The Role of Medication in ADHD

Last week, I had a blast hosting another free webinar for Beyond BookSmart that was all about ADHD. Amy McDuffie, an Executive Function coach and ADHD expert, joined me to explore how the ADHD brain works and what the roles of medication, therapy and executive function coaching are within the larger umbrella of ADHD treatment. We also took some time to cover some of our coaches’ favorite tools and strategies that can support the areas of executive functioning that people with ADHD often struggle with, and featured psychiatrist, Dr. Theresa, to fill in some of our expertise gaps around ADHD medication. So, today, I’m bringing you the audio from the webinar AND a bonus Q&A section that Amy & I did after the webinar (there were just too many great questions we didn’t get to!) If you joined us live and just want to hear the bonus content, you can skip ahead to around 47 minutes to listen to just that. And if you didn’t get a chance to watch the webinar at all, be sure to look for the link in the show notes below!

For those who have been blessed with careful ears, you’ll hear me share in this episode that I was recently diagnosed with ADHD myself. Because of my recent diagnosis, this episode is particularly close to my heart. I hope you enjoy listening half as much as I enjoyed being a part of these important conversations and if you do, be sure to give us a 5-star review on the platform you’re listening on! And last but certainly not least, thank you for being a part of the Focus Forward community.

Here are the show notes for this week:

Watch our webinar, How to Thrive with ADHD After a Diagnosis

https://thinkingoutsidetheclassroom.wistia.com/medias/u3pueh40rs

Slides from our webinar, How to Thrive with ADHD After a Diagnosis

https://www.beyondbooksmart.com/hubfs/How%20to%20Thrive%20with%20ADHD%20After%20a%20Diagnosis%202023.pdf

Watch our webinar about Motivation:

https://thinkingoutsidetheclassroom.wistia.com/medias/o3it96iuot

Beyond BookSmart ADHD Success Kit

https://www.beyondbooksmart.com/adhd-success-kit-2022

Focus Forward Ep 13: How to Unlock the Superpowers of ADHD

https://www.beyondbooksmart.com/podcast?wchannelid=y1lzulxlcs&wmediaid=by637taszi

Focus Forward Ep 18: Flipping the ADHD Narrative: How "The Disruptors" is Changing the Way We Talk About ADHD (ft. Nancy Armstrong)

https://www.beyondbooksmart.com/podcast?wchannelid=y1lzulxlcs&wmediaid=wwh3rsdpbw

2-Minute Neuroscience: ADHD

https://www.youtube.com/watch?v=w8JnDhp83gA

Transcript

Hannah Choi 00:04

Hi everyone, and welcome to Focus Forward, an executive function podcast where we explore the challenges and celebrate the wins, you'll experience as you change your life by working on improving your executive function skills. I'm your host, Hannah Choi.

Hannah Choi 00:18

Oh, you guys, thank you so much for taking the time to go to Apple podcasts and rate Focus Forward. For me, it really means a lot to see that little number next, all those stars go up. I really appreciate it. If you want to help us out, and you haven't already rated it, you can scroll to the bottom of the Focus Forward section of your Apple podcasts app and give us a rating and hopefully it's five stars. If it's not, email me, tell me why. Thanks, guys. I really appreciate you all so much.

Hannah Choi 00:47

I had a blast hosting another beyond booksmart free webinar last week, this time, all about ADHD. Amy McDuffie joined me again as one of our ADHD experts. And we covered what ADHD is and what it is not how the ADHD brain and medication work, the roles therapy and executive function coaching play for people with ADHD, and the benefits of pairing those interventions for maximum success. We also took some time to cover some of our coaches favorite tools and strategies that can support the areas of executive functioning that people with ADHD often struggle with. And this webinar was an updated version of the ADHD fundamentals webinar that we held in June of 2022. So today, I'm bringing you the audio from this year's ADHD webinar. If you listen to Focus Forward regularly, you may notice that much of the content is similar to the ADHD focused episode we did in October of 2022. In fact, I even used some of the audio from last year's webinar in that episode, I really hope you listen anyway. And don't report me for plagiarizing myself, although you'd have to report me to me, and I'm cool with it. So it's all just such good stuff. And I want to share it with as many people as possible in as many formats as we can. So some people like to watch video to learn, and others like to listen and still others prefer to read. And as a coach, I really recognize the value of honoring these differences in people. And so this is me making that happen. If you'd like some visuals while you listen, the slides from the webinar are linked in the show notes. Also, today, you'll hear me share that I was recently diagnosed with ADHD myself. And so this webinar and that ADHD episode are particularly close to my heart. In fact, doing all the research for the ADHD episode last year confirmed what I had been wondering for quite a while.

Hannah Choi 03:02

At the end of our webinar presentation last week, Amy and I answered some of the Q&A topics that our attendees asked both with their registrations and during the live webinar. And people asked such good questions. So good. And if you listened to the Focus Forward episode of the audio from our Laziness vs. Executive Dysfunction webinar, all about unlocking motivation, you may remember that Amy, Vin and I sat down the next day to answer more Q&A topics. Because there were some great questions we couldn't get to before this latest webinar ended, Amy and I decided to meet up again, just like last time, so stay tuned at the end of the webinar audio for the bonus content. If you joined us live and you just want to hear the bonus content, you can skip ahead to about 46 minutes to listen to just that. And if you missed the webinar, and you want to watch it, the link to it and our other webinar presentations is in the show notes. Okay, now on to the show.

Hannah Choi 04:07

All right. So hello, and welcome to our webinar "How to Thrive with ADHD After Diagnosis". We are so thrilled to welcome people joining us from across the US and around the world as we saw, and we have closed captions available. So if you'd like to use those, be sure to turn them on. My name is Hannah Choi, and I'll be your moderator for tonight's event. I use she her pronouns and I'm the host of our podcast, all about executive functioning called Focus Forward. So if you listen there, you might know you get to see a face to the name or Yeah, face to my voice. I have been an executive function coach at beyond booksmart since 2017, and I have coached dozens of students from elementary age all the way up to college and I also work with adults and I'm a mom of two kids who are 11 and 14 and I live in Connecticut. I am also joined by Amy McDuffie who you may recognize from our laziness versus executive dysfunction webinar around motivation. Amy, would you please introduce yourself and share your background and your roles with Beyond BookSmart?

