Welcome to sheep Resisted, I'm your host Sadie Sutton, a 19
year old from the Bay Area studying psychology at the
University of Pennsylvania. Sheep resisted is the teen
mental health podcast made for teenagers by a teen.
In each episode I'll bring you authentic, accessible and
relatable conversations about every aspect of mental Wellness
you can expect. Evidence based teen approved
resources, coping skills including lots of DBT insights
and education, and each piece of content you consume.
She Persisted offers you a safe space to feel validated and
understood in your struggle while encouraging you to take
ownership of your journey and build your life worth living.
So let's dive in. This week on She Persisted.
You know, sometimes people find it very helpful to have a clear
diagnosis and sometimes people are able to say, well, who cares
whether or not I have it or whether or not I have a
diagnosis. Like, let's just figure out how
to make me better at focusing and more effective.
And I would say certainly for anyone out there that whether or
not you have ADHD, if you are having problems with your
performance in school or professionally, then the things
that we're going to talk about today will be helpful for you.
Hello, hello and welcome back to another episode.
I don't have my normal microphone today, so sorry if it
doesn't sound as crisp and clear, but we have a great
episode that was recorded with the correct microphone.
We have doctor Nick Nesson on the podcast today.
He is a Harvard trained psychiatrist, researcher and
expert in ADHD. And we talk about all the skills
that you can use to navigate ADHD like lifestyle changes,
supplements, medication, executive functioning skills,
therapy, and different technological shifts you can
make to really to the root cause.
And a lot of what we talked about in this episode is
treating and coping with ADHD without stimulants.
I know you guys always love the ADHD episodes and this one does
not disappoint. So without further ado, let's
dive into this episode. Thank you so much for joining me
on She Persisted. I'm so excited to have you here.
So it's about ADHD. People always love and have so
many questions about and it's definitely a topic that people
are becoming more and more aware and curious about.
And so I'm really excited to get your thoughts on all things, not
taking a medication approach, what changes people can make in
their lifestyle, and then also your background and career.
So thank you for coming on. She persisted.
Absolutely. Thank you for having me.
Of course. OK, so for people that are not
familiar with your background or your career, can you explain how
you got into specializing in this specific area and becoming
an expert in ADHD? Absolutely.
So I'm Doctor Nissan, I'm a psychiatrist and my, my, my
training, I guess I, I went through formal medical training,
sort of the first part of becoming a psychiatrist.
So I did undergraduate at the University of Notre Dame,
Medical School at Brown University and then psychiatry
training at Harvard Medical School.
And it was really at Brown that I started to really fall in love
with psychiatry. I was seeing, I had always
thought that I wanted to be a surgeon and do cleft flip and
cleft palate repairs because I felt like it was, you know, so
terrible to be in a situation where you'd be born, you know,
with a condition where in many parts of the world where you
would be, you know, bullied or rejected because of it.
And, and really wanted to help with that stigma.
And then I did my required psychiatry rotation and I
realized that there's so much stigma and, and mental illness.
And it was something that I had experienced, you know, with,
with friends and, and loved ones growing up.
But I think it really, yeah, it really impacted me during my
training. So then, as you know, going
through my psychiatry training, I was realizing that ADHD was an
issue that was on people's minds.
You know, as you know, in the last few years during COVID, a
lot of people were converted to fully virtual workspaces, fully
virtual educational spaces, and they were all feeling
scatterbrained. And actually during the
pandemic, the the rates of ADHD diagnosis surge and the rates of
prescribing of ADHD medication surge.
And I think a lot of people were sort of confused by that and
also scared by that. A lot of the, the medications
that are used for ADHD have side effects and they have concerns
associated with them. So, you know, I really felt a
need to think of, well, how can I sort of make this clear for
patients what ADHD is? And then also what their options
are that are available to them so they don't feel like they
are, you know, only given one possible solution being
Adderall. So I wanted to look beyond that.
Can you give us that explanation that you give patients?
I think it's very helpful, especially for people that are
listening with a sibling or a friend that has ADHD and they're
not super familiar with the diagnosis or the implications in
school and work and just day-to-day life.
