Episode Transcript
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Dr. Elise Fallucco (00:00):
Welcome back
to Child Mental Health for
(00:01):
Pediatric clinicians, thepodcast formerly known as
Psyched for peds.
I'm your host, Dr.
Elise Fallucco, childpsychiatrist, and mom.
And thank you for joining us aswe begin part two of our series,
child Mental Health Talks withParents about A DHD.
We're gonna be continuing ourconversation from the previous
(00:23):
episode with Ashley and Laurenneurodiversity advocates who
share their lived experiences ofraising kids with A DHD.
We're gonna learn about thisconcept of masking, and when I
say masking, I'm not referringto the actual mask that you put
on your face, but morefigurative masking.
(00:43):
So what we know is that kidswith A DHD can mask or
camouflage their symptoms, in aneffort to be more socially
acceptable or to fit in betterwith peers.
They can copy how other kidsinteract or even suppress their
natural urges to fidget or tointerrupt and this can be
conscious or unconscious, butthe important thing to know is
(01:06):
that masking symptoms comes at acost and oftentimes can
contribute to low self-esteemand anxiety.
So let's continue thisconversation with Ashley and
Lauren about masking symptoms inA DHD.
You mentioned this reallyimportant thing, the concept of
masking.
Which is this I which is thisconcept that children, but
(01:29):
particularly girls are likely tomask symptoms that they have,
meaning that they eitherconsciously or unconsciously
suppress some certain behaviorsto fit in with social norms and
social expectations.
So tell us more, how did younotice that your children were
masking symptoms?
How could you tell that theywere masking?
Lauren (01:52):
Yeah, I actually noticed
it with my daughter.
I went to visit her at schoolone day for lunch, and I went in
and she was so quiet, just shutdown.
Really?
She was shutting down in thelunchroom, but all of her
friends are having very animatedconversations.
And normally at home, she wouldbe the one, just, my husband
calls her chicharona, which islike Italian for Chatty Cathy
(02:16):
and she's the one you describedbefore she interrupts.
She's constantly talkative.
Yes.
But now she's in a socialsituation at lunch and just
completely quiet.
What is that?
Yeah, exactly.
And so I actually, she ended uptalking to me about it and she
said she didn't feel like shecould be herself at school.
She's always afraid that she'sgonna interrupt somebody and
that's gonna make them mad.
And so she's just quiet and shefeels like a shell of herself.
(02:40):
She was really describingmasking.
And then she would come home andboth of my kids would come home
and they'd be exhausted and havemeltdowns.
Or she would want to get all ofthose words out right away when
she gets in the car, and so shewould just talk to me about, all
kinds of different things.
so I noticed the big differencein her when I saw her at school
(03:02):
versus at home.
That was like my first clue.
And then with learning aboutmasking and how exhausting it is
for them, it really kinda, thathammered it home made sense.
Dr. Elise Fallucco (03:13):
that must
have been really odd to visit
your daughter, who's normallyvery talkative and vivacious and
gregarious, and to see her.
Shut down.
And for our savvy listeners, Iimagine they're wondering if
your daughter was on stimulantmedication at the time.
Because we know that treatmentwith stimulant medication can
sometimes make kids seem morequiet or feel like they're not
(03:34):
their typical giggly, more hyperinterrupting selves.
So I just wanna confirm yourdaughter was off of medication
when you visited school and sawyour sweet chatty Kathy as more
of a quiet wallflower.
Lauren (03:46):
Yes.
Dr. Elise Fallucco (03:47):
And Lauren,
what about you?
Ashley (03:49):
So I could tell that my
daughter was masking at school
because when we did theassessment for A DHD and we gave
the form to her teacher it cameback as being a student with no
troubles in the classroom, whichvaried very differently from
what my husband and I had put onour forms.
And so we came to therealization that at school she's
(04:13):
on her best behavior, she'sworking hard, trying to get
grades, good grades and shewould come home at the end of
the night and just.
