July 14, 2021 • 43 mins
How many people are living their life undiagnosed? This episode is about ADHD but the message is about disorders. The barriers that exist to get a proper diagnosis and treatment are criminal, and it's time we address them. I spoke with Dr Jeremy Sharp, a psychologist, consultant and speaker about ADHD and the process of getting diagnosed. You'll also hear from Lesly Quiambao. She got diagnosed after my last episode and explains what the process was like.
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Episode Transcript
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Speaker 1 (00:00):
Prodigy is a production of I Heart Radio. This episode
might be a bit chaotic, but given the subject, I
think it might be appropriate. Last season of Prodigy, I
did an episode on a d h D where I
told my story and the response really surprised me. It
resonated with people. I even had listeners get diagnosed after
(00:22):
and we'll hear from one of them later. So my
friend has been treated for depression for the last fifteen years.
She got diagnosed with bipolar just six months ago because
one doctor finally decided to test her and realized what
it actually was. Disorders have symptoms that crossover, yet doctors
are sometimes just throwing out guesses based on short conversations.
(00:44):
This is why testing is so critical. While this episode
is about a d h D specifically, I think the
underlying message really applies to most disorders. There's a ton
of people out there who are undiagnosed or misdiagnosed. The
U S health care system especially is terrible. It's expensive,
difficult to navigate, and non uniform. I got a physical
(01:07):
at my primary care doctor six months ago, and a
few weeks later a bill showed up from the testing
company for seventeen dollars I filed a complaint with the
Better Business Bureau and the company knocked it down to
fifty bucks. Wait, like, what are their margins? How can
they reduce the cost by that much from a complaint
and still be profitable. It's a scam even with criminal costs.
(01:31):
A d h D is not easy to get diagnosed
and treated for the main reason is that the primary
and most effective treatment is a controlled substance adderall, it's
an amphetamine, which is a central nervous system stimulant that
treats the chemicals and nerves that contribute to hyperactivity and impulsivity.
(01:51):
Since a d h D has hyperactivity in the name,
it's commonly associated with excessive energy or fidgeting. That doesn't
sound so bad, but in reality, it's impulsivity. That's the
inability to control your thoughts and actions. That's pretty damn
important for functioning in society. Your doctor might be skeptical
(02:13):
or even consider you a drug seeker. This is especially
challenging when a common symptom of the disorder is substance abuse.
It's actually self medicating and creates the dilemma. Your brain
is overloaded with thoughts and you want to calm them.
If people want to cheat the system to get stimulants.
Let them. They're probably suffering and need treatment too. But
(02:36):
even so, that's no excuse for skepticism. We need to
encourage people to assess and address their mental health, not
criminalize it. Disorders like a d h D are the
silent killer. You don't need a straight jacket, but you
can't achieve your potential. You exist in limbo between what
you could be and what you are. There's a pervasive
(02:58):
belief that a d h D is over diagnosed, especially
in children and adolescence, but in adults as well. The
main argument for this is the fact that more people
are diagnosed now than they were in the past. However,
there isn't sufficient research to show exactly why it's more
common now, but it seems pretty obvious to me. We
(03:19):
understand it better and can recognize it easier. In my
parents generation, a d D simply wasn't a thing. Those
parents raised children who they also believe don't have a
d h D. I got tested when I was fourteen
and the results said I probably had a d h D.
My parents didn't understand it, and I don't blame them
for it, but my adolescence was a mess. I barely
(03:43):
made it out alive. It altered the trajectory of my life.
A thirty five, I got diagnosed and medicated, and it
vastly improved my life. Yet I am constantly presented with
the notion that the medication is bad and my disorder
isn't valid. Even today, I've gone nine days without it
because the pharmacy was out, then my doctor was out,
(04:06):
then the next pharmacy was out. I can't even call
the pharmacy to see if they have it in stock
before telling my doctor where to call it in. It's
not allowed for some reason. People without a d h
D who have taken a stimulant like add or all
feel basically jacked, like they've done a bunch of cocaine.
They go and alphabetize their book collection. But when you
(04:27):
take it consistently, you don't get that feeling. It just
helps you operate closer to what society expects for people
who need it. It's like a life jacket when you're drowning.
And if you have a d h D, it's incredibly
likely that one of your parents does too. And every
person with a d h D that I've ever talked
to about that says, oh my god, my dad immediately
(04:49):
like no, like instant reaction. There's no hesitation and there
isn't for me either. Women have an even harder time.
Minorities are far less diagnosed. Is it because other ethnicities
have less disorders? No, they just have a greater barrier
to healthcare. This episode is about a d h D
and what to do if you think you might have it.
(05:11):
If it helps one person, then it's worth it. My
name is mull Berlante, and this is prodigy. Dr Jeremy
(05:32):
Sharp is a license psychologist who has managed assessment clinics
for over a decade now. He's a speaker and consultant
for a variety of organizations regarding mental health. He's incredibly
qualified to answer these questions about a d h D
and the testing process. And since I went off so
much in the beginning, I should probably add the disclaimer
that just because he's on this episode doesn't necessarily mean
(05:53):
he agrees with all my opinions. Diagnosis of a d
h D still comes down to what behaviors someone can
observe in another individual. Right, we don't have any brain
scans or blood us or anything like that to to
diagnose a d h D, So keep that in mind
as we talk through this. But generally speaking, the diagnostic
criteria say that, you know, a d h D is
(06:15):
a persistent pattern of inattention and hyperactivity or impulsivity that
interferes with functioning or development. So that's great, that's a
nice general definition. More at the neurological level, I mean,
we think that the brain structure is involved in a
d h D. Are you know there's a lot happening
in the frontal lobes, which is that kind of command
(06:36):
center of the brain that plays a large role in
self regulation and impulse control and things like that. Uh,
there's some implication of the basil ganglia and the cerebellum.
But generally speaking, yeah, it's this combination of inattention and
hyperactivity or impulsivity that causes a significant impairment in people's lives.
After the a d h D and Me episode I
(06:58):
did a while back, one of the listeners that reached
out to me told me it made them realize that
they might have a d h D as well. Her
name is Leslie Kimbo. I should also mention that Leslie
lives in Canada and unfortunately your experience may vary based
on location. So when I first heard your episode, I
had felt a lot of relief things that you had
mentioned I had connected with. People. Tend to think of
(07:20):
it just as hyperactivity. I can't focus. But impulsivity, How
does that relate to hyperactivity? Yeah? I mean I see
both of those kind of on the continuum of holding
back or regulating your behavior, right so that that filter,
uh that exists in our brains that says, hey, maybe
don't do that right now. But you're right. I mean,
(07:42):
hyperactivity I think gets a lot of attention, especially with
you with kids when they're younger, because that's what people
can can see. It's the the fidgeting or the getting up,
or the you know, constantly moving around or the jumping
on the couch. You know, it's all that kind of stuff.
So it's it's very in your face. Impulsivity comes into play,
especially as a d h D kids sort of grow
(08:06):
into a d h D adults. So that's a big
component here too, you know. And that's like interrupting other people,
or getting that tattoo without really thinking it through, or
buying that car that looks amazing but maybe doesn't match
your bank account. You know, it's those behaviors get a
lot more prevalent, I think as kids get older, interrupting people.
(08:27):
I feel like it's a pretty big one. Definitely. I'm
always concerned I'm gonna forget it if I don't get
it out fast enough, or finishing someone else's sentences, stuff
like that, right, right, Yeah, that's a common thing that
The reason that people give is, um, you know, there's
just so much going on in my brain. I have
to blurt it out or I have interrupt or it's
gonna go away. So I feel like the misconceptions about
(08:51):
it are huge, maybe possibly because it's you know, it's
called hyperactivity disorder. UM. I think even my parents don't
even fully believes that I have it. UM. And I
feel like this is probably super common with people. What
like misconceptions do you often see about a d h D.
That's a great question. Um. One is like a lot
(09:12):
of people say that just because they're forgetful, like you
know you, I'm sure you've heard those those people like
I'm so forgetful, I just had an a d D moment,
you know, or something like that. So this gets to
your point that it's not just one specific like small
dimension of functioning, Like just being forgetful doesn't doesn't mean
you have a d h D. UM Like, people are
(09:33):
naturally forgetful, you know, that's normal. One of the biggest
misconceptions that I also see is this idea that it's
very wide spread. I think people overestimate the prevalence, you
know too. For someone to really have a d h D, theoretically,
you know, they should be more impaired than about of
(09:55):
the population. The other misconception is that a d h
D does not persist into adulthood. And we have some
pretty good information now that it it really does, so
adult a d h D is a is a thing
that we need to be concerned about and really looking into. Yeah,
and I think people tend to dismiss it as not
that serious. But I mean if you really think about
(10:16):
it in attention, if I'm being able to get things
into my working memory, then I'm unable to sort of
like learn new things, which is kind of important. Oh
it's super important. Yeah, not to mention. I mean, yeah,
you give the example of learning new things that's really
important as we can get older. Um, but I think
about too, just holding onto the things that we need
(10:37):
to hold on too, so when to pay your bills, UM,
do dates, UM work meetings, things like that, just all
the things that we keep track of. There's a big
impact in adulthood. If you get a diagnosis, then you
know and you can work with possibly what a therapist
to develop strategies for dealing with some of those inadequacies
(10:59):
are like deficient in sees. Yeah, definitely, we have UM
really two main directions for treatment if you want to
go either route. So you know, there's medication, of course,
I think most people you know, for better, for worse,
or familiar with riddling at all, you know, and all
the variations thereof to treat it from a medication standpoint.