So how do you explain that to patients?
Absolutely. So ADHD is a neuropsychiatric
disorder, which means that it's a disorder that has a strong
footing in both the hardware and the software of the brain.
You could have, and I have had one patient who had a stroke in
in one specific area in the front of the brain and he had,
you know, wildly severe ADHD as a result of that.
So there's definitely a physical, possible physical
source to it. But then there's also a
behavioral source to it. There's a problem with software
or there's a problem with nature nurture.
There's a problem with nurture. There's ways that you can make
it worse. And certainly being in
situations that that don't train you to hold your attention for a
long time, like a lot of social medias nowadays, that's a way
that's going to train it to be to be poorer.
And so a way that I like to talk about it for people is that it
is, it's a problem of both nature and nurture for people.
There's a strong genetic backing to people that have ADHD.
So there's a genetic risk profile that needs to be
considered. If you have parents that have
ADHD, if you have siblings that have ADHD, it makes it more
likely that you have ADHD. And then there's also varying
severities of ADHD. So some people have very mild
symptoms and they're able to just kind of figure it out on
their own and, and you know, still do well.
And then there's very severe ADHD where you can imagine, you
know, where somebody can't even put together a short list of to
do's or they don't even have a calendar or haven't been able
to, you know, set up a calendar and remember to check it.
Those sorts of people never hold jobs or or aren't able to, to
get a career graduating in classes.
So there's a whole range of severity.
And then the other thing that I would say is that there's a lot
of diagnostic uncertainty out there.
Many people think that they have ADHD, but probably, you know, a
fraction of those people do actually have ADHD, meaning that
it's significant enough to cause impairment in their functioning.
And it's something that develops typically in childhood and that
has notable impacts across multiple environments as they're
growing up. And, you know, people can have
lapses in their ability to concentrate and focus and
depression, for example. So sometimes people have
undiagnosed depression. They have difficulty focusing,
but they're also, you know, relatively sad or low energy.
And it's, it turns out it's actually depression and not ADHD
or maybe they have low thyroid and they feel very, you know,
very fatigued or they have anemia and they feel low energy
and difficulty with concentration.
So that's why it can be important to have an evaluation
by a medical doctor or psychiatrist to really make sure
that this is what you have so that you can go about trying to
treat it. You mentioned that a lot of
people think they have ADHD but they don't actually have ADHD.
And this is a really big thing on TikTok.
There is like a whole adult ADHD movement and you see so many
people being like I just found out I have ADHD or like my ADHD
brain. And when you look at the data,
like the percentage of the population that has ADHD, it
doesn't really match up with what we feel like we're kind of
seeing on social media. And I think just like all things
mental health related, there's a spectrum.
Like not all of us are perfect focusers 24/7 and not all of us
have severe ADHD. What are your thoughts on that
self diagnosing aspect? And even just like the huge rise
of diagnosis, is it people are just more aware and actually
getting diagnosed? Or is it you just maybe are not
the best at focusing and this is not an ADHD problem?
Yeah, it's a, it's a super juicy question.
And actually amongst my psychiatrist friends, some of us
sort of feel like a need to push back and be like, you know, is
ADHD just created by sort of the economy and this drive for like
increased productivity? And like, should we be more
accepting and willing that, hey, like we're, you know, we're just
kind of dumb people that like kind of do some things right
sometimes and are very inefficient other times and like
grow in our acceptance of that. And I think there is something
to be said of that, that, you know, humans can strive towards
too much sort of robot like efficiency or, or perfectionism
and that we should accept a little bit more our dumbness or
our lack of efficiency. So that being said, the IT is
extremely difficult in the United States to get evaluated
for ADHD. The diagnosis is often made by a
child and adolescent psychiatrist, of which there's
an enormous scarcity in many parts of the country.
It's impossible to see a child and adolescent psychiatrist.
And of those that are out there also a lot of them don't accept
insurance. And so then there's an issue of
accessibility based on, you know, economic means.
