Hi! I'm Andrew Baxter, Team Lead with mentalhealthliteracy.org
In today's episode of Meet the Psychiatrist, Rachel, from our Youth Advisory Committee,
sits down with Dr. Sparshu,
to chat about a disorder that is very common, but frequently misunderstood...ADHD.
Oh, and if you're watching this on YouTube, we've used the Chapter Feature down below in the
playback bar. So if you have specific questions, you can scroll forward to those.
Hi Dr. Sparshu. So can we start with really understanding
ADHD. I was recently diagnosed in early adulthood, and I appreciate learning as much as I can.
So, what IS ADHD? Well, before we talk about what ADHD is,
why don't we spend a little time talking about what ADHD isn't?
And, ADHD is NOT laziness; it's not caused by
bad parenting or a lack of discipline. It's not just being a little bit spacey
or forgetful, or hyper sometimes. And, it's got nothing to do with
how smart you are. ADHD, or Attention Deficit
Hyper Activity Disorder, is what we call a Neurodevelopmental condition; which means
that the brains of people living with ADHD grow a little bit differently
than the brains of people who don't have ADHD; in particular, those areas that are focused on
Attention, Learning, Memory, Impulse Control, and Planning.
Now, everybody's brain is a little bit different, and
everybody living with ADHDi is unique. But, most people with ADHD have some symptoms that
fit within one of three big categories: 1. Predominantly Inattentive
2. Predominantly Hyperactive and Impulsive; or 3. Some combination of those two
With those sort of categories of symptoms in mind, how does ADHD affect people?
People living with ADHD have a lot of problems with
Focus, unless it is something they are very passionate about
or very interested in. Then, they tend to Hyper Focus;,
sometimes to the exclusion of everything else going on in their life. So, things like video
games and social media.....well, people with ADHD can spend hours and hours doing those things. But,
then, when it comes time to doing those boring, day to day tasks,
well, they can wander from one to another, struggling to get them done,
or forgetting what it was that they even set out to do in the first place.
Procrastination is a very common problem for people with ADHD.
They often do their best work at the last minute; or, they may have a million, brilliant ideas, but
struggle to make any of them actually happen. Frustration is pretty common, and
underachievement in school, and then later in work, is something that we see a lot.
People with ADHD often struggle with disorganization,
distractibility, and forgetfulness. And, for those living with the Hyper Active symptoms,
they tend to be talkers. They tend to talk a lot, interrupt other people, bud into conversations.
They have a lot of energy, may be very fidgety, restless;
and, they tend to do things first and think about the consequences later.
Almost everyone with ADHD also feel their emotions intensely. And, because of that,
it can sometimes be difficult to control how they are feeling. And, once their minds get going,
it can be difficult for them to relax and turn it off, which is especially a problem at night time.
Now, a lot of people might hear that and think "Wow! It sounds like me! Maybe I have ADHD."
And, there's the potential that they do, but it's important to remember that ADHD is more
than just a list of symptoms. It's a chronic developmental issue. It starts in childhood,
it impacts multiple aspects of a person's life, and causes them all sorts of problems over time.
OK, so I've heard the terms ADD and ADHD, so what is the difference between the two?
There isn't actually a difference between them. ADD....that's
just the old term for ADHD. Now, there are some people who like to say they have ADD,
as a way of explaining to others that mostly what they are struggling with
is the inattentive symptoms without too much in the way of hyperactivity and impulsivity.
But, ADHD as a clinical term is made to be this big umbrella that captures everybody with all
three of those clusters of symptoms. It's kind of like saying Attention Deficits and/or Hyper
Activity problems....it is just more of a mouthful when we say it that way,
so we usually just cut it down to ADHD
So, how to you diagnose ADHD?
So, when it comes to diagnosing ADHD, nothing beats a good clinical interview. And, part of that
is taking a family history. ADHD is highly heritable, so it's very common for one or more
family members to have been previously diagnosed. It's also not unusual for me to be asking
questions, and then one of the parents realizes that all those things apply to them.
And, they might actually have ADHD, but it just was never diagnosed when they were a kid.
It's important to look for things that increase the risk for ADHD,; such as, if an individual's
mom smoked, did drugs, or drank alcohol while she was pregnant, or if the person was born
with a very low birth weight? But honestly, most people with ADHD do not have a history of that.
What they do have a history of is some combination of the symptoms we talked about earlier, and that
they have been there throughout their life and are getting in the way of them being successful.
Sometimes we may run some tests, but that's mainly to rule other things out,
like if they have hearing issues. We may ask them to see a psychologist for additional tests, but
that's to look for things like learning disorders or get a better idea of their cognitive profile.
So again, nothing beats taking a good history. And, one of the things that I like doing is
looking at old report cards to get a feel of how they've been doing in school. And, when
I see teacher comments year after year, teacher after teacher, saying things like "Very bright,
but needs to apply themselves", or "Would do better to use class time for paying attention
to the lesson instead of talking and distracting peers", or "Constantly loses marks by rushing
through work ; needs to slow down and check over their assignments before handing them in",
well then it's a pretty good indication that the person may have ADHD.
Some people are harder to diagnose than others, like
girls for example can be a bit harder to pick up than boys, because they are
predominantly inattentive more commonly. So, if we have two kids, and the one kid is
bouncing off the walls, talking nonstop, interrupting others, getting into all
sorts of mischief; then, we have a girl who is quietly sitting there, staring off into space,
doodling, getting distracted by the squirrels outside the window; well,
it's not hard to guess which one the parent or teacher is going to suggest goes to see a doctor.