(11:20):
But therapy wise, yeah, we have some nice research supported
interventions UM that you could do in therapy or coaching.
You know sometimes people do a d h D coaching
instead of therapy. You know, that person would work with
you on skills like time management, organization, planning, problem solving,
UM skills that we have to use in day to
day life. Great, and so something that I've been thinking
(11:44):
is that maybe calling it executive function disorder might be
a more accurate term for it. Yeah, you're not alone
that's for sure. Um, there's a big contingent I think
of our field in the medical field that we get
on board with that. I think we are. We're just
learning more and more about a d h D as
time goes on and we get more sophisticated UM means
(12:07):
of looking at what the brain is up to, you know,
physiological indicators and things like that. I would not be
surprised if we see that shift down the road a
little ways and and change the language a bit. But yeah,
executive functioning is a is a huge part of a
d h D. UM. Now, the trouble with that is
that executive functioning is also a big part of UM
(12:27):
just day to day life, and it overlaps with UH
several other mental health diagnoses or medical diagnoses, Like your
executive functioning could be impaired if you were anxious or depressed,
or of course you know, had dementia or you know autism,
Like it comes up in a lot of different contexts. UM,
so we'd have to do a really good job of
(12:49):
of kind of defining it. But yeah, there's there's a
big push for the role of executive functioning and a
d h D and learning more about them. That's when
I first started noticing these symptoms of a d h D.
I was getting some panic attacks in the year, and
it was, you know, a baffling to me because I
had gone to the emergency department and they would tell me, Leslie,
(13:12):
you're having panic attacks. There's nothing physically wrong with you.
You need to learn how to relax. I noticed all
of this kept coming up, and I went to my
doctor after figuring out it could be a d h D,
and he was kind of dismissive, you know, telling me, oh,
you know what, come back another time. I got the
inkling that, you know, one he wasn't so interested or concerned,
(13:32):
and two that he wasn't so well versed in a
d h D as well, So to give him that
benefit of the doubt, I guess, you know, maybe he
didn't know as much about it either. I think not
all general practitioners know too much about a d h D. Like,
what would you say to somebody or what would you
suggest someone say to somebody. Let's say they have a
d h D, they have been diagnosed or they strongly
(13:53):
believe they have it, and the person says doesn't think
a d h D is like a serious thing, and
they're just like, oh, it's like, you know, it's nothing
but sickly. Oh gosh, that's a that's a great question,
my goodness. Um, it depends. So I would probably go
the route of, uh, you know, just showing some good
hard science to say, of course, this is a thing,
(14:16):
we know a lot about it. Here's what it is,
here's what it means. Um. I would also, and this
is that you can totally a psychologist, I would probably
turn it back on them and say, what makes you
think that? Or you know, what have you read? Like?
I would try to learn more about their experience that
they would, um feel compelled to deny my experience. Does
(14:36):
that make sense? Yeah? Absolutely, yeah, and then get a
better understanding of why they think what they think, so
you can address that directly right right, because you know,
I'm sure they have some reason to think that maybe
they've read something or seen something, or maybe they're just
in denial or who knows what it might be. But
that at least opens up the conversation and then I
can share anything that might be relevant with them. All right,
(14:58):
let's take a quick mental health break, be right back.
Welcome back to Prodigy for more info. Visit the episode
page at Prodigy podcast dot com. I was curious, like
what some of the symptoms are that maybe if someone's
experiencing it might be an indicator of a d h D. Yeah, yeah, definitely.
Would you like to talk more adult or so if
(15:20):
we could maybe just address adolescens and up. Okay, so
generally speaking, you know I mentioned earlier there we look
at symptoms in kind of two camps. There's the inattentive
set of symptoms and there's the hyperactive impulsive set of symptoms. Um.
Just speaking to the inattentive side, I mean, this is
things like just not paying close attention to detail. It's
(15:43):
trouble actually focusing and sustaining attention. Um, it's not listening
when people are talking to you. It's being disorganized, it's
losing things frequently, it's being for careful. So those are
a bunch of inattentive symptoms. UM, I think those are
relevant and adolescents and adulthood. Now, as far as hyperactivity
(16:05):
and impulsivity, I think this is where things get a
little more uh nuanced, where we think that hyperactive impulsive
symptoms are more present when kids are younger. So you
know that's like I said earlier, the fidgeting, they're like
getting out of your seat, the running and the climbing
and the jumping, just being you know, talking, blurting out
(16:26):
that sort of stuff. But what we think is that
as kids get older and then you know, shift into adults,
of course, the hyperactive behaviors and the impulsivity change a
bit and kind of moreph more into what looks like
in attention UM. So you know, inattentive symptoms tend to
um tend to get more significant as as kids get
(16:48):
older and grow into adults. But then there's this whole
other set of kind of soft signs of adult d
h D or you know older adolescent a d HD
that you know that aren't in the diagnostic manual but
are still things to pay attention to. So just the
experience of say, working really hard but not getting much
(17:12):
done or um it takes you know, double the amount
of time to be as productive as you peers um
blanking out or you know, forgetting important information. UM. Bad
driving so you know a lot of speeding tickets, a
lot of rolling stop signs, stuff like that, being late frequently,
(17:33):
not being able to finish projects, UM, impulsive spending Um,
what else high caffeine intakes sometimes, you know, So those
are those are some of the soft signs that adults
might notice that aren't necessarily going to be in the
diagnostic manual, but uh, but certainly could be an indicator
of a d h D. Yeah, it really feels like
(17:55):
it affects pretty much every part of my life. And
then I'll so I had a listener right in to
ask what the link is like, is there a link
to substance abuse? Um, yes there is. Uh. Now I'm
just gonna speak to what I know about the literature
with kids and adolescens. Um, but the so there is
(18:19):
a link, I'll just say that, UM, what we know
those that, uh, if kids and adolescents are properly medicated
for a d h D, it it tends to lessen
the likelihood they're going to have substance abuse problems. Um.
So there is kind of a mediating factor there with it,
you know, with medication, Um, but unmedicated a d h
(18:40):
D especially yeahs as Um, you know, as kids turn
into adults, that can be that can be a problem.
They have a higher likelihood of substance abuse, UM, reckless behavior, um,
driving fast, you know, all those kind of sensation seeking activities. Yeah,
I had all that stuff, and if I had, if
(19:02):
I had been medicated at least when I was at
that age, like adalysta, it would have helped a lot. Sure, Sure,
and a lot of you know, there's this whole um
belief system around self medicating. And you know, I see
a lot of teenagers with a d h D who
self medicate with marijuana for example. Um, maybe that persists
(19:25):
into adulthood, or maybe they shift to UH for substances,
but there is some belief that that you know, some
of those substances are like I said, self medicating and
kind of helping them self regulate or you know, calm
their brain a bit. Yeah. I was using that marijuana
all day, every day pretty much. And actually when I
got on medication, my intake is just reduced to you know,
(19:47):
just occasionally recreationally. Oh that's interesting. Yeah. Um. And then
so co morbidity. Uh, this is a really common thing
that you see in a d h D. Right, Like,
oftentimes you have a d h DEAL alongside something else,
and I know it's kind of hard to differentiate between
different things, so it's difficult to diagnose. So I was
just curiously, what is the rate of comorbidity? M hmm,
(20:11):
you're gonna make me quote statistics. Well, you don't have
to be dangerous. Okay, let's say there's a lot. Um.
So the main the main comorbidities that I think of
are and again I see a lot of kids and adolescents,
but uh, learning disorders. There's there's a lot of overlap
between a d h D and learning disorders, uh, like
(20:32):
dyslexia or UM, you know, math disorder, dis calculia. UM.
