1 00:00:00,040 --> 00:00:03,440 Welcome to sheep Resisted, I'm your host Sadie Sutton, a 19 2 00:00:03,440 --> 00:00:05,920 year old from the Bay Area studying psychology at the 3 00:00:05,920 --> 00:00:09,520 University of Pennsylvania. Sheep resisted is the teen 4 00:00:09,520 --> 00:00:12,360 mental health podcast made for teenagers by a teen. 5 00:00:12,880 --> 00:00:15,600 In each episode I'll bring you authentic, accessible and 6 00:00:15,600 --> 00:00:18,880 relatable conversations about every aspect of mental Wellness 7 00:00:19,440 --> 00:00:21,480 you can expect. Evidence based teen approved 8 00:00:21,480 --> 00:00:25,520 resources, coping skills including lots of DBT insights 9 00:00:25,560 --> 00:00:28,160 and education, and each piece of content you consume. 10 00:00:28,840 --> 00:00:31,960 She Persisted offers you a safe space to feel validated and 11 00:00:31,960 --> 00:00:34,640 understood in your struggle while encouraging you to take 12 00:00:34,640 --> 00:00:37,000 ownership of your journey and build your life worth living. 13 00:00:37,360 --> 00:00:41,200 So let's dive in. This week on She Persisted. 14 00:00:41,520 --> 00:00:44,880 You know, sometimes people find it very helpful to have a clear 15 00:00:44,880 --> 00:00:48,680 diagnosis and sometimes people are able to say, well, who cares 16 00:00:48,680 --> 00:00:50,480 whether or not I have it or whether or not I have a 17 00:00:50,480 --> 00:00:53,560 diagnosis. Like, let's just figure out how 18 00:00:53,560 --> 00:00:56,800 to make me better at focusing and more effective. 19 00:00:56,800 --> 00:01:00,600 And I would say certainly for anyone out there that whether or 20 00:01:00,600 --> 00:01:03,960 not you have ADHD, if you are having problems with your 21 00:01:03,960 --> 00:01:07,480 performance in school or professionally, then the things 22 00:01:07,480 --> 00:01:09,520 that we're going to talk about today will be helpful for you. 23 00:01:09,960 --> 00:01:12,600 Hello, hello and welcome back to another episode. 24 00:01:12,600 --> 00:01:14,800 I don't have my normal microphone today, so sorry if it 25 00:01:14,800 --> 00:01:17,840 doesn't sound as crisp and clear, but we have a great 26 00:01:17,840 --> 00:01:20,840 episode that was recorded with the correct microphone. 27 00:01:21,040 --> 00:01:23,520 We have doctor Nick Nesson on the podcast today. 28 00:01:23,520 --> 00:01:25,840 He is a Harvard trained psychiatrist, researcher and 29 00:01:25,840 --> 00:01:30,000 expert in ADHD. And we talk about all the skills 30 00:01:30,000 --> 00:01:33,360 that you can use to navigate ADHD like lifestyle changes, 31 00:01:33,360 --> 00:01:35,960 supplements, medication, executive functioning skills, 32 00:01:35,960 --> 00:01:38,800 therapy, and different technological shifts you can 33 00:01:38,800 --> 00:01:41,200 make to really to the root cause. 34 00:01:41,600 --> 00:01:45,160 And a lot of what we talked about in this episode is 35 00:01:45,160 --> 00:01:47,720 treating and coping with ADHD without stimulants. 36 00:01:47,800 --> 00:01:51,120 I know you guys always love the ADHD episodes and this one does 37 00:01:51,120 --> 00:01:54,080 not disappoint. So without further ado, let's 38 00:01:54,080 --> 00:01:57,680 dive into this episode. Thank you so much for joining me 39 00:01:57,680 --> 00:02:00,120 on She Persisted. I'm so excited to have you here. 40 00:02:00,840 --> 00:02:04,200 So it's about ADHD. People always love and have so 41 00:02:04,200 --> 00:02:08,000 many questions about and it's definitely a topic that people 42 00:02:08,000 --> 00:02:10,919 are becoming more and more aware and curious about. 43 00:02:10,919 --> 00:02:15,200 And so I'm really excited to get your thoughts on all things, not 44 00:02:15,200 --> 00:02:18,520 taking a medication approach, what changes people can make in 45 00:02:18,520 --> 00:02:21,760 their lifestyle, and then also your background and career. 46 00:02:21,760 --> 00:02:23,600 So thank you for coming on. She persisted. 47 00:02:24,160 --> 00:02:25,760 Absolutely. Thank you for having me. 48 00:02:26,160 --> 00:02:28,440 Of course. OK, so for people that are not 49 00:02:28,440 --> 00:02:32,440 familiar with your background or your career, can you explain how 50 00:02:32,440 --> 00:02:37,200 you got into specializing in this specific area and becoming 51 00:02:37,200 --> 00:02:40,080 an expert in ADHD? Absolutely. 52 00:02:40,280 --> 00:02:44,360 So I'm Doctor Nissan, I'm a psychiatrist and my, my, my 53 00:02:44,360 --> 00:02:47,480 training, I guess I, I went through formal medical training, 54 00:02:47,560 --> 00:02:49,680 sort of the first part of becoming a psychiatrist. 55 00:02:49,680 --> 00:02:52,840 So I did undergraduate at the University of Notre Dame, 56 00:02:52,840 --> 00:02:56,480 Medical School at Brown University and then psychiatry 57 00:02:56,480 --> 00:02:58,280 training at Harvard Medical School. 58 00:02:58,720 --> 00:03:02,360 And it was really at Brown that I started to really fall in love 59 00:03:02,360 --> 00:03:05,200 with psychiatry. I was seeing, I had always 60 00:03:05,200 --> 00:03:07,440 thought that I wanted to be a surgeon and do cleft flip and 61 00:03:07,440 --> 00:03:11,360 cleft palate repairs because I felt like it was, you know, so 62 00:03:11,360 --> 00:03:14,160 terrible to be in a situation where you'd be born, you know, 63 00:03:14,160 --> 00:03:16,600 with a condition where in many parts of the world where you 64 00:03:16,600 --> 00:03:19,640 would be, you know, bullied or rejected because of it. 65 00:03:20,160 --> 00:03:22,400 And, and really wanted to help with that stigma. 66 00:03:22,480 --> 00:03:25,560 And then I did my required psychiatry rotation and I 67 00:03:25,560 --> 00:03:29,120 realized that there's so much stigma and, and mental illness. 68 00:03:29,440 --> 00:03:31,720 And it was something that I had experienced, you know, with, 69 00:03:32,160 --> 00:03:34,200 with friends and, and loved ones growing up. 70 00:03:34,200 --> 00:03:36,880 But I think it really, yeah, it really impacted me during my 71 00:03:36,880 --> 00:03:39,440 training. So then, as you know, going 72 00:03:39,440 --> 00:03:42,600 through my psychiatry training, I was realizing that ADHD was an 73 00:03:42,600 --> 00:03:44,120 issue that was on people's minds. 74 00:03:44,200 --> 00:03:47,520 You know, as you know, in the last few years during COVID, a 75 00:03:47,520 --> 00:03:52,640 lot of people were converted to fully virtual workspaces, fully 76 00:03:52,640 --> 00:03:56,200 virtual educational spaces, and they were all feeling 77 00:03:56,200 --> 00:03:57,960 scatterbrained. And actually during the 78 00:03:57,960 --> 00:04:02,680 pandemic, the the rates of ADHD diagnosis surge and the rates of 79 00:04:02,680 --> 00:04:05,120 prescribing of ADHD medication surge. 80 00:04:05,480 --> 00:04:08,080 And I think a lot of people were sort of confused by that and 81 00:04:08,080 --> 00:04:11,640 also scared by that. A lot of the, the medications 82 00:04:11,640 --> 00:04:14,760 that are used for ADHD have side effects and they have concerns 83 00:04:14,760 --> 00:04:17,519 associated with them. So, you know, I really felt a 84 00:04:17,519 --> 00:04:20,360 need to think of, well, how can I sort of make this clear for 85 00:04:20,360 --> 00:04:24,400 patients what ADHD is? And then also what their options 86 00:04:24,400 --> 00:04:27,680 are that are available to them so they don't feel like they 87 00:04:27,680 --> 00:04:31,120 are, you know, only given one possible solution being 88 00:04:31,120 --> 00:04:33,960 Adderall. So I wanted to look beyond that. 89 00:04:34,800 --> 00:04:37,920 Can you give us that explanation that you give patients? 90 00:04:37,920 --> 00:04:40,240 I think it's very helpful, especially for people that are 91 00:04:40,240 --> 00:04:43,400 listening with a sibling or a friend that has ADHD and they're 92 00:04:43,400 --> 00:04:47,840 not super familiar with the diagnosis or the implications in 93 00:04:47,840 --> 00:04:49,760 school and work and just day-to-day life. 94 00:04:49,760 --> 00:04:51,760 So how do you explain that to patients? 95 00:04:52,400 --> 00:04:56,800 Absolutely. So ADHD is a neuropsychiatric 96 00:04:57,080 --> 00:05:01,760 disorder, which means that it's a disorder that has a strong 97 00:05:01,760 --> 00:05:05,520 footing in both the hardware and the software of the brain. 