Parenting is often lived in the extremes. It's either great joy or chaotic, overwhelmed. In one moment, you're nailing it and the next you're losing your cool. I want to help you find your way to the messy middle, to a place of balance. You see balance is a verb, not a state of being. It is a thing you do. Not a thing you are. It is an action, a process, a series of micro corrections that you make each and every day to keep yourself feeling centered. We are never truly balanced. We are engaged in the process of balancing.
Hello, I'm Dr. Laura Froyen and this is The Balanced Parent Podcast where overwhelmed, stressed out and disconnected parents go to find tools, mindset shifts and practices to help them stop yelling at the people they love and start connecting on a deeper level. All delivered with heaping doses of grace and compassion. Join me in conversations that will help you get clear on your goals and values and start showing up in your parenting, your relationships, your life with openhearted authenticity and balance. Let's go!
Laura: Hello everybody, on this week's episode of the Balanced Parent podcast, we are going to be talking about ADHD how it's diagnosed in kids and how to get your child the support that they actually need, that's gonna benefit them and help them be successful and have a really fun life moving forward. So, to help me with this conversation, I have Doctor Katia Fredriksen and Doctor Yael Rothman. They are two amazing neuropsychologists and they're gonna help us learn all about this. So, Doctor Katia, Doctor Yael, welcome to the show. I'm so happy to have you. Why don't Doctor Katia, why don't you go first and tell us a little bit more about who you are and what you do and then we'll, we'll go to Yael.
Dr. Katia: Absolutely. So, well, I can sort of do a little bit for both of us because we both work at the same group practice in Maryland. It's called The Stixrud Group, it's in Silver Spring in Maryland. And so we're both pediatric neuropsychologists, which means that we are, we are trained in clinical psychology. We are licensed psychologists and we have a specialty with, specialized postdoctoral training in neuropsychology and in particular for us with the pediatric population, which is sort of anything childhood through early twenties. Really. So sometimes when we have young adults come in, I'm like, yep, sorry, you're still pediatric. Even if it's probably not something a college student wants to hear. Right? But yeah, so, and so what it means to be a neuropsychologist is that we are, when we're speaking with younger kids, we'll sort of say we're thinking doctors, right? So we sort of help kids and families figure out how the kids brain works, what comes down to them, what are natural, sort of areas of strength, what things might be more difficult, whether that implies anything diagnostically and regardless of whether it does or not, what would be helpful at home, at school, et cetera, just as you sort of said in the beginning of your introduction to help make their lives as happy and productive and, you know, meeting their goals, right? And so in order to do that, we administer a battery of all different kinds of tests and activities to sort of see, you look at, we look at cognitive skills, language, fine motor attention, executive functioning, academics, socio, emotional functioning.
Okay. And so we're looking, we're wondering about things like, you know, always based on, of course what the parents or teachers or whoever brings up the concern, whatever the concern is that informs our referral question, but we're also just casting a broader net so that we can a come away saying, hey, little Billy is really good at XYZ. We want to come away, speaking about strengths as well as areas of concern and we want to cast a broad net so that we are sure we can catch anything that's underlying and subtle that people may not be aware of. So we're looking at things like ADHD learning disorders, autism, executive function difficulties, psychological anxiety, sort of vulnerabilities, those sorts of things.
Laura: Thank you.
Dr. Katia: Yeah, sure. Sorry, I went on a bit there but.
Laura: You’re great. No, you’re so good.
Dr. Katia: This is what we do. Okay, good.
Laura: I feel like.
Dr. Katia: I think that like for both of us. Yeah.
Laura: Yeah. But do you want to tell me a little bit Yael about your background at all or kind of what you, what drew you to this field, what you're interested in and why we're talking about ADHD specifically today?
Dr. Yael: Oh, sure, sure. I became, I, I think I've always been, I grew up with a family of medical doctors, a lot of medical doctors in my family. And I've always been interested in physical and mental health. As I went to college, I pursued a degree in biological psychology and thought I was going to medical school and then took a course on neuropsych and I had never heard of this profession before and I thought it was so fascinating. I remember hearing about the case studies that and studying the brain behavior relationships and I just really felt passionate for it. So I went on to do some research with children with different developmental differences, like epilepsy or like autism and then medical differences like epilepsy and continued to grad school and it was just I, I really love getting the chance to get to know a child so much more than other medical providers really do. We get to be with the child for seven hours?
Laura: Yeah. My.
Dr. Yael: Interview.
Laura: Oh, I was just going to say my 11 year old went through the neuropsych process over the this past summer. So almost a year ago now we started in it. So I definitely sat in a neuropsychologists office for those seven hours. She had two days. She's on the autism spectrum. We had a wonderful experience with our evaluator. She loved the process, loved the tests. And so I guess maybe this, that's a good place to, to start because I've gotten a lot of questions since. So my daughter has, is very open about her diagnosis. She really wants me to talk about it because she thinks it'll make it easier for other kids to talk about it and easier for other, you know, parents to get support if they need it. So when I started talking about it, I got a lot of emails from people asking me how we explained what was going to happen to our daughter, why we were doing it and how we handled it in a way that made it ended up making it very positive for her. And I felt like you guys were the perfect people to start that conversation with. So I, I'm kind of thinking about the parents who are, you know, maybe their bells are starting to ring that maybe an eval is, is necessary. Maybe they've gotten that feedback from teachers or other adults in their child's lives. So how does that conversation start going with the kiddos when you decided, you know, to call, get on the waitlist because they can be long. We were lucky. And, and start having that process get started for your kiddos. Do you have any tips for parents?
Dr. Yael: Of how the parents can tell their children about?
Laura: Yeah. Yeah. Yes. Yeah.