Amy McDuffie 05:14

Yes, thank you, Hannah. Hi, everyone, I have been a coach and executive function consultant with beyond booksmart. For over two years. I use she her pronouns, and my background is in special education, specifically in behavior and learning disabilities, with students from elementary through high school. And I'm also a former behavior specialist. These opportunities allowed me to really experience both the gifts and challenges of students diagnosed with ADHD. Much of my work in the school setting focused on providing interventions for students, and coaching teachers on how to best provide support. I'm also the parent of two pretty awesome teens, ages 14 and 17. And I'm so glad you all are here. And I'm really excited to be with you.

Hannah Choi 05:59

Thank you, Amy. And for those of you who are joining us who may not be familiar with Beyond BookSmart, we have been providing one on one executive function coaching with students and adults since 2006. Even before that term executive function became widely known. And you may already know this term since ADHD and executive function skill challenges are so closely bound. But if it's new to you, you're not alone, I promise. Executive function skills are mental skills that we use to navigate our lives and get through our days. They include attention, memory, time management, planning, prioritizing, and emotional regulation. And many of our clients have an ADHD diagnosis, which gives us extensive experience in supporting individuals with ADHD or similar challenges. And today's webinar is an updated version of the ADHD fundamentals webinar that we ran last summer, which was hosted by Jackie Hebert. And that webinar was one of our highest attended webinars. So we know that this topic is really important to people. And I am personally thrilled to be hosting this time, because the topic is really close to my heart, I was recently diagnosed with ADHD. And I've been doing a lot of the same navigation of new waters that many of you likely are. And so I'm really happy to be here with you today. So you may be joining us today because you or your child was recently diagnosed with ADHD, but maybe you just suspect a diagnosis. And if this is the case, we really encourage you to listen to the webinar, and then reach out to your pediatrician or your primary care provider for guidance on what to do next.

Amy McDuffie 07:37

Thanks, Hannah. It can be really overwhelming when you learn or suspect that you or a loved one has ADHD. There's just so much information out there. And it can be hard to sort through it all. But we find it can also be a huge relief to get a diagnosis because it gives you context for your or your child's struggles, and also a defined place to look for help and support, which you are doing right now. We're here tonight to provide that for you. So here's what's here's what to expect in our webinar. First, we'll briefly define ADHD and explore some common assumptions about it. Then we'll move to learning about medication options. Then we'll touch upon behavioral approaches to treating ADHD, and share some of our coaches favorite tools and strategies that can make life a little easier. We'll share some resources and answer some of your questions before we finish up. So please use the Q&A function at the bottom of your screen throughout the webinar.

Hannah Choi 08:38

Yes, thanks. And because we're not medical doctors - Sorry mom and dad! We will be sharing a recording of some of the webinar from last summer. We had Dr. Theresa Cerulli join us to discuss the option of medication to treat ADHD. Dr. Cerulli is a graduate of Tufts University, University of Massachusetts Medical School, Harvard Longwood residency program in adult psychiatry, and Harvard fellowships in Medical Psychiatry and neuro psychiatry, and she is a board certified physician in psychiatry and is on the faculty at Beth Israel Deaconess Medical Center in Boston, and for the neuroscience Education Institute, so we'll hear from her later.

Amy McDuffie 09:21

All right, so you might be wondering just how common is ADHD? You're in very good company. Research from the National Institute of Mental Health, the NIMH reveals 11% of children and 4.4% of adults meet the criteria for ADHD, with males diagnosed at a higher rate than females. Now those statistics are from 2011. So we hope that NIMH updates their data soon. But with that degree of prevalence, you can see why it's essential to educate caregivers, children and adults with ADHD and help them identify supports to manage their symptoms.

Hannah Choi 09:59

Yes, and thanks to the efforts of high profile and successful people with ADHD, there's less stigma associated with a diagnosis. In fact, you'll meet many people who consider their ADHD a superpower of sorts. And it provides great energy and creativity when channeled effectively. There are so many great examples of people with this superpower from Simone Biles that you can see on the screen now, and astronaut Scott Kelly and so many others, and ADHD does not have to be a hindrance to success. All right, but all of that inspirational wisdom still leaves us with an important question.

Hannah Choi 10:35

What is ADHD? And what is it not? All right, so ADHD is a brain based condition that impacts daily life. And it often can affect motivation. And it often runs in families. And it has three subtypes, there's hyperactive impulsive, and then there's inattentive, which you may know as add the ADD is what it was formerly called. And now it is called ADHD inattentive type. And then there is the third type, which is the combined type that has characteristics from both. And ADHD directly impacts executive functioning. And ADHD is not a result of poor parenting. It is not a choice. And it is not something that children typically outgrow. And it is not a learning disability. And it's also doesn't have to be an immovable barrier to success and happiness. And I want to touch upon just a few of these points. Not everyone outgrows it. But with intervention, you can manage symptoms, and sometimes the symptoms just change over your life, because the demands on us change. So the symptoms can look different as we age. And ADHD is not considered a learning disability because it's a medical condition that, as we learned, impacts your it will what you'll learn as we will learn it impacts neurotransmitters in the brain. And research indicates that 30 to 50% of children with ADHD also have a specific learning disability, and that the two conditions can interact, which can make learning extremely challenging.

12:10

Yes, let's talk more about that for a minute. It's not a learning disability, but a medical condition. And understanding these dynamics can really help us empathize with individuals with ADHD. So if you attended our Laziness vs. Executive Dysfunction webinar, this may sound familiar. So ADHD is characterized by lower levels of the neurotransmitters dopamine and norepinephrine, affecting how the ADHD brain perceives both reward and pleasure. And this leads to a lack of enthusiasm per task, and a tendency to prioritize short term rewards over long term rewards. Another significant difference in the ADHD brain involves the default mode network, which activates during daydreaming or when we're not focused on a task. In ADHD, this network is more often activated constantly diverting attention toward unrelated thoughts. So that explains why staying focused on tedious or repetitive tasks can be such a chore with ADHD. It really isn't a matter of well, it's a matter of neurology. And that's why brain based interventions can be really effective for individuals with ADHD.