98 00:05:05,840 --> 00:05:09,760 You could have, and I have had one patient who had a stroke in 99 00:05:10,040 --> 00:05:13,120 in one specific area in the front of the brain and he had, 100 00:05:13,120 --> 00:05:16,160 you know, wildly severe ADHD as a result of that. 101 00:05:16,160 --> 00:05:19,160 So there's definitely a physical, possible physical 102 00:05:19,160 --> 00:05:21,320 source to it. But then there's also a 103 00:05:21,320 --> 00:05:24,080 behavioral source to it. There's a problem with software 104 00:05:24,080 --> 00:05:26,040 or there's a problem with nature nurture. 105 00:05:26,040 --> 00:05:28,120 There's a problem with nurture. There's ways that you can make 106 00:05:28,120 --> 00:05:30,520 it worse. And certainly being in 107 00:05:30,520 --> 00:05:33,840 situations that that don't train you to hold your attention for a 108 00:05:33,840 --> 00:05:37,080 long time, like a lot of social medias nowadays, that's a way 109 00:05:37,080 --> 00:05:39,560 that's going to train it to be to be poorer. 110 00:05:39,560 --> 00:05:42,600 And so a way that I like to talk about it for people is that it 111 00:05:42,600 --> 00:05:45,600 is, it's a problem of both nature and nurture for people. 112 00:05:45,600 --> 00:05:48,720 There's a strong genetic backing to people that have ADHD. 113 00:05:48,960 --> 00:05:51,240 So there's a genetic risk profile that needs to be 114 00:05:51,240 --> 00:05:53,360 considered. If you have parents that have 115 00:05:53,360 --> 00:05:55,920 ADHD, if you have siblings that have ADHD, it makes it more 116 00:05:55,920 --> 00:05:59,120 likely that you have ADHD. And then there's also varying 117 00:05:59,120 --> 00:06:02,560 severities of ADHD. So some people have very mild 118 00:06:02,560 --> 00:06:05,320 symptoms and they're able to just kind of figure it out on 119 00:06:05,320 --> 00:06:07,480 their own and, and you know, still do well. 120 00:06:07,720 --> 00:06:10,880 And then there's very severe ADHD where you can imagine, you 121 00:06:10,880 --> 00:06:14,160 know, where somebody can't even put together a short list of to 122 00:06:14,160 --> 00:06:17,160 do's or they don't even have a calendar or haven't been able 123 00:06:17,160 --> 00:06:20,360 to, you know, set up a calendar and remember to check it. 124 00:06:20,600 --> 00:06:24,720 Those sorts of people never hold jobs or or aren't able to, to 125 00:06:24,720 --> 00:06:26,480 get a career graduating in classes. 126 00:06:26,480 --> 00:06:28,720 So there's a whole range of severity. 127 00:06:29,040 --> 00:06:31,200 And then the other thing that I would say is that there's a lot 128 00:06:31,200 --> 00:06:33,640 of diagnostic uncertainty out there. 129 00:06:33,760 --> 00:06:37,800 Many people think that they have ADHD, but probably, you know, a 130 00:06:37,800 --> 00:06:41,680 fraction of those people do actually have ADHD, meaning that 131 00:06:41,680 --> 00:06:45,040 it's significant enough to cause impairment in their functioning. 132 00:06:45,200 --> 00:06:49,400 And it's something that develops typically in childhood and that 133 00:06:49,400 --> 00:06:52,840 has notable impacts across multiple environments as they're 134 00:06:52,840 --> 00:06:55,440 growing up. And, you know, people can have 135 00:06:55,440 --> 00:06:58,560 lapses in their ability to concentrate and focus and 136 00:06:58,560 --> 00:07:01,360 depression, for example. So sometimes people have 137 00:07:01,360 --> 00:07:04,320 undiagnosed depression. They have difficulty focusing, 138 00:07:04,320 --> 00:07:07,960 but they're also, you know, relatively sad or low energy. 139 00:07:07,960 --> 00:07:10,800 And it's, it turns out it's actually depression and not ADHD 140 00:07:10,800 --> 00:07:14,400 or maybe they have low thyroid and they feel very, you know, 141 00:07:14,800 --> 00:07:18,080 very fatigued or they have anemia and they feel low energy 142 00:07:18,080 --> 00:07:19,640 and difficulty with concentration. 143 00:07:19,640 --> 00:07:22,720 So that's why it can be important to have an evaluation 144 00:07:22,720 --> 00:07:25,960 by a medical doctor or psychiatrist to really make sure 145 00:07:25,960 --> 00:07:29,560 that this is what you have so that you can go about trying to 146 00:07:29,560 --> 00:07:31,840 treat it. You mentioned that a lot of 147 00:07:31,840 --> 00:07:35,440 people think they have ADHD but they don't actually have ADHD. 148 00:07:35,440 --> 00:07:37,280 And this is a really big thing on TikTok. 149 00:07:37,280 --> 00:07:40,600 There is like a whole adult ADHD movement and you see so many 150 00:07:40,600 --> 00:07:44,920 people being like I just found out I have ADHD or like my ADHD 151 00:07:44,920 --> 00:07:47,360 brain. And when you look at the data, 152 00:07:47,360 --> 00:07:51,440 like the percentage of the population that has ADHD, it 153 00:07:51,440 --> 00:07:54,080 doesn't really match up with what we feel like we're kind of 154 00:07:54,080 --> 00:07:56,760 seeing on social media. And I think just like all things 155 00:07:56,760 --> 00:07:58,280 mental health related, there's a spectrum. 156 00:07:58,280 --> 00:08:02,960 Like not all of us are perfect focusers 24/7 and not all of us 157 00:08:02,960 --> 00:08:06,280 have severe ADHD. What are your thoughts on that 158 00:08:06,440 --> 00:08:10,000 self diagnosing aspect? And even just like the huge rise 159 00:08:10,000 --> 00:08:13,920 of diagnosis, is it people are just more aware and actually 160 00:08:13,920 --> 00:08:16,720 getting diagnosed? Or is it you just maybe are not 161 00:08:16,720 --> 00:08:19,320 the best at focusing and this is not an ADHD problem? 162 00:08:20,040 --> 00:08:22,400 Yeah, it's a, it's a super juicy question. 163 00:08:22,400 --> 00:08:25,720 And actually amongst my psychiatrist friends, some of us 164 00:08:25,720 --> 00:08:29,840 sort of feel like a need to push back and be like, you know, is 165 00:08:29,840 --> 00:08:33,880 ADHD just created by sort of the economy and this drive for like 166 00:08:33,880 --> 00:08:37,080 increased productivity? And like, should we be more 167 00:08:37,120 --> 00:08:40,320 accepting and willing that, hey, like we're, you know, we're just 168 00:08:40,760 --> 00:08:44,720 kind of dumb people that like kind of do some things right 169 00:08:44,720 --> 00:08:47,840 sometimes and are very inefficient other times and like 170 00:08:47,840 --> 00:08:50,320 grow in our acceptance of that. And I think there is something 171 00:08:50,320 --> 00:08:53,760 to be said of that, that, you know, humans can strive towards 172 00:08:53,760 --> 00:08:57,800 too much sort of robot like efficiency or, or perfectionism 173 00:08:57,920 --> 00:09:00,960 and that we should accept a little bit more our dumbness or 174 00:09:00,960 --> 00:09:06,000 our lack of efficiency. So that being said, the IT is 175 00:09:06,000 --> 00:09:09,280 extremely difficult in the United States to get evaluated 176 00:09:09,280 --> 00:09:12,760 for ADHD. The diagnosis is often made by a 177 00:09:12,760 --> 00:09:14,920 child and adolescent psychiatrist, of which there's 178 00:09:14,920 --> 00:09:17,400 an enormous scarcity in many parts of the country. 179 00:09:17,680 --> 00:09:20,400 It's impossible to see a child and adolescent psychiatrist. 180 00:09:20,600 --> 00:09:23,280 And of those that are out there also a lot of them don't accept 181 00:09:23,280 --> 00:09:25,080 insurance. And so then there's an issue of 182 00:09:25,080 --> 00:09:28,120 accessibility based on, you know, economic means. 183 00:09:28,160 --> 00:09:31,520 And so they would be one group of clinicians that would be able 184 00:09:31,520 --> 00:09:36,320 to do a diagnosis. But another sort of a required 185 00:09:36,320 --> 00:09:39,520 standard for people that are getting like academic 186 00:09:39,520 --> 00:09:42,800 accommodations, extra time on tests and things like that is to 187 00:09:42,800 --> 00:09:46,880 get a neuropsychological evaluation, which is a several 188 00:09:46,880 --> 00:09:50,520 hour long evaluation by a neuropsychologist, which is a 189 00:09:50,760 --> 00:09:55,520 subset of clinical psychologists who charge thousands of dollars 190 00:09:55,520 --> 00:09:58,400 for these evaluations. And so again, it's not only are 191 00:09:58,400 --> 00:10:01,440 they are they few and far between, but also, you know, not 192 00:10:01,440 --> 00:10:03,400 accessible to everyone. So I think there are a lot of 193 00:10:03,400 --> 00:10:06,720 people across the country that maybe really did struggle 194 00:10:06,720 --> 00:10:10,320 academically their whole lives and they didn't have the 195 00:10:10,320 --> 00:10:14,520 resources or the the means or, or know anyone around them that 196 00:10:14,520 --> 00:10:16,960 could evaluate them for ADHD or they just didn't know about 197 00:10:16,960 --> 00:10:19,560 ADHD. The other thing I would say is 198 00:10:19,560 --> 00:10:23,120 that, you know, sometimes people find it very helpful to have a 199 00:10:23,120 --> 00:10:26,360 clear diagnosis. And sometimes people are able to 200 00:10:26,360 --> 00:10:28,720 say, well, who cares whether or not I have it or whether or not 201 00:10:28,720 --> 00:10:32,040 I have a diagnosis? Like let's just figure out how 202 00:10:32,040 --> 00:10:35,920 to make me sort of better at focusing and more effective. 