore the diverse manifestations of ADHD in boys and girls, revealing biases in diagnosis and shedding light on unique ADHD traits like hyper-focus and creativity. We dive into the clinical side, discussing stimulant and non-stimulant medications and the importance of treating impulsivity with mindfulness techniques. This episode is a compassionate call to understand ADHD better, celebrate its unique strengths, and support those who live with it every day.
be on this podcast, which is kind of surprising because people, everybody, first of all everybody thinks they have ADHD newsflash. Not everybody has it, um, and second, it's kind of a popular topic these days, so, hello, let's talk about ADHD.
Speaker 2:How is it possible? We haven't talked about it, but yeah, Uh. I don't know we talk about ADHD attention deficit hyperactivity disorder.
Speaker 1:for listeners who have not heard that yes, and who at one point back in the day was known as ADD, yes, which is sort of like in the like colloquial, like throat. You know, people say like I have OCD or I have ADD. Yeah, you know people might not necessarily have it yeah.
Speaker 2:Well, and then. So, like us as clinicians would maybe, or professors would correct, you know certainly students, I don't necessarily correct it on the real world, but I do sometimes. But it's funny because one of the self-report measures called the Brown ADD scale and it's one of the most used ones and it's that's the name of it. They haven't renamed it.
Speaker 1:Oh, it's still good for them. Way to hold on to tradition. We should do another podcast episode on that, because our field has a problem with that.
Speaker 2:On which one Wait? Which one? I want to write it down.
Speaker 1:Holding on to tradition, all right, you got it. We get too attached to things. Look at this, guys we're in real time planning our future.
Speaker 2:All right, so talk to me about ADHD.
Speaker 1:Yeah, so I work predominantly with adults, like on on occasional or with a teen, but mostly with adults, and so I actually work with a lot of adults with ADHD and I I guess I want to start by saying like I think we should address the common misconceptions about it, Especially the right Cause, like these days, you know, I think a lot of people think that they have it or concern they have it because, frankly, because of phones, you know, people come in and say like I'm having such a hard time focusing, I can't get through an article, I'm like jumping around all the time.
Speaker 1:And I'm like yeah same Do you?
Speaker 2:feel like oh, you have ADHD too, dr Rubin.
Speaker 1:And I'm like I actually don't. However, I can understand why you think that you do, because distractibility is something that, unfortunately, we're conditioning our brains to do, so I guess, like, let's start there, though, is that something you're finding a lot like? People come in and they think they have it and you're like, nah, you don't.
Speaker 2:This is what this is yes, and in this, in this college setting, they'll come and be like, oh, oh, yeah, I have it because I could. You know, I'm having a hard time focusing in class. I'm like sure what classes they're like. You know world biomechanical history, dah, dah, dah dah. And I'm like, well, yeah, I wouldn't be able to focus on that either.
Speaker 1:You know, and it's also okay to get distracted from time to time Distraction is not ADHD as a diagnosis.
Speaker 1:Yes, yes, correct, and so you know. I think for listeners out there, it's important to recognize that just because you're experiencing high distractibility, like you don't want to actually just jump to, I have this diagnosis. And you know, unfortunately there's a lot of misinformation out there these days, especially on things like TikTok right, where people are saying if you have no, I don't know, throw out three things, one of them being just distractibility you must have this diagnosis. So keep in mind that you know like we live in a world of high distractibility right now and it literally it is like changing our brains. We are all conditioning ourselves to not be as skilled at paying attention. We're constantly being stimulated by screens and all that, and that that does not ADHD make is the best way to say it. So you know how, like, actually, and also say it's important to mention if you're experiencing high emotionality, so sometimes, like people are very anxious, you're also going to have trouble focusing right, so high intense emotion interrupts cognitive processing. So that's another thing that's important to acknowledge.
Speaker 2:Yeah, I used to always talk about that a lot in my neuropsych training because in neuropsychological evaluation they would make a diagnosis and I'd say, well, but if they have some kind of familial like a divorce going on or something like that, you can't make the diagnosis of some organic cognitive diagnosis diagnosis without having like real clear understanding of the context. So yes nice to kind of feed into our contextual behavior. Isn't that we talk a lot about here?
Speaker 1:Yes, yes, context is everything, that is exactly right?