Be exhausted, maybe have ameltdown or whatever else it
was.
So that's how I figured it outwith her.
And then with my son, I thinkthe same thing happened.
His forms from his teacher alsoshowed good behavior, good
(04:35):
grades in school and she didn'tnotice any issues.
But then again, we would noticeit at home.
And so I think this reflectsmasking.
Where our kids perform reallywell at school.
They get good grades, they havegood social relationships.
Everything that a teacher wouldexpect.
And then our kids come home andtotally crash from masking all
(04:57):
day.
And then we would see more ofthe A DHD behaviors at home
Dr. Elise Fallucco (05:02):
To follow
up, Ashley, on your kids they
may not even be old enough toanswer this question, but are
they conscious of what that isor have they ever talked about
what it is like to masksymptoms?
Ashley (05:15):
They don't know the term
for masking.
But I do think, at least with myolder child, she has described
being at school in a way that Iknow she's describing that.
Like it's a lot harder for herto just be who she wants to be.
And to be herself.
(05:35):
And I think that gets to whatyou mentioned is trying to fit
in with certain socialsituations.
So yeah, I think she's likeconscious of it, but doesn't
have the language for it.
Now that I think about it withmy son, it was less about the
difference between school andhome, but also being at home,
but in different settings withdifferent people.
(05:57):
So if you were to describe someof my son's.
Behaviors or how he acts incertain situations to family
members.
They would probably be totallyshocked.
They'd be like, what are youtalking about?
He never does that when we'rewith him or if he sleeps over
our house or anything like that.
So just even the differencebetween how he acts around
(06:20):
people that he's supercomfortable with.
Not that he's not comfortablewith other family members, but
there's a difference betweenyour nuclear family in your own
home versus being at somebodyelse's house or being at a party
somewhere, right?
And so he's always on his bestbehavior there, trying to not
show certain emotions orbehaviors.
(06:43):
And then when we get home, itall comes out
Dr. Elise Fallucco (06:45):
and that,
it's gotta make things hard.
For you guys and for cliniciansto figure out what's going on.
Because one of the majorcriteria for A DHD is to be able
to show that these behaviors arepresent in more than one
setting.
And it's usually school plushome, but if there's a lot of
masking going on, if kids havelearned, on some level that
people don't like it when theyinterrupt or some the teachers
(07:08):
get mad when you blurt outanswers in class, and if they're
able to have some level ofcontrol over the symptoms, then
you wouldn't see as much atschool as you would at
Ashley (07:19):
home.
Yeah.
And we actually weren't able toget his full a DH ADHD diagnosis
until we had a therapist comeinto our house and see him in
his own home environment.
Running around, comfortable withwhat he does in our own home.
Where she just looked at me andwas like, is he always like
this?
And I was like, yep.
But right outside of that house,he might not be running around
(07:42):
like that, where people wouldpick that up as hyperactivity.
Lauren (07:46):
And some people might
even think, oh, they're able to
hold it together, that's good.
But then it comes at a cost,right?
There's this exhaustion and it'sdifficult.
And I started to notice that mydaughter was experiencing
symptoms of anxiety because shewas having to constantly self
(08:06):
monitor and make sure she wasn'tmisstepping in a social
environment or and so then itbecame like even with the
clothing, I don't wanna wear thewrong thing.
I'm gonna get made fun of, orI'm gonna this or that.
And not having experiencedbullying or anything like that,
that would cause that concern,but just constantly seeing am I
(08:27):
fitting in?
Am I doing the right things?
So I don't know for any parentsthat might be listening and
being like, oh, that sounds likethey're good at solving their
problems.
But that kind of, that anxiety,that heightened anxiety and
exhaustion from masking alsocreated emotional volatility
when she would get home fromschool and difficulty regulating
(08:48):
her emotions.
Dr. Elise Fallucco (08:49):
Yeah.