And so they would be one group of clinicians that would be able
to do a diagnosis. But another sort of a required
standard for people that are getting like academic
accommodations, extra time on tests and things like that is to
get a neuropsychological evaluation, which is a several
hour long evaluation by a neuropsychologist, which is a
subset of clinical psychologists who charge thousands of dollars
for these evaluations. And so again, it's not only are
they are they few and far between, but also, you know, not
accessible to everyone. So I think there are a lot of
people across the country that maybe really did struggle
academically their whole lives and they didn't have the
resources or the the means or, or know anyone around them that
could evaluate them for ADHD or they just didn't know about
ADHD. The other thing I would say is
that, you know, sometimes people find it very helpful to have a
clear diagnosis. And sometimes people are able to
say, well, who cares whether or not I have it or whether or not
I have a diagnosis? Like let's just figure out how
to make me sort of better at focusing and more effective.
And I would say certainly for anyone out there that whether or
not you have ADHD, if you are having problems with your
performance in school or or professionally, then the things
that we're going to talk about today will be helpful for you.
So in many ways, CBT for ADHD, cognitive behavioral therapy for
ADHD or executive function coaching is something that kind
of all of us need. A lot of people say it's sort of
like, you know, adulting 101, but it's true.
So yeah, I, I guess sort of it's a, it's a long winded answer to
your question, but I would say that yes, there are probably
people that have undiagnosed ADHD.
Yes, there's probably people that are just sort of following
the TikTok trend and they think they have it too, but they
probably don't. And the main distinction between
those groups of people would be whether or not they had these
symptoms from a early age and that were consistent across
different atmospheres or different scenarios.
So these symptoms were present both at school and at home.
And then also whether or not you can rule out that they had other
things going on. So it definitely wasn't due to
depression. It wasn't due to, like I
mentioned before, a thyroid issue or anemia or another
medical problem like that. Sleep apnea also.
Yeah. And that it's significant enough
to cause impairment across those areas.
Yeah, it's, it's really interesting.
I'm excited to dive into all of the behavioral shifts you can
make because when we think about like the context of COVID and
how much we're now relying on technology and academic and
workplace settings and how distracting that can be.
And also what are interactions with social media look like now
versus even five years ago? Like things are much more
engaging and at a much faster pace.
And so it makes sense that with all of those distractions and
with how our attention spans have responded, that maybe it
feels harder to focus and it did five years ago, or maybe the
environment looks so different and you don't necessarily have
the skills that transfer over. And so I think that's another
piece of the puzzle that I think universally it can be a
relatable experience. But before we dive into all the
things people can do, I think another really interesting piece
of this puzzle is over medication.
And there was all the news headlines about Adderall
shortages and a bunch of studies that have been done with regard
to adolescent prescriptions of stimulants and so, so many
schools of thoughts here. But what is your perspective on
stimulants for ADHD and potentially over prescribing
them to kids and young adults? Yeah.
So stimulant medications are typically the treatment for ADHD
both in children and adults. So these would be medications
like Adderall, Ritalin, there's a lot of new versions of these
medications, Vyvanse, Focalin, Concerta, Adderallics are
there's a lot of of these brands out there.
And these medications, when you look at the effect size, so how
effective and the kind of how, how big of a chunk of people you
could expect to improve with these medications.
They're amongst the most effective medications that we
have in psychiatry and also in in medicine generally.
The effect sizes comparably are are really good.
So it really helps to add a stimulant for people that have
true ADHD. There are two major sort of
classes and so one is amphetamine based and one is
methylphenidate based. Amphetamine based are the
Adderall and Adderall type of medications.
So Adderall XR, Vyvanse is sort of a relative as well.
And then the methylphenidate medications are Ritalin,
Concerta, Focalin and several of these other medications, The
amphetamine based ones increase dopamine and norepinephrine,
which are two neurotransmitters. They increase them more in the
synapse. So these are kind of like
stronger stimulant medications. Adderall is a stronger stimulant
medication. Methylphenidate increases
dopamine and norepinephrine a little less.
So methylphenidate or Ritalin is a little bit of a like a lighter
version of Adderall, even though, you know, the outcomes
are pretty similar. So there are some some
significant concerns with these medications.