There's a fair amount of overlap with d h D
and autism in the sense that individuals with autism also
often meet criteria for a d h D. It doesn't
necessarily go the other way though, Uh not not not
everyone with a d h D will you know, have
(20:54):
autism obviously, UM, anxiety, depression, those are big ones as well,
and like you mentioned, substance use can can play a
role in there also, So there is significant overlap with
a number of other mental health concerns that we have
to be aware of. I always felt like I had
(21:16):
a little bit of like some symptoms of autism, like
when especially in regards to a sensory overload, do you
see the sensory overload with the d h D people
at all. Yeah, absolutely, absolutely, Um, that's a whole can
of worms. Sensory processing as a just as an area,
(21:37):
is a lot to tackle. But I can say, yeah,
briefly at least that, um, sensory issues. We see that
in a lot of different uh, a lot of different disorders, Autism, anxiety,
a d h D certainly. Um. So the short answer
is is yes, So that's not surprising to me that
(21:57):
that you may have experienced that. The other piece to
that that we see a lot that we really have
to do a good job of assessing and separating, is
the social impact of a d h D versus versus
autism um. Because kids with a d h D who
grow into adults, uh, And you may or may not
have experienced this, but you know there can some social
(22:18):
impact with that, you know, impulsivity and sort of interrupting
and maybe having trouble um keeping personal boundaries with peers
or or other people, you know, like getting too close
or just too intense. You know. So there can be
social difficulties with a d h D two Um, but
they're not the same flavor and quality as as with autism.
You know where those those kids are adults just like
(22:42):
don't don't get social interaction. They don't have the instruction
manual for social interactions. So it's there's a difference, but
they can look the same. And that's why you know,
it's important to get a good assessment to kind of
separate those Yeah, I always felt like the differentiation was
um sort of like a blindness to social signals. And
you know I don't have that so um, right, but
(23:03):
I wanted to ask, uh, like, when exactly do you
think that someone should seek an evaluation for a d
h D. Yeah, yeah, I love that question. So you know,
adults can look through the symptom checklist, right or the
list of symptoms and if it rings true, talk to
(23:24):
your doc. You know, if a lot of those ring true. Um,
now other signs or if someone if other people mention
it to you, that's, uh, that's a great sign that
you might want to get it checked out. Um. And
the biggest thing for me is if you are noticing
true imparent in your life. Right, So, if if these
(23:46):
problems are really causing trouble in your life, are you
missing deadlines? Are you um overdrawn on your bank account?
Have you missed your bills. Um, are your relationships being
impacted by these behaviors? Um? You know, those are all
all good signs that you might want to seek an assessment. Yeah.
One thing that helped me, I think was like reading
(24:08):
through there's on on other people with a d h
d S experiences. It just felt a little bit easier
to relate to as opposed to just like reading the
d s M. But yeah, not a lot of people
outside of our you know, our field like to read
the d s M. Yeah, good point. But yeah, that's great.
I mean the that feeling of um, I'm not alone,
(24:30):
or like you're telling my story, that kind of experience
can be really really powerful. So yeah, read It's a
great place for that. When you do decide, okay, you
know I want to get an evaluation. What is the
best way to go about finding somewhere to get tested? Like,
do you need to referral or it to bend Um,
I'm really glad that you asked about this. I think
(24:50):
that the the easiest way to start is probably go
to your primary care doc and just say, hey, I've
got this going on. I think I want to get
tested for a d h D. And then that person
that can provide a referral if you need it. Um.
Not all insurance plans require one by any means, but
(25:11):
if you need it, you can get it there. Uh.
Your PCP can also rule out any medical concerns that
might be getting in the way and masquerading as a
d h D UM, so you can get that taken
care of. And your PCP can also hopefully hook you
up with a good psychologist, neuropsychologist, um, you know, psychiatrist
(25:32):
perhaps or even a behavioral neurologist that specialize in a
d h D and they can facilitate that connection so
you can you can get a really good assessment. And
if all that fails, you can also just search on
Google and make sure that you find somebody who specializes
in a d h D testing. What would you google
like a d h D testing near me? Yeah, that's
(25:54):
exactly what I would do. A d h D specialist
near me, a d h D testing, Yeah, anything like them. Yeah. So,
because my next question was what do you do if
you bring it up to your primary care doctor psychiatrist
and they are dismissive of it, like, oh, that's not
a real thing, or you've been fine in your life
and they may not realize like, hey, it's taken me
like three times longer to do this stuff, but search
(26:17):
it out yourself. Yeah, yeah, that's what I would say.
And especially, yeah, especially if they are the kind of
loan dissenting opinion like of other people in your life
have mentioned it. Uh, if you feel like you've read
experiences that really fit, Yeah, if they are dismissive, and
I would take matters into your own hands and just
try to try to make an appointment on your own.
(26:38):
So I literally just searched up a d h D
assessments near me, and I spent maybe a week calling
um different a d h D assessments within the Toronto
area even Ontario, and I continue to go further beyond
that because everything is virtual now. Maybe it's a bit
of the A d h D intense focus when you're
interested in something. But I kind of went NonStop for
(27:00):
a couple of days until I've found a good, um,
you know, convenient pricing and scheduling that worked best for me.
What is getting tested, like, like what types of tests
are used? Anything related to that. Yeah. Yeah, So the
evaluation process should be relatively comprehensive and the reason it's
(27:22):
relatively comprehensive is because of those comorbidities that we talked
about just a bit ago. This is the way I
explain it to people. I say, we're not just ruling
in a d h D. We are that's actually kind
of easy. Um, what we're doing is ruling out a
bunch of other stuff. So we are looking at all
aspects of your functioning to figure out if this is
(27:44):
really a d h D or if it's any number
of other things that might be going on. So what
does that look like? UM? It should look like a
lengthy clinical interview with you, UM, where you know that
person the clinician should you know, ask a lot of
questions about childhood, m about your history, about you know,
(28:05):
your life, your medical history, any traumatic experiences, any mood issues.
I mean, it really should be pretty thorough. So I
always recommend that people bring any records that you can
get your hands on to this interview. That can mean
like report cards, um um, any kind of qualitative you know,
description or reports of your behavior, like from your parents
(28:27):
or anything like that. UM. So, any records, any prior testing,
any medication. So that's the first step. He did an
initial history intake. So he asked me, you know, starting
literally from my childhood experiences and you know up until
now and everything from how was it learning, how was
it dealing with people? How did you feel? So it
(28:50):
was very comprehensive for several hours, and then we did
several questionnaires, so one was on you know, social anxiety.
He didn't specify what they were, so then I didn't
focus on those. I just focus on the questions some
I think we're social anxiety, skin picking, hyperactivity, and focus.
I don't know the exact titles, unfortunately, of those questionnaires,
(29:11):
but those are the main ideas that clinician should also
conduct interviews with significant others in your life, or what
we call collateral interviews, because we don't just trust you,
uh and being an expert on your own experience for
better or for worse. We have to get the opinion
of others who have interacted with you. So you know,
(29:33):
if you're a younger adult, this might be parents, um, siblings,
significant other like romantic partner, roommates like your clinicians should
do some of those collateral interviews to to see, you know,
how other people perceive you. I'm sorry, because the psychological
testing is not enough on its own, right, right. Yeah,
(29:54):
Standard of care suggests that we do all of these things.
We do the interview, we do the testing, end, we
do these collateral interviews with others. Yeah. So they sent
him a separate questionnaire asking questions about, you know, more
about focus, skin picking, and hyperactivity, mainly along those lines,
and then how I dealt with certain situations. So that's
(30:16):
that's interesting. And I know that because that's like I
guess the like reporting from somebody close to you. That's
why you know, they want to have the parents and stuff,
which is you know, a big deal. But I guess
that wasn't really an option with me. Um, Like god,
I would I guess I could have called my parents,
but I feel like they would have probably like, oh yeah,
you could focus. They focused all the time. Like really, okay,
(30:38):
that's different. Well I try to explain. I'm like, yeah,
only on certain things. Um. But yeah, So actually I
have a list here of the kinds of ones. So
we did a clinical procedure or clinical interview. Psycho social
history connors, adult A d h D rating skills, long version, Brown,
executive function attention scales, Patient Health Questionnaire nine, Social phobia inventory,
(31:04):
skin picking scale revised. So those were all the ones
that we had done formerly. Okay, and I am not
familiar with the skin picking thing. Could you explain that
one was? That one was a little weird for me actually. Um,
So apparently people with a d h D tend to
pick their skin pretty often, either maybe scalp or something
(31:24):
like fidgety. So I think he was looking for any
severities to the point where like maybe I had scars,
or I had the urges and the compulsion to skin
pick or touch my face or my body, um, which
I sometimes do oddly enough. Um, but apparently, yeah, it
is part of a d h D as well. Yeah,
(31:45):
I do it with my cuticles. Like I'm suizing. I
didn't realize that was the thing. You know, typically will
give you some measure of intelligence that always freaks people out. So, um,
I like to substitute that instead of saying in tells,
we just call it like cognitive ability. Okay, so we
look at what your brain is up to in a
bunch of different domains. Um, we might uh test some
(32:09):
of your academic skills, depending on if that's a relevant
issue you. We'll probably do some testing around executive functioning. Uh, attention, memory,
all sorts of cognitive domains to see what your brain
is up to. We'll also do some personality assessment most likely.