Dr. Yael: I, I think that, it can, the conversation can often go in a positive direction when you use the child's words. I like to direct parents. Like, what has your child noticed and that they're frustrated with, oh, you know how math has been like a little harder lately, we found someone who's going to look at ways to make school a little bit easier for you and, or you know how you've been saying how you feel really frustrated that, kids aren't playing the same games you want to play all the time or you know how you've said XYZ. And I like to really pull in and that's why we found doctor. So, and so, and they're going to see how you think and learn best and then we'll figure out ways to make this situation easier and more positive for you. So I like that to pull in their words. I like to say that we are not medical doctors that give shots or take your temperature and things like that. So children know they're not walking into a lab, kind of, you know, a doctor's office, it's more of a thinking doctor. You're going to do different activities that maybe you've never seen before, like puzzles and draw some pictures and answer some questions. So, but Katia, do you want to add to that a little bit?
Dr. Katia: I think that's great. I mean, the only thing I would add is that it's, it's a useful vehicle when the child is already participating in or has previously participated in either therapy or ot or speech because then you can say, oh, you know, when you go and see Miss Jen, it's gonna be kind of like that. So it just normalizes the whole process. And I like how you said activities. Yeah. I, I, I like to use the word activities. I don't know, I feel like testing just sounds kind of threatening. And, you know, I'm in need of anxiety provoking. And so I tend to say activities, although it does sometimes backfire because sometimes at the end a six year old will be like, well, those didn't seem like games to me. And you're like, oh, I'm sorry.
Dr. Yael: I, I try not to use the word game.
Dr. Katia: You can play games, say activities.
Laura: That's interesting.
Dr. Katia: That these are not games.
Laura: My 11 year old had a lot of fun. She thought they were games. So I can understand why maybe a six year old wouldn't.
Dr. Katia: Well, a lot of kids do, a lot of kids really do. I mean, especially kids who are comfortable with adults and who are sort of curious and interested in things that are new or might be a little challenging or, yeah, I mean, really kids will and some, and sadly, I mean, some of the kids who don't particularly like school very much, you know, obviously that's not a good thing, but it does make them happier to come and see us because they're quite excited about getting a little break from the school day.
Dr. Yael: So I would also tell parents, if there are any concerns about their child's engagement or anxiety about kids meeting someone new, you could, I would recommend talking to the professional about that and sometimes in some occasions we schedule another day just to meet and say, hey, and here's who I am and this is my office and here's my shelf and here's a book that we might be looking at together if you really think, that there's any concerns there, please tell the professional and they can come up with a nice plan too.
Laura: That's lovely. Thank you. Okay, so let's hone in a little bit on, on ADHD. Can you tell me a little bit like I, so I feel like there's ADHD is having a moment, right? It's very big and out there and I feel like there's maybe some misconceptions about what ADHD is, how it shows up in childhood. And so can you talk to us just start off from the very beginning of, you know, what is ADHD? How is it diagnosed? Maybe? How does it look different in kids versus all of the adult stuff that we're seeing on TikTok these days? Can we dive in there? I saw, I saw a smile on Katia's face when I talk to TikTok.
Dr. Katia: Oh my gosh. Yeah, I know that there's such a, I mean, there's such a wide variety of material there that is often questionable. Yeah. So, not always but, but often, so, ADHD and I'll, as you said, I'll start at the beginning. ADHD stands for attention deficit hyperactivity disorder. There are various, there are lots of different ways that this can look. Right? So you've heard the old, you know, if you've met one person with X, you've met one person with X. Well, this applies to ADHD as well, right? It looks very different in different people based on gender, age, just individual characteristics. But so the broad strokes are, there are three sorts of things that you as a clinician are looking for as you consider this as a potential diagnosis. One is that the person in question has difficulty focusing and sustaining attention, particularly when they are being required to attend to things that are not interesting to them that are either hard or perceived as boring, stressful, et cetera.
In case, so that's one piece you're looking for. You're looking for difficulty inhibiting impulses that could be observed in the person's behavior. So this is the kid who's always cutting line or, you know, that sort of thing or it could be observed in their approach to tasks. So they're always rushing through their work and wanting to be the first to finish. So it can look different in different people. And the last thing you're looking for is difficulty regulating their sort of their activity level, their motoric restlessness fidgeting, sort of always on the go that sort of difficulty sitting still. So you're looking for some combination of those three things. And, and it's gonna look different in different people and there are different subtypes of ADHD that can encapsulate those distinctions. So there is the pre predominantly inattentive presentation which refers to the kids who are more of the inattentive destructible daydreaming zoned out kind of presentation. There is the predominantly hyperactive impulsive presentation which, yeah, and I was saying we've never actually, I, at least I, I've never actually diagnosed because it, it tends to you at once. Okay? Because it, it's like it tends to be accompanied by the attention piece as well. And then there's the combined presentation which is all of the above, right? And so there are specific diagnostic criteria that you that you look at and there are certain numbers of traits that you need to see.
And you need to see them in more than one place, right? So if we have a kid who is looking quite sort of fidgety and inattentive at school, we need to also be hearing concerns about those sorts of characteristics, either at home or at soccer practice or at religious service or while they're sitting with us in the office. Because if you're just seeing it in one setting, that could be something related to the setting more so than the actual individual child. So just to do due diligence and the the diagnostic criteria require you to see the traits in different settings and also they require you to see the traits be sufficiently significant that they're impacting the person's life. Right? So, there is this, everybody, sort of, you know, a lot of people say, oh, I'm so ADHD this, I'm so sort of like, oh, man, I real ADHD moment the other day and it's like, well, that's, oh, well, and good. And certainly I, you know, empathize with your experience but it's not necessarily ADHD the, you know, quote unquote proper diagnosed ADHD.
Laura: A meeting the criteria, right? These are, these are human traits, these are just human traits. You have extra choices. Yeah.
Dr. Katia: Exactly. On a spectrum. And so it needs to sort of surpass the level of, you know, typical day to day experience for people where it's actually having a significant impact on the person's functioning. And so, you know, you had asked about sort of how it looks different at different stages. And so you, we know that ADHD is associated with the frontal, the development of the frontal lobe of the brain, which is developing well through our sort of mid twenties, late twenties, I feel like each time they look at it it's longer. And so, yeah. Right. And so, as those areas of the brain develop, we, you know, we hope and expect to see associated menstruation when it comes to those ADHD traits. So, of course, again, as we've been saying, everybody's different and you can't really take out your crystal and prognosticate. But that being said, I mean, often what you continue to see in adulthood is more of the higher order executive functioning, vulnerability, sort of the inattentive, forgetful, disorganized. The piles of papers, the missed appointment, the late for lunch with friends, that sort of stuff. And again, I'm just, I'm speaking in generalities, but this is what you, you may often see lingering into adulthood.
