Episode Transcript
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(00:02):
Hello everybody. Welcome back to the Christina
Crow podcast where we connect the dots in search for more
balanced mental health. I am coming to you solo today
and today I want to talk about something that comes up a lot in
my supervision and consultation sessions I'm doing with your
therapist possibly and other therapists who are working with
(00:24):
clients who have ADHD. From the perspective of myself
as an ADHD psychotherapist, one thing that I find and sometimes
has a murky understanding is what the components of treatment
are, quote UN quote, when we saygetting treated for ADHD and
that how long is that supposed to last, right?
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So people often think treatment means just medication.
And I think we work really hard in the community of clinicians
and advocacy to always remember the best practices for ADHD are
what we call multimodal care or multidisciplinary care.
And what that means is there's usually medication, which is
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first line and far and away the most efficacious thing you can
do. And then once you've got a
handle on that, therapy and coaching and it's ADHD kind of
aware and adapted psychotherapy because you can't do
neurotypical therapy and expect awesome outcomes and executive
function based coaching and in that order too, right?
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And it's not a one and done process.
It's a lifelong check in on care, adapting and growth
because we change as we get older.
Obviously circumstances in our lives change, but the longer we
go post diagnosis, the longer weknow ourselves that we have a
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greater self-awareness, we have a greater understanding of how
ADHD shows up in our lives, and everything becomes different
with every new layer of understanding, right?
There's not a lot of data about what percentage of people
actually get to access all three.
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There is a little bit of data that is from a couple of
different studies and I'll sharesome of that with you here.
There is one that kind of, I'm quoting to you some of the
largest studies, reasonably maybe the most generalizable,
but one study looked at people with ADHD and about 30 to 55% of
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them had received medications, check in on care, adapting and
growth. Because we change as we get
older. Obviously circumstances in our
lives change. But the longer we go post
diagnosis, the longer we know ourselves that we have a greater
self-awareness, we have a greater understanding of how
(02:59):
ADHD shows up in our lives. And everything becomes different
with every new layer of understanding, right?
There's not a lot of data about what percentage of people
actually get to access all three.
There is a little bit of data that is from a couple of
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different studies, and I'll share some of that with you
here. There is one that kind of I'm
quoting to you some of the largest studies and maybe the
most generalizable. But one study looked at people
with ADHD and about 30 to 55% ofthem had received medications
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for their ADHD in the past year,30 to 55%.
So that means there's another 50% of people with ADHD who are
not taking medication. So what are they doing?
About 62% of people have tried apsychological treatment at some
point or another. And because these are trials,
I'm going to assume that means like standard CBT or DBT or
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something of that nature. And there was a claims based
study in the US that found amongadults with ADHD and anxiety and
depression, probably 52 to almost 60% of them did receive
psychotherapy during their ADHD treatment regimen.
And to me that's a funny sentence because I don't like
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during their AD like the ADHD treatment regimen doesn't
exactly end. So I'm assuming that meant just
based on the very specific time periods that this study was
retrospectively looking at this data, coaching is much less well
tracked. Some surveys will suggest like
20 to 25% of people ever access ADHD coaching or executive
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function coaching and counseling.
The coaching is very distinct from therapy and I think it's
probably under reported how often people are getting these
interventions and they can obviously be quite helpful.
And there's quite a lot of therapists that have coaching
training as well and employ thatin their techniques if they know
they're working with someone with ADHD.
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So it may not be tracked that way because I might be getting
captured under the therapy part.And while therapy and coaching
are recommended, a lot of studies further don't actually
distinguish between therapy, counseling and coaching and are
obviously quite different. Or they don't explicitly ask
whether someone is only using medication versus being able to
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access all of them. And if you think back to what
your doctor said when they were prescribing medication to you,
they probably said something like, and you should probably
get some therapy and coaching. So I don't even know that the
doctors necessarily distinguish them, although we definitely get
referrals from physicians who very specifically and from
psychologists, psychology clinics who also diagnosed folks
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who specifically say this personcould really benefit from some
therapy for various things. And they will be more specific
for more obvious cases to them, I would imagine.
So one of the questions people always ask is if I'm going to
start this medication, do I haveto take it forever?
And my answer to that is always,you take it as long as you want
the benefit of it. ADHD is a neurodevelopmental
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condition, means you're born with it and it's going to be
there when you're saying goodbye.
The symptoms don't disappear after childhood, they just
change the way they present withage and life stage and external
stressors. They will always remain a part
of your wiring 'cause it's just how your brain functions.