Uh that sounds like you've had some of that experience
from from what you told me, right, Uh, So we'll
(32:32):
typically do a personality measure UM, and we'll also do uh,
we'll administer some your rating scales, which are standardized uh
well normed questionnaires that would compare your behaviors to other
individuals your age and gender and so forth. And we'll
give those rating scales both to you and to any
(32:53):
of those um collateral folks who might be involved in
your life, so we can get real, you know, solid
data from them about what they're seeing as well. And
then we pull all that together and try to synthesize
all that info and uh yeah, figure out if it's
a d h D or something else or both or
anything else we might need to talk about. All right,
(33:14):
let's take a quick mental health break, be right back.
Welcome back to Prodigy. For more info, visit the episode
page at Prodigy podcast dot com, or to ask if,
like how accurate the tests are, like, is it possible
or what is the likelihood for a person with or
without a d h D to get an incorrect diagnosis,
possibly maybe because of the testing environment. Mm hmm. That's
(33:36):
a really complicated question to be honest. Um, it's a
great one, but it's all complicated. Um. The short answer
is that depending on the battery, so the tests that
we give you in the process you go through, UM,
it is possible certainly to come up as a you know,
a false positive let's say, where it looks like you
(33:57):
have a d h D but it's actually something else.
The troubles that we don't have a clear, uh, well
defined profile let's say this as hey, this is a
d h D, So we can't look at like a
specific pattern of scores on the cognitive testing that that
very clearly says this is a d h D. That's
(34:18):
why we have to um integrate all of this information
that we get from the interviews with you and other
people and the rating scales and really pull all of
that together and see see how the whole picture looks. UM.
So it is possible, certainly. What I thought it was
is that the difference between my intelligence and my working memory,
(34:39):
like there was a huge gap there, UM, And I
thought that that was like a really what you guys
possibly looked for. Yeah, yeah, that's definitely I don't want
to throw that out by any means. Um that is
often present. So there's that, you know, again, gap between
kind of overall intelligence and working memory or processing speed.
We found, you know, uh, located with the tension um.
(35:02):
So we will look gaps like that or relative weaknesses
in your profile. And it's not definitive by any means, Like,
just because someone has low working memory doesn't necessarily mean
they have a d h D. There are other things
that might contribute to low working memory. But it's a
I mean, it's a sign. Is the reverse also true,
(35:22):
like you could have a good working memory and um
have a d h D. Yes, yes, okay, interesting, Yeah,
it is fascinating. It makes our jobs a little tougher.
So I took about maybe another two to three weeks
for him to compile a report for me. It was
a written report, formalized and he had emailed it to me,
(35:45):
and at the same time we had another about hour
and a half um formal video interview where he just
told me about the results that he had concluded based
on his findings. And you know, he told me everything
from the questionnaire, anything that he had he had observed,
and even anything kind of off off the record like, oh,
I noticed you have a bit of these tendencies. It's
good to work on these. He was just a really
(36:07):
nice I think psychologists to do that. But yeah, that's
that's how it would happen. Once you get a diagnosis,
what should you then do? You should walk away with
some pretty pretty solid recommendations from that clinician as to
what to do next. Most likely it would involve a
consult for medication. Um, we still think medication is pretty
(36:28):
effective at you know, helping with a d h D symptoms,
So they would likely recommend medication. Uh, And they would
likely recommend some coaching or some cognitive behavioral therapy to
teach some of those skills that I mentioned earlier. He
said that I would probably benefit from therapy specifically CBT,
and I would, you know, just on his advice that
(36:51):
medication would largely help me with my focus issues. That
clinician might give you referral for, you know, for trusted
colleagues in the area for you to to go to,
but if not, you can of course search them out
on your own. Another part that I like to recommend
to folks is just uh psycho education or like self
(37:15):
learning about a d h D. So you know that's
where you get on the websites. You know, there's attitude, Um,
there's I mean even Reddit could be fine. Uh, you
know they're there are some reputable sites out there and
books of course that will help you learn as much
as possible about a d h D and what it
looks like for you. And that psycho education piece, that
(37:37):
learning component can be really really powerful in helping people
move forward. Yeah, it seems like it's important to understand,
you know and understand it, especially related to yourself. UM,
I'll put those resources on the website. UM. I've just
had one more question that I don't want to forget
to ask, but like, do you do you see a
difference between genders or between you know, like between male
(38:00):
how it manifests it between genders? Yeah? Yeah, Um, I mean,
first of all, we know that men or males are
diagnosed more frequently than women. UM. I think historically here's
the thing, I don't know that that it necessarily presents
(38:22):
differently in girls than boys. Um. There may be you know,
some some evidence that girls trend more toward uh inattentive
symptoms from the beginning, with less of that hyperactivity and
impulsivity certainly, um, but I don't know that it's so
much that the presentation is vastly different. It's that people
(38:44):
aren't looking out for a d h D and girls
as much as they are and boys. Does that make
sense where Yeah, so people just aren't, you know, It's
like we see what we're looking for, and and I
think that boys we are looking for. Boys with h D,
like poorly behaved boys in school are a lot more noticeable,
(39:06):
and it's easier to attribute that to something like a
d h D. Whereas you know, girls who are kind
of you know, hyper energetic or talkative, um, you know,
they might be more likely to get labeled as precocious
or um, you know, a lot of personality or assertive
or something like that. Um. And it's it's less likely
(39:27):
to be seen as a behavior problem. So so yeah,
I think it's a little of both. Um. I think
girls do tend to fly under the radar a bit
because they show up as a little more inattentive. But
for the ones who are more hyperactive, I don't know
that they get recognized as much as boys. Do because
teachers and parents just aren't really looking for it. Yeah.
(39:49):
When I just think of a stereotypical child with a
d h D, in my mind, it's always just a boy.
It's always a boy. Right. Um, is there anything that
I missed that you think we should cover. I think
the main thing is that I hope people might take
away is just that, uh, you know, if you think
it's going on, Um, they're definitely options out there to
(40:12):
to look into it, and it is a very um treatable,
uh concern. You know. That's the good news. I always say,
you know to parents, like, the good news is that
we know a lot about this and there's uh, there's
there are many options to to help you, so uh
don't lose hope. You know, it's never too late. We
work with adults, you know, forties, fifties, sixties who are
(40:36):
just getting diagnosed for the first time, so it's never
too late and there's plenty of options to help you. Yeah.
I'm gonna send my dad over to you. Uh. But Yeah,
one troubling thing is it feels like because of a
d h D, it's hard to actually take the first step.
At least it was for me, right, right, well, I'm
(40:57):
curious if I could turn the tables and ask you what,
from your standpoint, would have made it easier to access
an evaluation or services or whatever would have been the
first step for you. Yeah, if I could have just
reached out to a testing facility first thing and just
call it and made an appointment, But it feels like
like I would have to find a psychiatrist, and then
finding get an appointment with the psychiatrist can be difficult.
(41:20):
It's so hard. Yeah, they'll be like, oh, if we
have an appointment, sure three months out, and I'm like, okay,
like three months out, it's like basically a lifetime in
my mind, you know, oh sure sure. Well yeah, maybe
that's important to highlight again just to say that you
don't you know, a lot of insurance plans do not
require a referral. So if you can reach out on
your own, um and make an appointment with you know,
(41:40):
an assessment clinician, UM, that's a great that's a great step.
You may not have to go through a physician first.
So after Leslie was diagnosed, she went back to her
same primary care physician and he said, okay, well draw
off the report and we'll submit it to a psychiatrist
and they'll go back to you in the next six
months x months. So her partner recommended his family physician,
(42:05):
who got her an appointment in a few weeks. The
process still take a few more months because she got
bounced around to a few different psychiatrists, but she eventually
did get the treatment that worked for her. Again. Leslie
is in Canada and your experience may be different based
on your location. Dr Jeremy Sharp is a consultant who
helps grow mental health clinics. He's also an excellent speaker
(42:26):
on all subjects related to mental health. He's really been
a wonderful guest and I highly recommend him for your organization.
You can find more info at the Testing Psychologist dot com.
Leslie is working on a book about people's experience during
the pandemic, and it's interviewed people all over the world,
including me. You can find her on Instagram at Leslie
(42:48):
dot q. That's spelled l E s l Y dot
c u E. As usual, all links will be on
the episode page at Prodigy podcast dot com. Prodigy was
creating and produced by me Lord Berlante. The executive producer
is Tyler Klang. Thank you so much for listening. If
you want to help out, you can follow the show
(43:09):
on Apple podcast or Spotify or whatever, or share an
episode with a friend. I also really appreciate it when
listeners send me messages and I respond to everyone. Prodigy
is a production of I Heart Radio. For more podcasts
in My heart Radio, visit the iHeart Radio app or
wherever you get your podcasts.