203 00:10:35,920 --> 00:10:39,720 And I would say certainly for anyone out there that whether or 204 00:10:39,720 --> 00:10:43,080 not you have ADHD, if you are having problems with your 205 00:10:43,080 --> 00:10:46,880 performance in school or or professionally, then the things 206 00:10:46,880 --> 00:10:48,880 that we're going to talk about today will be helpful for you. 207 00:10:48,960 --> 00:10:53,320 So in many ways, CBT for ADHD, cognitive behavioral therapy for 208 00:10:53,320 --> 00:10:56,280 ADHD or executive function coaching is something that kind 209 00:10:56,320 --> 00:10:58,720 of all of us need. A lot of people say it's sort of 210 00:10:58,720 --> 00:11:01,880 like, you know, adulting 101, but it's true. 211 00:11:02,240 --> 00:11:05,920 So yeah, I, I guess sort of it's a, it's a long winded answer to 212 00:11:05,920 --> 00:11:09,440 your question, but I would say that yes, there are probably 213 00:11:09,440 --> 00:11:11,760 people that have undiagnosed ADHD. 214 00:11:11,960 --> 00:11:15,400 Yes, there's probably people that are just sort of following 215 00:11:15,400 --> 00:11:17,960 the TikTok trend and they think they have it too, but they 216 00:11:17,960 --> 00:11:21,240 probably don't. And the main distinction between 217 00:11:21,240 --> 00:11:24,120 those groups of people would be whether or not they had these 218 00:11:24,120 --> 00:11:27,680 symptoms from a early age and that were consistent across 219 00:11:27,680 --> 00:11:30,240 different atmospheres or different scenarios. 220 00:11:30,240 --> 00:11:33,040 So these symptoms were present both at school and at home. 221 00:11:33,560 --> 00:11:36,560 And then also whether or not you can rule out that they had other 222 00:11:36,560 --> 00:11:38,760 things going on. So it definitely wasn't due to 223 00:11:38,760 --> 00:11:40,800 depression. It wasn't due to, like I 224 00:11:40,800 --> 00:11:43,440 mentioned before, a thyroid issue or anemia or another 225 00:11:43,440 --> 00:11:45,520 medical problem like that. Sleep apnea also. 226 00:11:45,800 --> 00:11:47,360 Yeah. And that it's significant enough 227 00:11:47,360 --> 00:11:49,600 to cause impairment across those areas. 228 00:11:50,520 --> 00:11:52,120 Yeah, it's, it's really interesting. 229 00:11:52,160 --> 00:11:54,840 I'm excited to dive into all of the behavioral shifts you can 230 00:11:54,840 --> 00:11:58,800 make because when we think about like the context of COVID and 231 00:11:58,800 --> 00:12:02,080 how much we're now relying on technology and academic and 232 00:12:02,120 --> 00:12:05,000 workplace settings and how distracting that can be. 233 00:12:05,000 --> 00:12:09,360 And also what are interactions with social media look like now 234 00:12:09,360 --> 00:12:11,880 versus even five years ago? Like things are much more 235 00:12:11,880 --> 00:12:14,480 engaging and at a much faster pace. 236 00:12:14,480 --> 00:12:17,960 And so it makes sense that with all of those distractions and 237 00:12:17,960 --> 00:12:20,920 with how our attention spans have responded, that maybe it 238 00:12:20,920 --> 00:12:24,240 feels harder to focus and it did five years ago, or maybe the 239 00:12:24,240 --> 00:12:26,720 environment looks so different and you don't necessarily have 240 00:12:26,720 --> 00:12:29,720 the skills that transfer over. And so I think that's another 241 00:12:29,720 --> 00:12:33,280 piece of the puzzle that I think universally it can be a 242 00:12:33,280 --> 00:12:36,400 relatable experience. But before we dive into all the 243 00:12:36,400 --> 00:12:38,920 things people can do, I think another really interesting piece 244 00:12:38,920 --> 00:12:41,120 of this puzzle is over medication. 245 00:12:41,120 --> 00:12:44,440 And there was all the news headlines about Adderall 246 00:12:44,440 --> 00:12:48,480 shortages and a bunch of studies that have been done with regard 247 00:12:48,480 --> 00:12:52,720 to adolescent prescriptions of stimulants and so, so many 248 00:12:52,720 --> 00:12:57,040 schools of thoughts here. But what is your perspective on 249 00:12:57,120 --> 00:13:01,080 stimulants for ADHD and potentially over prescribing 250 00:13:01,080 --> 00:13:04,520 them to kids and young adults? Yeah. 251 00:13:04,640 --> 00:13:08,400 So stimulant medications are typically the treatment for ADHD 252 00:13:08,400 --> 00:13:11,760 both in children and adults. So these would be medications 253 00:13:11,760 --> 00:13:15,560 like Adderall, Ritalin, there's a lot of new versions of these 254 00:13:15,560 --> 00:13:19,360 medications, Vyvanse, Focalin, Concerta, Adderallics are 255 00:13:19,360 --> 00:13:22,840 there's a lot of of these brands out there. 256 00:13:22,880 --> 00:13:26,840 And these medications, when you look at the effect size, so how 257 00:13:26,840 --> 00:13:31,280 effective and the kind of how, how big of a chunk of people you 258 00:13:31,280 --> 00:13:34,280 could expect to improve with these medications. 259 00:13:34,800 --> 00:13:37,880 They're amongst the most effective medications that we 260 00:13:37,880 --> 00:13:40,920 have in psychiatry and also in in medicine generally. 261 00:13:40,920 --> 00:13:43,480 The effect sizes comparably are are really good. 262 00:13:43,880 --> 00:13:47,760 So it really helps to add a stimulant for people that have 263 00:13:47,960 --> 00:13:51,600 true ADHD. There are two major sort of 264 00:13:51,600 --> 00:13:55,520 classes and so one is amphetamine based and one is 265 00:13:55,520 --> 00:13:59,520 methylphenidate based. Amphetamine based are the 266 00:13:59,520 --> 00:14:02,320 Adderall and Adderall type of medications. 267 00:14:02,800 --> 00:14:05,880 So Adderall XR, Vyvanse is sort of a relative as well. 268 00:14:06,160 --> 00:14:09,840 And then the methylphenidate medications are Ritalin, 269 00:14:09,840 --> 00:14:13,840 Concerta, Focalin and several of these other medications, The 270 00:14:13,880 --> 00:14:18,040 amphetamine based ones increase dopamine and norepinephrine, 271 00:14:18,040 --> 00:14:21,040 which are two neurotransmitters. They increase them more in the 272 00:14:21,040 --> 00:14:22,720 synapse. So these are kind of like 273 00:14:22,720 --> 00:14:26,600 stronger stimulant medications. Adderall is a stronger stimulant 274 00:14:26,600 --> 00:14:29,720 medication. Methylphenidate increases 275 00:14:29,720 --> 00:14:32,000 dopamine and norepinephrine a little less. 276 00:14:32,160 --> 00:14:36,720 So methylphenidate or Ritalin is a little bit of a like a lighter 277 00:14:36,720 --> 00:14:40,200 version of Adderall, even though, you know, the outcomes 278 00:14:40,200 --> 00:14:43,800 are pretty similar. So there are some some 279 00:14:43,800 --> 00:14:45,840 significant concerns with these medications. 280 00:14:45,840 --> 00:14:48,800 I personally, you know, would definitely think twice about 281 00:14:49,080 --> 00:14:51,840 using them for myself or for any loved one or for any of my 282 00:14:51,840 --> 00:14:54,040 patients. In fact, I very rarely prescribe 283 00:14:54,040 --> 00:14:56,760 them and that is for a couple different reasons. 