Laura: Okay. I, I have a question on the age thing. So I, a lot of what we think of with ADHD when kids are young is pretty developmentally normal, right? Not being able to maintain focus trouble with impulse control. So can young kids? I be diagnosed with ADHD like at what age should we start we think, like start thinking about moving into an evaluation pro pro process because I think that lots of people get their, you know, their, the ping in their brain and gets on their radar at quite a young age, probably too young. What do you think?
Dr. Yael: So, giving a diagnosis can happen even at very young ages. But you would see pretty extreme behaviors. If you're thinking about like a preschool student to get a diagnosis, it can happen. I've never given a diagnosis to a preschool student before, but I do know of people who have and it was because of extreme behaviors that were happening. However, keeping an eye on behaviors, if you're hearing from the preschool teacher about things that make, behavior more complicated in the classroom. If you're seeing things that make life very challenging at home. If your child is complaining about certain things, I would bring it up to people. Maybe you're a pediatrician and, and talk about it a little bit. The answer is often to monitor, and maybe put in place some supports to make life a little bit easier.
Oh, here's some, structured plan that could be helpful. A routine at home if you think that could be helpful for your child. But an, an evaluation may not be the first thing that people would recommend at that time. But I, I think both Katia and I really believe that if you have worries, ask, I, I think you don't have to keep those asking people asking the teacher. Hey, I see this at home. Do you ever see this in your classroom? And having a conversation about that or asking the doctor and then, and, and kind of writing it down? Katia always has a beautiful thing that she says, think about it in like four, put a note on your calendar, four months. Did this behavior go away that I was worried about or has it changed something? So to remind you because in the moment, it's hard to see what's been going on in the moment. All I see is how frustrating this behavior might be but is this just today or is this something that I see every day?
Dr. Katia: Right. Is this a phase? Right?
Dr. Yael: Yes. Yeah. And that is why most professionals I would say do diagnose a little bit later. There is not as many diagnosis in early childhood because behavior is so variable. I don't know if anyone listening or if you have observed a preschool classroom, it's going to be totally different from one child to the next.
Laura: And one day to the next.
Dr. Yael: Like one day to the next, the kids in the classroom range from 3 to 4 and that development is so different. I love watching my own child and seeing that and, and experiencing that. So I a lot of it is kind of monitoring and then supporting what's going on but asking for help or questions to be answered for sure. And some people call us just to do a consultation just to ask a question or two, which I think many professionals would be open to as well, but Katia would, you want to add to that at all?
Dr. Katia: Well, I'm just, well, I think that's that's a really thorough answer. I mean, the only thing I wanna add is just, I think sometimes and I'm and I've been guilty of this as apparent. I think sometimes we are afraid to ask the question because we're afraid of what the answer might be. Right? So we have a worry and it's almost, there's this magical thinking, well, if I don't ask about it, maybe it'll just go away and nobody else will notice it and it's not a real thing. Right? And, I can completely understand that. I think we've all been there at one point or another. Just again, like, yeah, I was saying, give it, give it some time. But if it's still there, I mean, it's really worth following up on because the more you wait and see and wait and see and wait and see. You know, you may miss out on some some windows when it would have been really useful to put intervention or support of some sort in place. So I would just, you know, try to ask the question.
Laura: I really love that. I love this very specific recommendation to you of putting a note in your calendar four months ahead to kind of check back in. I really love using our modern, I think our modern tools and technology can sometimes take things away from us in our parenting. But this is a time where it can really add to us, you know, add be a benefit for us. I, I really love that suggestion. I love that kind of wait and see, but with intention and consciousness approach, as opposed to just kind of waiting and seeing and ignoring, I think it's hard for parents when they're getting feedback from an adult or their you know, in their child's life, like a teacher or they're seeing things, I think it's really hard for the average parent to piece out. Okay. So what is typical, developmentally appropriate stuff? And what is extra, what is more than what's developmentally appropriate? And I feel like there's not a lot of confidence in like, okay, so when do we actually need to make that decision to go and get support? Do you have any tips for parents who are in that place?
Dr. Katia: Well, I mean, I think so, I tend to say, well, a speaking to the teacher, right? Because the teacher has, is in the exact perfect position to compare the child to children of their same age, not just in that classroom, but in the years of previous classrooms the teacher has had, right. So I think the teacher is a wonderful resource. Excuse me. And I would also, I mean, I would go to the pediatrician because,, you can just set up a consult check in with the pediatrician. Say, hey, these are my concerns and they'll give you a standardized questionnaire to fill out and then they can score that questionnaire. And again, it will compare the way you rate your child at that age to the way other parents rate their child at that age. And so that'll give you an idea of, of whether something is quote unquote nor normal or not.
Dr. Yael: And, and we talk a lot about how parents really know their child the best out of anyone. Right? So, trust your, trust yourself and, and ask for help if you really feel like something is not quite right. And if a professional tells you, hey, actually that's a behavior that we commonly see in development. What, how awesome that you sought out that and got that answer. And that's great. And that's still really good to find out. It is really hard to piece apart, especially in early development. What is developmentally, typical and what isn't because they overlap completely a lot of behaviors in developmental diagnoses like autism ADHD, do have very typical beginnings. We expect children to have repetitive motor mannerisms as toddlers like that is something that is commonly seen in little ones. But as you get older, you don't see that. Right? So these are rooted in typical behaviors that become atypical as time goes on.