Hannah Choi 13:26

Yes, so true. Thank you, Amy. Alright, so now that we know what happens inside the ADHD brain, let's take a look at how ADHD can show up in behavior. Okay, so here is the top of an iceberg. And this is the part that everyone sees when a person has executive function challenges due to ADHD. The people around them see the top they see the behaviors that are problematic. They're forgetful, they seem lazy and scattered. They're sloppy or moody, they behave impulsively, and sometimes can even be rude to others. Does this sound familiar to anyone? Now remember that icebergs are actually mostly hidden under the water. And it's the same with executive function challenges. When we look deeper, we can see the specific skill deficits that people with ADHD can often have and that are causing the challenging behaviors that impact those around us. And so a person may have a poor sense of time or difficulty planning ahead, when that can make them seem scattered, and they may have trouble regulating emotion and seem irritable or moody. When they have no strategies to self monitor, a person can look impulsive, and students or adults who are too overwhelmed to get started can look lazy. And when they have no systems to track to sorry, excuse me to track their belongings or to maintain their focus, they can be forgetful. And when a person has trouble thinking flexibly, it can affect their problem solving and perspective taking and that can often come off as rude or demanding behavior. Beer. And as I mentioned in the beginning, ADHD can impact one or more of these skill areas. So you can see how it can directly impact our ability to manage everyday demands.

Amy McDuffie 15:13

Thank you, Hannah. So we'll shift now to the role of medication for ADHD. Many of you wrote in with questions about that, and we recognize that medication is a personal choice. And for those who are considering it, we wanted to provide some support there. So let's hear from Dr. Cerulli to learn how that works.

Theresa Cerulli, MD 15:33

So medications, I will say, it should be something to at least discuss with your providers medication isn't for everyone, but should at least be considered for everyone is how I would have I would think about it. And mostly because of the data. Looking at this was these were NIMH funded studies, not pharmaceutical funded studies years ago, looking at the role of behavioral interventions versus motivate medication intervention, interventions, versus combined in treating ADHD, and the sitter. So the surprise was that medication interventions, compared with behavioral interventions alone, the medication invent interventions were more significantly impactful. And then we all made the assumption that the combined medication and behavioral treatment would be even more impactful and which was true, but not to the extent that they had anticipated. So it does look like a main a main part of the treatment intervention should be medication should at least be considered this is neural neuro biologically based. And the sometimes it's hard to make headway in your behavioral strategies, meaning I call that "from the outside in" using strategies you learn in your environment, with some coaching, hopefully, and therapy, from the outside in, those strategies become hard to learn, and or utilize if you're also not not working from the inside out and helping with the neurobiological aspects in terms of what's happening in the brain. So initially, at least considering the combination of therapies, internal and external, so to speak, are, are considered them should should at least be considered. That's how we think about it. And here's our ADHD brain here on on the slide with the power switch in the frontal lobe. Think of the brain as a large electrical circuit, it really is that we're sending electrical signals when one part of the brain is talking to another part of the brain. So in the ADHD brain, all the circuitry is there, there's nothing that's we're not missing something. There's not, you know, holes in the section of the brain that's involved in attention concentration. But it just, it turns out that there's a higher level of stimulation is needed to literally turn the circuit on. And the reason that this switch here is in the frontal lobe this on switch is because that's the area that's mostly involved in ADHD, from what we can tell that area is under active or hypo active. If you look at functional scans, have somebody do a concentration task that has ADHD, and you scan them in a functional scanner, looking at what happens. And it turns out that that area of the brain that's used with concentration and attention is under active, it's too quiet. It takes something stimulating to flip the switch, which is where the medications come in. I get this question all the time. Why in the world would you talk about stimulant medications? For somebody who's already hyperactive and impulsive? It's kind of counterintuitive. And the reason is because you're not trying to stimulate the whole person. You want to stimulate that frontal part of the brain that Its job is to help us focus, concentrate, built around, filter out background noises, organize and plan. You're trying to turn it on to do its job most efficiently and effectively. So choosing the right medication is the question we get all the time. It should be in partnership certainly with somebody who really knows ADHD well, and the primary care physicians are especially if you're working with kids, the pediatricians are quite familiar but all with adults with ADHD your internist may or may not be they because the stimulant medications, which are many of the options we have available, are controlled substances. A lot of the internists and general practitioners for adults are their little hesitant to be involved in in prescribing so we usually refer you to a psychiatrist and neurologist, somebody who does this on a more routine basis. For ADHD, there are stimulants. There are also non stimulants. The non stimulants have some similar effects in the brain. Not quite as strong, I would say Say is the stimulants and we'll go through them quickly through the pros and cons. Stimulants have been around for years and years the gosh, Ritalin 1950s There was some amphetamines available even before that in the 1930s not yet used for ADHD but at least existed so stimulants have been around for more years than I have been concert they've been well studied. They're relatively affordable because there's many options and so usually there's a lot of generic brands that are available which insurance is more willing to pay for so that has that advantage. Cons is that they are controlled substances. They do have the potential for addiction. If we have clients that working with when there's any concern around that we are really careful usually move that would be someone I'd move to a non stimulant is first line. Some examples of stimulants you may have heard of certainly, Ritalin, Concerta, and meditate those fall into the methylphenidate category of stimulants. There's a second stimulant category and that's amphetamines. Some of the names you may have heard of there are Adderall, Vyvanse and dexedrine. So stimulants, if that's the umbrella term, under stimulants, you have two subcategories methylphenidate and amphetamines. And then there's about 29 or so total stimulants if I wanted to make a list and but most of those 29 fall into either methylphenidate or amphetamines in some form, some are long acting, some are short acting. An example in the methylphenidate Ritalin itself and its original form that tablet lasted only about three and a half, four hours. And that was it, which is why it was so hard to get tend to go to the nurse's office at lunchtime to take their second dose of Ritalin than they needed a third dose after school and potentially another for homework. It was really kind of rough that up down on off feeling. Concerta is a long acting rhythm and it's still Ritalin. It's just a 10 to 12 hour version that you can take once in the morning and have it last throughout the day. So there's many methylphenidates that are short acting, many that are long acting, some that are in between. Same thing with amphetamines, the non stimulants, they aren't controlled substances, there is no potential for addiction. That is one of the beauties of the non stimulants. They haven't been out as long so we don't have as many available. In fact, there are only for adults, we only have two non stimulants FDA approved for treating ADHD. In children, we had three new we now have four because Quelbree came became available last year as another non stimulant available for actually kids and adults. So we don't have the long list of that we do with stimulants where there's I said 29 I think it's actually even a little more than that now. Preparations, non stimulants we're more limited choice, but they do have their advantages that it's not that they don't have side effects, stimulants and non stimulants both can have side effects. The side effects with the non stimulants are just a bit different. I already said that not addictive, there's no withdrawal risk. They're not quite as strong. If you looked at the robustness of response, you're going to get more effect over and above not on a stimulant over and above not taking a stimulant compared with what we call the robustness of of effect of a non stimulant. But it really should be tailored to the individual and discussed with your individual provider. Hopefully someone that really is specialized in ADHD.