I personally, you know, would definitely think twice about
using them for myself or for any loved one or for any of my
patients. In fact, I very rarely prescribe
them and that is for a couple different reasons.
First of all, these medications are known to have addictive
properties. So for this reason, they're
scheduled two, so they're controlled substances, which
means that you have to work very closely with your prescriber to
to get these prescribed to you. And you know, you can't just get
one prescription with a million refills and you're all set.
You need to check in with them regularly to make sure that
you're not having, you know, an, an addiction or a dependency to
develop. Also as part of that, your body
can become accustomed to, to the medication tolerance is what
it's called, meaning that you, if you don't take breaks one
weekend or two weekend days to sort of have your system reset,
then you're gonna keep needing more and more to have the
effect. So because they're controlled
substances, there's a lot of logistical challenges related to
that. You mentioned the the shortages,
those are a huge pain in the butt for both patients and for
prescribers because there is a shortage.
I think is, is first Adderall, then people had to prescribe
other stimulants to sort of replace those.
And so then it led to shortages of all other sorts of
stimulants. And so then that meant that
patients were calling around to all these different pharmacies
trying to see what they had in stock and pharmacies were
overwhelmed and to some, to some extent still happening right
now. It's been going on for over a
year and a half now. So that's one thing for people
to think about is like do you really want a medication where
there's going to be this much headache each month to, you
know, get it refilled? The second thing I would say is
that there are concerns around physical health.
So stimulants are known to increase your cardiovascular
measures, so increase your heart rate and your blood pressure.
For a long time it hasn't been known whether or not that has
any long term risk, but there was a recent study that was
published by Zhong and colleagues that showed that
there was an association between long term stimulant use and
cardiovascular events, heart attack, stroke things, things
like that. And so certainly especially in
the adult population or even in the kids population where you
would be taking this for a long period of time, that's something
you want to think about. So for any of my patients that
do prescribe stimulants, I say, you know, this really should be
a temporary measure until we can get your executive functioning
to top notch and then we can get rid of this stuff.
So that's one thing to consider. The other thing is there's for a
long time, there have been animal studies that show there's
maybe some neurotoxicity, some some toxicity to neurons and
that there could possibly be some areas of the brain that are
damaged by use of stimulants. And you know that there's many,
there's, there's other side effects that are worth
considering. People if they were genetically
predisposed to psychosis or schizophrenia, for example,
stimulants, especially amphetamine based stimulants
like Adderall could have some risk of triggering psychosis or
a manic episode in somebody with bipolar disorder, a genetic
predisposition, insomnia is a common side effect and problem.
So there's there's many things that are downsides to these
medications, even though like I mentioned at the beginning, they
have good effects sizes and can be very helpful for people.
Yeah. So executive functioning and
behavioral shifts that you can make to improve attention and
focus and just like general functioning when it comes to
completing tasks and staying engaged.
Talk to me about what that looks like.
Does executive functioning like fall under the umbrella of CBT?
Are you pulling from different modalities?
What do you recommend that patients implement?
Yeah. So there are a few evidence
based, I like to call them psychosocial interventions.
These are medication free interventions that can be
helpful for ADHD with randomized controlled trials backing them
up. So one is CBT for ADHD, that's
cognitive behavioral therapy for ADHD.
Another one is executive function coaching.
Actually, executive function coaching doesn't have as strong
of an evidence base, but I'll talk about some of the
similarities here in a little bit.
Another one is cognitive remediation or cognitive
training. It's done by psychologists.
And then the final one that I'd say is mindfulness based
cognitive therapy. So the first three that I
mentioned have some similarities and overlaps.
These are different forms of psychological support, often
delivered by a therapist or a psychiatrist that are focused
around a few different major executive functions.
The most common ones would include calendar management.
So this is making sure first of all, that you have a calendar,
Second of all, that you're practicing good calendar
hygiene. So there's something I check in
with people on their appointments is do you have both
formal commitments and informal commitments on your calendar?
So you can see, hey, I told somebody I was going to meet
with them for lunch at 1:00 PM, but then now I see I also have a
meeting scheduled for 1:00 PM. I signed up to go to this
conference on, you know, a month from now.