Laura: Yes. Yeah. Like my, my 11 year old when she was around four, she became obsessed with dragons and she was a dragon most of the time from 4 to 6 and that was fine from 4 to 6. And then she continued to be a dragon through seven and eight and then it started causing social problems, you know, and those are things that, you know, like something that started out, you know, very, very developmentally typical, you know, and her special interests have moved on past dragons now she's got Taylor Swift going. Which again is, you know, not a problem for her. She's, you know, like, but the, I, I see what you're saying that those things can, you just have to keep an eye on them?
Can I ask you? So kind of on the flip side there, a lot of parents feel worried about getting a label or a diagnosis for their kid. They feel worried about getting their kid pigeon holed in a certain way. They feel worried about some kind of stigma. And I'm curious about what you would have to say around what are some of the benefits for getting your kid evaluated and possibly diagnosed? Especially when we're talking about ADHD. What does it give access to for your child? What kind of support does it allow parents and their teachers to, to give to a child? What are, what are the benefits?
Dr. Yael: Yeah, so I would first step back and as a parent try to figure out where the worry is coming from from you. So a lot of times parents come to us with a worry that if I give a label to my child, it will make them feel less than or lack self-confidence, feel different. Unfortunately, what happens is mo so first of all children are more self aware than we give them credit for.
Laura: Yes.
Dr. Yael: So I think everyone should be thinking about that, that kids, if you think something's not going quite right. The child knows that something is not going quite right. But when we don't have a word or understanding of why something isn't working out for us, we often will go to a negative self attribution. And so a child could be, oh. kids don't want to play with me. I must be stupid. I must be weird. I must be a problem. I can't do math the same way that my classmates can. I must not, I'm never going to know anything. I so something negative go into their head. So instead we could give them this, this idea, this profile. Hey, actually you're a really bright kid who knows so many things and this is one thing that's a little harder for you, but we know how to help you. So that would change. It's not, instead of giving them the poor self esteem, it would actually increase your self esteem, make you a better advocate for yourself. Help connect you to other people and understand how your brain works and thinks best. So if that's where the worry is coming from instead, it would actually be a more positive label than the one that they probably are thinking about themselves in those moments when they have no understanding.
Laura: Gosh, yeah.
Dr. Yael: Another worry. I’m sorry, yeah.
Laura: I just really love.
Dr. Yael: I’m sorry, yeah.
Laura: No, no, I just really love that reframe. I think our kids are going to make sense of what's happening to them in the world around them and having having that as something that helps them make sense of it. Having it kind of an informed perspective to come from is really beautiful. So thank you for sharing that.
Dr. Yael: Definitely. And, and all of these worries are so understandable. I mean, and expected, I mean, these are your children, you want to protect them and, and support them. Sometimes parents also might have worries from when they had uh a diagnosis as a child, which does happen a lot. We know these are genetic components, there are genetic components in these diagnoses, but we've come a long way, the stigma has reduced over time. We understand how our brains work better. We understand interventions and supports better. So their experience might be, I am expecting will be quite different than their child's experience will be with this diagnosis. So that's another thing. So what are the benefits for a child to hear about their diagnosis are just what I mentioned before? It's to empower them.
We want children to understand. Here's how I think and learn best and then be able over their lifetime to advocate for those needs. Hey, I do really well when I get to sit in the front row, is that okay? Is that where I can be today or I really am gonna need to write this down or take a picture of the board if I need to remember what we're gonna talk about today. So I, I'm gonna need that accommodation and it, it, it helps them as they move through life to become their best self advocates and, and and feel empowered and learn about the gifts that come the diagnosis as well and we can talk about those in a little bit, but it's not all challenges when you're a different thinker. It also is some beautiful gifts that can be attributed to the diagnosis as well.
Laura: I would love to hear what some of those are?
Dr. Yael: Sure. Should I keep going or Katia do you want to take?
Dr. Katia: I'll jump in and you can take a breath. Sorry.
Dr. Yael: No, I, I know I can go on. We both know.
Dr. Katia: I know. Me too. Oh my God. We, we like we are boxes man.
Laura: It's so fun to hear it. People geek out on a topic that they love. So it's good.
Dr. Katia: Oh, yeah, totally. Oh my gosh. Geeking. Them here. Yes. Well, drinks. Yes. But there was one other thing you had asked about. I don't know if you want to continue with strengths or, or go back to that, but you asked about like access to services and I think that sort of benefit that is confirmed diagnosis. Which direction do you want to go in?
Laura: Let's go with the, the access to services and supports and then we'll go into, you know, into.
Dr. Katia: Okay. Well, so that's a secondary piece. So the first there's the I mean, there's the child's just personal insight and understanding and sense of self worth. And, and, and, and the parents, insight and understanding, right? And, and I think it's so important for many parents is this idea of distinguishing between what a child is not yet developmentally ready to do versus something the child is choosing not to do in order to be aggravating to the parent, right? So we refer to it as the the can't do versus the won't do, right? And so an aspect of it's very helpful with diagnosis is helping parents under it really sort of helps parents understand. Oh, wow. There are certain things that you know, my kid may just not be ready for it yet. I may need to sort of modify this demand, put more sort of structure scaffolding in place, et cetera. And that will create a less frustrating experience for everyone in the house, right? So, so for the the children and the parents knowledge and benefit, but then also as regards services at school, for example. So it's, I mean, you know, it really varies from school to school. Whether they're independent, whether they're public, whether they're in this district or that, I mean, it doesn't matter, it just varies from school to school. There's no hard and firm rule. But so some schools will offer accommodations informally.
So we come across that a lot in the course of our work where parents will come in and say that the kid is already receiving some sort of accommodations like preferential seating or access to headphones or whatever it is something. But nothing has been formally documented. And so in some cases that may be adequate in other cases, it may not be. And again, it's a very case by case sort of situation. But so in general, though the idea is that in order to trigger essentially the special education laws, your child needs to have a formal diagnosis and you use that as a platform or the evaluator or whoever pediatrician or whoever clinician uses that as a platform to request specific interventions or supports accommodations for the child at school. And so, you know, you alluded to the IEP. So there's the 504, which is the accommodation plan, which means that the academic instruction, the curriculum things are being delivered. It's the same content.