Amy McDuffie 23:41

All right, that was great information. So medication provides a place to start for many with ADHD. But as some educational professionals say, "Pills don't teach skills". I know it might sound silly, but it's worth noting for the reminder it provides medication as we just learned can set the stage to make learning and applying new skills easier by turning on the brain's ability to focus, which allows us allows us to take better advantage of other beneficial supports. Also, because some people choose not to take ADHD medication, it's important to explore these other supports. So the other half of the equation is how you go about learning new habits and behaviors. Let's find out more about two options therapy and coaching. Both of which can teach you different ways of thinking about your ADHD, and tools and strategies to support the areas that you or your child find challenging. So therapy and executive function coaching work together to address the negative behaviors and habits that have been learned over time, but in different ways. Therapists help transform negative patterns of thinking influenced by living with ADHD and constructively rebuilt the way people feel about themselves. Their therapy can be a really helpful piece of overall treatment, particularly if there's self esteem issues, or coexisting mental health conditions like depression or anxiety that are part of the big picture. The longer that ADHD is untreated, it's more likely that there are deep seated beliefs about self worth, and potential that can be holding a person back. It's significant to note that a child with ADHD could receive 20,000 corrective or negative comments by the time they are age 10. Now that's fertile ground for feelings of shame to take root. We're not therapists, so we can't elaborate on the specific benefits and approaches to therapy. But we really encourage you to find a therapist who has experience supporting people with ADHD.

Hannah Choi 25:56

Yes, I know that my therapist has been invaluable to me as I figured out how to manage my ADHD and all the emotions that come with that diagnosis. So managing those emotions, and those negative narratives that come along with it are just one part of the puzzle. Because ADHD impacts executive functioning so directly, working specifically on developing good habits to level the playing field is really, really helpful. And that's where executive function coaching can help. So what is executive function coaching, it supports clients to explore their strengths and their challenges, and then refine their tools to manage their daily life challenges. And all of this helps foster healthy habits. And having a coach is beneficial for everyone, actually, regardless of your ADHD diagnosis, because you don't have to have ADHD, to have stroke struggles with executive function. And life can just be tough enough for everybody. So learning some new strategies is always helpful. And as we said before, Amy and I are both coaches, and we have been for some time now. And I just love how we get to teach adults and students, all those executive function skills like organizing, planning, prioritizing, managing time, and maintaining focus, learning to assess yourself and work more efficiently. But it's really so much more than just building on those specific skills and habits. Right, Amy?

Amy McDuffie 27:26

Absolutely. Yes, I definitely agree with you there, Hannah. I also really just value the strong trust and rapport that I get to build with clients. And I love those moments when I get to see a shift in confidence and autonomy. You know, really our goal is our goal as coaches is for clients to develop the skills they need in order to become successful and independent.

Hannah Choi 27:51

Yes, there's just nothing like it when we see our clients finding that. And also, everybody comes from a different place and has different needs and different challenges. And so what what I really like about that one on one aspect of coaching is that it can really help clients focus on their specific goals and their needs. So Amy, what do you see in your clients with ADHD when they first start coaching?

Amy McDuffie 28:19

Yeah, that's a really, really important question, because clients often come to us when they're feeling pretty frustrated, which is completely understandable. And oftentimes, individuals with ADHD experience much more frustration and failure than they do success, which ends up having a negative impact on their self perception, and also increases stress. So this can become a real barrier leading to the self-reinforcing negative cycle, and also results in less efficient processing. Because our brains just don't function well under stress. I know I've seen clients come into coaching with the assumption that they just can't improve their grades or stay on top of their work. Because this combination of past failure and unhelpful habits have really diminished their confidence in it for taking any steps towards making a change. And that's why it's really important to help clients with ADHD recognize their strengths. And as coaches, we can build upon those strengths and draw parallels between the skills needed to generalize that success to other areas. We also initially work on finding small wins and help clients recognize the benefits from these changes, which then leads to greater self confidence. And this increase in self-confidence and feelings of success then became motivating to build upon this habits and ends up creating a positive cycle of success that can really snowball into some major changes.

Hannah Choi 29:51

Yes, it's so it's just so great to see that happening. So let's talk about some of the specific tools and strategies that we coaches use to teach people with have ADHD, or just executive function challenges to make the life a little easier. So a common common common executive function skill challenge area for people with ADHD. And actually, I would say for most everybody is planning, prioritizing and time management. And so let's start with that time management. One helpful strategy is using timers and then blocking out your time, we really liked the Pomodoro Technique, which you may have heard of before, and it involves setting a timer for a focused work period, then that's usually about 25 minutes, the brain doesn't really like to work longer, in general. So 25 minutes is often a good amount of time. And then after the timer goes off, you take a five minute break, make sure you set a time and mercy or five minute break doesn't turn into an hour, and then restart that cycle. And then if you're finding it difficult to get back to work, after the break, you can try stretching or getting up and walking around having a snack or a drink, or just maybe switching to a different activity temporarily. And when prioritizing what you're going to work on in those blocks of time, some people like to decide ahead of time, what they're going to work on, based on the difficulty of the task or its urgency, and then others like to start with what they're feeling most motivated to work on. And it really just depends on what works best for you. And as all tools. And what we really say to all of our clients all the time is we really, really want you to try things out, and then see what works best for you. And as a person with ADHD, the way that you do things might look different from the way everyone else does. And I'm here to tell you that that is okay. And a tool that we like to use for planning is called peak performance. And what peak performance does it helps you to learn to pay attention to when you're most productive. And so this can give you some insights on how to schedule your days. So if you tend to get tired in the afternoons, I think that's pretty standard for most people, scheduling a focus to work session in the afternoon is not maybe a realistic expectation. And if you have a hard time winding down after school, jumping right into homework when you first get home might be stressful and unproductive.