But now I'm just realizing that one of the nights is actually my
anniversary, you know, something like that.
Does it have built in transition times?
So things like if you have one meeting here and then another
one across town, you can have them back-to-back.
You need to build in your time to get from one to the other.
And then having notifications on our way to know that.
And then also an important part of the calendar hygiene is
checking at least twice daily. So practicing with people,
checking in the morning and checking in the evening before
the end of the day. And in the evening you're
checking what's coming up the next day.
So you can see that as part of that, I like to do with people
something that's called mimetic processing, which is like a
visualization exercise where we literally close our eyes and we
imagine ourselves going through every part of the day.
And as you're doing that, you're, you're picturing
yourself putting on the clothes and then you're picturing
yourself for me, you know, going into the clinic and then seeing
if we're a patient, you can sort of see how things are going to
go from one thing to the next. You prepare yourself.
And then you might recognize where there's errors where
you're like, oh, crap, I was thinking, I have this thing at
4:00, but like it's way over there.
And in my thing before it always takes up the whole hour.
How am I going to get there in time?
And so you can see those those errors beforehand.
So that's calendar management. It's one of the themes across
these different approaches. Another one would be task list
management. So to do lists, there's a whole
system to do this. And usually with people, I
recommend having a general list that's sub categorized into
different sort of spheres of life and then having a daily To
Do List. And you as part of this, you
practice prioritization skills, which for that I with people, I
use what's called the Eisenhower Matrix.
This is a matrix that I think was made popular by President
Eisenhower that is organizing things based on how urgent and
important they are. If it's both urgent and
important, you do it today. You put it on your today To Do
List. If it is important but not
urgent, then you need to put it on your calendar.
You need to schedule it. This is something that like
everyone with ADHD needs to learn because for everyone with
ADHD, there's this issue of like, there's, there's all these
things that I need to do, but it's not urgent.
So I never do it. And so you need to develop this
ability to identify those things and then put it on your
calendar. And as long as you have a
calendar that you're following, then you can do that.
So anyways, that's task list management.
Do you have? Different platforms that you
like people to use for tasks and to do lists.
Yeah, I do usually I have AI have a bit of a bias towards the
Google Workspace because usually if people, most people have a
Gmail. And so then if you have a Gmail,
then you have Google Calendar. And then I like to use Google
Keep. Google Keep has really good.
It's it's good for to do lists. You know, people experiment with
other ones, which is fine. There could be problems with
integration and with, you know, being able to update it both on
your laptop and on your phone or whatever.
But as long as they're able to do that, that's fine.
I have some patients and, and clients who who prefer to do
things manually or keep, you know, a physical calendar or To
Do List with them. And that's fine as long I tell
them like it. It must be portable though.
You need to have it with you so that you know, if you are away
from your office that you can stay on top of these things.
Otherwise their papers multiply. And so everyone with ADHD will
say, well, I already know these things.
Like I've already tried this a million times, right?
And I tell people it's like going to the gym, like you,
you're never done, you know, you're never like, OK, now I'm
fit done with that. Check that off.
Like, no, you need to, if you're going to be fit, you need to be
fit every day. And it's the same thing with
good executive functioning, you're going to fail.
You're going to have a million calendars, you're going to make
a million mistakes. But if you follow this
systematically and you work with somebody, you will develop these
skills and not that long of a time like usually with people
that are working with me intensively, it's it's less than
two months in order to really get this all pretty much sorted
out. So yeah, those are two things.
And there's other things about sort of minimizing distractions
in the the workplace. There's different technological
supports that people can use, like reading tools.
There's Swift read, there's bionic reader.
These are different sort of reading supports that help to
hold focus while people are reading large pieces of text.
There's things like binaural beats and sound machines that do
have evidence. So there's, there's, there's
many sort of non medication tools that that people can use.
I'm gonna get my To Do List. I can show you.
We can do show and tell because I'm very type A and to my
knowledge, not ADHD. And I think I take it too far in
the other direction and crazy with my calendar.
And I've been doing this for years.
So it's not just like a weekly phase where I'm like, oh, I'll
be really organized and insane with this.