And so that means that treatment, quote UN quote, needs
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to change as well. It needs to evolve alongside the
person. And what works for you when
you're 10 in school may not be the same as what's going to work
for you when you're 30 and managing your career or maybe
the evolution or beginning of your family life.
And that may not be what works for you when you're 50,
balancing maybe caring for agingparents, maybe an empty nest,
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maybe you still have teenagers at home and you're still
working, maybe you're off work, right?
So everything's going to be different.
And I think what I see a lot is that someone will come to me to
consult on a case that somebody who previously had really great
symptom control, all of a suddenthey've come back to therapy and
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their life is just like a dumpster fire.
Everything's falling apart. And then I ask about the history
and the medication history, and the therapist will be able to
reference their file and say, yeah, they're on medication.
And so last time we checked, they were on like, one of the
first couple doses of one of thestimulants.
And I say, what time of day are these problems occurring?
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They're occurring more in the evening.
OK, so those are like off medication hours.
And is it worse now than it was when they had what's changed in
their life since they had reallygreat symptom control?
And then we go through those factors.
The reality is we've landed in aplace where something needs to
change, either the external stressors or the medication dose
or even maybe the type of medication.
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It always seems to take everybody by surprise because
they figured, well, we addressedit at the beginning.
Do we have to keep addressing it?
And I hate to be the bearer of bad news, but yeah, you got to
keep addressing it because this is a condition that fluctuates
throughout your lifespan, and itfluctuates based on lots of
different variables, both external and internal.
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If you're a menstruating person and you have hormonal shifts, it
fluctuates based on that as well.
So those are all the things thatas therapists working with our
clients with ADHD, we've got to have the competencies and the
knowledge and the ability to keep track of a couple of
different moving targets that wewouldn't necessarily have to if
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we were working with someone that doesn't have ADHD.
In particular, raising kids today is hard, and finding the
right support can feel really overwhelming.
I dig a little deeper. Our team of therapists
specializes in supporting children, teens and families
through life's challenges, from anxiety and ADHD to school
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stress, friendships and big transitions.
We offer in person and virtual appointments across Ontario, so
help is always within reach. Learn more at Dig a Little
deeper.ca. So beyond medication, medication
is a very important tool. It's first line for a reason.
It's first line because it's farand away the most efficacious
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thing you can do. So if you can only do one of the
three and you don't have any contraindications medically,
like reasons why you can't take the medication, medication's the
biggest bang for your buck. There's no doubt about that.
But if you've already been able to do that or square it away or
for whatever reason, you're one of the 20% of people that can't
take it. Or if you're very sensitive to
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the effects and, and it's just not a good experience, then
therapy, coaching, skill building, and then
accommodations, not just at work, not just at school, but in
your home life are really important part of things to
consider. I think a lot of us feel like we
get diagnosed, we take medication, we're like amazed.
We're like, Oh my God, this is how the rest of the world can
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get through the day. Holy jeez, this is amazing.
And then we start trying to makeup for lost time.
We start trying to make up for feeling behind.
We start trying to make up for career mistakes we may have
made. We start trying to make up for
relationship mistakes we may have made and we pile on more
and more, which is new to us because we can suddenly do more.
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But then if we're not careful, we end up getting into this
place where the novelty of doingmore is starting to wear off now
and we're overloaded. We've over committed.
We are like burning out, teetering on overwhelm and
haven't developed the skills to be able to say to the other
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people in our lives, I can't be doing all this stuff.
I don't want to be doing all this stuff.
I need more help. I need to outsource.
We need to delegate, we need to automate things in our lives so
that life isn't so hard. And one of the things that I
tell people often is you need toactually do less.
You just need to be really specific about the things that
you do. Now I'm not going to get into
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all the nitty gritty of how I doit, but that is a really
important part of customizing the therapy experience that you
have. And for many clients that they
what therapy really does is it helps you understand how you're
very unique. In particular presentation of
ADHD shows up in your relationships, how it shows up
in your relationship with yourself, how it shows up in
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your daily functioning. And this is not daily
functioning that other people are holding you to some
standard. It's what you want to be able to
get done in a day, what makes you feel good.
And at a very baseline, this isn't about productivity.
This is like showering, brushingyour teeth, eating and feeding
yourself well-being active during the day, doing the things
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that you're good at and that you're fine fulfilling and that
are your strengths. Having some fun, having some
lightness, and being able to putyourself to bed at a time that
allows your body to rest and recuperate.