Amy McDuffie 32:17

Yes, thank you so much, Hannah. I totally agree it's so important to recognize those peak performance times during the day. And I think it's also really helpful to determine why the task is important to you, you know, to remind yourself of the potential benefits, which may not always seem immediate, but could have some greater benefit down the road. And this can really help boost motivation for taking the steps to get started. Some other strategies that can help with focus include things like taking notes, using checklists, asking questions, and just writing information down in your own words. It's really about creating opportunities for engagement and active participation whenever possible. And some people find it's also helpful to drink water or to gum, also to use alternate seating or even stand and to create opportunities for movement. And this is definitely something to consider in the school environment where students do a lot of sitting.

Hannah Choi 33:21

I also wanted to touch on some strategies that can help remember help with remembering to take your medication. And this could be ADHD medication or any other prescriptions you might have. Memory can be a big challenge area for people with ADHD. I know it is my kryptonite. We suggest setting up automatic refills for prescriptions that allow this and adding a reminder in your calendar for the following month when you receive this month supply. And you can create a recurring alarm as a reminder to take your meds or and then also like keep them in something like near something that you use daily, maybe by your planner or bedside table or the kitchen counter. And ordering a three month supply when possible. You can't do this without medications can reduce how often you need to reorder, which is really helpful. And if the current Adderall shortage affects you, being proactive is crucial. Your pharmacist may need to collaborate with other pharmacies to source refills, and finding a cooperative pharmacy will make things much easier. Let's see. All right. I'm gonna go with this one. Let's see. How do you know when a teen is being lazy versus when it's ADHD? This sounds very familiar to me. Amy. Does it sound like that to you?

Amy McDuffie 34:48

It's that's a that's a tough question to be honest. Yeah, I'm happy to start out on that one. Yeah. I you know, coming from you know, a behavioral behavioral person Active, excuse me, I really like to find out, you know, where the problem issue is, and also, you know, help determine why that's happening. So I feel like, that's a really important step here. Like, you know, how, how is this child being impacted? And, you know, why is that occurring? Because I do think that, you know, behavior serves a function. And I think we need to determine that before we can identify, you know, if it's ADHD related, which it very well could be, or if it's more of a behavioral issue. So, I don't know, Hannah, what are your thoughts on that?

Hannah Choi 35:39

Yeah, well, it reminds me of the last webinar that we, that we both hosted back in May, where it was actually the topic of the webinar. And, and, and we, we do like what like you just said, it's, it's, I mean, I would say it's not laziness. It can feel that way. As the parent, I can very much feel that way. It can also feel that way, as a person with ADHD, sometimes I find myself, I like catch myself thinking, I'm being really lazy. And then I realized, like, wait a second, I'm just not, I'm not figuring out why. And I'm not figuring out a tool to help me get past that what feels like a laziness barrier. I do know that a lot of screen time can deplete what little dopamine people with ADHD already have. So extended amounts of screen time can can make it feel like everything else is really boring, which can impact your motivation. So you know, if there's, you might want to have a discussion with yourself, if you're the person who's experiencing that, or with your partner or with your child, if, if there might be some dopamine depletion going on from a lot of screentime, which is totally normal. Everybody, does it. I'm not at all saying is there's anything wrong with it, but it can be, there can be a connection of it there. So yeah, all right. Um, let's see. Oh, here we go. Can you give an example of how ADHD can be a superpower? I would like to take that one.

Amy McDuffie 37:20

Yeah, absolutely. Absolutely. Yeah.

Hannah Choi 37:24

So that Default Mode Network section that you were talking you and Dr. Cerulli were talking about earlier is, is it's both a challenge and also a superpower. So even while I'm talking right now, I have like a lot of ideas going on in my head. And what I'm doing is like making all these connections between topics. And I feel like I'm really good at synthesizing information. Because I have this deep, I even I'm focusing on talking right now to all of you, I have this default mode network that is like susceptible, making all these connections out here. And I feel like it gives me some really creative ideas. And I also feel like it really helps me as a podcast host. Because I feel like it helps me come up with some really cool questions and make connections that a more linear thinker might not make. It does require extra effort to stay focused and to kind of ignore that default mode network when I when I really need to focus. So it's a it's a challenge, and it's also a superpower. And also, there's just a lot of energy behind the things that people with ADHD are really interested in. So I think that that is, you know, some of the most successful CEOs in the world have ADHD. What about you, Amy, what do you see in your clients are the students that you used to work with?

Amy McDuffie 38:46

I really, I really value the creativity that I feel like many individuals with ADHD have. And you mentioned, Hannah, you know, the energy and I think that's, that's such an important part that to frame it as a positive. And, you know, that kind of goes, you know, really into, like, the dialogue about ADHD that we really should reframe it as, you know, as a positive and look at, you know, you know, the gifts that ADHD can bring for individuals.

Hannah Choi 39:19

Yep, I agree. Okay, here is a great question. I'm so glad somebody asked this. How does mood play into executive functioning with my daughter who has to attempt inattentive ADHD getting into the frame of mind to do anything is a big challenge. Yeah, so just to get a little brain nerdy. So our executive function skills reside in our frontal lobe or prefrontal cortex which is right behind our foreheads. And we can only really access them when we are at rest and digest when our body when we're not stressed out. We're not upset we're not anxious. And so if you, if you already are struggling with executive functioning, which a person with ADHD does, and also one of those really big, important executive function skills in there that do that does really challenge people with ADHD is emotional regulation. So regulating your emotions so that you can stay up in the front part of your brain, the top part of your brain where your executive function skills are is a huge part of success. Right? Like, if you already have trouble accessing them, and your emotions are not being managed, then it makes it even harder to get started even harder to get over the anxiety that you might have or the frustration you might feel or the fear you might have for what you're going to work on.