You brought up a really goodpoint about what does it mean if
they're able to have some degreeof control over their symptoms
at school?
Does that mean that there's evena problem?
That if we're saying that A DHDis defined by deficits in
executive functioning and inimpulse control and yet this
child, your daughter can keepherself from interrupting people
(09:11):
at lunch and make herself superquiet, what does that say?
And I think.
This is yours is a really greatexample of how every child is
very complicated.
And a DHD is not like a lightswitch on or off.
Like you either have all of thesymptoms or you have none of the
symptoms, but there still issome degree of control.
Just like with anything likewhen you're highly motivated to
(09:32):
do something, you may be able tomake subtle adjustments, but as
you put it so well, Lauren, itcomes at a cost and it's also
not something that can besustained for long periods of
time.
Exactly.
On your own.
Yeah.
And I don't think that they,even, like you said, your
daughter maybe doesn't have thelanguage to explain this looking
back at my childhood and seeingmyself retro retroactively
(09:55):
saying, oh, I, I was shuttingdown because I was afraid to be
too much.
That was the message, right?
You're too much, you need tocalm it down.
And so I would just shut downand it really affected my sense
of identity of who I am.
And it impaired me from beingable to explore that in a safe
way.
When you're too much foreverybody.
You don't, make friends easily,so.
(10:16):
Right.
And, I think girls, are moremotivated to have friendships
and maintain friendships thanboys.
So girls are very motivated tomask, try to fit in even at that
personal cost.
Thank you for sharing that.
Lauren (10:30):
Oh yeah.
Dr. Elise Fallucco (10:32):
Did you know
you had a DHD when you were
growing up?
Lauren (10:34):
No.
Okay.
So I was recently diagnosedafter my kids got diagnosed.
Yes.
Pretty typical.
I was gifted A DHD.
But the disorganization, Iforget that I had homework when
I got home because it was out ofcontext.
And then I'd be walking toschool and I'd be like, oh,
shoot, I had homework becausenow I'm back in the context of
school.
Things like that.
Dr. Elise Fallucco (10:52):
Mm-hmm.
Um,
Lauren (10:52):
Forgetting to turn
homework in after you've worked
all weekend on the project.
And I would just redo thehomework Or I would
overcompensate with mygiftedness for the A DHD and
mask and shut down socially alot.
Dr. Elise Fallucco (11:09):
But not
knowing what that was.
You know, At the time, as you'regrowing up, you are, you're
gifted and you're a DHD, youdon't know it's a DH, adhd.
No.
You just know that there'ssomething about you let's say
the talkative or theinterrupting or some part about
you, that you're gettingfeedback socially that people
don't like that, that maybeother girls or other people are
giving you looks orcommunicating somehow that is
(11:31):
not acceptable.
And being the savvy human thatyou are and somebody who is
seeking social connection andrelationships, you are smart
enough to internalize that andsay, okay, let's shut that down.
But exactly.
But the internalizing is hard,right?
It makes you, it develops like ashame of oh, you are this way
and you need to not be this way.
Ashley (11:52):
It doesn't allow you to
be authentic.
Right.
And at peace with yourself andwhat you normally do.
Lauren (11:57):
And constantly, I think
there was this feeling of, I am
I'm really smart.
I should be able to do this.
And those easy things of likestaying organized or remembering
that you have to wear your coraloutfit today or this or that.
Those things were really hardfor me.
And then the hard things, thethings that were supposed to be
(12:18):
hard were really easy.
So it was like people were like,how come you can do all of this
but you can't, stay on top ofwhen this project is due or you
have poor time management skillsor whatever.
And so That was my thing waslike, how come I am not able to
do these?
It just always felt likesomething's wrong with me.
And I think that's what, like Isee in my daughter, she was
(12:41):
constantly feeling like there'ssomething wrong with me.
And I think that's somethingthat whenever these kids are
masking, that they're reallyinternalizing a lot.