284 00:14:56,760 --> 00:15:00,040 First of all, these medications are known to have addictive 285 00:15:00,040 --> 00:15:03,120 properties. So for this reason, they're 286 00:15:03,120 --> 00:15:06,040 scheduled two, so they're controlled substances, which 287 00:15:06,040 --> 00:15:10,600 means that you have to work very closely with your prescriber to 288 00:15:10,600 --> 00:15:14,240 to get these prescribed to you. And you know, you can't just get 289 00:15:14,320 --> 00:15:16,840 one prescription with a million refills and you're all set. 290 00:15:17,040 --> 00:15:19,600 You need to check in with them regularly to make sure that 291 00:15:19,600 --> 00:15:23,600 you're not having, you know, an, an addiction or a dependency to 292 00:15:23,600 --> 00:15:26,200 develop. Also as part of that, your body 293 00:15:26,200 --> 00:15:31,360 can become accustomed to, to the medication tolerance is what 294 00:15:31,360 --> 00:15:35,480 it's called, meaning that you, if you don't take breaks one 295 00:15:35,480 --> 00:15:38,880 weekend or two weekend days to sort of have your system reset, 296 00:15:39,200 --> 00:15:41,360 then you're gonna keep needing more and more to have the 297 00:15:41,360 --> 00:15:43,960 effect. So because they're controlled 298 00:15:43,960 --> 00:15:46,840 substances, there's a lot of logistical challenges related to 299 00:15:46,840 --> 00:15:48,800 that. You mentioned the the shortages, 300 00:15:49,720 --> 00:15:53,200 those are a huge pain in the butt for both patients and for 301 00:15:53,200 --> 00:15:55,280 prescribers because there is a shortage. 302 00:15:55,280 --> 00:15:58,720 I think is, is first Adderall, then people had to prescribe 303 00:15:58,720 --> 00:16:00,760 other stimulants to sort of replace those. 304 00:16:00,760 --> 00:16:03,360 And so then it led to shortages of all other sorts of 305 00:16:03,720 --> 00:16:05,520 stimulants. And so then that meant that 306 00:16:05,520 --> 00:16:08,120 patients were calling around to all these different pharmacies 307 00:16:08,120 --> 00:16:10,400 trying to see what they had in stock and pharmacies were 308 00:16:10,400 --> 00:16:13,640 overwhelmed and to some, to some extent still happening right 309 00:16:13,640 --> 00:16:15,360 now. It's been going on for over a 310 00:16:15,360 --> 00:16:18,360 year and a half now. So that's one thing for people 311 00:16:18,360 --> 00:16:21,360 to think about is like do you really want a medication where 312 00:16:21,360 --> 00:16:23,760 there's going to be this much headache each month to, you 313 00:16:23,760 --> 00:16:27,960 know, get it refilled? The second thing I would say is 314 00:16:27,960 --> 00:16:30,600 that there are concerns around physical health. 315 00:16:30,720 --> 00:16:35,880 So stimulants are known to increase your cardiovascular 316 00:16:35,920 --> 00:16:39,400 measures, so increase your heart rate and your blood pressure. 317 00:16:40,240 --> 00:16:43,120 For a long time it hasn't been known whether or not that has 318 00:16:43,120 --> 00:16:45,480 any long term risk, but there was a recent study that was 319 00:16:45,480 --> 00:16:48,640 published by Zhong and colleagues that showed that 320 00:16:48,960 --> 00:16:53,840 there was an association between long term stimulant use and 321 00:16:53,840 --> 00:16:57,400 cardiovascular events, heart attack, stroke things, things 322 00:16:57,400 --> 00:16:59,480 like that. And so certainly especially in 323 00:16:59,480 --> 00:17:02,600 the adult population or even in the kids population where you 324 00:17:02,600 --> 00:17:05,280 would be taking this for a long period of time, that's something 325 00:17:05,280 --> 00:17:07,440 you want to think about. So for any of my patients that 326 00:17:07,440 --> 00:17:10,400 do prescribe stimulants, I say, you know, this really should be 327 00:17:10,400 --> 00:17:12,960 a temporary measure until we can get your executive functioning 328 00:17:13,079 --> 00:17:15,319 to top notch and then we can get rid of this stuff. 329 00:17:16,000 --> 00:17:18,800 So that's one thing to consider. The other thing is there's for a 330 00:17:18,800 --> 00:17:22,160 long time, there have been animal studies that show there's 331 00:17:22,160 --> 00:17:26,800 maybe some neurotoxicity, some some toxicity to neurons and 332 00:17:26,800 --> 00:17:29,840 that there could possibly be some areas of the brain that are 333 00:17:29,840 --> 00:17:33,560 damaged by use of stimulants. And you know that there's many, 334 00:17:33,560 --> 00:17:35,400 there's, there's other side effects that are worth 335 00:17:35,400 --> 00:17:38,240 considering. People if they were genetically 336 00:17:38,240 --> 00:17:41,240 predisposed to psychosis or schizophrenia, for example, 337 00:17:41,240 --> 00:17:44,160 stimulants, especially amphetamine based stimulants 338 00:17:44,160 --> 00:17:48,120 like Adderall could have some risk of triggering psychosis or 339 00:17:48,120 --> 00:17:51,880 a manic episode in somebody with bipolar disorder, a genetic 340 00:17:51,880 --> 00:17:55,800 predisposition, insomnia is a common side effect and problem. 341 00:17:55,800 --> 00:17:59,400 So there's there's many things that are downsides to these 342 00:17:59,400 --> 00:18:02,080 medications, even though like I mentioned at the beginning, they 343 00:18:02,080 --> 00:18:04,600 have good effects sizes and can be very helpful for people. 344 00:18:05,560 --> 00:18:09,280 Yeah. So executive functioning and 345 00:18:09,400 --> 00:18:13,600 behavioral shifts that you can make to improve attention and 346 00:18:13,600 --> 00:18:18,080 focus and just like general functioning when it comes to 347 00:18:18,080 --> 00:18:20,440 completing tasks and staying engaged. 348 00:18:20,920 --> 00:18:23,360 Talk to me about what that looks like. 349 00:18:23,440 --> 00:18:26,840 Does executive functioning like fall under the umbrella of CBT? 350 00:18:26,840 --> 00:18:28,880 Are you pulling from different modalities? 351 00:18:28,880 --> 00:18:31,480 What do you recommend that patients implement? 352 00:18:32,400 --> 00:18:36,040 Yeah. So there are a few evidence 353 00:18:36,040 --> 00:18:40,040 based, I like to call them psychosocial interventions. 354 00:18:40,320 --> 00:18:43,200 These are medication free interventions that can be 355 00:18:43,200 --> 00:18:46,280 helpful for ADHD with randomized controlled trials backing them 356 00:18:46,280 --> 00:18:49,600 up. So one is CBT for ADHD, that's 357 00:18:49,600 --> 00:18:51,880 cognitive behavioral therapy for ADHD. 358 00:18:52,200 --> 00:18:55,440 Another one is executive function coaching. 359 00:18:55,680 --> 00:18:58,680 Actually, executive function coaching doesn't have as strong 360 00:18:58,680 --> 00:19:01,760 of an evidence base, but I'll talk about some of the 361 00:19:01,760 --> 00:19:03,240 similarities here in a little bit. 362 00:19:03,680 --> 00:19:06,840 Another one is cognitive remediation or cognitive 363 00:19:06,840 --> 00:19:08,760 training. It's done by psychologists. 364 00:19:09,200 --> 00:19:12,680 And then the final one that I'd say is mindfulness based 365 00:19:12,680 --> 00:19:15,560 cognitive therapy. So the first three that I 366 00:19:15,560 --> 00:19:18,040 mentioned have some similarities and overlaps. 367 00:19:18,040 --> 00:19:23,040 These are different forms of psychological support, often 368 00:19:23,040 --> 00:19:27,400 delivered by a therapist or a psychiatrist that are focused 369 00:19:27,400 --> 00:19:30,520 around a few different major executive functions. 370 00:19:30,520 --> 00:19:34,240 The most common ones would include calendar management. 371 00:19:34,680 --> 00:19:36,840 So this is making sure first of all, that you have a calendar, 372 00:19:37,920 --> 00:19:40,000 Second of all, that you're practicing good calendar 373 00:19:40,000 --> 00:19:41,800 hygiene. So there's something I check in 374 00:19:41,800 --> 00:19:45,080 with people on their appointments is do you have both 375 00:19:45,080 --> 00:19:48,360 formal commitments and informal commitments on your calendar? 376 00:19:48,360 --> 00:19:50,920 So you can see, hey, I told somebody I was going to meet 377 00:19:50,920 --> 00:19:53,880 with them for lunch at 1:00 PM, but then now I see I also have a 378 00:19:53,880 --> 00:19:58,040 meeting scheduled for 1:00 PM. I signed up to go to this 379 00:19:58,040 --> 00:20:00,840 conference on, you know, a month from now. 380 00:20:00,840 --> 00:20:03,080 But now I'm just realizing that one of the nights is actually my 381 00:20:03,080 --> 00:20:05,240 anniversary, you know, something like that. 382 00:20:05,960 --> 00:20:08,800 Does it have built in transition times? 383 00:20:08,800 --> 00:20:12,320 So things like if you have one meeting here and then another 384 00:20:12,320 --> 00:20:15,920 one across town, you can have them back-to-back. 385 00:20:16,080 --> 00:20:18,440 You need to build in your time to get from one to the other. 