Amy McDuffie 40:45

Yeah, absolutely. Hannah, I mean, it really that emotional regulation or self regulation piece, it really is the starting point, you know, of things to focus on and then to work on building strategies from there.

Hannah Choi 41:00

Yeah, yep. Somebody asked about screen time. We could literally talk about screen time all night.

Amy McDuffie 41:07

Yeah, yeah. And I feel like that's, that's such an important question. Because, you know, it's one that we all we all live. Yeah. So I'm, if that's okay, Hannah, I'm happy to share. Okay. So this is something that I've, you know, that I've actually been working on with a client, and, you know, having two teenagers myself, it's something that we address in our own home as well. And I feel like, you know, for me, the approach that I like to take is to really look at, you know, how we spend our time, so, you know, how your kids are spending their time. And, you know, really what they're missing, you know, are there things that they have enjoyed doing in their lives, their hobbies, other things that might be sacrificed, if they're spending tons of time on the screen. So I like to, you know, kind of approach things from that angle in terms of, you know, what else could you be doing with your time, and then, I love the approach in my own house of, you know, taking the, the adolescent need for independence and autonomy. And, you know, really talking with my kiddos about, you know, are you in control of your phone? Or are you allowing your phone to control you and, you know, taking that approach and teaching them about, you know, the intention of all of the the apps and, you know, wanting to, you know, maintain our attention and take our time away. So, those are just some approaches that I use, you know, in my own house and with with my client as well. How about you, Hannah?

Hannah Choi 42:44

Yeah, I really love that last point that you made, because learning to, to reflect on our own experience, and then take what we've learned, and then apply it to our life to make positive change is is such an important skill to learn as a teen because you're soon going to be an adult and not have your parents around to help you monitor all that. So learning that self awareness, and just self control is so great. So I love that. I love that you mentioned that. Yeah, I got to interview Dr. Clifford Sussman, who is a psychiatrist who specializes in screen addiction. And he had some really, really great tips for, like you said, working with your, with your child, your teen to, to, you know, work together to come up with a potential solution for you know, setting reasonable limits, while also giving them that autonomy and independence that they do crave. And they do need because they need to develop that skill for success in life outside of, you know, our safe and cozy homes. And then he also talked a lot about See, here's where my memory is... so anyway, just listen to the episode!

Amy McDuffie 44:06

That is a great episode, Hannah. That's one of my favorites.

Hannah Choi 44:12

We are live folks, we are live. Here's one. How can you tell if it is anxiety or ADHD? Oh, whoever wrote that? I feel Yeah, I feel you. What do you see in your clients? Amy?

Amy McDuffie 44:28

Oh, wow. I honestly he and I often see both of those in conjunction and, you know, the symptoms of anxiety and ADHD. There's definitely some overlap there. And you know, we talked about the you know, the cycle of failure and I what I have seen is when clients expect have that experience of past failure, it causes more anxiety and that anxiety you know, leads to avoidance with Whether it's for, you know, completing assignments or the thing they have to do, and it just, it does create that ongoing cycle. So it's, it's hard for me to separate the two, honestly, when I think about the work that I do with my clients, because I do see it often together. How about you?

Hannah Choi 45:18

Yep. Yep, I agree. I mean, I agree personally, that is, has been my experience. And I also see it in my clients as well. I know, for me, personally, I have a lot of anxiety around forgetting things, because memory is my most challenged area. So I am, I am often anxious that I am, you know, forgetting an important appointment or forgetting to do something that I told someone I would do. And so I have to use a lot of strategies to support myself there and I don't succeed every time. I have recently double booked myself. And so you know, it happens. But I encourage you to explore both. And to, like Amy said, it's hard to separate them, I do think it's pretty common to have both. And, and also, like, maybe we even internalized this as a child, you know, you you like all those corrective messages we heard, you know, we talked about earlier, it's, you know, when you hear that over your over the years and years, it's, it's hard not to come a little anxious about that.

Hannah Choi 46:20

Okay, so this is where we ended our Q&A section of the webinar. Now keep listening to hear the rest of the conversation that I recorded with Amy the next morning. And in keeping with my goal of authenticity, you can hear some sounds of daily life in the background of my recording. My mother in law, who I love dearly, did not realize I was recording. Good morning, Amy.

Amy McDuffie 46:46

Hey, good morning.

Hannah Choi 46:48

Thanks for coming back. It's not too early, but it is the morning, but I appreciate the quick turnover.

Amy McDuffie 46:56

Yeah, absolutely.

Hannah Choi 46:58

That was so fun last night. I'm so glad we got to do that again.

Amy McDuffie 47:01

Yeah, me too. I really, I really enjoyed that I could talk about, you know, ADHD is something I could talk about all day. So.

Hannah Choi 47:10

Okay, well, then I'm glad we're talking about it. So I was laughing so hard internally, because as you know, every time we were practicing, I kept almost I kept saying not almost saying I kept saying laziness versus execution webinar. Not laziness versus executive dysfunction webinars. So

Amy McDuffie 47:31

yeah, that would be a different webinar, for sure. It'll be different. Yes, exactly. I mean, that would that would be a different source of motivation, for sure. So

Hannah Choi 47:51

All right, so yeah, so I was very proud of myself control and yours as well, because I know you were wondering if I was gonna say it?

Amy McDuffie 47:59

Well, and I was trying not to think about it too much, because then I didn't want to internalize it and say it myself. So I feel like we did. We did well, with that. We did. We did. We said the word.

Hannah Choi 48:13

All right, let's dive into some of these questions that are just so good. I love. I just love how thoughtful everyone is. And so some of these questions were submitted during our live Q&A. And some of them were submitted when people registered for the webinar. So we've just kind of mixed them together. Okay, so here's the question when searching for a therapist, what kind of therapists should I look for?

Amy McDuffie 48:39

Yeah, so Hannah, I'm happy to jump in on that. One. I would recommend looking for a therapist who is experienced working with individuals with ADHD. And you know, also if you you know, feel comfortable and know someone who has an ADHD diagnosis, you know, maybe getting a recommendation from them as well. Then what do you think?