There's something wrong with me.
And so I think having the labelof A DHD helps to explain like,
you have these struggles withexecutive functioning, but that
doesn't mean anything's wrongwith you, it's just the way your
brain is wired.
(13:01):
And so being able to put a labelon it and talk about it in a
positive way, and I love thatyou talked about the A DHD
superpowers.
It's not even putting a positivespin on it, it's talking about
the strengths and weaknessesthat we all have.
Yeah.
Dr. Elise Fallucco (13:15):
Getting a
diagnosis in some parts can be
therapeutic in and of itself.
I've seen this in some of ourpatients.
There's this sense of reliefwhen you get a diagnosis and
somebody explains, Hey, this iswhy you are the way you are.
It helps you understand yourselfbetter, and it helps your family
and your teachers and otherpeople.
Better understand the strengthsand weaknesses that make you
(13:36):
you.
Lauren (13:37):
Yeah, exactly.
Speaking of A DHD superpowers,what do you think is one of your
kids' A DHD superpowers and howdoes that, what does that look
like?
Ashley (13:53):
Good question.
For my son, it's definitely hiscreativity.
He makes amazing art pieces,drawings that are very detailed
and he has incredible visualspatial reasoning.
So we always like to tell him wethink he's gonna be like an
architect someday, or anengineer because he has that
(14:13):
math ability.
But then the way he can draw andbuild things all at once is just
really something to see.
And for my daughter, I think hersuperpower is that chatting that
we talked about.
So she.
Is in particular very gifted attalking to adults.
And it's really neat to see howshe can interact with people
(14:37):
across ages.
And also her empathy.
She really is in tune with herown feelings.
And since we talk about her ADHD and how that can manifest in
her, she has the language aboutfeelings and can now recognize
it in others, including kids.
So she will help kids at schoolwho are struggling with
(14:58):
different feelings and.
I'll get text messages from someof her friend's parents saying
that she's helped a kid throughthe loss of a pet or things like
that.
And so really her empathy andability to talk to people is
awesome.
I think she'll be a therapistone day.
Dr. Elise Fallucco (15:13):
Oh yeah,
Ashley (15:14):
you do.
I really do.
Aw,
Dr. Elise Fallucco (15:15):
that's
awesome.
I
Lauren (15:17):
would say for my son,
he's incredibly creative.
He, I've always said he hasstories inside of him, so he is
constantly writing stories andworld building and thinking of
multiple things all at once.
So I think in Webs, he thinks inwebs, he thinks in like multiple
things all going on at one time,and he can see how they're all
(15:38):
connected and how they're allgonna piece together.
So I think he'll be a writer oneday.
Wow.
And then my daughter, I thinkher superpower is.
Honestly, socially, she isreally good at making friends
and because she is, I think, sotalkative and excited by things.
(15:59):
And so she's just that bubblyLabrador retriever, personality.
So that's definitely one of hersuperpowers.
But also like creative problemsolving.
She's really good at coming upwith solutions for things that
are very out of the box.
So I don't know what she willdo, but she definitely has that
empathy going as well.
She is always there to come upwith a solution.
(16:22):
That's amazing.
Yeah.
Dr. Elise Fallucco (16:24):
I'm so glad
to hear both of you recognize
all of your children's manysuperpowers, and even as you
just list all of them, you'resetting such a great example for
all of our clinicians to remindthem to take a strength-based
approach to kids with all typesof mental health issues.
And while medicine tends to bevery problem oriented, it's a
(16:44):
good reminder that we need totake a step back and recognize
and integrate strengths into ourunderstanding of who a child is
or a teenager is, and of courseinto their treatment plan.
We're gonna take a pause in thisconversation.
And continue.
Next episode in part three,talking with parents about A
DHD, where Lauren and Ashley aregonna share what they wish
(17:08):
everyone knew about kids with aDHD.
Thanks for listening.
Hope you'll join us next time.