But there may be a difference in the method of delivery or the way the child is treated or in, in other words, where they can sit and you know, they can have the fidget or they can have extra time, those sorts of things, it's the same content. And or there is the heavier duty IEP which refers to when a child is being given a direct service of some sort or another at school. So it's you know, some sort of pull out for learning support or portion for learning support for speech, for ot for counseling, whatever it is. Okay. Or, or there could be, you know, obviously you can, well, obviously, but you can also access these sorts of plans via medical disability. So there may be some physical sort of gross motor or maybe something else that the child can support with that will also access you those sorts of plans. But so that's the other another reason why it's useful when there is a diagnosis to call it what it is and to spell it out because then you can you, you, the child has certain legal rights based on that diagnosis.
Laura: Yeah. And so I, I feel curious, I, I guess I do want to talk about kind of the positive attributes of ADHD the gifts that, that come along with the diagnosis. But I feel curious about and something that parents who have a kid with an ADHD diagnosis struggle with is what does that actually mean for their kids functioning and how to make accommodations, how to shift things? And I know that they will, you know, every everybody, you know, like you said their ADHD is very individual. And very, you know, the approach needs to be tailored to the kiddo that has, has the ADHD but what are some of the general things that kids might struggle with, let's say, let's just keep it, you know, let's let school be school, let's just keep it at home. How my, my ADHD struggles show up at home and what are some of the things that parents can be thinking about at home to support their kids?
Dr. Katia: You wanna do struggles? Yeah. And I'll do interventions or vice versa.
Dr. Yael: I, I was thinking yeah, we, we can keep adding to each other. I was thinking about how these can, again, they'll look different from one person to the next. Let's say it's about following directions and that's really hard to keep all of these directions in mind. One thing that we often preach is about making things more visual, writing things down having routines and structure at home in the written form. I've had fun conversations with families about how a young child spends 30 minutes in the shower, but never uses soap, right? They're just playing in the shower and enjoying it and daydreaming and feeling the water on them and then they put a laminated schedule in the shower that says first you wash your hair, then you wash your whatever it is. A whole list of parts that are going to be washed and that child had more independence there instead of the parent opening the door and yelling. Did you wash your hair yet? Did you do this yet? Did you do that yet? It now was a checklist that was, there for the child to get to know and, and, gradually get comfortable with. Katia, I realize I'm saying an intervention as well. Sorry.
Dr. Katia: Oh, my goodness. Speaking of following instructions.
Dr. Yael: It's true. I'll need that support.
Dr. Katia: Speaking a following instructions.
Dr. Yael: But structure and routines and visual schedules are great for all kids. A lot of kids do really well with these and can be really nice interventions for children who are struggling with you repeating yourself over and over again at home about following an instruction making this like the morning routine as well. You can print it out in the mirror and again, this gives the young person more independence. So it's not the parent constantly reminding they can go through it eventually on their own. And you can do this with everything. Packing the bag can have a little visual schedule,making a lunch can have a little routine for that and that can be a really nice piece there.
Dr. Katia: Right. Because it increases independence, which in turn increases self confidence and also is increases the parents or decreases the parents blood pressure, I guess. So it's positive all around. Yeah. And we also so there are various sorts of, you know, we often talk to parents about strategies to use at home. And so that's a big one is the visuals. We talk to parents about health behaviors about sort of maximizing sleep. We talk about sort of what the National Sleep Foundation and these sorts of places there are set. Well, a range of sort of hours recommended for each age range. So that, and, you know, obviously they're gonna be outliers, but just it gives you an gross idea of, you know, elementary school age children, 9 to 11 hours nightly are recommended. So, so it gives you sort of a gross idea of.
Okay, so, if we have, you know, if I want bedtime, so Jimmy has to get up for school at 6:30 or whatever. So I want bedtime to be 8:30 maybe. So then I can count back and figure out, well, I have to start the routine at this time and we have to eat dinner at this time, you know, and so you can sort of work that out. And so we, we really encourage uh the sleep is a huge component for so many things ADHD included. And so tough these days with the screens and the phones and all of this business. So we talk a lot with parents about sleep hygiene about getting just the basic common sense stuff, getting some sort of regular physical activity. Common sense, nutrition and hydration. So those sorts of things are very important as well. For, you know, things that parents can work on at home.
Laura: Can you talk to me for a second about screen usage? And kiddos with ADHD are kiddo, like I feel like there is this kind of sense out there that kiddos who have ADHD are more drawn to screens. And I'm kind of curious about that. Do you know any of the like the research or data to support that or why that might be?
Dr. Yael: So one of the things that can be a, a gift along with ADHD and also can be a complication is a tendency to hyper focus on areas of interest. Which is really fascinating because you, you don't think about that in ADHD. You think more of the attention deficit versus the attention hyper focus and screens are a very common one in the population. I do think there was some research showing that there was a higher use of screens in ADHD . However, it's probably coming from a lot of different reasons. Some being family life, like we parents who might be dealing with a child who needs more attention for their hyperactivity and impulsivity might need those moments to get things done and, and have that screen time. So it, it might be for some uh family systems to get by. It, I, I think that it can also be, you know, just a very strong area of interest for most children right now, a social peace as well that goes along in, in it here too. When we get concerned, I think about the use of screens is really when it's getting in the way of other activities being completed.
So, we don't say I, I don't think I've ever said like you have to remove every screen. I've never given that recommendation. It can often even be a soothing technique for some that I have quiet time at the end of my day. But if you, your child is using the screen so much that they're not able to do other activities, they're missing out on different activities. That's something to now reassess and understand and to make sure it's not impacting sleep. We know that we would recommend just as Katia was saying before about sleep hygiene that screens not be used before bedtime because it can actually activate us instead of get us tired. So are probably the, the main things we think about with screens unless you wanted to add anything to that, Katia.