Speaker 1:Thank you for mentioning that. Yeah, so again, if you're listening to this and you're wondering, like, do I have this? Like, okay, you may be distractible, but not necessarily. So I think maybe now would be a good time we can talk about some things that um can help you. Um, you know, recognize some things that may suggest ADHD. And again, we're not here to diagnose right, we're not. You know there's um to to be diagnosed by, uh, with ADHD. And again, we're not here to diagnose right, we're not. You know there's to be diagnosed by with ADHD. You know you do need to be evaluated by a clinician, a psychiatrist, you know, a licensed therapist and, as Pete mentioned, you know, a lot of times, actually, the best way to get the cleanest or clearest diagnosis is a neuropsychological evaluation in addition to some of these measures.
Speaker 2:Yeah, so there's three types. I think that's all.
Speaker 1:Maybe we'll start with a little bit of.
Speaker 2:I'll start us off and then you can maybe talk about some of the other, the other diagnostic criteria. But there's inattentive type or hyperactivity or combined, and I think that's important to differentiate, because we've been talking a lot about inattention, you know, because I think that's a lot of what we see in adults, because usually for the real diagnostic impression the symptoms would present around three to six years old. So you know, for any kind of like cognitive, organic cognitive diagnosis, you want to have some visibility or some presentation of the symptoms early on. You know, and there's a whole budding body of literature for adult ADHD.
Speaker 1:Yes, which, by the way, can we just say adult ADHD just really means how it's presenting as an adult, like it's a way somebody's brain is wired right Like that's the thing like it's presenting early on, because you've had that brain your whole life.
Speaker 2:You've had the brain whole life and maybe during school, you know, if your intelligence is a little high you may have just gotten by with good grades. Or you know there's things that kind of help people mask some of the symptoms. Or you know, if you're middle upper class, you've got, you know, kind of no child left behind. You know. So you know which is a federal legislation that says that no child could be left behind. You have to give accommodations if they stay with them. But sometimes that actually holds like hurts people, you know, because they're going to push them through without actually diagnosing what might be going on.
Speaker 1:I love that you just pulled out. No child left behind. I was like wow, that's way way, way to go way back to the Bush era.
Speaker 2:But that's still active today.
Speaker 1:I'm embarrassed to say I have absolutely no idea. Absolutely no idea. But sure, sure, but keep going. Yes, so, uh, so it's something that symptoms um may like would have presented, starting at three to six, by the way, somebody might not have they yes to Pete's point, they might not have caught them. So, like an adult looking back, an adult that's never been diagnosed may look back and say, oh, I guess I did like struggle to stay in my seat in school, or I was having a lot of trouble paying attention in certain subjects.
Speaker 2:Well, I always joke and say if ADHD was as known as it was, you know, when I was a kid, I would have been diagnosed and or prescribed. Probably too, because the hyperactive piece yeah. And this is why men and boys are three times more likely to be diagnosed with ADHD compared to girls which is annoying yeah.
Speaker 1:Well there's, well there's. I mean, look there's like people have make assumptions and have biases, right, so this is it doesn't and again, I I'm not an ADHD researcher, nurse pizza, it's like you know, I don't think we're at the point yet, we don't know. Is it higher in boys, like actually, or is it just diagnosed more, right, like certainly, there's lots of. I've worked with quite a few women that you know are diagnosed in adulthood, but it's just they didn't have the hyperactive component as obviously quote unquote I would say, when they were kids.
Speaker 2:And that might link. And you're right, neither of us have researched on this, but I'm wondering, as you were talking, if like at links to girls have like better language development earlier on, and you know more emotional insight, and so my guess is that that's probably linked why, you know, boys just want to throw dirt and kind of eat or eat dirt you know, sure, sure, and they're sort of presenting on there.
Speaker 1:There's more of sort of the like, externalizing behaviors right Like like frustration. That's sort of not, that's that's shown outwardly as opposed to girls or girls.