It somehow has maintained. But I have my Google calendars
that I integrate all of them onto my Apple calendar.
So I have literally 8 Gmails from like school and work and
other work and the podcast. And so it all has to be on one.
So I had like my 16 integrated calendars color code.
And I do what you're talking about where it's like informal,
informal commitments and things I might do that I want to kind
of be aware of when those need to be blocked off.
And then I have a sauna, which is incredible.
And this I have every class and then work commitment
color-coded. And these are all the things I
didn't do yesterday, but I like organize all deliverables and
deadlines on there, which works really well.
And then where it gets crazy is that I have my bullet journal,
which I don't know if you've ever worked with anyone that
does bullet journaling, but it's a whole other crazy side of
scheduling. And I do like my weekly calendar
and then I also have my daily to do lists.
So clearly I'm very reinforced by checking things off.
But it helps to not forget things and to have everything
organized and on all the places at all times.
Absolutely, yeah. You anyone that's looking
you're, you're seeing some A+ executive functioning skills
right there maybe. Too much.
Yeah, no, I mean, well, it is something to think about, you
know, And that that is, I've had, I've had patients that are
the other side and I treat things other than ADHD.
But people that have you, you don't, I'm not saying you have
these things, but people do out there have obsessive compulsive
personality disorder or OCD, compulsive disorder where, you
know, then there's a challenge of tolerating a bit of
imperfections, a bit of breaking rules and doing exposures to
that. And it goes back to what we were
talking about before of like this, you know, is, is ADHD
real? And do we just not have
tolerance enough in society for sort of imperfections and
inefficiency? So it's a balance, I think for
sure. But those sort of systems that
you have are exactly what's needed to have good executive
functioning and probably to do well on the things that are
important to you. So I think for people out there
that have ADHD, that might seem, it might seem like a huge leap
to get to wherever they are now, which is probably nothing or a
million like dead, like zombie calendars out there to getting
to where you are. But I think there's also there's
a lot of intermediate steps and for people, you know, I had one
patient who's a writer. And so he, he's a writer and he
does some like tutoring on the side.
And so he really only has like one formal commitment, like he
has two or three meetings for tutoring during the week.
The rest of his time is completely open.
And so putting structure and actually creating a calendar in
the 1st place was an important first step.
And even with great executive functioning, his calendar, you
know, looks a lot simpler than yours does.
So there's a whole sort of gradient for the people can
exist out there. Yeah, I will say I do give
myself a lot of grace. Like I write the tasks down so I
don't have to remember them, which helps a lot with mental
stress and saving yourself work being like, am I supposed to be
somewhere? Like I have this recording like
that helps. And then I'm always like, well,
tomorrow it'll happen at some point.
But I, I wonder if this is a piece of the puzzle as well,
which is willpower, and if you've written down the things
or it's that idea of like, it's important but not urgent.
How do you help people get out of that kind of mental block
where it doesn't need to be done, but it should be done and
it could save you stress down the line?
How do you kind of like bridge that gap between intention and
action with regard to like focus and tasks?
That's a, that's a really great question.
The answer would be that it's a motivation question.
So we're talking about things that are important and not
urgent. And so if you don't want to do
something or it's not really getting done, you need to ask
yourself, is it important and or is it urgent?
If it's not important and it's not urgent, but it's not
important, then you need to delete it.
A lot of people have these zombie to do lists that have,
you know, these things on there that are like read the book
about the history of like human civilization and it's like, OK,
it's not urgent. And you know, if you're, that's
not your career area, it's probably not important either.
So you shouldn't be holding on to all this guilt about not
doing that And it being one of 100 things that you haven't been
able to check off, you need to get rid of it.
So it's really important is identifying the things that are
not truly important and not truly urgent and deleting them.
But for the things that are important, but they're not
urgent, like we said, those need to be scheduled.
So for example, for me, I did this training and early
identification of cognitive decline and reversal sort of
protocols for that. It was a part of my professional
development that I didn't need to do per SE and it was
definitely not urgent, but I wanted to and like it was
important to me. So I scheduled time each week.