Dr. Katia: No. And I mean, we often talk to families you know, when kids are a bit older and have their own phones or ipads or whatever, we, we tend to recommend that those not be in the bedroom at night. Right? And I, I have had, you know, very sort of, rigid teenagers who have really rebelled against that recommendation. And parents have said, well, she, she says that her friends might have an emergency and they might need to contact her in the night. And her friends have, blah, blah, blah and, and she just won't let go of that phone. And I always say, well, tell her to just give the friend the, do you have a landline? Tell the phone? Tell her to, give the friend the landline number if it's really an emergency. Surely, surely you won't mind the friend. No, I mean, then, you know, it will only be an emergency under which circumstance the house. I mean, you know, so I feel like, kids have very strong feelings about this and you really need to sort of think through. Okay, is there a way I can reassure you, to get you on board with this? So I don't have to battle with you on it every night. Without sort of giving up, without over amod you and giving up on what I think is an important thing for your well being.
Laura: I think too for those of us who have younger kids starting now with ourselves, like keeping screens and phones out of our bedrooms ourselves is probably good, right? So modeling that ourselves. So that when the kids do get phones in the future. They already know that everyone leaves their phones in the kitchen. Mom and dad included. You know? It's a good idea.
Dr. Katia: It's good to model the behavior. I mean, it's so hard but we need to try to practice what we preach. Right?
Laura: Yes.
Dr. Yael: And another thing that, screens don't have to be the enemy. They can be a helpful tool. These individuals as an, young, as a child becomes an adolescent, it actually there can be really cool apps to help with scheduling and organizing and different things that you can use these to be beneficial for everyone as well, I think can be helpful.
Laura: Yeah, you can use them to offload some of the executive functioning.
Dr. Yael: For sure.
Laura: Beautiful. Okay. So you mentioned Yael the kind of hyper focus, what are some of the other positives and benefits to having ADHD?
Dr. Yael: So research has actually shown that individuals with ADHD are more creative than individuals without ADHD more out of the box thinkers. And that's really interesting and awesome. And you can see that there's a high proportion of a high number of CEO s who have ADHD which you think about people who have created and come up with an idea and then started a business about it. So that's really cool. Some things like being spontaneous. It can be a beautiful asset at many times. And that's something that goes along. A risk taker, I there, can definitely be some beautiful things that be, uh, being a risk taker can support in, in your life. And, and being really interested in a topic, hyper focusing can actually lend itself towards different careers later on. I think there's been some famous athletes who have talked about how being hyper focused because of their ADHD on their sport lend themselves to become, you know, in the Olympics. And, and it's a really cool trade as well.
Laura: Katia, did you have anything to add?
Dr. Katia: No, I was just thinking about just the benefits of the hyperfocus. I mean, again, almost like a bad thing hyperfocus. Like it just sounds like a negative term and it can be when you're trying to get your kid transitioned off.
Laura: I was gonna say the transitions can be really difficult when a kid is in hyperfocus.
Dr. Katia: The transitions can be pretty hard, but it's so often things, there are two sides of a coin, right? I mean, so energy level, I sometimes I just chuckle, watching the kids in the waiting room at the office or watching my own kids and thinking my goodness, I wish I could bottle your energy and sell it and I would be a gazillionaire you. But like, I mean, these things, all these things, they have their side which can be more difficult to manage and then they have a side that's actually really quite positive. It just needs to be directed properly.
Laura: Great. Okay. And so one of the other things that, I wanted to make sure that we talked about is the differences in boys and girls and how ADHD presents and why we seem to be missing ADHD in girls so much.
Dr. Katia: Should I go ahead?
Dr. Yael: We need like a wink. We needed that.
Dr. Katia: You need a signal.
Dr. Katia: Yeah. So, yeah, because they can't see this if we look like, make weird winks, nobody can tell. So, right. So this is, this is one of those you used the word earlier Laura misconception, I mean, right. So there are lots of misconceptions out there about ADHD and one is essentially that it's like a boys issue. That girls don't have ADHD and that misconception arises from the fact that again, speaking in generalities, girls tend to present more frequently with that inattentive presentation that we discussed earlier, which is more subtle, it's less readily evident. So if you imagine yourself as a teacher sitting in a classroom with 30 kids, and there's the one kid who's sort of sitting on the side quietly doodling or looking out the window or just, you know, just seeming to be a lot, that person will not catch your attention it's really gonna be the kids who are, there's some sort of, behavioral manifestation who are gonna be more, who are going to be more readily observed. Right? So, and so that can happen at home too, right. I mean, so same sort of principle in all sorts of different settings where these girls can just slip under the radar.
And again, I am speaking in generality, so there's certainly, boys for whom we use a predominantly in inattentive presentation diagnosis, subtitle or subtype. But just again, speaking in generalities, that's often the case for girls. And so it can lead to a situation where very often these girls are quite bright, they wanna do well, they manage to sort of mask either intentionally or unintentionally. These symptoms are masked when they're younger and then they at some point or another, though most kids will start to hit some sort of wall as the difficulty level rises, the level of output demands and complexity rises. So middle school, high school, college and adulthood, women were diagnosed with ADHD and I mean, it was there all along, it just wasn't, people weren't aware of it this much. And so that's one of the reasons why sort of rates of ADHD diagnosis have increased over time is that we've gotten better at noticing these kids. And it's important to do so because even though you know, the repercussions may not be obvious there are repercussions, there are effects on learning, there are effects on emotional well being social functioning. And so it's really important to catch these kids so that we can give them the supports they need.
Laura: Yeah, there's even studies that tie, you know, ADHD to differences in lifespan too. So, the range is between 7 to 10 years of shortened lifespan for undiagnosed ADHD which is really interesting to think about. Like that is a, you know, that's something sorry, untreated. ADHD not undiagnosed. It, it, it's something that in any other diagnosis we would not, would be, it would be a big deal, you know.
Dr. Katia: Well, and when you allude to, I mean, you mentioned untreated. I mean, so one thing we haven't mentioned is medication, right? So that's a first year treatment recommendation that we make to families. So there are lots of things that can be done at school that can be done at home in terms of parenting strategies, health behaviors, et cetera, accommodations. And then we always recommend learning about and, you know, learning about medication because that is.