Speaker 1:Yes, Maybe you're a little bit better sometimes Again, we're speaking in generalizations here at naming it. Yeah, absolutely, Absolutely Well. So, Pete, would you want to name just a couple more like important things that from the DSM, before we kind of dive into talking about, um, you know, kind of clinically, what we help people understand about ADHD Cause, to be to be clear, you know not that I've never done this. I have, but but I actually don't really like pull out the DSM when I'm working with folks with ADHD, when I'm wanting them to understand their brains better, I um, yeah, but but it's, that's not, it's not total BS.
Speaker 2:I'll say that I'm, I'm around it a lot because of the sports world, uh because uh there's this thing happening which I think will be important just to to give name to uh, where you know people are. People abuse all kinds of medicines, and I think the medicines for ADHD are definitely abusable because they're super helpful. Yes, you know like they really work.
Speaker 1:And so sometimes and mostly stimulants Most of them for those of you not familiar, usually stimulants. There's non-stimulant medication, but like mostly stimulants, like Adderall, for example, that help with focus.
Speaker 2:Right, and so I think psychiatrists are trying to shift away from that for some non-stimulants, so that this way they can kind of get a more organic diagnosis, because I'll have someone say, oh well, I took the stimulant and it helps. I must have ADHD and it's like no, it helps everybody, that's not diagnostic, if it helps, so that's important.
Speaker 2:But fidgeting fidgeting will be something that you'll see unable to take a part in, sort of you know activities, maybe not completing tasks, like they'll start something but not finish, maybe interrupting or not fully attending, you know, in a classroom setting, for example. It's more like the hyperactivity stuff. What would you say for inattention?
Speaker 1:For inattention and you mean just sort of like oh, do you want to sort of shift into like when I'm trying to help people clinically?
Speaker 2:I don't understand. No inattention, just examples, yeah, yeah, yeah, just examples of that.
Speaker 1:Yeah, sure, so maybe well and maybe this is kind of a good segue though, because this is going to start to bleed into what I was going to say is that within a type of type, it is difficulty paying attention to things, but this is really important to distinguish it's difficulty paying attention to things that are kind of like a hassle, dull, boring, not interesting. That's where someone with ADHD has much more intense distractibility than somebody without. I mean, again to Pete's point, we all get distractible if we're, like, bored by something, right, but if you have an ADHD brain, your brain is going to make way more thoughts and try to pull you like have a difficulty tolerating the discomfort of focusing on the boring or hassle task. However and this is what's really cool about having a brain with ADHD, if you're into the thing you're studying, adhd superpower is hyper-focus.
Speaker 1:That actually, folks with an ADHD brain, if they really like something, they can focus for hours and hours and hours, and sometimes actually to a degree that it can become problematic Like they have trouble like shifting out of that attentional focus. But that's something that's um, kind of a um, not a very well-known um sort of uh experience of someone with ADHD. So just to be clear, it's not like having a brain with ADHD is bad. There's actually some really cool things about it, also related to having, um, your brain make a lot of thoughts. Um, I've worked with not that being creative in ADHD or when I'm the same, but a lot of folks I've worked with with ADHD do tend to be like creative individuals. Their brain has a lot of ideas, they make a lot of ideas and that's cool, right Like.
Speaker 2:I love that you call that the superpower. I love that it is. I think it is. I'm like superpower.
Speaker 1:I love that it is. I think it is. I'm like, yeah, yeah, it really is so, um, so, anyway. So inattention, uh is a is a major component of it. However, it's inattention to things that, uh, if you have a brain with ADHD, your brain doesn't like right, yeah. If your brain likes it, your brain's focusing on it super well, you know.
Speaker 2:Yeah Well, which is just? I mean probably just it's life, I mean that's, you know, like you're saying, like that's just life.
Speaker 1:Totally. It's like, and again, I think, but if we want to distinguish with that type of brain, it does it to a more, a much more significant degree than somebody without it, right? I think maybe this would be important to sort of like bring in some other things that we see commonly. So you mentioned like difficulty, like finishing tasks and that kind of thing. So part of that has to do with like can be or can be a difficulty focusing. But there's also I, by the way, I was never taught this phrase, but I think this is sort of maybe like a term that's being used nowadays time blindness. I've never used that. I mean, I had a student that was using it. I'm like, oh, that's a cool term.
Speaker 2:Yeah.