Yes, I know that was very much my experience. I was the kid in the back of the class not paying
attention, reading a book under my desk. But, because I really didn't struggle academically,
it didn't get picked up on as much. Yes, and adults are harder to pick up too,
because a lot of adults don't just show up with a parent in tow and a giant stack of report cards:)
So, you have to try to spell out your symptoms as best as you can through what
you have been experiencing in your life. It can be helpful though if you bring somebody with
you , like a partner or somebody who knows you well, to provide that little bit of extra history,
and make sure you get diagnosed appropriately.
So, following that, once you receive a diagnosis, how can you treat ADHD?
Well, diagnosis is part of the treatment, because
for a lot of people, when they realize that what they've been struggling with is a medical
condition, that can be very therapeutic. But, you need a lot more than just a label. So, you
have to work with your team to figure out what's causing you problems, and then work together
to find solutions for that. And in general, our interventions fall into two big categories:
1. Psychosocial Interventions; and 2. Biological Interventions
Psychosocial things would be like accommodations at school, getting extra time on exams, getting
to work in a quiet space with fewer distractions, or working with a coach or therapist for things
like emotional regulation skills, planning, using memory aids, countering procrastination habits.
It's also important to think about not just what are your challenges and how do we compensate for
them, but what are your strengths and learn to embrace and lean into those.
A lot of people with ADHD have great untapped strength. I know a lot of folks with ADHD who are
incredible outside the box thinkers. They ask questions that nobody else would think about.
They are compassionate, funny, spontaneous, and often really creative.
Then we have those Biological Interventions, and those are things like medications,
but they are also about taking care of your body, making sure that you are
eating a healthy and well-balanced diet, practicing good sleep habits, and that
especially for the people with hyperactive symptoms, they get lots of regular exercise.
So, touching on medication, I know that sometimes the first medication or the first dosage doesn't
necessarily work for some people? I was very fortunate that my doctor and I only needed to
make some minor tweaks. But, if not everyone needs medication, why would you risk it?
Well, it's important to treat ADHD as fully as possible and as early as possible
to give us the best chance of a good outcome.
Now it's true that not everybody responds to the first medication, and every medication carries
the risk of potential side effects. But, ADHD medications in general, tend to be very safe,
even for kids, especially when they prescribed appropriately and when monitored by a doctor.
If we think of ADHD like ropes holding you back from living your best life,
well, sometimes those psychosocial interventions are only enough to get your one arm free.
And you can still put up a good fight with one arm tied behind your back,
but why go through life that way? Life can be hard, especially as kids get older and the amount
of responsibility and expectation increases. It's important that we figure out what are
our obstacles, what are our frustrations, and remove as many of them as possible.
Now don't get me wrong, many people with ADHD are very smart and hardworking. But, that only takes you
so far. It doesn't matter how smart you are if you never remember to bring your assignments home, or
you can't get those brilliant thoughts going on in your head down on a piece of paper in an organized
ad coherent way. And, being hardworking..... there is only so many last minute, all nighters
you can pull before it catches up to you. And it's important to recognize that people with untreated
ADHD or under treated ADHD are at a much higher risk of developing other mental health disorders,
like depression, anxiety, and addiction. And, it impacts not just how you do at school or at work,
but your personal life. People with ADHD have a higher risk of things like unplanned pregnancy
and traffic accidents. There's a lot at stake,
so it's really important that you consider all of your treatment options carefully.
Dr. Sparshu, if you had one thing to say, what would be your take away message to kids with ADHD?
So, for people living with ADHD, I just want to remind them that you're not stupid or lazy or
unmotivated or incompetent or whatever else you may have been told over your life; or maybe
those are some of the things you've told yourself. The truth is you have a medical condition, and it
has impacted your brain, in particular its ability to focus. So, just like if you had blurry vision,
what you need to do is get a pair of glasses. For ADHD, there are a lot of safe and effective
treatment options. They may not always be easy or quick, especially when it comes time to changing
some of those things that you have been struggling with for years; but, it's worth it, so that you don't
have to spend the rest of your life squinting.
And, what about for teachers?
I honestly believe that every student wants to succeed.
Nobody wants to be told that they are underachieving, or that they are not
living up to their potential, or to be constantly reminded that they are
daydreaming or distracted or making careless mistakes. So when you notice that you are saying
that to a student over and over and over again, or putting those comments down on a report card,
it may be an opportunity to pause and think about why. It may be a chance to start a
conversation with that young person's family that gets them on a path to seeking help.
You can also be a part of the solution by implementing accommodations and learning
strategies in your classroom for the students who are struggling with ADHD.
And lastly, what would be your take away to family members and parents?
Well, I would say that hope begins with diagnosis. So, don't be afraid to reach out for help,
and ask questions and advocate for that person that you love .
Remember parents that ADHD is not caused by parenting. It's a neurodevelopmental disorder.
But just because it's hardwired in the brain doesn't mean that you are powerless
to do anything to change it. You can be an important part of the treatment team.
You have insights about that person that nobody else has; and since you love them,
chances are you are going to work hard to make sure that they get the best treatment possible.
It's important to take care of yourself through that process
because the treatment of ADHD is more of a marathon than a sprint. And, we want to make sure
that you are there with us at the finish line.
Thank you so much for talking with me today,
Dr. Sparshu. I definitely learned a lot and wish I had had some of that information earlier on.
It's my pleasure:)
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