386 00:20:19,160 --> 00:20:21,880 And then having notifications on our way to know that. 387 00:20:21,880 --> 00:20:24,640 And then also an important part of the calendar hygiene is 388 00:20:24,640 --> 00:20:27,120 checking at least twice daily. So practicing with people, 389 00:20:27,120 --> 00:20:29,920 checking in the morning and checking in the evening before 390 00:20:29,920 --> 00:20:31,840 the end of the day. And in the evening you're 391 00:20:31,840 --> 00:20:33,440 checking what's coming up the next day. 392 00:20:33,440 --> 00:20:36,600 So you can see that as part of that, I like to do with people 393 00:20:36,600 --> 00:20:38,640 something that's called mimetic processing, which is like a 394 00:20:38,640 --> 00:20:42,120 visualization exercise where we literally close our eyes and we 395 00:20:42,120 --> 00:20:44,640 imagine ourselves going through every part of the day. 396 00:20:45,280 --> 00:20:46,960 And as you're doing that, you're, you're picturing 397 00:20:46,960 --> 00:20:49,080 yourself putting on the clothes and then you're picturing 398 00:20:49,080 --> 00:20:52,520 yourself for me, you know, going into the clinic and then seeing 399 00:20:52,520 --> 00:20:55,080 if we're a patient, you can sort of see how things are going to 400 00:20:55,080 --> 00:20:57,760 go from one thing to the next. You prepare yourself. 401 00:20:58,000 --> 00:21:00,000 And then you might recognize where there's errors where 402 00:21:00,000 --> 00:21:02,520 you're like, oh, crap, I was thinking, I have this thing at 403 00:21:02,520 --> 00:21:04,880 4:00, but like it's way over there. 404 00:21:04,880 --> 00:21:07,440 And in my thing before it always takes up the whole hour. 405 00:21:07,440 --> 00:21:08,720 How am I going to get there in time? 406 00:21:09,200 --> 00:21:12,040 And so you can see those those errors beforehand. 407 00:21:12,600 --> 00:21:15,520 So that's calendar management. It's one of the themes across 408 00:21:15,520 --> 00:21:19,280 these different approaches. Another one would be task list 409 00:21:19,280 --> 00:21:22,000 management. So to do lists, there's a whole 410 00:21:22,000 --> 00:21:25,000 system to do this. And usually with people, I 411 00:21:25,000 --> 00:21:29,280 recommend having a general list that's sub categorized into 412 00:21:29,320 --> 00:21:32,160 different sort of spheres of life and then having a daily To 413 00:21:32,160 --> 00:21:35,200 Do List. And you as part of this, you 414 00:21:35,480 --> 00:21:39,000 practice prioritization skills, which for that I with people, I 415 00:21:39,000 --> 00:21:41,640 use what's called the Eisenhower Matrix. 416 00:21:42,360 --> 00:21:45,760 This is a matrix that I think was made popular by President 417 00:21:45,760 --> 00:21:49,480 Eisenhower that is organizing things based on how urgent and 418 00:21:49,480 --> 00:21:51,520 important they are. If it's both urgent and 419 00:21:51,520 --> 00:21:54,400 important, you do it today. You put it on your today To Do 420 00:21:54,400 --> 00:21:57,120 List. If it is important but not 421 00:21:57,120 --> 00:22:00,000 urgent, then you need to put it on your calendar. 422 00:22:00,000 --> 00:22:02,600 You need to schedule it. This is something that like 423 00:22:03,080 --> 00:22:06,640 everyone with ADHD needs to learn because for everyone with 424 00:22:06,640 --> 00:22:09,440 ADHD, there's this issue of like, there's, there's all these 425 00:22:09,440 --> 00:22:12,040 things that I need to do, but it's not urgent. 426 00:22:12,040 --> 00:22:14,840 So I never do it. And so you need to develop this 427 00:22:14,840 --> 00:22:18,080 ability to identify those things and then put it on your 428 00:22:18,080 --> 00:22:19,560 calendar. And as long as you have a 429 00:22:19,560 --> 00:22:22,200 calendar that you're following, then you can do that. 430 00:22:22,920 --> 00:22:25,680 So anyways, that's task list management. 431 00:22:27,040 --> 00:22:29,280 Do you have? Different platforms that you 432 00:22:29,280 --> 00:22:32,320 like people to use for tasks and to do lists. 433 00:22:33,160 --> 00:22:36,560 Yeah, I do usually I have AI have a bit of a bias towards the 434 00:22:36,560 --> 00:22:40,920 Google Workspace because usually if people, most people have a 435 00:22:40,920 --> 00:22:43,640 Gmail. And so then if you have a Gmail, 436 00:22:43,640 --> 00:22:46,400 then you have Google Calendar. And then I like to use Google 437 00:22:46,400 --> 00:22:48,560 Keep. Google Keep has really good. 438 00:22:48,600 --> 00:22:51,680 It's it's good for to do lists. You know, people experiment with 439 00:22:51,680 --> 00:22:53,800 other ones, which is fine. There could be problems with 440 00:22:53,800 --> 00:22:57,520 integration and with, you know, being able to update it both on 441 00:22:57,520 --> 00:23:00,040 your laptop and on your phone or whatever. 442 00:23:00,360 --> 00:23:01,960 But as long as they're able to do that, that's fine. 443 00:23:01,960 --> 00:23:05,960 I have some patients and, and clients who who prefer to do 444 00:23:05,960 --> 00:23:09,880 things manually or keep, you know, a physical calendar or To 445 00:23:09,880 --> 00:23:12,280 Do List with them. And that's fine as long I tell 446 00:23:12,280 --> 00:23:14,000 them like it. It must be portable though. 447 00:23:14,000 --> 00:23:18,000 You need to have it with you so that you know, if you are away 448 00:23:18,000 --> 00:23:20,920 from your office that you can stay on top of these things. 449 00:23:20,920 --> 00:23:24,600 Otherwise their papers multiply. And so everyone with ADHD will 450 00:23:24,600 --> 00:23:26,000 say, well, I already know these things. 451 00:23:26,000 --> 00:23:28,160 Like I've already tried this a million times, right? 452 00:23:28,680 --> 00:23:31,760 And I tell people it's like going to the gym, like you, 453 00:23:31,920 --> 00:23:34,400 you're never done, you know, you're never like, OK, now I'm 454 00:23:34,400 --> 00:23:36,400 fit done with that. Check that off. 455 00:23:36,400 --> 00:23:38,920 Like, no, you need to, if you're going to be fit, you need to be 456 00:23:38,920 --> 00:23:42,040 fit every day. And it's the same thing with 457 00:23:42,040 --> 00:23:44,480 good executive functioning, you're going to fail. 458 00:23:44,480 --> 00:23:46,600 You're going to have a million calendars, you're going to make 459 00:23:46,600 --> 00:23:48,960 a million mistakes. But if you follow this 460 00:23:48,960 --> 00:23:51,600 systematically and you work with somebody, you will develop these 461 00:23:51,600 --> 00:23:55,520 skills and not that long of a time like usually with people 462 00:23:55,520 --> 00:23:57,640 that are working with me intensively, it's it's less than 463 00:23:57,640 --> 00:24:01,440 two months in order to really get this all pretty much sorted 464 00:24:01,440 --> 00:24:03,720 out. So yeah, those are two things. 465 00:24:03,720 --> 00:24:06,240 And there's other things about sort of minimizing distractions 466 00:24:06,240 --> 00:24:09,400 in the the workplace. There's different technological 467 00:24:09,400 --> 00:24:12,880 supports that people can use, like reading tools. 468 00:24:12,880 --> 00:24:15,080 There's Swift read, there's bionic reader. 469 00:24:15,080 --> 00:24:17,800 These are different sort of reading supports that help to 470 00:24:17,800 --> 00:24:20,960 hold focus while people are reading large pieces of text. 471 00:24:21,480 --> 00:24:25,880 There's things like binaural beats and sound machines that do 472 00:24:25,880 --> 00:24:28,360 have evidence. So there's, there's, there's 473 00:24:28,360 --> 00:24:32,760 many sort of non medication tools that that people can use. 474 00:24:33,600 --> 00:24:36,120 I'm gonna get my To Do List. I can show you. 475 00:24:36,120 --> 00:24:39,720 We can do show and tell because I'm very type A and to my 476 00:24:39,720 --> 00:24:42,880 knowledge, not ADHD. And I think I take it too far in 477 00:24:42,880 --> 00:24:46,280 the other direction and crazy with my calendar. 478 00:24:46,480 --> 00:24:48,600 And I've been doing this for years. 479 00:24:48,600 --> 00:24:51,240 So it's not just like a weekly phase where I'm like, oh, I'll 480 00:24:51,240 --> 00:24:53,320 be really organized and insane with this. 481 00:24:53,360 --> 00:24:57,160 It somehow has maintained. But I have my Google calendars 482 00:24:57,160 --> 00:25:00,880 that I integrate all of them onto my Apple calendar. 