Laura: So what’s the parents are really nervous about that?
Dr. Katia: For sure. Oh, for sure. We have that conversation all the time. I mean, and so we're not MDs, we're not medical doctors. We don't prescribe, but we do know a fair amount about it just based on our experience and training and so forth. And yeah, it's scary. It's scary to medicate your child for sure, for sure. And, you know, so parents, rightly so have lots of questions about it and the efficacy and the safety etcetera. And, I mean, fortunately we're able to tell them the stimulant medication, which is the first order medication used in the treatment of ADHD is, has been used with children, I think since the sixties. Right? I mean, it's been around for a long time. So there's a lot of long term research on the safety and efficacy of the medication. So we can really point to some good data, which is not always the case with medications that are used with children very often. It just gets piggybacked onto adult research.
Right? And so with this one, there's a lot of long term, and there's a lot of sort of long term data that you can point to. And yeah, so I, I totally understand that. It's scary. I mean, the other thing I, I always point out to parents too is that really, it's something that is in and out of the bloodstream in the course of a day.
So it's not like one of these medications, like if your child is taking an SSRI, I like an anxiety or depression. You know, it's like a Prozac or whatever it is where you have to work up to a therapeutic level and you have to be at that level for a certain amount of time before you see an effect, et cetera, et cetera. It's really just you will see what you will see over the course of that day. And if there is something that you really don't like or your child is not comfortable with, you are not obligated to read, administer the medication the next day. So I think having that feeling of control and, and we will say, and often times it is trial and error, the first thing will not always fit. And so, you know, if you see something you don't like, that's fine. That's okay. That's normal. You know, your doctor can prescribe you another one to try. It's just everybody is different and everybody one size does not fit all right? So, I think that having that control over it helps parents feel more comfortable. The more informed we are and the more control we have when we're doing an an intervention like that with our child, I think it really helps us feel more comfortable.
Laura: Yeah. And do you recommend that parents take their kids to see a child psychiatrist to get medication prescribed or is your family doctor or pediatrician an appropriate place to go?
Dr. Yael: It's a great question. Almost all pediatricians, all the ones I've ever worked with are very comfortable with the class of stimulant medications. So that could be a totally great place to begin. I, I would say psychiatrists are also very comfortable with this. They are special. The pediatrician is more of a generalist. So if you are comfortable with your pediatrician, you feel like this is someone who knows you and understands you. I think that would be a great place to begin if you would feel better. Seeing someone who only sees individuals who have, differences and who need medication versus the pediatrician who sees probably mostly well visit, well visits, uh, kids who are doing pretty development, who are developmentally typical. So that, that would be the difference. Psychiatrists,often, at least in our area are hard to get into and see and they can have long waitlists and sometimes don't take insurance. So that often will push family to see their pediatrician who again is usually very well versed.
Dr. Katia: Yeah, I would, I tend to same thing. I tend to think it's, it's best, you know, provided you're comfortable and you like your pediatrician, although you wouldn't continue to see them otherwise, if that were the case. Yeah. So, I would start with your pediatrician and, and more I think of, I, I would send someone directly to a child psychiatrist or adolescent psychiatrist more if it's a very sort of a complicated picture, like there are multiple things going on that the child is depressed and they have ADHD and, you know, there's just more of a complicated picture and we just want to be absolutely sure we're crossing our Ts and dotting our I's, but if we're looking at ADHD on its own, I always just say head off to the pediatrician, it's much easier and more cost effective, and time wise, much more efficient.
Laura: Okay. And are, you know, so I know here in the US and in Canada there have been some shortages around ADHD medications. Is that ongoing? And is that affecting kids?
Dr. Katia: It is ongoing and it's no fun.
Laura: I'm sure it's not.
Dr. Katia: Oh, yeah, it is ongoing. And, so, yeah, it's just so hard because everybody is so busy in their lives and it's just an added stressor it's an added demand and, you will find yourself in certain months, like on the phone. I, I mean, I have a, one of my daughters has ADHD and is medicated. And I was, I had, I feel like I post it on my laptop with all the local pharmacies and their numbers. And there were months when I would just be going down the list, call, call, call, call, call and there were months when we needed to change her medication to accommodate what was available. And it's very frustrating. But you,, you know, it's just one of those situations where you just have to do the best you can under the circumstances. And, it's, but, yeah, it's hard and it's ongoing. But it does, seem to wax and wane so certain medications that were once difficult to get are now. So it just seems to see.
Laura: Yeah.
Dr. Katia: So it can be easy one month hard the next month. Just unpredictable.
Laura: Okay. Have you seen any changes in being for families being able to get the diagnosis or resistance within other fields to accept that diagnosis? Because I, I feel like there is a, there is a kind of a vibe in the air that ADHD is being over diagnosed all of a sudden. And I, I highly doubt that that's the case, but I do think that some, you know, I've heard from some parents that some doctors are skeptical of ADHD diagnosis coming in. I'm curious if that's something you've experienced and how parents can kind of deal with some of that skepticism around. Perhaps it being over diagnosed.
Dr. Yael: I think that this is coming from a few different places. One is that there are more diagnoses over time because we become more aware and better understanding of these more subtle presentations, the more inattentive presentations. And so it is becoming more accurate that way that we are the the diagnosis we missed were getting better at spotting. We are evidence based practitioners. We follow the guidelines and, you have to talk, we talk to multiple sources to see if symptoms present in different settings. And we are lucky to work amongst people who would do the same if there is a professional who is just saying yes to everybody who walks in their door and saying yes, that's ADHD ADHD without doing any sort of question, to different, sources or finding, making sure that all symptoms are all criteria are met, then we'd have a problem with that. And if, so I, I question these doctors who are skeptical, where are they coming from? What are they skeptical about? Is it that they, are saying? Oh, this child is so smart. So it can't be ADHD, hey, that's true. Right? And let's talk about that actually.
Laura: And kind of able us. Yes.