Prodigy is a production of I Heart Radio. This episode
might be a bit chaotic, but given the subject, I
think it might be appropriate. Last season of Prodigy, I
did an episode on a d h D where I
told my story and the response really surprised me. It
resonated with people. I even had listeners get diagnosed after
(00:22):
and we'll hear from one of them later. So my
friend has been treated for depression for the last fifteen years.
She got diagnosed with bipolar just six months ago because
one doctor finally decided to test her and realized what
it actually was. Disorders have symptoms that crossover, yet doctors
are sometimes just throwing out guesses based on short conversations.
(00:44):
This is why testing is so critical. While this episode
is about a d h D specifically, I think the
underlying message really applies to most disorders. There's a ton
of people out there who are undiagnosed or misdiagnosed. The
U S health care system especially is terrible. It's expensive,
difficult to navigate, and non uniform. I got a physical
(01:07):
at my primary care doctor six months ago, and a
few weeks later a bill showed up from the testing
company for seventeen dollars I filed a complaint with the
Better Business Bureau and the company knocked it down to
fifty bucks. Wait, like, what are their margins? How can
they reduce the cost by that much from a complaint
and still be profitable. It's a scam even with criminal costs.
(01:31):
A d h D is not easy to get diagnosed
and treated for the main reason is that the primary
and most effective treatment is a controlled substance adderall, it's
an amphetamine, which is a central nervous system stimulant that
treats the chemicals and nerves that contribute to hyperactivity and impulsivity.
(01:51):
Since a d h D has hyperactivity in the name,
it's commonly associated with excessive energy or fidgeting. That doesn't
sound so bad, but in reality, it's impulsivity. That's the
inability to control your thoughts and actions. That's pretty damn
important for functioning in society. Your doctor might be skeptical
(02:13):
or even consider you a drug seeker. This is especially
challenging when a common symptom of the disorder is substance abuse.
It's actually self medicating and creates the dilemma. Your brain
is overloaded with thoughts and you want to calm them.
If people want to cheat the system to get stimulants.
Let them. They're probably suffering and need treatment too. But
(02:36):
even so, that's no excuse for skepticism. We need to
encourage people to assess and address their mental health, not
criminalize it. Disorders like a d h D are the
silent killer. You don't need a straight jacket, but you
can't achieve your potential. You exist in limbo between what
you could be and what you are. There's a pervasive
(02:58):
belief that a d h D is over diagnosed, especially
in children and adolescence, but in adults as well. The
main argument for this is the fact that more people
are diagnosed now than they were in the past. However,
there isn't sufficient research to show exactly why it's more
common now, but it seems pretty obvious to me. We
(03:19):
understand it better and can recognize it easier. In my
parents generation, a d D simply wasn't a thing. Those
parents raised children who they also believe don't have a
d h D. I got tested when I was fourteen
and the results said I probably had a d h D.
My parents didn't understand it, and I don't blame them
for it, but my adolescence was a mess. I barely
(03:43):
made it out alive. It altered the trajectory of my life.
A thirty five, I got diagnosed and medicated, and it
vastly improved my life. Yet I am constantly presented with
the notion that the medication is bad and my disorder
isn't valid. Even today, I've gone nine days without it
because the pharmacy was out, then my doctor was out,
(04:06):
then the next pharmacy was out. I can't even call
the pharmacy to see if they have it in stock
before telling my doctor where to call it in. It's
not allowed for some reason. People without a d h
D who have taken a stimulant like add or all
feel basically jacked, like they've done a bunch of cocaine.
They go and alphabetize their book collection. But when you
(04:27):
take it consistently, you don't get that feeling. It just
helps you operate closer to what society expects for people
who need it. It's like a life jacket when you're drowning.
And if you have a d h D, it's incredibly
likely that one of your parents does too. And every
person with a d h D that I've ever talked
to about that says, oh my god, my dad immediately
(04:49):
like no, like instant reaction. There's no hesitation and there
isn't for me either. Women have an even harder time.
Minorities are far less diagnosed. Is it because other ethnicities
have less disorders? No, they just have a greater barrier
to healthcare. This episode is about a d h D
and what to do if you think you might have it.
(05:11):
If it helps one person, then it's worth it. My
name is mull Berlante, and this is prodigy. Dr Jeremy
(05:32):
Sharp is a license psychologist who has managed assessment clinics
for over a decade now. He's a speaker and consultant
for a variety of organizations regarding mental health. He's incredibly
qualified to answer these questions about a d h D
and the testing process. And since I went off so
much in the beginning, I should probably add the disclaimer
that just because he's on this episode doesn't necessarily mean
(05:53):
he agrees with all my opinions. Diagnosis of a d
h D still comes down to what behaviors someone can
observe in another individual. Right, we don't have any brain
scans or blood us or anything like that to to
diagnose a d h D, So keep that in mind
as we talk through this. But generally speaking, the diagnostic
criteria say that, you know, a d h D is
(06:15):
a persistent pattern of inattention and hyperactivity or impulsivity that
interferes with functioning or development. So that's great, that's a
nice general definition. More at the neurological level, I mean,
we think that the brain structure is involved in a
d h D. Are you know there's a lot happening
in the frontal lobes, which is that kind of command
(06:36):
center of the brain that plays a large role in
self regulation and impulse control and things like that. Uh,
there's some implication of the basil ganglia and the cerebellum.
But generally speaking, yeah, it's this combination of inattention and
hyperactivity or impulsivity that causes a significant impairment in people's lives.
After the a d h D and Me episode I
(06:58):
did a while back, one of the listeners that reached
out to me told me it made them realize that
they might have a d h D as well. Her
name is Leslie Kimbo. I should also mention that Leslie
lives in Canada and unfortunately your experience may vary based
on location. So when I first heard your episode, I
had felt a lot of relief things that you had
mentioned I had connected with. People. Tend to think of
(07:20):
it just as hyperactivity. I can't focus. But impulsivity, How
does that relate to hyperactivity? Yeah? I mean I see
both of those kind of on the continuum of holding
back or regulating your behavior, right so that that filter,
uh that exists in our brains that says, hey, maybe
don't do that right now. But you're right. I mean,
(07:42):
hyperactivity I think gets a lot of attention, especially with
you with kids when they're younger, because that's what people
can can see. It's the the fidgeting or the getting up,
or the you know, constantly moving around or the jumping
on the couch. You know, it's all that kind of stuff.
So it's it's very in your face. Impulsivity comes into play,
especially as a d h D kids sort of grow
(08:06):
into a d h D adults. So that's a big
component here too, you know. And that's like interrupting other people,
or getting that tattoo without really thinking it through, or
buying that car that looks amazing but maybe doesn't match
your bank account. You know, it's those behaviors get a
lot more prevalent, I think as kids get older, interrupting people.
(08:27):
I feel like it's a pretty big one. Definitely. I'm
always concerned I'm gonna forget it if I don't get
it out fast enough, or finishing someone else's sentences, stuff
like that, right, right, Yeah, that's a common thing that
The reason that people give is, um, you know, there's
just so much going on in my brain. I have
to blurt it out or I have interrupt or it's
gonna go away. So I feel like the misconceptions about
(08:51):
it are huge, maybe possibly because it's you know, it's
called hyperactivity disorder. UM. I think even my parents don't
even fully believes that I have it. UM. And I
feel like this is probably super common with people. What
like misconceptions do you often see about a d h D.
That's a great question. Um. One is like a lot
(09:12):
of people say that just because they're forgetful, like you
know you, I'm sure you've heard those those people like
I'm so forgetful, I just had an a d D moment,
you know, or something like that. So this gets to
your point that it's not just one specific like small
dimension of functioning, Like just being forgetful doesn't doesn't mean
you have a d h D. UM Like, people are
(09:33):
naturally forgetful, you know, that's normal. One of the biggest
misconceptions that I also see is this idea that it's
very wide spread. I think people overestimate the prevalence, you
know too. For someone to really have a d h D, theoretically,
you know, they should be more impaired than about of
(09:55):
the population. The other misconception is that a d h
D does not persist into adulthood. And we have some
pretty good information now that it it really does, so
adult a d h D is a is a thing
that we need to be concerned about and really looking into. Yeah,
and I think people tend to dismiss it as not
that serious. But I mean if you really think about
(10:16):
it in attention, if I'm being able to get things
into my working memory, then I'm unable to sort of
like learn new things, which is kind of important. Oh
it's super important. Yeah, not to mention. I mean, yeah,
you give the example of learning new things that's really
important as we can get older. Um, but I think
about too, just holding onto the things that we need
(10:37):
to hold on too, so when to pay your bills, UM,
do dates, UM work meetings, things like that, just all
the things that we keep track of. There's a big
impact in adulthood. If you get a diagnosis, then you
know and you can work with possibly what a therapist
to develop strategies for dealing with some of those inadequacies
(10:59):
are like deficient in sees. Yeah, definitely, we have UM
really two main directions for treatment if you want to
go either route. So you know, there's medication, of course,
I think most people you know, for better, for worse,
or familiar with riddling at all, you know, and all
the variations thereof to treat it from a medication standpoint.