483 00:25:01,320 --> 00:25:05,520 So I have literally 8 Gmails from like school and work and 484 00:25:05,520 --> 00:25:08,720 other work and the podcast. And so it all has to be on one. 485 00:25:09,040 --> 00:25:12,120 So I had like my 16 integrated calendars color code. 486 00:25:12,120 --> 00:25:14,320 And I do what you're talking about where it's like informal, 487 00:25:14,320 --> 00:25:18,520 informal commitments and things I might do that I want to kind 488 00:25:18,520 --> 00:25:20,600 of be aware of when those need to be blocked off. 489 00:25:20,800 --> 00:25:25,440 And then I have a sauna, which is incredible. 490 00:25:26,280 --> 00:25:30,640 And this I have every class and then work commitment 491 00:25:30,640 --> 00:25:33,480 color-coded. And these are all the things I 492 00:25:33,480 --> 00:25:38,160 didn't do yesterday, but I like organize all deliverables and 493 00:25:38,160 --> 00:25:40,320 deadlines on there, which works really well. 494 00:25:41,080 --> 00:25:44,880 And then where it gets crazy is that I have my bullet journal, 495 00:25:44,960 --> 00:25:47,360 which I don't know if you've ever worked with anyone that 496 00:25:47,360 --> 00:25:49,880 does bullet journaling, but it's a whole other crazy side of 497 00:25:49,880 --> 00:25:52,760 scheduling. And I do like my weekly calendar 498 00:25:53,360 --> 00:25:57,560 and then I also have my daily to do lists. 499 00:25:58,400 --> 00:26:02,360 So clearly I'm very reinforced by checking things off. 500 00:26:02,880 --> 00:26:06,640 But it helps to not forget things and to have everything 501 00:26:06,640 --> 00:26:09,680 organized and on all the places at all times. 502 00:26:10,360 --> 00:26:12,720 Absolutely, yeah. You anyone that's looking 503 00:26:12,720 --> 00:26:15,520 you're, you're seeing some A+ executive functioning skills 504 00:26:15,520 --> 00:26:16,760 right there maybe. Too much. 505 00:26:17,360 --> 00:26:19,520 Yeah, no, I mean, well, it is something to think about, you 506 00:26:19,520 --> 00:26:21,960 know, And that that is, I've had, I've had patients that are 507 00:26:21,960 --> 00:26:24,120 the other side and I treat things other than ADHD. 508 00:26:24,120 --> 00:26:27,360 But people that have you, you don't, I'm not saying you have 509 00:26:27,360 --> 00:26:30,600 these things, but people do out there have obsessive compulsive 510 00:26:30,600 --> 00:26:35,120 personality disorder or OCD, compulsive disorder where, you 511 00:26:35,120 --> 00:26:37,760 know, then there's a challenge of tolerating a bit of 512 00:26:38,160 --> 00:26:42,160 imperfections, a bit of breaking rules and doing exposures to 513 00:26:42,160 --> 00:26:44,240 that. And it goes back to what we were 514 00:26:44,240 --> 00:26:47,880 talking about before of like this, you know, is, is ADHD 515 00:26:47,880 --> 00:26:49,680 real? And do we just not have 516 00:26:49,680 --> 00:26:53,400 tolerance enough in society for sort of imperfections and 517 00:26:53,600 --> 00:26:56,240 inefficiency? So it's a balance, I think for 518 00:26:56,240 --> 00:26:58,600 sure. But those sort of systems that 519 00:26:58,600 --> 00:27:01,960 you have are exactly what's needed to have good executive 520 00:27:01,960 --> 00:27:06,360 functioning and probably to do well on the things that are 521 00:27:06,360 --> 00:27:09,400 important to you. So I think for people out there 522 00:27:09,400 --> 00:27:12,440 that have ADHD, that might seem, it might seem like a huge leap 523 00:27:12,440 --> 00:27:15,360 to get to wherever they are now, which is probably nothing or a 524 00:27:15,360 --> 00:27:19,560 million like dead, like zombie calendars out there to getting 525 00:27:19,560 --> 00:27:21,680 to where you are. But I think there's also there's 526 00:27:21,720 --> 00:27:25,320 a lot of intermediate steps and for people, you know, I had one 527 00:27:25,320 --> 00:27:29,040 patient who's a writer. And so he, he's a writer and he 528 00:27:29,040 --> 00:27:31,240 does some like tutoring on the side. 529 00:27:31,240 --> 00:27:35,200 And so he really only has like one formal commitment, like he 530 00:27:35,200 --> 00:27:37,560 has two or three meetings for tutoring during the week. 531 00:27:37,560 --> 00:27:39,280 The rest of his time is completely open. 532 00:27:39,720 --> 00:27:43,120 And so putting structure and actually creating a calendar in 533 00:27:43,120 --> 00:27:45,040 the 1st place was an important first step. 534 00:27:45,320 --> 00:27:48,920 And even with great executive functioning, his calendar, you 535 00:27:48,920 --> 00:27:50,960 know, looks a lot simpler than yours does. 536 00:27:51,240 --> 00:27:54,080 So there's a whole sort of gradient for the people can 537 00:27:54,200 --> 00:27:57,520 exist out there. Yeah, I will say I do give 538 00:27:57,520 --> 00:28:00,120 myself a lot of grace. Like I write the tasks down so I 539 00:28:00,120 --> 00:28:02,440 don't have to remember them, which helps a lot with mental 540 00:28:02,440 --> 00:28:05,440 stress and saving yourself work being like, am I supposed to be 541 00:28:05,440 --> 00:28:07,840 somewhere? Like I have this recording like 542 00:28:08,160 --> 00:28:10,320 that helps. And then I'm always like, well, 543 00:28:10,560 --> 00:28:12,760 tomorrow it'll happen at some point. 544 00:28:13,240 --> 00:28:16,000 But I, I wonder if this is a piece of the puzzle as well, 545 00:28:16,000 --> 00:28:20,400 which is willpower, and if you've written down the things 546 00:28:20,400 --> 00:28:23,600 or it's that idea of like, it's important but not urgent. 547 00:28:24,320 --> 00:28:27,840 How do you help people get out of that kind of mental block 548 00:28:27,840 --> 00:28:30,880 where it doesn't need to be done, but it should be done and 549 00:28:30,880 --> 00:28:32,840 it could save you stress down the line? 550 00:28:33,360 --> 00:28:36,880 How do you kind of like bridge that gap between intention and 551 00:28:36,880 --> 00:28:39,400 action with regard to like focus and tasks? 552 00:28:39,960 --> 00:28:41,880 That's a, that's a really great question. 553 00:28:41,880 --> 00:28:45,240 The answer would be that it's a motivation question. 554 00:28:45,240 --> 00:28:48,880 So we're talking about things that are important and not 555 00:28:48,880 --> 00:28:52,400 urgent. And so if you don't want to do 556 00:28:52,400 --> 00:28:55,080 something or it's not really getting done, you need to ask 557 00:28:55,080 --> 00:28:57,720 yourself, is it important and or is it urgent? 558 00:28:58,040 --> 00:29:01,400 If it's not important and it's not urgent, but it's not 559 00:29:01,400 --> 00:29:03,600 important, then you need to delete it. 560 00:29:03,600 --> 00:29:06,240 A lot of people have these zombie to do lists that have, 561 00:29:06,520 --> 00:29:09,240 you know, these things on there that are like read the book 562 00:29:09,240 --> 00:29:14,160 about the history of like human civilization and it's like, OK, 563 00:29:14,160 --> 00:29:17,240 it's not urgent. And you know, if you're, that's 564 00:29:17,240 --> 00:29:19,560 not your career area, it's probably not important either. 565 00:29:19,960 --> 00:29:23,200 So you shouldn't be holding on to all this guilt about not 566 00:29:23,200 --> 00:29:26,120 doing that And it being one of 100 things that you haven't been 567 00:29:26,120 --> 00:29:27,960 able to check off, you need to get rid of it. 568 00:29:28,320 --> 00:29:30,240 So it's really important is identifying the things that are 569 00:29:30,240 --> 00:29:33,320 not truly important and not truly urgent and deleting them. 570 00:29:33,560 --> 00:29:36,880 But for the things that are important, but they're not 571 00:29:36,880 --> 00:29:39,680 urgent, like we said, those need to be scheduled. 572 00:29:40,480 --> 00:29:44,240 So for example, for me, I did this training and early 573 00:29:44,240 --> 00:29:48,760 identification of cognitive decline and reversal sort of 574 00:29:48,760 --> 00:29:52,680 protocols for that. It was a part of my professional 575 00:29:52,680 --> 00:29:56,040 development that I didn't need to do per SE and it was 576 00:29:56,040 --> 00:30:00,120 definitely not urgent, but I wanted to and like it was 577 00:30:00,120 --> 00:30:03,520 important to me. So I scheduled time each week. 578 00:30:03,520 --> 00:30:06,440 I made it through the modules and the testing and stuff in 579 00:30:06,440 --> 00:30:08,640 order to do that. So I think a lot of people have 580 00:30:08,640 --> 00:30:11,040 things like that. And so, you know, if you're 581 00:30:11,040 --> 00:30:13,240 still struggling with something, even though you do think like, 582 00:30:13,240 --> 00:30:15,480 yeah, this is something I want to do for my professional 583 00:30:15,480 --> 00:30:17,640 development or for my own development, but I'm still 584 00:30:17,640 --> 00:30:20,720 procrastinating. I'd say the first thing is 585 00:30:21,080 --> 00:30:25,920 recognizing that procrastination is very normal in ADHDI like to 586 00:30:25,920 --> 00:30:29,640 tell people that procrastination is their own self medicating of 587 00:30:29,720 --> 00:30:33,080 of a stimulant, which is that when you are procrastinating and 588 00:30:33,080 --> 00:30:36,280 you're down to the crunch, you're definitely stimulated. 