These are all like basic parts of functioning for the human
body. You got to be able to get to bed
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properly. And that's why one of the things
that is ultimately hard is that if you take medication, it works
during the day. We're all fairly unmedicated by
six, 7:00 and we're all just back to ADHD nonsense in the
evening, which means that we don't put ourselves to bed
'cause we don't have the executive function on board if
we haven't built the skills during our on medication time to
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get to bed. So when you are on medication,
that's when you want to have tough conversations, that's when
you want to do hard things, That's when you want to plan and
set up routines and structures and scaffolding for your
evenings and when you're off medication so that all of that
stuff becomes easier and you're not taxed unnecessarily during
the hours when you're most vulnerable.
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OK. And those are the things that a
really great ADHD therapist can help you sort out.
You can build strategies that include not just yourself, but
all the people in your life, allthe people in your family that
are sustainable in real life andin real relationships.
And then I think one of the things are seasons of care, like
treatment can feel cyclical. You may feel stable for years.
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You may get to that place where you're like, I can down dose.
I don't need to be at 50. I'm really good at 40 milligrams
of my medication. And then you're going through
some sort of transition, right? Something comes like a new job
or parenthood or empty nesting or divorce or getting sick, and
it brings all those symptoms right back into focus.
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Everything starts to fall apart again because of course, we
didn't see it coming because we have time blindness.
So then come back to therapy, goback to the therapist that you
hit it off with. Find somebody.
So if that wasn't super helpful,find somebody who has like a lot
of experience working with ADHD.They when you have a console
call with them, they can demonstrate to you and explain
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to you how they work with peoplewith ADHD, how they understand
that slightly shifts the way youlook at treatment and you do
things a bit differently to meeta nerve divergent brain where
they're at and understands what it means to live with ADHD long
term. So it's, it's not like getting a
broken bone fixed and then you're done.
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It's more like diabetes, right? It requires ongoing monitoring,
self-awareness adjustments, and the willingness to just be real
with yourself to stay well. As a psychotherapist
specializing in ADHD, my role isto help my clients not just
manage their symptoms, but also navigate the deeper challenges
like the emotional stuff, the shame, the rejection
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sensitivity, the cumulative impact of living in a world not
designed for ADHD brains. And then overtime, therapy helps
build up strength, identification, resilience, and
the ability to trust yourself again and to trust other people
to be there for you so that whennew challenges continue to arise
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every single time you're a bit better and you can adapt faster.
And you can recognize it faster as you go through all of the
totally normal ups and downs of life that happen as we go
through different decades and have different developmental
tasks of adulthood. I guess we take away now for
this. One is ADHD treatment is in a
single prescription, a few therapy sessions or one like
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lifestyle tweak or some magic hack or some app.
It's a lifelong process of learning how to live with your
brain, and with all the right supports, people can really
thrive, like really thrive, havereally transformational
experiences. And I've seen it and I love it.
That's why I love working with, you know, folks with ADHD and
therapists who have ADHD themselves or therapists who I
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don't know if they've got ADHD or not, but this is their
patient population. We all love it because people
get better and it just requires the ability to figure out what
you specifically need to track that needs your ongoing check
ins, litmus tests, attention, flexibility and care and
compassion for yourself. And the more you can demonstrate
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some self compassion, the actually better you get.
So more self compassion actuallyequals better functioning, not
worse. I know a lot of us are worried
if we take our foot off the selfflagellation pedal that
everything's going to fall apartbecause that's the only way we
knew how to get things done was by beating ourselves up.
But it's actually the opposite. If you are looking to give
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yourself a break, figuring out the kind of pacing and routines
that thrive for a lot of ADHD brains, working with someone who
has a lot of experience that canhelp you out in doing that is
certainly my recommendation. So I hope this was helpful.
I hope that was a good perspective into how we can
think about treatment in a really helpful way, and I would
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love to hear everyone's feedback.
And until next time, take care of yourselves.
Thanks for joining me today. As I continue to try to make the
invisible visible. My hope is that these
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conversations help you feel a little more seen and supported
as you navigate your own journey.
If you're curious to digdeeperyoullfindmoreresourcesarticlesandepisodes@digalittledeeper.ca
and if something today you heardstirred something inside of you,
please know that reaching out toa licensed professional can be
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an important next step. You certainly are not alone and
you don't have to carry it or.