(11:20):
But therapy wise, yeah, we have some nice research supported
interventions UM that you could do in therapy or coaching.
You know sometimes people do a d h D coaching
instead of therapy. You know, that person would work with
you on skills like time management, organization, planning, problem solving,
UM skills that we have to use in day to
day life. Great, and so something that I've been thinking
(11:44):
is that maybe calling it executive function disorder might be
a more accurate term for it. Yeah, you're not alone
that's for sure. Um, there's a big contingent I think
of our field in the medical field that we get
on board with that. I think we are. We're just
learning more and more about a d h D as
time goes on and we get more sophisticated UM means
(12:07):
of looking at what the brain is up to, you know,
physiological indicators and things like that. I would not be
surprised if we see that shift down the road a
little ways and and change the language a bit. But yeah,
executive functioning is a is a huge part of a
d h D. UM. Now, the trouble with that is
that executive functioning is also a big part of UM
(12:27):
just day to day life, and it overlaps with UH
several other mental health diagnoses or medical diagnoses, Like your
executive functioning could be impaired if you were anxious or depressed,
or of course you know, had dementia or you know autism,
Like it comes up in a lot of different contexts. UM,
so we'd have to do a really good job of
(12:49):
of kind of defining it. But yeah, there's there's a
big push for the role of executive functioning and a
d h D and learning more about them. That's when
I first started noticing these symptoms of a d h D.
I was getting some panic attacks in the year, and
it was, you know, a baffling to me because I
had gone to the emergency department and they would tell me, Leslie,
(13:12):
you're having panic attacks. There's nothing physically wrong with you.
You need to learn how to relax. I noticed all
of this kept coming up, and I went to my
doctor after figuring out it could be a d h D,
and he was kind of dismissive, you know, telling me, oh,
you know what, come back another time. I got the
inkling that, you know, one he wasn't so interested or concerned,
(13:32):
and two that he wasn't so well versed in a
d h D as well, So to give him that
benefit of the doubt, I guess, you know, maybe he
didn't know as much about it either. I think not
all general practitioners know too much about a d h D. Like,
what would you say to somebody or what would you
suggest someone say to somebody. Let's say they have a
d h D, they have been diagnosed or they strongly
(13:53):
believe they have it, and the person says doesn't think
a d h D is like a serious thing, and
they're just like, oh, it's like, you know, it's nothing
but sickly. Oh gosh, that's a that's a great question,
my goodness. Um, it depends. So I would probably go
the route of, uh, you know, just showing some good
hard science to say, of course, this is a thing,
(14:16):
we know a lot about it. Here's what it is,
here's what it means. Um. I would also, and this
is that you can totally a psychologist, I would probably
turn it back on them and say, what makes you
think that? Or you know, what have you read? Like?
I would try to learn more about their experience that
they would, um feel compelled to deny my experience. Does
(14:36):
that make sense? Yeah? Absolutely, yeah, and then get a
better understanding of why they think what they think, so
you can address that directly right right, because you know,
I'm sure they have some reason to think that maybe
they've read something or seen something, or maybe they're just
in denial or who knows what it might be. But
that at least opens up the conversation and then I
can share anything that might be relevant with them. All right,
(14:58):
let's take a quick mental health break, be right back.
Welcome back to Prodigy for more info. Visit the episode
page at Prodigy podcast dot com. I was curious, like
what some of the symptoms are that maybe if someone's
experiencing it might be an indicator of a d h D. Yeah, yeah, definitely.
Would you like to talk more adult or so if
(15:20):
we could maybe just address adolescens and up. Okay, so
generally speaking, you know I mentioned earlier there we look
at symptoms in kind of two camps. There's the inattentive
set of symptoms and there's the hyperactive impulsive set of symptoms. Um.
Just speaking to the inattentive side, I mean, this is
things like just not paying close attention to detail. It's
(15:43):
trouble actually focusing and sustaining attention. Um, it's not listening
when people are talking to you. It's being disorganized, it's
losing things frequently, it's being for careful. So those are
a bunch of inattentive symptoms. UM, I think those are
relevant and adolescents and adulthood. Now, as far as hyperactivity
(16:05):
and impulsivity, I think this is where things get a
little more uh nuanced, where we think that hyperactive impulsive
symptoms are more present when kids are younger. So you
know that's like I said earlier, the fidgeting, they're like
getting out of your seat, the running and the climbing
and the jumping, just being you know, talking, blurting out
(16:26):
that sort of stuff. But what we think is that
as kids get older and then you know, shift into adults,
of course, the hyperactive behaviors and the impulsivity change a
bit and kind of moreph more into what looks like
in attention UM. So you know, inattentive symptoms tend to
um tend to get more significant as as kids get
(16:48):
older and grow into adults. But then there's this whole
other set of kind of soft signs of adult d
h D or you know older adolescent a d HD
that you know that aren't in the diagnostic manual but
are still things to pay attention to. So just the
experience of say, working really hard but not getting much
(17:12):
done or um it takes you know, double the amount
of time to be as productive as you peers um
blanking out or you know, forgetting important information. UM. Bad
driving so you know a lot of speeding tickets, a
lot of rolling stop signs, stuff like that, being late frequently,
(17:33):
not being able to finish projects, UM, impulsive spending Um,
what else high caffeine intakes sometimes, you know, So those
are those are some of the soft signs that adults
might notice that aren't necessarily going to be in the
diagnostic manual, but uh, but certainly could be an indicator
of a d h D. Yeah, it really feels like
(17:55):
it affects pretty much every part of my life. And
then I'll so I had a listener right in to
ask what the link is like, is there a link
to substance abuse? Um, yes there is. Uh. Now I'm
just gonna speak to what I know about the literature
with kids and adolescens. Um, but the so there is
(18:19):
a link, I'll just say that, UM, what we know
those that, uh, if kids and adolescents are properly medicated
for a d h D, it it tends to lessen
the likelihood they're going to have substance abuse problems. Um.
So there is kind of a mediating factor there with it,
you know, with medication, Um, but unmedicated a d h
(18:40):
D especially yeahs as Um, you know, as kids turn
into adults, that can be that can be a problem.
They have a higher likelihood of substance abuse, UM, reckless behavior, um,
driving fast, you know, all those kind of sensation seeking activities. Yeah,
I had all that stuff, and if I had, if
(19:02):
I had been medicated at least when I was at
that age, like adalysta, it would have helped a lot. Sure, Sure,
and a lot of you know, there's this whole um
belief system around self medicating. And you know, I see
a lot of teenagers with a d h D who
self medicate with marijuana for example. Um, maybe that persists
(19:25):
into adulthood, or maybe they shift to UH for substances,
but there is some belief that that you know, some
of those substances are like I said, self medicating and
kind of helping them self regulate or you know, calm
their brain a bit. Yeah. I was using that marijuana
all day, every day pretty much. And actually when I
got on medication, my intake is just reduced to you know,
(19:47):
just occasionally recreationally. Oh that's interesting. Yeah. Um. And then
so co morbidity. Uh, this is a really common thing
that you see in a d h D. Right, Like,
oftentimes you have a d h DEAL alongside something else,
and I know it's kind of hard to differentiate between
different things, so it's difficult to diagnose. So I was
just curiously, what is the rate of comorbidity? M hmm,
(20:11):
you're gonna make me quote statistics. Well, you don't have
to be dangerous. Okay, let's say there's a lot. Um.
So the main the main comorbidities that I think of
are and again I see a lot of kids and adolescents,
but uh, learning disorders. There's there's a lot of overlap
between a d h D and learning disorders, uh, like
(20:32):
dyslexia or UM, you know, math disorder, dis calculia. UM.