Dr. Yael: So I, I would just question the provider and say, what is it about this diagnosis that I just got from a professional that you are skeptical about? And, and then find out a little bit more, maybe it is that they don't realize that ADHD can present in these more subtle ways or look a little different in or something. And because we all have, you know, a thing, things we don't know completely about in the and so.
Laura: Of course, yeah. Thank you so much. Okay. So is there anything else that you guys would like to share with my audience about the ADHD process? I know you have a book out for kids, introducing ADHD to to children. Right?
Dr. Katia: Right. Yeah. Yeah, we as part of our work, part of the process is helping, guiding parents for resources. Right? And so parents will often ask us and, or we will just proactively provide resources so that parents can learn more about you know, their child's sort of how their child's brain works and how the, you know, we talked earlier about the importance of children understanding their own diagnoses. And so, we also like to provide resources that will help parents with that journey, right? And so we keep a pretty close finger on the pulse of what's available in terms of the resources that are out there. And we were, we were consistently finding a hole in the, in the literature when it came, right, when it came to books that will specifically lay out a diagnosis in a developmentally appropriate and sort of like visually appealing manner. And that has a good sort of balance of concerns versus strengths and different ways in which the diagnosis can present, et cetera, et cetera. And so we, we were having trouble finding that sort of resource and it's really something that I think a lot of parents really wanted. And so we we decided to, to create it, it was a COVID project when we were needing our brains to get a little exercise. Right? And yeah, and so our so we so we wrote this book and we got this lovely publisher and this great illustrator who we think we think the world of. And the idea is that it presents ADHD diagnosis for an elementary school age population.
And it's a book that a parent could read with a child or a teacher or a therapist or a grandparent or whoever to help walk them through the process. And it's an interactive book. So that I don't mean it has flaps. That would be cool though. It has questions and so I got, I love flap books when the kids are younger. Oh my gosh. Anyway, it has questions and you know, so and so has this issue, has this ever happened to you or, you know? So it just, it's supposed to be an engaging sort of vehicle for conversation. So it presents three, the book presents a brief description of neurological development again, highly visual and sort of developmentally appropriate level of discussion. Three vignettes of different ways in which ADHD can, can present because of course, we have discussed the many different ways in which ADHD can present we're trying to sort of hit the hit the main basis. Sort of what that means. Fun facts, strengths, things that can be done to help with the things that are harder in a workbook to sort of go through and individualize the book for the child. Yeah, and so we're working on, we got a couple more in the pipeline but we want to start with ADHD because that's such a big one.
Laura: Yeah, I will say that I read the book with my, my daughter who's eight, almost nine. and for whom ADHD bells ring for me. And so it was fun to read through that and she's like, oh, that's kind of like me. Oh mom, that's a little bit like me. And, you know, it's just interesting and so, I mean, and we, you know, we talked and I was like, well, you know, is that something that you would want to, you know, go and talk with someone who, you know, knows how kids think and then she's like, no, it's a problem. Yeah, but you know, if we need it, sure. You know, so it was a very lovely book just to, like, proactively have with my, for my kiddo too, which was really nice.
Dr. Katia: All right. Oh, yeah. And we've totally had friends and, uh, who have read the book,, with their kids who, there's no suspicion of ADHD and the kids have. Oh, wow. Yeah, that makes me think of so. And so in my class and maybe that's why they have trouble with bar or whatever, you know. And so we, that was not our, our direct intention but such a nice sort of vehicle for explaining neurodiversity to kids.
Laura: And acceptance, you know, not and not just acceptance but affirmation to, you know, my, both my girls go to a very neuro diverse school. And lots of their kids are kind of out and proud with their ADHD and autism diagnoses. And so yes, reading it. My daughter's like, oh, that's like friend and, oh, this is kind of like my other friends, you know, and that's why my best friend needs fidgets. And I mean, it was just, it's a lovely book. Thank you for putting it out in the world.
Dr. Katia: Thanks. Gosh. Thank you. Yeah. Thank you. We appreciate your feedback and I love to hear that you read it with your daughter.
Laura: Oh, I think it's so much, it's like so important for our parents to have access to those books, you know, that they can share with their kids. Even if they're like a again, like, even if things are on the radar, it's one of the perks of my job when I get to have amazing guests and authors on the show, I get to have those books in my house. And I just, I love that my kids get to have access to diversity in that way. So I really appreciate that so much.
Dr. Katia: Oh, well, we're glad to happy to help. Well, that's the, like you were saying, having the books in the house. I mean, that's part of the idea of this is just to make it more accessible. I mean, we love our work and think it's a really useful thing to do, but so we know it's not accessible for everyone. There's going to be a neuropsychologist hanging out on every corner who you can get in to see in a, in a, in a, you know, time efficient manner. And so the idea of the book is just to put it out there in a cost effective and accessible means.
Laura: Yeah. Well, we really appreciate it and I know you also do a lot of work on social media. So where can our listeners sign and connect with you and learn from you?
Dr. Yael: Thank you so much. Yeah, we are also trying to make it evidence based information accessible to individuals. So you could go to our website, which is Neuropsych Moms. You can also follow us on Instagram, Facebook and Twitter again, Neuropsych Moms and and psych as people know psy. So, neuropsych moms.
Laura: Wait, is that Neuropsych Moms or is it Neuropsych Mom Docs?
Dr. Yael: We, oh, thank you so much. But we recently have just changed it. So okay. Yes. So we dropped the docs hoping to make it a little easier, but it's still a little complicated.
Dr. Katia: Yeah, it was, so, it was clunky. It was clunky. But you know, what can you do?
Laura: Okay. So, neuropsych moms. Yes. Okay. Good. Well, I hope everyone will go and give you a follow and I appreciate you joining me on the show and I hope you'll keep me posted as more books come out.
Dr. Katia: Oh, for sure. Thank you for having us. We really appreciate it. It's always, we're, it's like what you said. Geeking out, we love just sitting and chatting about all this fun. Yeah.
Laura: Same. All right. Well, thank you so much.
Dr. Yael and Dr. Katia: Thanks.
Dr. Katia: Take care. Bye bye.
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