589 00:30:36,360 --> 00:30:39,280 You're giving yourself a huge bump of norepinephrine, which is 590 00:30:39,280 --> 00:30:42,800 one of the components of stimulant medications there the 591 00:30:42,800 --> 00:30:45,840 impacts on the synapse. So you're doing self medicating 592 00:30:45,840 --> 00:30:48,440 by doing that and you'll, you'll probably see you are able to 593 00:30:48,440 --> 00:30:51,080 hyper focus when you're, you know, put in that stressful 594 00:30:51,080 --> 00:30:53,520 situation. So that's normal. 595 00:30:53,560 --> 00:30:58,120 One thing is breaking down tasks and putting early deadlines to 596 00:30:58,120 --> 00:31:01,200 things is very important. So you know, instead of I'm 597 00:31:01,200 --> 00:31:05,720 going to finish this 10 page paper a month from now to 598 00:31:05,720 --> 00:31:07,960 instead say, OK, I'm going to. On Monday. 599 00:31:09,000 --> 00:31:11,800 Oh, there you go. Well, that's great. 600 00:31:11,800 --> 00:31:13,080 That's great. So now you're gonna get it. 601 00:31:13,080 --> 00:31:15,200 You're gonna get some stimulant here coming, some natural 602 00:31:15,200 --> 00:31:17,800 stimulant coming in. Literally you're gonna laser 603 00:31:17,800 --> 00:31:21,000 focus. But so for people to instead for 604 00:31:21,000 --> 00:31:25,360 ADHD, people need like extremely aggressive tight deadlines. 605 00:31:25,360 --> 00:31:29,960 So to say like, OK, we're going to set a timer right now for 45 606 00:31:29,960 --> 00:31:32,880 minutes and you're going to write the entire introduction 45 607 00:31:32,880 --> 00:31:33,640 minutes. Boom. 608 00:31:33,760 --> 00:31:36,680 You want to set extremely aggressive timelines, ones that 609 00:31:36,680 --> 00:31:38,680 maybe you won't even achieve and that's OK. 610 00:31:38,680 --> 00:31:41,680 But you're trying to create this pinch for you with a, a bite 611 00:31:41,680 --> 00:31:43,640 size of the work that you need to do. 612 00:31:44,000 --> 00:31:47,320 And another thing is it with it being a small ask of OK, it's 613 00:31:47,320 --> 00:31:49,680 only the introduction. I can write that in 45 minutes. 614 00:31:50,800 --> 00:31:53,040 The the great thing is that it was something that's known in 615 00:31:53,040 --> 00:31:56,280 behavioral psychology is that it, once you get started, it's 616 00:31:56,280 --> 00:31:58,880 easier to keep going. So often times I'll do that with 617 00:31:58,880 --> 00:32:01,800 people, but then at 45 minutes, they just want to keep going and 618 00:32:01,800 --> 00:32:04,040 they get a lot of it done. So that's something to 619 00:32:04,040 --> 00:32:06,840 definitely use. But the other thing is often 620 00:32:06,840 --> 00:32:09,840 times people, if they're procrastinating or they're not 621 00:32:09,840 --> 00:32:13,040 doing things that they, that are important to them, then it's a 622 00:32:13,040 --> 00:32:16,120 matter of motivation. And that's something to visit 623 00:32:16,120 --> 00:32:17,480 with them. And and so there's a thing 624 00:32:17,480 --> 00:32:19,560 called motivational interviewing that I do with people. 625 00:32:20,080 --> 00:32:23,800 And so I'll say, OK, you know, you said that you were going to 626 00:32:23,840 --> 00:32:27,840 work out this last week and, and it was scheduled in for you to 627 00:32:27,840 --> 00:32:31,120 do it at 3:00 PM. And looking back on your week, 628 00:32:31,120 --> 00:32:33,040 it doesn't look like you did it at all. 629 00:32:33,360 --> 00:32:37,080 So do you not want to do it like you could say, for example, is 630 00:32:37,080 --> 00:32:39,880 it really worth it to do it? Are there other things that are 631 00:32:39,880 --> 00:32:42,480 better uses of your time than working out? 632 00:32:42,800 --> 00:32:45,720 So by challenging it, instead of saying like you should be 633 00:32:45,720 --> 00:32:48,800 working out, we're saying, well, maybe you shouldn't be working 634 00:32:48,800 --> 00:32:50,880 out. What we're doing is we're giving 635 00:32:50,880 --> 00:32:54,080 you an opportunity to instead convince me rather than me 636 00:32:54,080 --> 00:32:56,440 convince you. That's, that's what's happening 637 00:32:56,440 --> 00:32:59,240 in motivational interviewing. And so the person starts saying, 638 00:32:59,240 --> 00:33:01,080 no, like I do, I do want to work. 639 00:33:01,080 --> 00:33:03,320 I I know I should. And this is something that's 640 00:33:03,320 --> 00:33:05,800 used in addictions as well, you know, well, why don't you keep 641 00:33:05,800 --> 00:33:07,000 drinking? Why don't, why don't you drink 642 00:33:07,000 --> 00:33:09,120 more? You use these sort of extreme 643 00:33:09,120 --> 00:33:10,120 examples. So, yeah. 644 00:33:10,120 --> 00:33:13,080 So motivational interviewing is something that's that's very 645 00:33:13,080 --> 00:33:16,160 important in order to boost motivation once it starts to go 646 00:33:16,160 --> 00:33:17,560 down. Yeah. 647 00:33:18,480 --> 00:33:20,920 And then you mentioned earlier that there are different 648 00:33:20,920 --> 00:33:24,080 techniques you can use to improve focus. 649 00:33:24,080 --> 00:33:26,760 Obviously one thing is like getting started on a small piece 650 00:33:26,760 --> 00:33:29,920 of the task and then it's easier to just maintain rather than 651 00:33:29,920 --> 00:33:33,040 motivate to do the whole thing. Are there other ways that people 652 00:33:33,040 --> 00:33:37,960 can help improve their focus if that's a barrier to getting 653 00:33:37,960 --> 00:33:40,840 these things done and and sticking with a task? 654 00:33:42,000 --> 00:33:44,360 Absolutely. So often times people need 655 00:33:44,360 --> 00:33:46,600 stimulation as a part of their did. 656 00:33:46,600 --> 00:33:49,800 They need more stimulation in order to focus and get things 657 00:33:49,800 --> 00:33:52,320 done. One way to do that is by using 658 00:33:52,320 --> 00:33:55,000 what I call artificial procrastination or these tight 659 00:33:55,000 --> 00:33:58,000 deadlines that the people can do in order to really feel the 660 00:33:58,000 --> 00:34:01,160 pinch and get things done. And they do that by breaking it 661 00:34:01,160 --> 00:34:03,720 into a smaller task. Another thing is often times 662 00:34:03,720 --> 00:34:06,680 people find that they need higher beats, permanent music. 663 00:34:06,720 --> 00:34:10,679 So instrumental music is less likely to cause a distraction. 664 00:34:10,679 --> 00:34:14,040 And having it be upbeat can make the person feel a little bit 665 00:34:14,040 --> 00:34:16,600 more stimulated, a little bit more active. 666 00:34:17,120 --> 00:34:20,159 And then we want to eliminate distractions. 667 00:34:20,159 --> 00:34:24,920 So like number one thing for people is to take your phone and 668 00:34:24,920 --> 00:34:28,719 put it either in another room or put it in a drawer, make sure 669 00:34:28,719 --> 00:34:32,400 notifications off that it's silenced, things like that. 670 00:34:32,679 --> 00:34:36,280 Sometimes people need to either X out of all of their open 671 00:34:36,280 --> 00:34:40,199 windows or or minimize one of those and open a new window. 672 00:34:40,199 --> 00:34:43,000 That's only with the thing that they're working on in order to 673 00:34:43,000 --> 00:34:46,520 decrease those distractions, making sure that there's no 674 00:34:46,520 --> 00:34:50,320 notifications for, you know, some of those, those common pop 675 00:34:50,320 --> 00:34:53,800 ups on computers. So like iMessage or WhatsApp, 676 00:34:53,800 --> 00:34:56,960 things like that, that you're not having any Dings on your 677 00:34:56,960 --> 00:34:58,560 computer as you're as you're doing that. 678 00:34:58,800 --> 00:35:01,400 So those, yeah, those would be some of the common examples. 