There's a fair amount of overlap with d h D
and autism in the sense that individuals with autism also
often meet criteria for a d h D. It doesn't
necessarily go the other way though, Uh not not not
everyone with a d h D will you know, have
(20:54):
autism obviously, UM, anxiety, depression, those are big ones as well,
and like you mentioned, substance use can can play a
role in there also, So there is significant overlap with
a number of other mental health concerns that we have
to be aware of. I always felt like I had
(21:16):
a little bit of like some symptoms of autism, like
when especially in regards to a sensory overload, do you
see the sensory overload with the d h D people
at all. Yeah, absolutely, absolutely, Um, that's a whole can
of worms. Sensory processing as a just as an area,
(21:37):
is a lot to tackle. But I can say, yeah,
briefly at least that, um, sensory issues. We see that
in a lot of different uh, a lot of different disorders, Autism, anxiety,
a d h D certainly. Um. So the short answer
is is yes, So that's not surprising to me that
(21:57):
that you may have experienced that. The other piece to
that that we see a lot that we really have
to do a good job of assessing and separating, is
the social impact of a d h D versus versus
autism um. Because kids with a d h D who
grow into adults, uh, And you may or may not
have experienced this, but you know there can some social
(22:18):
impact with that, you know, impulsivity and sort of interrupting
and maybe having trouble um keeping personal boundaries with peers
or or other people, you know, like getting too close
or just too intense. You know. So there can be
social difficulties with a d h D two Um, but
they're not the same flavor and quality as as with autism.
You know where those those kids are adults just like
(22:42):
don't don't get social interaction. They don't have the instruction
manual for social interactions. So it's there's a difference, but
they can look the same. And that's why you know,
it's important to get a good assessment to kind of
separate those Yeah, I always felt like the differentiation was
um sort of like a blindness to social signals. And
you know I don't have that so um, right, but
(23:03):
I wanted to ask, uh, like, when exactly do you
think that someone should seek an evaluation for a d
h D. Yeah, yeah, I love that question. So you know,
adults can look through the symptom checklist, right or the
list of symptoms and if it rings true, talk to
(23:24):
your doc. You know, if a lot of those ring true. Um,
now other signs or if someone if other people mention
it to you, that's, uh, that's a great sign that
you might want to get it checked out. Um. And
the biggest thing for me is if you are noticing
true imparent in your life. Right, So, if if these
(23:46):
problems are really causing trouble in your life, are you
missing deadlines? Are you um overdrawn on your bank account?
Have you missed your bills. Um, are your relationships being
impacted by these behaviors? Um? You know, those are all
all good signs that you might want to seek an assessment. Yeah.
One thing that helped me, I think was like reading
(24:08):
through there's on on other people with a d h
d S experiences. It just felt a little bit easier
to relate to as opposed to just like reading the
d s M. But yeah, not a lot of people
outside of our you know, our field like to read
the d s M. Yeah, good point. But yeah, that's great.
I mean the that feeling of um, I'm not alone,
(24:30):
or like you're telling my story, that kind of experience
can be really really powerful. So yeah, read It's a
great place for that. When you do decide, okay, you
know I want to get an evaluation. What is the
best way to go about finding somewhere to get tested? Like,
do you need to referral or it to bend Um,
I'm really glad that you asked about this. I think
(24:50):
that the the easiest way to start is probably go
to your primary care doc and just say, hey, I've
got this going on. I think I want to get
tested for a d h D. And then that person
that can provide a referral if you need it. Um.
Not all insurance plans require one by any means, but
(25:11):
if you need it, you can get it there. Uh.
Your PCP can also rule out any medical concerns that
might be getting in the way and masquerading as a
d h D UM, so you can get that taken
care of. And your PCP can also hopefully hook you
up with a good psychologist, neuropsychologist, um, you know, psychiatrist
(25:32):
perhaps or even a behavioral neurologist that specialize in a
d h D and they can facilitate that connection so
you can you can get a really good assessment. And
if all that fails, you can also just search on
Google and make sure that you find somebody who specializes
in a d h D testing. What would you google
like a d h D testing near me? Yeah, that's
(25:54):
exactly what I would do. A d h D specialist
near me, a d h D testing, Yeah, anything like them. Yeah. So,
because my next question was what do you do if
you bring it up to your primary care doctor psychiatrist
and they are dismissive of it, like, oh, that's not
a real thing, or you've been fine in your life
and they may not realize like, hey, it's taken me
like three times longer to do this stuff, but search
(26:17):
it out yourself. Yeah, yeah, that's what I would say.
And especially, yeah, especially if they are the kind of
loan dissenting opinion like of other people in your life
have mentioned it. Uh, if you feel like you've read
experiences that really fit, Yeah, if they are dismissive, and
I would take matters into your own hands and just
try to try to make an appointment on your own.
(26:38):
So I literally just searched up a d h D
assessments near me, and I spent maybe a week calling
um different a d h D assessments within the Toronto
area even Ontario, and I continue to go further beyond
that because everything is virtual now. Maybe it's a bit
of the A d h D intense focus when you're
interested in something. But I kind of went NonStop for
(27:00):
a couple of days until I've found a good, um,
you know, convenient pricing and scheduling that worked best for me.
What is getting tested, like, like what types of tests
are used? Anything related to that. Yeah. Yeah, So the
evaluation process should be relatively comprehensive and the reason it's
(27:22):
relatively comprehensive is because of those comorbidities that we talked
about just a bit ago. This is the way I
explain it to people. I say, we're not just ruling
in a d h D. We are that's actually kind
of easy. Um, what we're doing is ruling out a
bunch of other stuff. So we are looking at all
aspects of your functioning to figure out if this is
(27:44):
really a d h D or if it's any number
of other things that might be going on. So what
does that look like? UM? It should look like a
lengthy clinical interview with you, UM, where you know that
person the clinician should you know, ask a lot of
questions about childhood, m about your history, about you know,
(28:05):
your life, your medical history, any traumatic experiences, any mood issues.
I mean, it really should be pretty thorough. So I
always recommend that people bring any records that you can
get your hands on to this interview. That can mean
like report cards, um um, any kind of qualitative you know,
description or reports of your behavior, like from your parents
(28:27):
or anything like that. UM. So, any records, any prior testing,
any medication. So that's the first step. He did an
initial history intake. So he asked me, you know, starting
literally from my childhood experiences and you know up until
now and everything from how was it learning, how was
it dealing with people? How did you feel? So it
(28:50):
was very comprehensive for several hours, and then we did
several questionnaires, so one was on you know, social anxiety.
He didn't specify what they were, so then I didn't
focus on those. I just focus on the questions some
I think we're social anxiety, skin picking, hyperactivity, and focus.
I don't know the exact titles, unfortunately, of those questionnaires,
(29:11):
but those are the main ideas that clinician should also
conduct interviews with significant others in your life, or what
we call collateral interviews, because we don't just trust you,
uh and being an expert on your own experience for
better or for worse. We have to get the opinion
of others who have interacted with you. So you know,
(29:33):
if you're a younger adult, this might be parents, um, siblings,
significant other like romantic partner, roommates like your clinicians should
do some of those collateral interviews to to see, you know,
how other people perceive you. I'm sorry, because the psychological
testing is not enough on its own, right, right. Yeah,
(29:54):
Standard of care suggests that we do all of these things.
We do the interview, we do the testing, end, we
do these collateral interviews with others. Yeah. So they sent
him a separate questionnaire asking questions about, you know, more
about focus, skin picking, and hyperactivity, mainly along those lines,
and then how I dealt with certain situations. So that's
(30:16):
that's interesting. And I know that because that's like I
guess the like reporting from somebody close to you. That's
why you know, they want to have the parents and stuff,
which is you know, a big deal. But I guess
that wasn't really an option with me. Um, Like god,
I would I guess I could have called my parents,
but I feel like they would have probably like, oh yeah,
you could focus. They focused all the time. Like really, okay,
(30:38):
that's different. Well I try to explain. I'm like, yeah,
only on certain things. Um. But yeah, So actually I
have a list here of the kinds of ones. So
we did a clinical procedure or clinical interview. Psycho social
history connors, adult A d h D rating skills, long version, Brown,
executive function attention scales, Patient Health Questionnaire nine, Social phobia inventory,
(31:04):
skin picking scale revised. So those were all the ones
that we had done formerly. Okay, and I am not
familiar with the skin picking thing. Could you explain that
one was? That one was a little weird for me actually. Um,
So apparently people with a d h D tend to
pick their skin pretty often, either maybe scalp or something
(31:24):
like fidgety. So I think he was looking for any
severities to the point where like maybe I had scars,
or I had the urges and the compulsion to skin
pick or touch my face or my body, um, which
I sometimes do oddly enough. Um, but apparently, yeah, it
is part of a d h D as well. Yeah,
(31:45):
I do it with my cuticles. Like I'm suizing. I
didn't realize that was the thing. You know, typically will
give you some measure of intelligence that always freaks people out. So, um,
I like to substitute that instead of saying in tells,
we just call it like cognitive ability. Okay, so we
look at what your brain is up to in a
bunch of different domains. Um, we might uh test some
(32:09):
of your academic skills, depending on if that's a relevant
issue you. We'll probably do some testing around executive functioning. Uh, attention, memory,
all sorts of cognitive domains to see what your brain
is up to. We'll also do some personality assessment most likely.