Hannah Choi 49:01

Yeah, for sure, you can also ask your psychiatrist or your whatever the doctor is that you're working with, for medication, if you take medication. I do know on Psychology Today, the different therapists will have profiles. And then and then on their profile, it'll say whether they work with people with ADHD, although I did reach out to one and she she told me that she doesn't work with ADHD. People with ADHD but it says so on her profile. So you might, you might and then they went to check back again. I noticed it was gone. So you might you might that might happen to you, but I encourage you to persevere. Yeah, yes. But yeah, absolutely. Someone who has experience and then you meet you might also meet with the person for the first time if you've never met with a therapist before. You may not know this that it can take a couple tries to find a therapist that you really gel with. But it's worth pursuing. It is frustrating because you have to tell your story, again to a new A person. But um, hopefully, hopefully you find the right one on the first try. Yeah. All right. Next, how do you approach a college age student who has been diagnosed with ADHD but will not accept help and wants to fix himself? And how do you help with the shame that they feel I actually entire my own personal experience real quick, I ended up when I got diagnosed, I realized, oh, there's actually nothing wrong with me, this is just how my brain is wired. So I actually felt a lot of relief, getting a diagnosis, so that I can understand the opposite experience. And it does, it can really feel like there's like something wrong with you, and that needs to be fixed. But, you know, as we talked about last night, it is it is just, you know, it's a, it's the way that your brain is, you know, it's neurotransmitters, it's not character flaws. And so I don't know if you know, approaching it from a real matter of fact, sort of factual viewpoint, that this is what's going on in your brain. And it's not necessarily like you as, as your essence, your soul, your person. What do you think?

Amy McDuffie 51:16

Yeah, I think that, that the education piece is so crucial. Because just having that having the understanding, knowing why that's happening, I think can really help with that piece. And in terms of, you know, addressing the shame piece, and dealing with denial, I think it's really important, you know, as, as parents, as professionals to really normalize our own struggles, and normalize the fact that everyone has challenges and struggles and things that we that we fail at. And, you know, just really, you know, trying to approach it from that perspective that, you know, this is this is what I'm dealing with, and that, you know, we all have those things. And I feel like that's a really important part in conjunction with the education piece.

Hannah Choi 52:11

Yeah, yep. Showing that empathy. And, and, and acknowledging their, their feelings and not denying them those feelings. And, yeah, yeah, it is hard, though. Yeah. What's what what I feel like is that, that, eventually, people who are feeling that way will hopefully feel, see the superpowers see the benefits of it, and are and are able to shift their perspective from something like wrong with them something that needs to be fixed to something like, oh, how can I leverage the, you know, the, the actual, like, really great things about this? And, you know, it does take a lot of work? Not, you know, it's definitely not easy, but I think that a shift in mindset can can help as well. Absolutely. Just wanted that therapy piece and executive function coaching thing coming.

Amy McDuffie 53:05

Right. Right. And I think also, you know, if it's possible, you know, to connect them with someone who has ADHD and has, you know, worked on some strategies and, you know, is able to share their perspective, I think that can be really helpful as well, because so many people are diagnosed with it, and, you know, are very successful. So I think that's a helpful piece, too.

Hannah Choi 53:31

Yep. Absolutely. And that we are seeing much less of a stigma around it, and people are more open to talking about it. And so hopefully, they are, you know, your your kid kiddos are able to connect with other people, I think, yeah, that's a really good point that you brought up, Amy. Thank you. All right. So next one. All right. Let's switch to an adult perspective. If you work in an office job, where you stare at computers all day, how can one unplug and not lose motivation to do other stuff? I feel like I can't separate myself from my electronics and I procrastinate on other things I need to do. That's a really I think this challenge for anybody right, regardless of your diagnosis. Yes. Especially in this day and age, this is you are absolutely not the first person to ask this question. I think many of our adult clients are saying yes, yes.

Amy McDuffie 54:33

Yeah. I agree with you there. Yes, absolutely. Because we do spend so much time, you know, staring at our screens, whether it's work or anything else, I think it's really helpful to you know, to actually schedule time away from the computer away from the screen, and, you know, whatever that looks like, whether you're actually in an office or working from home, but you know, scheduling that time and committing to sticking to it. I also think it's really helpful to enlist support, you know, whether from a family member or a friend, you know, to help you commit to that, whether it's, you're able to go for a walk, or whatever the thing is, where you're breaking away from it, you know, having support can be really motivating.

Hannah Choi 55:25

I have an adult client that I work with currently, and he is dealing with this exact same challenge at work. And he is lucky that he has an office so he is able to shut his door. So what he does is he schedules work time on his calendar, so he looks busy, so that people, you know, interrupt him less, and then he also shuts his office door. If you don't have an office door to shut, you can have, you could even put up a sign like I'm busy working, putting on headphones is a nice visual cue to other people that you are busy. And then the phone, the phone is a big one, they've done studies and they have found that we are I think 30% less effective. Just having our phone on our desk, even if it's flipped over and silenced, we are less productive. So I really encourage you to put your phone, like you know, leave your phone in your I don't know, on your friend's desk or your co workers desk or in your work bag or something. So it's really, really out of the way out of you know, the temptation zone. That can you really help if you feel like you can't put it away or you can't for some reason, maybe you need to be on call for a sick child or you have some other commitment where you really need to be connected to your phone. They do have apps that can help you with focus. So there's don't My favorite one is Focus Dog, which there's like a dog that makes doughnuts while you're focusing. We talked about that one before. There's also there's also Forest and you know, all those other focusing apps - the Flora flora. Yeah, those are both really like pre pretty ones. Right? So, if you want the tasty donuts get Focus Dog, Pretty one get Flora Forest or, or Flora. Those are some tools that you can use if you if you can't physically move your phone away from your Yeah, your workspace.

Amy McDuffie 57:31

Yeah, that's, that's great to know, to Hannah about the productivity. I need to I need to work on that.

Hannah Choi 57:39

Yeah, it's and I've actually asked my, a lot of my college clients, I challenged them to not have their phone with them when they're working. And they all begrudgingly admit that yes, they were more productive when their phone wasn't. So yes. But yeah, it is it is a powerful distractor having that there. So

Amy McDuffie 58:01

yeah, definitely. Yeah.