I made it through the modules and the testing and stuff in
order to do that. So I think a lot of people have
things like that. And so, you know, if you're
still struggling with something, even though you do think like,
yeah, this is something I want to do for my professional
development or for my own development, but I'm still
procrastinating. I'd say the first thing is
recognizing that procrastination is very normal in ADHDI like to
tell people that procrastination is their own self medicating of
of a stimulant, which is that when you are procrastinating and
you're down to the crunch, you're definitely stimulated.
You're giving yourself a huge bump of norepinephrine, which is
one of the components of stimulant medications there the
impacts on the synapse. So you're doing self medicating
by doing that and you'll, you'll probably see you are able to
hyper focus when you're, you know, put in that stressful
situation. So that's normal.
One thing is breaking down tasks and putting early deadlines to
things is very important. So you know, instead of I'm
going to finish this 10 page paper a month from now to
instead say, OK, I'm going to. On Monday.
Oh, there you go. Well, that's great.
That's great. So now you're gonna get it.
You're gonna get some stimulant here coming, some natural
stimulant coming in. Literally you're gonna laser
focus. But so for people to instead for
ADHD, people need like extremely aggressive tight deadlines.
So to say like, OK, we're going to set a timer right now for 45
minutes and you're going to write the entire introduction 45
minutes. Boom.
You want to set extremely aggressive timelines, ones that
maybe you won't even achieve and that's OK.
But you're trying to create this pinch for you with a, a bite
size of the work that you need to do.
And another thing is it with it being a small ask of OK, it's
only the introduction. I can write that in 45 minutes.
The the great thing is that it was something that's known in
behavioral psychology is that it, once you get started, it's
easier to keep going. So often times I'll do that with
people, but then at 45 minutes, they just want to keep going and
they get a lot of it done. So that's something to
definitely use. But the other thing is often
times people, if they're procrastinating or they're not
doing things that they, that are important to them, then it's a
matter of motivation. And that's something to visit
with them. And and so there's a thing
called motivational interviewing that I do with people.
And so I'll say, OK, you know, you said that you were going to
work out this last week and, and it was scheduled in for you to
do it at 3:00 PM. And looking back on your week,
it doesn't look like you did it at all.
So do you not want to do it like you could say, for example, is
it really worth it to do it? Are there other things that are
better uses of your time than working out?
So by challenging it, instead of saying like you should be
working out, we're saying, well, maybe you shouldn't be working
out. What we're doing is we're giving
you an opportunity to instead convince me rather than me
convince you. That's, that's what's happening
in motivational interviewing. And so the person starts saying,
no, like I do, I do want to work.
I I know I should. And this is something that's
used in addictions as well, you know, well, why don't you keep
drinking? Why don't, why don't you drink
more? You use these sort of extreme
examples. So, yeah.
So motivational interviewing is something that's that's very
important in order to boost motivation once it starts to go
down. Yeah.
And then you mentioned earlier that there are different
techniques you can use to improve focus.
Obviously one thing is like getting started on a small piece
of the task and then it's easier to just maintain rather than
motivate to do the whole thing. Are there other ways that people
can help improve their focus if that's a barrier to getting
these things done and and sticking with a task?
Absolutely. So often times people need
stimulation as a part of their did.
They need more stimulation in order to focus and get things
done. One way to do that is by using
what I call artificial procrastination or these tight
deadlines that the people can do in order to really feel the
pinch and get things done. And they do that by breaking it
into a smaller task. Another thing is often times
people find that they need higher beats, permanent music.
So instrumental music is less likely to cause a distraction.
And having it be upbeat can make the person feel a little bit
more stimulated, a little bit more active.
And then we want to eliminate distractions.
So like number one thing for people is to take your phone and
put it either in another room or put it in a drawer, make sure
notifications off that it's silenced, things like that.
Sometimes people need to either X out of all of their open
windows or or minimize one of those and open a new window.
That's only with the thing that they're working on in order to
decrease those distractions, making sure that there's no
notifications for, you know, some of those, those common pop
ups on computers. So like iMessage or WhatsApp,
things like that, that you're not having any Dings on your
computer as you're as you're doing that.