Uh that sounds like you've had some of that experience
from from what you told me, right, Uh, So we'll
(32:32):
typically do a personality measure UM, and we'll also do uh,
we'll administer some your rating scales, which are standardized uh
well normed questionnaires that would compare your behaviors to other
individuals your age and gender and so forth. And we'll
give those rating scales both to you and to any
(32:53):
of those um collateral folks who might be involved in
your life, so we can get real, you know, solid
data from them about what they're seeing as well. And
then we pull all that together and try to synthesize
all that info and uh yeah, figure out if it's
a d h D or something else or both or
anything else we might need to talk about. All right,
(33:14):
let's take a quick mental health break, be right back.
Welcome back to Prodigy. For more info, visit the episode
page at Prodigy podcast dot com, or to ask if,
like how accurate the tests are, like, is it possible
or what is the likelihood for a person with or
without a d h D to get an incorrect diagnosis,
possibly maybe because of the testing environment. Mm hmm. That's
(33:36):
a really complicated question to be honest. Um, it's a
great one, but it's all complicated. Um. The short answer
is that depending on the battery, so the tests that
we give you in the process you go through, UM,
it is possible certainly to come up as a you know,
a false positive let's say, where it looks like you
(33:57):
have a d h D but it's actually something else.
The troubles that we don't have a clear, uh, well
defined profile let's say this as hey, this is a
d h D, So we can't look at like a
specific pattern of scores on the cognitive testing that that
very clearly says this is a d h D. That's
(34:18):
why we have to um integrate all of this information
that we get from the interviews with you and other
people and the rating scales and really pull all of
that together and see see how the whole picture looks. UM.
So it is possible, certainly. What I thought it was
is that the difference between my intelligence and my working memory,
(34:39):
like there was a huge gap there, UM, And I
thought that that was like a really what you guys
possibly looked for. Yeah, yeah, that's definitely I don't want
to throw that out by any means. Um that is
often present. So there's that, you know, again, gap between
kind of overall intelligence and working memory or processing speed.
We found, you know, uh, located with the tension um.
(35:02):
So we will look gaps like that or relative weaknesses
in your profile. And it's not definitive by any means, Like,
just because someone has low working memory doesn't necessarily mean
they have a d h D. There are other things
that might contribute to low working memory. But it's a
I mean, it's a sign. Is the reverse also true,
(35:22):
like you could have a good working memory and um
have a d h D. Yes, yes, okay, interesting, Yeah,
it is fascinating. It makes our jobs a little tougher.
So I took about maybe another two to three weeks
for him to compile a report for me. It was
a written report, formalized and he had emailed it to me,
(35:45):
and at the same time we had another about hour
and a half um formal video interview where he just
told me about the results that he had concluded based
on his findings. And you know, he told me everything
from the questionnaire, anything that he had he had observed,
and even anything kind of off off the record like, oh,
I noticed you have a bit of these tendencies. It's
good to work on these. He was just a really
(36:07):
nice I think psychologists to do that. But yeah, that's
that's how it would happen. Once you get a diagnosis,
what should you then do? You should walk away with
some pretty pretty solid recommendations from that clinician as to
what to do next. Most likely it would involve a
consult for medication. Um, we still think medication is pretty
(36:28):
effective at you know, helping with a d h D symptoms,
So they would likely recommend medication. Uh, And they would
likely recommend some coaching or some cognitive behavioral therapy to
teach some of those skills that I mentioned earlier. He
said that I would probably benefit from therapy specifically CBT,
and I would, you know, just on his advice that
(36:51):
medication would largely help me with my focus issues. That
clinician might give you referral for, you know, for trusted
colleagues in the area for you to to go to,
but if not, you can of course search them out
on your own. Another part that I like to recommend
to folks is just uh psycho education or like self
(37:15):
learning about a d h D. So you know that's
where you get on the websites. You know, there's attitude, Um,
there's I mean even Reddit could be fine. Uh, you
know they're there are some reputable sites out there and
books of course that will help you learn as much
as possible about a d h D and what it
looks like for you. And that psycho education piece, that
(37:37):
learning component can be really really powerful in helping people
move forward. Yeah, it seems like it's important to understand,
you know and understand it, especially related to yourself. UM,
I'll put those resources on the website. UM. I've just
had one more question that I don't want to forget
to ask, but like, do you do you see a
difference between genders or between you know, like between male
(38:00):
how it manifests it between genders? Yeah? Yeah, Um, I mean,
first of all, we know that men or males are
diagnosed more frequently than women. UM. I think historically here's
the thing, I don't know that that it necessarily presents
(38:22):
differently in girls than boys. Um. There may be you know,
some some evidence that girls trend more toward uh inattentive
symptoms from the beginning, with less of that hyperactivity and
impulsivity certainly, um, but I don't know that it's so
much that the presentation is vastly different. It's that people
(38:44):
aren't looking out for a d h D and girls
as much as they are and boys. Does that make
sense where Yeah, so people just aren't, you know, It's
like we see what we're looking for, and and I
think that boys we are looking for. Boys with h D,
like poorly behaved boys in school are a lot more noticeable,
(39:06):
and it's easier to attribute that to something like a
d h D. Whereas you know, girls who are kind
of you know, hyper energetic or talkative, um, you know,
they might be more likely to get labeled as precocious
or um, you know, a lot of personality or assertive
or something like that. Um. And it's it's less likely
(39:27):
to be seen as a behavior problem. So so yeah,
I think it's a little of both. Um. I think
girls do tend to fly under the radar a bit
because they show up as a little more inattentive. But
for the ones who are more hyperactive, I don't know
that they get recognized as much as boys. Do because
teachers and parents just aren't really looking for it. Yeah.
(39:49):
When I just think of a stereotypical child with a
d h D, in my mind, it's always just a boy.
It's always a boy. Right. Um, is there anything that
I missed that you think we should cover. I think
the main thing is that I hope people might take
away is just that, uh, you know, if you think
it's going on, Um, they're definitely options out there to
(40:12):
to look into it, and it is a very um treatable,
uh concern. You know. That's the good news. I always say,
you know to parents, like, the good news is that
we know a lot about this and there's uh, there's
there are many options to to help you, so uh
don't lose hope. You know, it's never too late. We
work with adults, you know, forties, fifties, sixties who are
(40:36):
just getting diagnosed for the first time, so it's never
too late and there's plenty of options to help you. Yeah.
I'm gonna send my dad over to you. Uh. But Yeah,
one troubling thing is it feels like because of a
d h D, it's hard to actually take the first step.
At least it was for me, right, right, well, I'm
(40:57):
curious if I could turn the tables and ask you what,
from your standpoint, would have made it easier to access
an evaluation or services or whatever would have been the
first step for you. Yeah, if I could have just
reached out to a testing facility first thing and just
call it and made an appointment, But it feels like
like I would have to find a psychiatrist, and then
finding get an appointment with the psychiatrist can be difficult.
(41:20):
It's so hard. Yeah, they'll be like, oh, if we
have an appointment, sure three months out, and I'm like, okay,
like three months out, it's like basically a lifetime in
my mind, you know, oh sure sure. Well yeah, maybe
that's important to highlight again just to say that you
don't you know, a lot of insurance plans do not
require a referral. So if you can reach out on
your own, um and make an appointment with you know,
(41:40):
an assessment clinician, UM, that's a great that's a great step.
You may not have to go through a physician first.
So after Leslie was diagnosed, she went back to her
same primary care physician and he said, okay, well draw
off the report and we'll submit it to a psychiatrist
and they'll go back to you in the next six
months x months. So her partner recommended his family physician,
(42:05):
who got her an appointment in a few weeks. The
process still take a few more months because she got
bounced around to a few different psychiatrists, but she eventually
did get the treatment that worked for her. Again. Leslie
is in Canada and your experience may be different based
on your location. Dr Jeremy Sharp is a consultant who
helps grow mental health clinics. He's also an excellent speaker
(42:26):
on all subjects related to mental health. He's really been
a wonderful guest and I highly recommend him for your organization.
You can find more info at the Testing Psychologist dot com.
Leslie is working on a book about people's experience during
the pandemic, and it's interviewed people all over the world,
including me. You can find her on Instagram at Leslie
(42:48):
dot q. That's spelled l E s l Y dot
c u E. As usual, all links will be on
the episode page at Prodigy podcast dot com. Prodigy was
creating and produced by me Lord Berlante. The executive producer
is Tyler Klang. Thank you so much for listening. If
you want to help out, you can follow the show
(43:09):
on Apple podcast or Spotify or whatever, or share an
episode with a friend. I also really appreciate it when
listeners send me messages and I respond to everyone. Prodigy
is a production of I Heart Radio. For more podcasts
in My heart Radio, visit the iHeart Radio app or
wherever you get your podcasts.
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