Speaker 1:Which basically just means that folks with ADHD brains often have trouble sort of guesstimating how long it's going to take to complete a task. So a lot of times, like folks with ADHD, they'll like run late a lot of times. And I'll ask patients like I'll say here, I'll say, let me guess this is probably what happens. Like you're trying to get to the say they're late to my appointment, and I'll say my guess is you're probably doing some things and you think I can squeeze in one more thing.
Speaker 1:And they're like exactly right, and I said, yeah, so, whatever. So, clinically, what I recommend people doing, I'll say whatever your brain says it's going to take, if your brain says it's going to take 30 minutes, double it. You know, I'll say you just can't actually trust your brain in this regard. Your brain can't, um, very effectively guesstimate a long time take. So, like this is also like how people begin to work with that kind of brain.
Speaker 2:This is uh, I, I, I, I do that all the time.
Speaker 1:Uh, and I, I always put that on the, on the Zen, so that I'll bring in a little bit of Zen there, because you're just reading my mind. I was just thinking. I was like we've not talked about, uh, any, any Eastern approaches here yet.
Speaker 2:So that would be yeah, I think well cause. The reason I brought that up in terms of time is because time is a contract that we've created and so when you think about tasks that have to get done before I have to get to Dr Rubin's appointment, I am just sort of like in the moment and just sort of loosey-goosey kind of doing what I need to do and I'll arrive when I arrive. And some might think that's like disrespectful, but there's this sort of just really like present moment-ness that allows for you to sometimes to forget that you know how to organize your time or to structure it in a really, you know, pragmatic kind of way.
Speaker 2:So that's like my dialectic, because I'm very pragmatic and scheduled but I'm also just like loosey-goosey like wherever I get to, I guess.
Speaker 1:Sure, sure, well, and I think, like here, you know, if we're talking about folks, like if you're somebody listening that has ADHD, or you know somebody that has ADHD, it's just one also like practicing some compassion for the struggles of somebody that you know, there are some struggles of having this kind of brain. So, practically again, like we do live in a world where there are, you know, time, expectations, things you know.
Speaker 2:I mean, that's just you know is the world that we live in. I have a question.
Speaker 1:Yeah, tell me.
Speaker 2:I wonder if I'm wrong, because we haven't talked about impulsivity. So there's inattentive hyperactivity. Impulsive Okay, go ahead.
Speaker 1:Well, impulsivity can be another symptom or feature. So, going back when, when folks are hyperactive, right, like that's one example of like, like you know you're, you can't sit, still the fidgeting, maybe you blurt things out, you interrupt, right, but you know again, like, as people you know, in adulthood kind of their brains develop some of that impulsivity. It's not, I don't know. I think like a lot of times that clinically we talk about impulsivity, we sometimes think of it like with more severity, like it means like you know, maybe like you're really struggling with impulsivity in regards to, like I don't know, substance use or self-harm or something.
Speaker 1:But impulsivity is also just doing without thinking. And so folks with ADHD brains sometimes can err that way that they're sort of like a thought comes in and they'll say it, or they'll do something without um, without slowing down. This is again where some of the mindfulness comes in. So if we talk about other ways to work, this kind of brain mindfulness is extremely helpful because it's, I mean, one dorky science stuff. It does help throw neurons in the frontal lobe which has to do with executive functioning and organizational skills.
Speaker 1:So it doesn't cure ADHD, but it certainly supports it. But it also helps somebody to slow down their behavioral responses right and become more intentional in, for example, saying do I really need to do that extra thing before I leave for my appointment? Maybe not.
Speaker 2:Maybe not. I would say I love that you brought the word intentional in there, because I think that's also part of the Eastern perspective, because it's really about looking at attention to the nature of things. You know, and so the intention is just to sort of be with and sort of see things for what they are, and that's the mindfulness thing is how do I get this neutral observation rather than positive or negative judgment?
Speaker 1:Yes, yes, absolutely, and I think you know I can't believe we're like basically coming up on time.
Speaker 2:here we need a part two.
Speaker 1:I know we really do so. Okay, Pete's going to make a note, so uh. So for listeners, you know again, like hopefully, um you're walking away today with a little bit better understanding of uh what an ADHD uh brain um uh struggles with but also uh really excels at, and hopefully you can uh take some of this information and either practice compassion for yourself or people that you know that may have a brain that experiences the world this way.