Hannah Choi 58:03

All right. So let's see. Here's some more though is two more that will combine any tips for college freshmen with ADHD? What may be some good routines to practice over the summer? Great question. And then how do I help my teen who was diagnosed last month with ADHD? Learn some strategies to make things easier on them during the summer? While the pressure of school is off? Yeah, that's a great question. Yeah.

Amy McDuffie 58:32

Yes, are so great. And I, I love the thoughtfulness behind that. And, you know, taking advantage of summer time being, you know, a low stakes situation without the pressure school. And I really think it's a great time to work on things like organizational skills, whether it's your physical space to get that set up, you know, before school starts, or, you know, working on, you know, learning to use a planner or a Calendar, Google Calendar. This is something that I actually work on with my kids during the summer. You know, in terms of, you know, Google Calendar, and you know, helping them manage whether my daughter is dog sitting or babysitting, she uses like a physical wall calendar as well. So you know, whatever the organizational system is, that's going to be helpful just to get in the habit of using that. I feel like it's really important over the summer. What about you?

Hannah Choi 59:29

Yeah, yes, I'm working on that right now with a client where I'm encouraging them to. I joke and say, you have to change your relationship with your planner, you have to move beyond just holding hands. And so yeah, so I'm really encouraging them to write everything down in their calendar. And it's like you said, it's such a low stakes time. So even when they're going to hang out with friends, I encourage them to put it in their calendar. So they can just get in the habit of making the calendar event, you know, and then maybe even sharing it with their friends with their friends can also have it on their calendar, just to be a little bit of a role model and also have some built in some accountability. So, that's is such a great time to practice it.

Amy McDuffie 1:00:20

One of my clients, we actually started this summer, working on a schedule for laundry.

Hannah Choi 1:00:27

Because there's so many executive function skills. Yes, yes. And cooking, too.

Amy McDuffie 1:00:33

It's a good one, too. But yeah, so you know, even things like, you know, working on, you know, managing your chores, or, you know, setting up a plan to manage your laundry can be really hard to work on in the summertime. Yeah, so with one of my clients was laundry, like, we literally, you know, worked on making a schedule and a plan for the week of, you know, when to tackle laundry, and, you know, even down to, you know, pulling in some habit stacking that in the morning, right after the shower, we're going to start laundry and, and go from there. And it was really effective. And I think that's such a helpful thing to focus on in the summertime,

Hannah Choi 1:01:16

Especially for kids who are heading off to college. And we've, you know, we've talked about that, before, it's come up on a couple conversations on the podcast anyway, it's such a huge, huge thing. And there's so many executive function skills out there. Yeah. And also cooking to cooking is a really great way to practice executive function skills of planning and prioritizing and organization, and time management. And it, there's so many involved in there. And then also, they're learning the valuable skill of how to cook right is so important as you prepare to leave to leave the nest. Yeah, though. Yeah, absolutely. You're right. It is, it's such like a great low stakes environment to practice those things. And they, and they really, and you don't need to practice them in an academic way. You know, like the examples that we just gave have nothing to do with academics. But, and that's what's so cool about executive function coaching is how transferable all of the skills that our clients learn, like, like our student clients, learn, you know, strategies to support their academics, but all of those strategies are transferable to, you know, their daily life activities. It's pretty cool.

Amy McDuffie 1:02:36

Yeah, absolutely. And it's, it's so valuable, too, because, you know, just thinking about things like laundry and cooking, I mean, those are skills, you you have to have your entire life unless, you know, you're in a situation where someone does that for you have to learn to manage those things. And I think back and I wish that someone had like, either really kind of worked on those things with me in a more direct way. I mean, I figured them out, as we do. Yeah, right. Right. You know, it really does just make me aware of the value of, you know, really directly teaching the skills and the systems that you can apply across the board.

Hannah Choi 1:03:19

And what is so great about that is that you can directly teach your kids those, those executive function skills without them even realizing that they're learning. So, you know, if you sat down and very, very formally said, now, we should work on time management, and, you know, like prioritizing, they're gonna roll their eyes and say, No, thank you. But, you know, just don't mention them and they're gonna learn them just accidentally.

Amy McDuffie 1:03:48

Exactly, exactly. There's so many ways to naturally weave that in. Yes, yeah. If we, if we formally approach it with our own kids, I feel like at that point, like, they're, they're no longer listening. Yeah.

Hannah Choi 1:04:01

That's right. It's like when they're little and you would like, I don't know, you'd like hide the spinach and something tasty. Like, if you tell them there's spinach in here, they're gonna like, I'm not gonna eat that. decided in there. They don't know. Exactly, exactly. Sorry, kids. Parenting is all about tricking you.

Amy McDuffie 1:04:23

It's actually it's not manipulation. It's education.

Hannah Choi 1:04:28

That's right, disguised as a brownie or laundry.

Amy McDuffie 1:04:32

You'll think this later.

Hannah Choi 1:04:34

And you'll do the same to yours if you have them. Thanks again for joining me, Amy, such a pleasure.

Amy McDuffie 1:04:41

Absolutely. Hannah. This was great. Thank you so much.

Hannah Choi 1:04:45

And that is our show for today. Thank you so much for taking time out of your day to listen, I hope you learned something new about ADHD or maybe you just found a new view of it. It truly can be a superpower with the right interventions. tools and strategies. As I mentioned before, if you want to watch the entire webinar, you can find the link to it in the show notes. I also included some links to the slides that we shared during the webinar. I hope you join me at our next webinar. You can find more about our upcoming events by signing up for beyond book smarts monthly newsletter, the monthly think, or by checking the Events page in the resources section of our website. If you know anyone who might want to learn more about ADHD, please share this episode with them. You can reach out to me at podcast at beyond booksmart.com and also you can subscribe to Focus Forward on Apple and Google podcasts, Spotify or wherever else you get your podcasts. And as always, if you listen on Apple podcasts or Spotify, you can give us a boost by giving us a five star rating. We would love it. Sign up for our newsletter at beyond booksmart.com/podcast will let you know when new episodes drop and we'll share information related to the topic. Thanks for listening