So those, yeah, those would be some of the common examples.
And then one other question for people who are listening and
they want to continue to improve their executive functioning
skills, continue to adjust these behaviors.
Do you have any other recommendations for podcasts or
books or resources where they can continue to learn about
these things and kind of build their skill set around coping
with and navigating ADHD in more of like a holistic way?
Absolutely. There's a number of different
kind of Get things done sort of books and tools and manuals out
there. One is called Get Things Done.
One, there's a bullet notebook that you were just mentioning.
There's Atomic Habits and there's several materials around
that are out there that people use, so people can definitely
experiment with those. I do find though, that often
times people with ADHD, they need someone coaching them
through this. And with ADHD you don't
necessarily need ideas. What you need is accountability
and implementation. And so it's really helpful to
work with somebody for that. So that's the work that I do in
my clinic. My clinic is Nissan Clinic,
NISSENCLIN, ic.com. Otherwise, there's other folks
out there, you know, either if you were just looking for a
medication to try, then you would want to look for a
psychiatrist. If you are looking for more of
these skills, you could look for an executive functioning coach.
There's several places out there where you can look for those.
There is one that I recommend sometimes to people relatively
new, it's called Shimmer, and they do executive function
coaching. But certainly though, if you're
looking for someone to maybe prescribe and do these things,
and we're kind of a small community so that that's the
kind of work that I do. I would say some of the other
things that could be brought up or focused with whoever you're
working with. Is there some dietary
interventions that have a good evidence base?
They have randomized controlled trials.
And then there's also some supplements that I use as well
and non stimulant medications that I use.
So, you know, some things like that, I think often paired with
these lifestyle changes can create the biggest shift.
I didn't mention exercise yet, but exercises shouldn't be very
helpful for people with ADHD. And a lot of folks have ADHD
symptoms that worsen in college because they're no longer in
their team sports that they were doing in high school.
So that's also very common. So yeah, I would say you can
kind of string together some of these resources on your own.
Or what I do in my clinic is I try to put them all together.
My last question is going to be if you could like wave a magic
wand and give someone daily habits they were implementing
that are really conducive to helping support ADHD, Whether
it's exercising in the morning versus at night, or making sure
a certain food group is implemented every day or being
outside of the house when working.
Like what would those daily habits be?
First of all, you know, waking up, I do have a bit of a bias
towards exercising in the morning versus later in the day
just because as part of just, if you're trying to form a habit,
you want to minimize the chances for something to conflict with
that habit. So doing it first thing in the
day is helpful. And certainly if you're doing as
part of an ADHD regimen and you just want to make sure that it
happens, then you'd want to do it first.
So I would say you would wake up, you'd exercise, and then you
would check your calendar and review your calendar for the
day. You would do some memetic
processing, so like visualizing yourself going through the day.
You would have your appointments.
You would set up a, you know, a good work environment.
That's where you minimize distractions.
You have your phone with notifications off, your computer
with notifications off on any messaging, and you would have a
separate window for whatever you're working on.
And early in the day, probably for people that are taking
medications or supplements, that would be a time to do that.
So one of the non stimulant medications might be something
that would come in at that point or supplement.
Dietary wise, there's not necessarily something to add
that would have a huge benefit, but usually people that are
working with me that want to do a dietary approach, there'd be a
form of an elimination diet in order to remove possible
allergens from their, their diet that could be impacting their
ability to focus. And it would be a lower
carbohydrate diet as well to avoid some sort of like brain
fog or that like 2:00 PM brain fog that you have if you have a
big bowl of pasta for lunch. But then, you know, ending the
day with checking your calendar again and then you know, going
to bed and and getting good high quality sleep would definitely
be part of it as well. Amazing.
Well, if people want to continue to follow along with your work
or reach out to potentially work with you, where can people find
you? Absolutely.
So my probably the best spot would be my clinic which is
nissanclinic.com NISSENCLIN ic.com and then otherwise I'm on
Instagram at doctor Nissan Dr. dot NISSEN.
Amazing. I'll put that in the show notes
and thank you again so much for joining me.
Of course. Thank you so much for having me,
Sadie.