679 00:35:02,200 --> 00:35:05,600 And then one other question for people who are listening and 680 00:35:05,640 --> 00:35:09,080 they want to continue to improve their executive functioning 681 00:35:09,080 --> 00:35:12,000 skills, continue to adjust these behaviors. 682 00:35:12,240 --> 00:35:14,880 Do you have any other recommendations for podcasts or 683 00:35:14,880 --> 00:35:18,840 books or resources where they can continue to learn about 684 00:35:18,840 --> 00:35:22,280 these things and kind of build their skill set around coping 685 00:35:22,280 --> 00:35:25,480 with and navigating ADHD in more of like a holistic way? 686 00:35:26,640 --> 00:35:30,160 Absolutely. There's a number of different 687 00:35:30,280 --> 00:35:34,640 kind of Get things done sort of books and tools and manuals out 688 00:35:34,640 --> 00:35:37,640 there. One is called Get Things Done. 689 00:35:37,640 --> 00:35:40,880 One, there's a bullet notebook that you were just mentioning. 690 00:35:41,280 --> 00:35:45,080 There's Atomic Habits and there's several materials around 691 00:35:45,080 --> 00:35:48,280 that are out there that people use, so people can definitely 692 00:35:48,280 --> 00:35:50,760 experiment with those. I do find though, that often 693 00:35:50,760 --> 00:35:53,280 times people with ADHD, they need someone coaching them 694 00:35:53,280 --> 00:35:56,000 through this. And with ADHD you don't 695 00:35:56,000 --> 00:35:58,720 necessarily need ideas. What you need is accountability 696 00:35:58,720 --> 00:36:01,880 and implementation. And so it's really helpful to 697 00:36:01,880 --> 00:36:04,480 work with somebody for that. So that's the work that I do in 698 00:36:04,480 --> 00:36:06,640 my clinic. My clinic is Nissan Clinic, 699 00:36:06,800 --> 00:36:12,480 NISSENCLIN, ic.com. Otherwise, there's other folks 700 00:36:12,480 --> 00:36:15,920 out there, you know, either if you were just looking for a 701 00:36:15,920 --> 00:36:18,320 medication to try, then you would want to look for a 702 00:36:18,320 --> 00:36:21,720 psychiatrist. If you are looking for more of 703 00:36:21,720 --> 00:36:25,240 these skills, you could look for an executive functioning coach. 704 00:36:25,280 --> 00:36:28,480 There's several places out there where you can look for those. 705 00:36:28,920 --> 00:36:33,320 There is one that I recommend sometimes to people relatively 706 00:36:33,320 --> 00:36:35,920 new, it's called Shimmer, and they do executive function 707 00:36:35,920 --> 00:36:38,680 coaching. But certainly though, if you're 708 00:36:38,680 --> 00:36:42,600 looking for someone to maybe prescribe and do these things, 709 00:36:42,600 --> 00:36:45,360 and we're kind of a small community so that that's the 710 00:36:45,360 --> 00:36:48,000 kind of work that I do. I would say some of the other 711 00:36:48,000 --> 00:36:51,280 things that could be brought up or focused with whoever you're 712 00:36:51,280 --> 00:36:53,080 working with. Is there some dietary 713 00:36:53,080 --> 00:36:55,400 interventions that have a good evidence base? 714 00:36:55,400 --> 00:36:57,440 They have randomized controlled trials. 715 00:36:57,880 --> 00:37:00,360 And then there's also some supplements that I use as well 716 00:37:00,360 --> 00:37:02,880 and non stimulant medications that I use. 717 00:37:02,880 --> 00:37:06,880 So, you know, some things like that, I think often paired with 718 00:37:06,880 --> 00:37:10,600 these lifestyle changes can create the biggest shift. 719 00:37:11,040 --> 00:37:13,840 I didn't mention exercise yet, but exercises shouldn't be very 720 00:37:13,840 --> 00:37:17,920 helpful for people with ADHD. And a lot of folks have ADHD 721 00:37:17,920 --> 00:37:21,280 symptoms that worsen in college because they're no longer in 722 00:37:21,280 --> 00:37:23,240 their team sports that they were doing in high school. 723 00:37:23,280 --> 00:37:26,560 So that's also very common. So yeah, I would say you can 724 00:37:26,560 --> 00:37:29,280 kind of string together some of these resources on your own. 725 00:37:29,560 --> 00:37:32,440 Or what I do in my clinic is I try to put them all together. 726 00:37:32,880 --> 00:37:36,760 My last question is going to be if you could like wave a magic 727 00:37:36,760 --> 00:37:39,960 wand and give someone daily habits they were implementing 728 00:37:39,960 --> 00:37:44,080 that are really conducive to helping support ADHD, Whether 729 00:37:44,080 --> 00:37:46,800 it's exercising in the morning versus at night, or making sure 730 00:37:46,800 --> 00:37:50,480 a certain food group is implemented every day or being 731 00:37:50,480 --> 00:37:52,080 outside of the house when working. 732 00:37:52,080 --> 00:37:54,800 Like what would those daily habits be? 733 00:37:56,160 --> 00:37:59,920 First of all, you know, waking up, I do have a bit of a bias 734 00:37:59,920 --> 00:38:02,760 towards exercising in the morning versus later in the day 735 00:38:03,040 --> 00:38:06,320 just because as part of just, if you're trying to form a habit, 736 00:38:06,520 --> 00:38:10,360 you want to minimize the chances for something to conflict with 737 00:38:10,360 --> 00:38:12,800 that habit. So doing it first thing in the 738 00:38:12,800 --> 00:38:14,560 day is helpful. And certainly if you're doing as 739 00:38:14,560 --> 00:38:17,200 part of an ADHD regimen and you just want to make sure that it 740 00:38:17,200 --> 00:38:19,760 happens, then you'd want to do it first. 741 00:38:19,760 --> 00:38:22,160 So I would say you would wake up, you'd exercise, and then you 742 00:38:22,160 --> 00:38:25,080 would check your calendar and review your calendar for the 743 00:38:25,080 --> 00:38:27,120 day. You would do some memetic 744 00:38:27,120 --> 00:38:30,040 processing, so like visualizing yourself going through the day. 745 00:38:30,560 --> 00:38:33,480 You would have your appointments. 746 00:38:33,480 --> 00:38:36,240 You would set up a, you know, a good work environment. 747 00:38:36,240 --> 00:38:37,880 That's where you minimize distractions. 748 00:38:37,880 --> 00:38:40,920 You have your phone with notifications off, your computer 749 00:38:41,280 --> 00:38:45,080 with notifications off on any messaging, and you would have a 750 00:38:45,080 --> 00:38:47,480 separate window for whatever you're working on. 751 00:38:48,120 --> 00:38:50,840 And early in the day, probably for people that are taking 752 00:38:50,840 --> 00:38:53,640 medications or supplements, that would be a time to do that. 753 00:38:53,640 --> 00:38:56,880 So one of the non stimulant medications might be something 754 00:38:56,880 --> 00:38:59,920 that would come in at that point or supplement. 755 00:39:00,040 --> 00:39:03,680 Dietary wise, there's not necessarily something to add 756 00:39:03,680 --> 00:39:07,200 that would have a huge benefit, but usually people that are 757 00:39:07,200 --> 00:39:09,960 working with me that want to do a dietary approach, there'd be a 758 00:39:09,960 --> 00:39:14,480 form of an elimination diet in order to remove possible 759 00:39:14,480 --> 00:39:17,120 allergens from their, their diet that could be impacting their 760 00:39:17,120 --> 00:39:20,160 ability to focus. And it would be a lower 761 00:39:20,160 --> 00:39:23,360 carbohydrate diet as well to avoid some sort of like brain 762 00:39:23,360 --> 00:39:26,840 fog or that like 2:00 PM brain fog that you have if you have a 763 00:39:26,840 --> 00:39:29,600 big bowl of pasta for lunch. But then, you know, ending the 764 00:39:29,600 --> 00:39:32,840 day with checking your calendar again and then you know, going 765 00:39:32,840 --> 00:39:35,920 to bed and and getting good high quality sleep would definitely 766 00:39:35,920 --> 00:39:39,880 be part of it as well. Amazing. 767 00:39:40,320 --> 00:39:43,840 Well, if people want to continue to follow along with your work 768 00:39:43,840 --> 00:39:46,840 or reach out to potentially work with you, where can people find 769 00:39:46,840 --> 00:39:48,320 you? Absolutely. 770 00:39:48,320 --> 00:39:51,560 So my probably the best spot would be my clinic which is 771 00:39:51,560 --> 00:39:57,880 nissanclinic.com NISSENCLIN ic.com and then otherwise I'm on 772 00:39:57,880 --> 00:40:01,520 Instagram at doctor Nissan Dr. dot NISSEN. 773 00:40:02,400 --> 00:40:04,040 Amazing. I'll put that in the show notes 774 00:40:04,040 --> 00:40:06,080 and thank you again so much for joining me. 775 00:40:06,720 --> 00:40:08,120 Of course. Thank you so much for having me, 776 00:40:08,120 --> 00:40:08,480 Sadie.